Exercise training and music therapy in elderly with depressive syndrome: a pilot study

OBJECTIVE

Recent studies have thrown doubt on the true effectiveness of anti-depressants in light and moderate depression. The aim of this study is to evaluate the impact of physical training and music therapy on a sample group of subjects affected by light to moderate depression versus subjects treated with pharmacological therapy only.

DESIGN AND SETTING

Randomized controlled study. Patients were randomized into two groups. Subjects in the pharmacotherapy group received a therapy with antidepressant drugs; the exercise/music therapy group was assigned to receive physical exercise training combined with listening to music. The effects of interventions were assessed by differences in changes in mood state between the two groups.

MAIN OUTCOME MEASURES

Medically eligible patients were screened with the Hamilton Anxiety Scale and with the Geriatric Depression Scale. We used plasmatic cytokine dosage as a stress marker.

RESULTS

We recruited 24 subjects (mean age: 75.5 ± 7.4, 11 M/13 F). In the pharmacotherapy group there was a significant improvement in anxiety only (p<0.05) at 6-months. In the exercise/music therapy was a reduction in anxiety and in depression at 3-months and at 6-months (p<0.05). We noted an average reduction of the level of TNF-a from 57.67 (± 39.37) pg/ml to 35.80 (± 26.18) pg/ml.

CONCLUSIONS

Our training may potentially play a role in the treatment of subjects with mild to moderate depression. Further research should be carried out to obtain more evidence on effects of physical training and music therapy in depressed subjects.

Hypovitaminosis D: which oral supplement therapy?

OBJECTIVES

the possible therapeutic role of vitamin D in different kind of diseases explains the growing interest in this vitamin due to its pleiotropic effects. This short report shows preliminary results of prevalence of hypovitaminosis D in a group of patients and proposes a oral supplement therapy effective in correcting hypovitaminosis in a short time, without side effects.

METHODS

243 patients (aged 26-93; 67 males) were enrolled at this study. We evaluated plasma levels of 25-hydroxyvitamin D [25(OH)D] with the following cut-off values: <10 ng/ml or <0-25 nmol/L (deficient), 10-30 ng/ml or 25-75 nmol/L 30-50 (insufficient) and > 30 ng/ml or > 50 nmol/L (normal). The first 73 patients with hypovitaminosis D received at baseline 25,000 IU (Cholecalciferol) per os twice a month (Tp.A). The next patients (Tp.B) at baseline received a loading dose of 50,000 IU once a week for 8 weeks, followed by a maintenance dose of 25,000 IU twice a month.

RESULTS

hypovitaminosis D is a widespread condition (i.e., 82.3%) not only in elderly (75.6% of 75 patients aged <65 yrs and 86.5% of 168 subjects aged >65 yrs). Preliminary results at 6 months show that Tp.B is more effective in correcting hypovitaminosis D (baseline 14.4 ± 5.3 ng/ml; 24 wk 43.3 ± 14.7 ng/ml; p<0.0001).

CONCLUSION

hypovitaminosis D is an important public health problem. We believe it is important to quickly achieve normal Vit. D plasma values in order to produce pleiotropic effects.

[Effect of AChE and BuChE inhibition by rivastigmin in a group of old-old elderly patients with cerebrovascular impairment (SIVD type)]

AIM

Vascular dementia (VaD) is defined as a loss of cognitive function resulting from ischemic, hypoperfusive, or hemorrhagic brain lesions due to cerebrovascular disease or cardiovascular pathology. The main types of VaD are: Small Vessel Disease Dementia (sVAD), Large vessel disease dementia, hypoperfusive-ischemic dementia and hemorragic dementia. The sVAD is divided into two main categories: subcortical ischemic vascular dementia (SIVD) and cortical dementia. Currently, no drugs are approved for the treatment of VaD. This study aimed to determine whether rivastigmine, a second generation cholinesterase inhibitor with selectivity for the CNS, with capacity to inhibit both acetylcholinesterase (AChE) and butyryl-cholinesterase (BuChE), slows the rate of cognitive decline associated with VaD.

METHODS

Study subjects were 27 male and 43 female outpatients aged 80.03±6.53 years, with Mini-Mental State Examination (MMSE) score ranging batween 22 and 12, affected by VaD. They were included in the study if they were undergoing pharmacological treatment with acetylsalicylic acid 100 mg for at least six months. Patients were divided into two groups: one group was treated with ASA 100 mg and rivastigmine patch 9.5 mg (Rivastigmine group), the other just with ASA 100 mg (ASA group). All patients were followed for 6 months, with a first evaluation (T0) and a second examination after six mounths of treatment (T1).

RESULTS

Statistically data proved as the Rivastigmine group showed constant values at MMSE, compared with patients of the ASA group who experienced decline of their cognitive performances. The same result was found in CDR, ADL, GDS and NPI scales. It is remarkable to underline as Rivastigmine-treated patients had a mean improvement in GDS scales, in comparison with patients of the ASA group who showed a worsening of mood.

CONCLUSION

Rivastigmine-therapy improves cognitive performance in elderly with SIVD.

Mediterranean dietary pattern adherence: associations with prediabetes, metabolic syndrome, and related microinflammation

BACKGROUND

The adherence to the Mediterranean Diet (Med Diet) seems to reduce the incidence of metabolic syndrome. The present study aimed to explore whether the adherence to the overall Med Diet pattern and to specific Med Diet items is associated with the presence of metabolic syndrome, impaired fasting glucose (IFG), insulin resistance (IR), and microinflammation in subjects free of diabetes and cardiovascular diseases.

MEASUREMENTS

Each patient underwent clinical assessment. Adherence to the Med Diet was measured by a previously validated 14-item questionnaire. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria; IR was defined by homeostasis model assessment of insulin resistance (HOMA-IR); inflammation was assessed through a high-sensitivity C-reactive protein (hsCRP) assay.

RESULTS

A total of 120 subjects (64.2% women, mean age 59.8±10.2 years) were enrolled at this study. Subjects with lower Med Diet pattern adherence exhibited higher occurrence of metabolic syndrome and all its components and higher HOMA-IR and hsCRP values (P for all <0.0001). Subjects with metabolic syndrome were less likely to consume olive oil (P=0.002) and vegetables (P=0.023). By multivariable analyses, the overall Med Diet score was found to be strongly and inversely associated with the presence of metabolic syndrome [B=-0.066; 95% confidence interval (CI) -0.105 to -0.028; P=0.001], IFG (B=-0.076; 95% CI -0.114 to -0.038; p<0.0001), high HOMA-IR (B=-0.071; 95% CI -0.108 to -0.034; P<0.0001) and high hsCRP (B=-0.082; 95% CI -0.125 to -0.045; P<0.0001). None of specific Med Diet items independently predicted metabolic syndrome, IFG, and high HOMA-IR. Instead, the consumption of white meat over red meat (B=-0.324; 95% CI -0.467 to -0.178; P<0.0001) was found to be inversely associated with increased hsCRP.

CONCLUSIONS

The inverse associations between adherence to Med Diet and the prevalence of metabolic syndrome and prediabetes may be due more to the effects of the entire dietary pattern rather than to individual food components. Metabolic syndrome-related microinflammation may further be linked to specific Med Diet components.

[Predictors of liver fibrosis in patients with non-alcoholic fatty liver disease. The role of metabolic syndrome, insulin-resistance and inflammation]

INTRODUCTION

NAFLD (non-alcoholic fatty liver disease) reaches an high prevalence in the general population, and it is closely related to metabolic syndrome (MetS). The entity of metabolic abnormalities and the chronic inflammation seem to play a main role in the development of liver fibrosis. The aim of our study is to determine whether subjects with NAFLD and MetS have higher liver fibrosis degree when compared with NAFLD subjects without MetS, and to investigate the relations between fibrosis, MetS and its single components and inflammation.

MATERIALS AND METHODS

We considered 24 patients with NAFLD. Those who had viral- and alcohol- related liver disease were excluded. MetS was diagnosed according to NCEP ATP III criteria; inflammatory status was determined through C-reactive protein (PCR) assay. The peripheral insulin-resistance was assessed by calculating HOMA ir. Liver fibrosis was measured by transient elastography (Fibroscan®).

RESULTS

Subjects with MetS had higher HOMA ir, PCR and Fibroscan® score (log value: 0.92±0.24 KPa vs 0.73±0.2 KPa; p=0.047). The linear correlation analysis showed that Fibroscan® score was related to MetS, number of MetS components, waist circumference, HOMA ir and PCR. However the multivariate regression analysis showed that only HOMA ir (B=0.077; 95%CI: -0.002- 0.157; p=0.05) and PCR (B=0.152; 95% CI: 0.006 - 0.299; p=0.006) were independent predictors of higher Fibroscan® score.

CONCLUSION

MetS is associated to higher liver fibrosis degree in subjects with NAFLD. The insulin-resistance and inflammation seem to be the main determinants.

Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?

OBJECTIVE

To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers.

METHODS

Physical parameters, standard blood analytes, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) were assessed. Fifteen-item Geriatric Depression Scale and mini mental state examination (MMSE) were administered.

RESULTS

One hundred thirty-three subjects were enrolled. MetS patients (57) exhibited higher prevalence of depressive symptoms (p < 0.0001), worse cognitive function (p < 0.0001), and higher levels of ESR and hsCRP were higher (p < 0.0001). The univariate analysis showed a linear strong correlation of depressive symptoms (p < 0.0001) with the MMSE score (r = -0.422), body mass index (r = 0.414), MetS (r = 0.582), number of MetS components (r = 0.663), fasting blood glucose (r = 0.565), ESR (r = 0.565), hsCRP (r = 0.745), central obesity (r = 0.269; p = 0.002), and high-density lipoprotein cholesterol (r = -0.241; p = 0.005). However, the multivariate analysis showed that only age (B = -0.093; p = 0.032), MetS (B = 1.446; p = 0.025), fasting blood glucose (B = 0.039; p = 0.005), and hsCRP (B = 7.649; p < 0.0001) were independently associated with depressive symptoms.

CONCLUSIONS

MetS and inflammation are independently associated with depressive symptoms in older people. Inflammation may explain cognitive decline too. Further investigations are needed to better understand the direction of these associations and to determine whether these can be reversible.

Associations of plasma glucose levels and traits of metabolic syndrome with carotid intima media thickness in nondiabetic elderly subjects: are they mediated by insulin resistance?

BACKGROUND

The independent role of insulin resistance (IR) and high fasting blood glucose (FBG) levels within the normal range on vascular diseases is still under debate. This study was designed to explore whether IR, FBG levels, and the traits of metabolic syndrome are associated with increased carotid intima media thickness (IMT), the early marker of subclinical atherosclerosis, independently of each other in nondiabetic elderly subjects.

METHODS

Blood analytes and anthropometric measurements were obtained. Carotid IMT was measured by ultrasonography; metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. IR was assessed through homeostasis model assessment of insulin resistance (HOMA-IR).

RESULTS

At total of 207 subjects aged 68.2±3.6 years were enrolled. Subjects with increased carotid IMT (50.7%) were older (P=0.001), had a higher prevalence of metabolic syndrome (P<0.0001) and all its traits, impaired fasting glucose (IFG) (P<0.0001), and values of HOMA-IR (P<0.0001) than normal subjects. Increased carotid IMT significantly correlated with metabolic syndrome, its traits, IFG, and HOMA-IR. When multivariable regression models were constructed, central obesity [B=0.392; 95% confidence interval (CI) 0.280-0.505; P<0.0001], high-density lipoprotein cholesterol (HDL-C) (B=-0.007; 95% CI -0.013-0.000; P=0.042], hypertension (B=0.475; 95% CI 0.363-0.587; P<0.0001), and IFG (B=0.230; 95% CI 0.092-0.367; P=0.001) were found to be the independent determinants of increased carotid IMT independently of HOMA-IR, but not FBG (B=0.013; 95% CI 0.000-0.026; P=0.050) and HOMA-IR itself.

CONCLUSIONS

Our results suggest that hypertension, low HDL-C, and central obesity are independently associated with increased carotid IMT in nondiabetic elderly subjects. These associations seem to be not affected by IR. The associations of FBG levels within the normal range and IR with carotid IMT should be investigated further.

Screening cognition in the elderly with metabolic syndrome

BACKGROUND

Metabolic syndrome reaches its highest prevalence in the elderly, and evidence suggests that metabolic syndrome could be an independent risk factor for cognitive impairment. The aims of this study were to detect whether patients with metabolic syndrome have lower cognition and to investigate whether there is a relationship with cognition and single metabolic syndrome components.

METHODS

We assessed fasting blood glucose (FBG), high-density lipoprotein cholesterol (HDL-C), triglycerides, high-sensitivity C-reactive protein (hsCRP), and anthropometric measurements. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. The population sample was divided into two groups according to the presence of metabolic syndrome. Cognitive function was investigated through the Mini-Mental State Examination (MMSE).

RESULTS

We enrolled 159 elderly subjects (mean age, 69.8±4.8 years). Seventy had metabolic syndrome. Metabolic syndrome subjects had higher hsCRP values (P<0.0001) and lower MMSE scores (P<0.0001) than those without metabolic syndrome. MMSE scores were significantly correlated with body mass index (BMI), hsCRP, metabolic syndrome, the number of metabolic syndrome components, and each of them. However, at multivariate regression analysis, only fasting blood glucose [FBG; B=-0.046; 95% confidence interval (CI) -0.066 to -0.028; P<0.0001] and the number of metabolic syndrome components (B=-0.317; 95% CI -0.572 to -0.010; P=0.042) were found to be independent predictors of lower MMSE scores.

CONCLUSION

We found that subjects with metabolic syndrome have lower MMSE scores than those without, even without symptomatic cognitive impairment, and that the number of metabolic abnormalities is independently associated to lower MMSE scores. We suggest that these patients should always undergo cognitive screening to prevent more severe outcomes.

Gastrointestinal regulation of food intake: do gut motility, enteric nerves and entero-hormones play together?

The gastrointestinal system can be considered the gateway for food entry in our body. Rather than being a passive player, it is now clear that gut strongly influence the feeding behavior and contribute to maintain energy balance with different signals. The aim of this review is to summarize the current knowledge about the role of gastrointestinal tract in the control of food intake, by focusing on the interplay existing between the enteric nervous system and gastrointestinal hormones and their ability to modulate digestive motility and sensitivity. Also the latest advances about the contribution of gut microbiota and gastrointestinal taste receptors are described. From the reported data it clearly emerges that gut hormones together with nervous signals likely contribute to the regulation of energy balance and modulate food intake through the control of digestive motility and sensations. The close linkage among gastrointestinal hormones, the gut and the central nervous systems appears very intriguing and has induced the development of a new field of research: the gastroendocrinology.

[Vascular depression in the elderly. Does inflammation play a role?]

Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

Effect of beta-glucan, inositol and digestive enzymes in GI symptoms of patients with IBS

BACKGROUND

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal (GI). Diagnosis of IBS is based on the fulfilment of the Rome III criteria. Common GI symptoms are lower abdominal pain, bloating and disturbed defecation, such as urgent diarrhoea and/or episodes of chronic constipation. Many agents have been employed in the management of IBS, although only few have been demonstrated to show a relevant efficacy.

AIM

To evaluate the effectiveness of the administration of a mixture of beta-glucan, inositol and digestive enzymes (Biointo) in improving GI symptoms in patients affected by IBS.

PATIENTS AND METHODS

50 IBS patients (20 males, 30 females; mean age 51 +/- 19) were treated with Biointo (group A) while another group consisting of 40 IBS patients (15 males, 25 females; mean age 50 +/- 18) did not receive any therapy (group B).

RESULTS

Biointol administration improved significantly bloating, flatulence and abdominal pain, with a slight increasing of urgency for bowel movements. On the contrary, Biointol did not show any significant effect on the other IBS symptoms.

CONCLUSIONS

Currently, only few agents used in the management of IBS have been proven to be effective. Biointol administration has shown to improve some IBS symptoms, such as bloating, flatulence and abdominal pain, all connected to the presence of gas inside the intestinal lumen.

Long-term antibody persistence and immune memory to hepatitis B virus in adult celiac patients vaccinated as adolescents

Aim of this study was to investigate the anti-HBs antibody persistence and immune memory to hepatitis B virus in adult celiacs vaccinated as adolescents and the effect of a booster administration in non-protected individuals. Eleven years after primary vaccination, the proportion of vaccinees with titres ≥ 10 mIU/ml and antibody geometric mean concentrations (GMCs) were lower among celiac patients than among controls (68.6% vs 91.7%, p<0.01; GMCs 29.38 mIU/ml vs 250.6 mIU/ml, p<0.001). Participants with anti-HBs below 10 mIU/ml received a booster dose and were retested 2 weeks later to assess the anamnestic response. Post-booster anti-HBs levels were still <10 mIU/ml in 71.4% celiacs and 25% controls (p<0.01). Our findings indicate that the prevalence of seroprotective levels of anti-HBs detected eleven years after primary immunization as well as the frequency of response to a booster dose of vaccine are lower in celiac patients compared to healthy controls.

The quality of sleep in patients with coeliac disease

BACKGROUND

Coeliac disease is a chronic disease with a various clinical presentation, including anxiety and depression.

AIM

To investigate the quality of sleep in coeliac disease.

METHODS

The participants were coeliacs at diagnosis; coeliacs on a gluten-free diet at follow-up and healthy volunteers. Participants completed the Pittsburgh Sleep Quality Index (PSQI), SF36, Zung and Fatigue scales and State-Trait Anxiety Inventory (STAI).

RESULTS

The PSQI score was higher in coeliacs at diagnosis and in a gluten-free diet than in healthy volunteers (P < 0.001). A gluten-free diet did not improve the PSQI score (P = 0.245) in coeliac disease. The other test scores were similar between coeliacs at diagnosis and those on a gluten-free diet, whereas significant differences were found between coeliacs and volunteers. PSQI score was inversely associated with the quality of the physical (r = -0.327, P = 0.002) and mental (r = -0.455, P < 0.001) component scores. The sleep quality scores were related to depression (r = 0.633, P < 0.001), fatigue (r = 0.377, P < 0.001), state anxiety (r = 0.484, P < 0.001) and trait anxiety (r = 0.467, P < 0.001).

CONCLUSIONS

Sleep disorders are common in coeliac disease not only at diagnosis but also during treatment with a gluten-free diet. Sleep disorders are related to depression, anxiety and fatigue, and inversely related to quality of life scale scores.

Oxidative-stress-mediated arterial dysfunction in patients with peripheral arterial disease

AIMS

To investigate the existence of a relationship among flow-mediated dilation (FMD), nitric oxide (NO), and oxidative stress in patients with peripheral arterial disease (PAD), and to assess if the administration of an antioxidant was able to improve arterial dilatation.

METHODS AND RESULTS

We performed a cross-sectional study comparing FMD, 8-Hydroxy-2-deoxy-2-deoxyguanosine (8-OHdG), a marker of oxidative stress, and nitrite/nitrate (NOx) serum levels in a population of 25 PAD patients and 40 controls. In the second part of the study, 21 PAD patients were randomly allocated to a treatment sequence of 7 days of i.v. infusion of placebo or 6 g/day propionyl-L-carnitine (PLC) in a cross-over design. Compared with controls, patients with PAD had enhanced 8-OHdG serum levels (2.4 +/- 1.2 vs. 4.24 +/- 3.11 ng/mL; P < 0.001), reduced NOx (17.02 +/- 6.11 vs. 11.28 +/- 6.02 microM; P < 0.001), and lowered FMD (10.34 +/- 2.14 vs. 6.69 +/- 2.95; P < 0.001). PLC infusion was associated with an increase of FMD [from 6.6 +/- 0.6 to 11.1 +/- 1.2% (mean +/- SE), P = 0.004] and NOx (from 14.5 +/- 1.4 to 17.1 +/- 1.2 microM; +18%, P = 0.012) and a decrease of 8-OHdG (from 3.62 +/- 0.37 to 2.64 +/- 0.32 ng/mL; -27%, P < 0.001). No changes were observed after placebo treatment.

CONCLUSION

This study shows that in PAD patients, oxidative stress is implicated in determining reduced FMD.

Imbalance between nitric oxide generation and oxidative stress in patients with peripheral arterial disease: effect of an antioxidant treatment

BACKGROUND

Nitric oxide (NO), a potent vasodilator produced by endothelial cells, is reduced in patients with peripheral arterial disease (PAD), but the mechanism has not been fully elucidated. Because NO is rapidly inactivated by superoxide anion, we speculated that enhanced oxidative stress could lower NO generation. The aim of our study was to investigate if an imbalance between oxidative stress and NO does exist in patients with PAD and if an increase of NO formation could be achieved by an antioxidant treatment.

METHODS

In a first study, serum levels of nitrite and nitrate (NOx), markers of NO generation, and 8-hydroxy-2-deoxyguanosine (8-OHdG), a marker of oxidative stress and maximal walking distance (MWD), were measured in 40 PAD patients and 40 controls. In a second study, 10 PAD patients were randomly allocated in a crossover design to intravenous propionyl-L-carnitine (6 g/day) or placebo for 7 days, with a washout of 30 days between the two phases of the trial. Serum levels of NOx and 8-OHdG were measured before and after the study.

RESULTS

Compared with controls, serum levels of 8-OHdG (mean +/- SD) were significantly increased in PAD patients (4.4 +/- 3.1 ng/mL vs 2.4 +/- 1.2 ng/mL; P < .001), and serum levels of NOx were significantly decreased (11.6 +/- 6 microM vs 17 +/- 6.1 microM; P < .001). Levels of 8-OHdG and NOx were inversely correlated (r = -0.879; P < .001). Serum levels 8-OHdG were inversely correlated with MWD (r = -0.48, P = .002). The interventional trial showed no changes in the patients given placebo. Patients treated with propionyl-L-carnitine showed a significant increase of MWD from 101 +/- 31 meters to 129 +/- 35 meters (P = .007) and in NOx from 14.5 +/- 4.5 microM to 17.1 +/- 3.8 microM (P = .007). A significant decrease of 8-OHdG from 3.6 +/- 1.1 ng/mL to 2.6 +/- 1 ng/mL was also found (P = .005.)

CONCLUSIONS

This study suggests that in PAD patients, the reduction of NO generation could be dependent upon enhanced oxidative stress.

Cetirizine, a second-generation H1 antagonist, modulates Rantes and MCP-1 levels in allergic rhinitis

Chemokines and their receptors are involved in several allergic diseases. We measured RANTES and MCP-1 levels in sera of allergic rhinitis patients, and also we evaluated the effect of cetrizine, a second-generation H1 antagonist, on these chemoattractant proteins. 15 subjects were studied (10 males and 5 females; mean age: 26.7 years). They were suffering from perennial or seasonal allergic rhinitis induced by Dermatophagoides pteronyssinus (8 patients) or by grasses (7 patients). RANTES and MCP-1 serum levels were detected with an enzyme immunoassay before and after two weeks of treatment with 10 mg of cetirizine daily, and again after two weeks of washout. Baseline serum levels of RANTES and MCP-1 chemokines were significantly higher (p &lt; 0.02 and p = 0.007, respectively) in allergic patients than in the healthy control group. Cetirizine resulted in a significant decrease in RANTES (p &lt; 0.02) and MCP-1 (p = 0.003) versus baseline values. There is an increase in RANTES and MCP-1 in allergic rhinitis, which is counteracted by cetirizine.

Serum Tryptase in Allergic Rhinitis: Effect of Cetirizine Treatment

Activated mast cells release a large range of potent mediators of allergic inflammation, including proteases. The tryptase serum levels were evaluated in 13 subjects suffering from allergic perennial rhinitis. Moreover, the effects of cetirizine treatment on serum tryptase were studied using the UniCap™ tryptase fluoroenzymeimmunoassay.

In allergic patients the serum tryptase values (M±SD: 6.1 ± 2.4 μg/L) were significantly (p < 0.02) higher than the values detected in controls (3.0 ± 1.2 μg/L). In allergic rhinitis, after antihistamine treatment, tryptase values (4.4 ± 1.8 μg/L) decreased significantly (p < 0.001). After two weeks from the cetirizine stop, the tryptase levels increased again (5.5 ± 2.6 μg/l).

The results demonstrate that mast cells are constantly activated in perennial allergic rhinitis. The antihistamine treatment is effective in reducing the tryptase release from mast cells, but the mechanism of action of cetirizine is still to understand.

Serum tryptase in allergic rhinitis: effect of cetirizine and fluticasone propionate treatment

PURPOSE

A specific reaction against several kinds of inhalant allergens characterizes allergic rhinitis. Mast cells play a crucial role in the allergic inflammation releasing histamine and other mediators. Tryptase is considered to be a specific marker of mast cell activation. This study was devoted to evaluate the serum tryptase in allergic rhinitis and to evaluate the effect of cetirizine and fluticasone propionate on mast cell activation. 13 subjects, suffering from perennial allergic rhinitis induced by Dermatophagoides pteronyssinus, were studied.

MATERIALS AND METHODS

Tryptase serum levels were detected by the fluoroenzymeimmunoassay (Pharmacia & Upjohn AB, Uppsala, Sweden). Blood samples were taken four times: before starting the study, after two weeks of 10 mg cetirizine treatment once a day, after two weeks of wash-out, and again after 15 days of 100 micrograms intranasal fluticasone propionate therapy twice a day.

RESULTS

In allergic rhinitis, the basal values of serum tryptase (M +/- SD: 6.1 +/- 2.4 micrograms/l) were significantly higher than in controls (M +/- SD: 3.0 +/- 1.2 micrograms/l). After the antihistamine treatment, tryptase values (M +/- SD: 4.4 +/- 1.8 micrograms/l) decreased significantly (p < 0.001). After the stop of antihistamine treatment, tryptase levels increased (M +/- SD: 5.5 +/- 2.6 micrograms/l, p < 0.001). After the topical corticosteroid treatment, tryptase values decreased again significantly (M +/- SD: 4.5 +/- 3.1 micrograms/l, p < 0.04).

CONCLUSIONS

All these data seem to confirm the effective action of cetirizine and fluticasone propionate on tryptase serum levels. While the action of corticosteroid is well known, the action of cetirizine is still to define, considering the recent reports on anti-inflammatory effect of the second generation of H1 receptor antagonists. Further studies are necessary to understand if the pharmacological effect on tryptase is a specific one of cetirizine, or if it is common to other anti-H1 molecules.

Serum tryptase in allergic rhinitis: effect of cetirizine treatment

Activated mast cells release a large range of potent mediators of allergic inflammation, including proteases. The tryptase serum levels were evaluated in 13 subjects suffering from allergic perennial rhinitis. Moreover the effects of cetirizine treatment on serum tryptase were studied using the UniCap&#x2122; tryptase fluoroenzymeimmunoassay. In allergic patients the serum tryptase values (M&#x00B1;SD: 6.1 &#x00B1; 2.4 &#x03BC;g/L) were significantly (p &#x003C; 0.02) higher than the values detected in controls (3.0 &#x00B1; 1.2 &#x03BC;g/L). In allergic rhinitis, after antihistamine treatment, tryptase values (4.4 &#x00B1; 1.8 &#x03BC;g/L) decreased significantly (p &#x003C; 0.001). After two weeks from the cetirizine stop, the tryptase levels increased again (5.5 &#x00B1; 2.6 &#x03BC;g/l). The results demonstrate that mast cells are constantly activated in perennial allergic rhinitis. The antihistamine treatment is effective in reducing the tryptase release from mast cells, but the mechanism of action of cetirizine is still to understand.

Mast cell activation in acquired chronic urticaria-angioedema

Mast cells play a central role in the pathogenesis of many allergic disorders. They can be activated in different ways. The present study was focused to evaluate the role of mast cells in acquired chronic urticaria-angioedema induced by gastroesophageal reflux. Tryptase, an important marker of mast cell activation, was detected with UniCap Tryptase Fluoroenzymeimmunoassay (Pharmacia & Upjohn AB, Uppsala, Sweden). Eight subjects were studied: four males and four females, aged between 29 and 71 years (mean age: 45 yrs.), suffering from acquired chronic urticaria-angioedema. Results were compared with the results of seven healthy control subjects. Moreover, data were compared with those of 13 subjects (10 males and 3 females, mean age: 24.7 years) suffering from allergic rhinitis. In acquired chronic urticaria-angioedema, serum tryptase levels (mean +/- S.D.: 9.6 +/- 4.3 microg/l) were significantly higher (P < 0.007) than those of the controls (mean +/- S.D.: 3.0 +/- 1.2 microg/l) and higher also than in allergic rhinitis (mean +/- S.D.: 6.1 +/- 2.4 microg/l, P < 0.03). The results underline the central role of mast cells in the inflammation of acquired chronic urticaria-angioedema.

Hepatitis C virus: a high risk factor for a second primary malignancy besides hepatocellular carcinoma. Fact or fiction?

PURPOSE

Second primary malignancies occur more and more often. But the hepatocellular carcinoma (HCC) linked to a second primary cancer is not frequent.

MATERIALS AND METHODS

A retrospective study focused on a second primary cancer was performed in 37 patients with HCC, aged between 46 and 81 years, 27 males and 10 females.

RESULTS

5 out of them (13.5%), 3 males and 2 females, developed a second primary neoplasm before or after HCC. In 3 cases the second malignancy was a carcinoma of the kidney, of the breast, and the prostate. The fourth patient had a Hodgkin's lymphoma before HCC. The last and most unlucky case, besides HCC, had a basal cell carcinoma, a colorectal cancer, and a bladder carcinoma. The common data of these 5 patients were the presence of anti-HCV antibodies and the positivity of the HCV RNA polymerase reaction. One patient was also HBV positive.

CONCLUSION

Considering that a large number of virus has been found linked to human cancers, our results brought us to hypothesize that HCV could have played an important role not only in the development of HCC but of the second primary malignancy too. This is likely favoured by constitutional or acquired biological and molecular alterations. Tumor suppressor genes alterations have been reported to be frequently linked to cancers of kidney and breast, of colorectal and skin, of prostate, and lymphoemopoietic tissue. Now just these organs are involved in our patients in addition to the liver. Our results, if confirmed, are of a relevant interest, considering that world-wide HCC is constantly increasing for the spreading of the virus risk-factors.

Gastric asthma: an unrecognized disease with an unsuspected frequency

Bronchial asthma is a disease that has been recognized for centuries, which is influenced mainly by genetic and environmental factors. The current interest of bronchial asthma is focused to ascertain the causes and the mechanisms that induce bronchoconstriction. Recently, abnormalities of the esophageal and gastric tracts have become important related areas for research. In predisposed individuals, these abnormalities can trigger or worsen the particular syndrome better known as "gastric asthma." In bronchial asthma the disorder of gastroesophageal reflux (GER) occurs more often than would be expected by chance. The neurogenic mechanism is considered to be the main cause of bronchoconstriction. The diagnosis of gastric asthma is particularly difficult and it should be considered also when GER is less evident or not recognized. In asthmatic patients the recognition of gastric abnormalities is very relevant for therapeutic problems also when GER is in a subclinical stage. In fact, many drugs used in the treatment of bronchial asthma can promote or enhance GER and subsequently they can worsen the symptoms of gastric asthma.