Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation

The pathogenesis of slow transit constipation is still elusive. However, a genetic basis may be present. We investigated possible chromosomal abnormalities in enteric neurons and glial cells in patients with slow transit constipation. Colonic specimens from 22 patients with slow transit constipation undergoing surgery for intractable symptoms were obtained, and investigated by fluorescence in situ hybridization (FISH) for chromosomal abnormalities (chromosomes 1, 8, 17 and XY). These specimens were compared with of those obtained in 12 control subjects. Data analysis showed that 45.5% of patients displayed significant (>10%) aneusomy of chromosome 1 in enteric neurons. Aneusomy <10% for the same chromosome, but less than the cutoff suggested (10%), was found in enteric glial cells in 45.4% of the same patients. One patient had <10% aneusomy in enteric neurons for chromosome 8. No other abnormalities were found for the remaining probes, and no abnormalities were found in controls. We concluded that in a subgroup of patients with slow transit constipation a genetic basis may be present.

GITR modulates innate and adaptive mucosal immunity during the development of experimental colitis in mice

BACKGROUND

Uncontrolled T cell activation and abnormal function of the innate immune system against normal enteric bacterial flora play a critical part in the pathogenesis of inflammatory bowel disease (IBD). Therefore, pharmacological strategies directed to restore the normal responsiveness of the immune system could be efficacious in the treatment of these pathological conditions. Glucocorticoid-induced tumour necrosis factor receptor (GITR)-related gene is a member of the tumour necrosis factor receptor superfamily that is constitutively expressed at high levels on regulatory T cells and at low levels on unstimulated T cells, B cells and macrophages. GITR triggering leads to activation of T effectors and reversal of suppressive function of regulatory T cells.

AIM

To investigate the role of GITR in the development of experimental colitis in mice.

RESULTS

Using GITR(-/-) mice, GITR deletion protected against 2,4,6-trinitrobenzene sulphonic acid (TNBS)-induced colitis by reducing innate immune responses and effector T cell activity. Effector T cells isolated from GITR(-/-) mice were less effective than T cells isolated from GITR(+/+) mice to transfer colitis in immunodeficient mice. Blocking the GITR/ligand for GITR (GITRL) signal by giving soluble GITR prevented TNBS-induced colitis in normal GITR(+/+) and also in lymphocyte-deficient SCID mice.

CONCLUSIONS

Collectively, these data suggest that GITR plays a critical part in regulating both acquired and innate mucosal immune responses during the development of experimental colitis in mice. Therefore, targeting the GITR/GITRL system signalling may represent a potential pharmacological tool for the treatment of IBD.

Colon and gastric metastases from a primary signet-ring cell carcinoma of the urinary bladder

Signet-ring cell carcinoma is a relatively rare neoplasm that rarely occurs in the urinary bladder. We report a case of a 60-year-old man who presented with gross haematuria. Cystoscopy revealed a white sessile tumour of the anterior bladder wall. The histological diagnosis showed a primary signet-ring cell carcinoma of the bladder (T3bN0M0). Eighteen months after radical cystectomy, the patient developed colon and stomach metastases. This case represents the first description of a primary signet-ring cell carcinoma of the urinary bladder with gastrointestinal metastases.

Pre-clinical evidence and clinical translation of benign prostatic hyperplasia treatment by the vitamin D receptor agonist BXL-628 (Elocalcitol)

The active form of vitamin D, 1,25-dihydroxyvitamin D3, is a secosteroid hormone that binds to the vitamin D receptor (VDR), a member of the superfamily of nuclear receptors, and exerts a number of diverse biological functions. The natural hormone and synthetic VDR agonists are well known for their capacity to control calcium and bone metabolism, but they also regulate proliferation and differentiation of many cell types, and possess exquisite immunoregulatory properties, mostly by targeting dendritic cells (DC) and T cells. These properties have been clinically exploited in the treatment of different diseases, from secondary hyperparathyroidism to osteoporosis to psoriasis. The VDR is expressed by most cell types, including cells of the urogenital system such as prostate and bladder cells. In particular, the prostate has been recognized as a target organ of VDR agonists and represents an extra-renal synthesis site of 1,25-dihydroxyvitamin D3, but its capacity to respond to VDR agonists has, so far, been probed only for the treatment of prostate cancer. We have taken a different approach, and have analysed the capacity of VDR agonists to treat benign prostatic hyperplasia (BPH), a complex syndrome characterized by a static component related to prostate overgrowth, a dynamic component responsible for urinary irritative symptoms, and a possible inflammatory component. Pre-clinical data reviewed here demonstrate that VDR agonists, and notably BXL-628 (Elocalcitol), reduce the static component of BPH by inhibiting the activity of intra-prostatic growth factors downstream of the androgen receptor, and the dynamic component by targeting bladder cells. These data have led to a proof-of-concept clinical study that has successfully shown arrest of prostate growth in BPH patients treated with BXL-628. Ongoing clinical studies will assess the capacity of this VDR agonist to reduce symptoms and ameliorate flow parameters in BPH-affected individuals. The pronounced effects of BXL-628 on bladder smooth muscle cells and its anti-inflammatory properties indeed anticipate beneficial effects also on BPH-related lower urinary tract symptoms.

Hierarchical clustering analysis of tissue microarray immunostaining data identifies prognostically significant subsets of stage IIIA N2 non-small cell lung cancer patients. An Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 014)

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Background: Based on gene expression profiling, prognostically relevant cluster groups of patients have been recently identified for breast cancer, lung cancer, and lymphoma. The development of tissue microarray (TMA) technology provides methodology for the concomitant analysis of multiple proteins on large numbers of tumor samples. Methods: Here, we report the hierarchical clustering analysis of TMA immunostaining data from 87 patients with stage IIIA pN2 non-small cell lung cancer (NSCLC), treated with surgery alone between 1985 and 1997. A panel of 10 markers was tested by immunohistochemistry: EGFR, ErbB-2, c-kit, COX-2, survivin, bcl-2, cyclin D1, cyclin B1, MMP-2 and MMP-9. Univariate, multivariate analyses and unsupervised hierarchical clustering analysis by using these 10 markers were performed. Results: Bcl-2 (p<0.0001) and cyclin D1 (p=0.0036) are more expressed in squamous cell carcinoma (SCC), while MMP-2 (p=0.0115), MMP-9 (p=0.0075) and survivin (p=0.02) show increased expression levels in other histological subtypes. In univariate analysis, only squamous cell histology, bcl-2 and cyclin D1 expression were favorable prognostic factors (p=0.0149, p=0.0013, p<0.0001, respectively), while MMP-2 expression showed a significant correlation with poor outcome (p=0.013). In multivariate analysis, cyclin D1 and MMP-2 were the only positive and negative prognostic factors, respectively (p<0.0001, p=0.06). Unsupervised hierarchical clustering analysis produced 5 distinct cluster groups and the deduced dendrogram identified 2 prognostically significant subsets of patients, with a median survival of 51 (groups 1–2) and 10 (groups 3–4-5) months, respectively (p<0.0001). Notably, groups 1–2 were mostly composed of SCC (80%). Conclusions: This study suggests that hierarchical clustering of TMA immunostaining data by using a limited set of markers might provide a useful tool for the identification of radically resected NSCLC patients at high risk of recurrence, likely to benefit from more aggressive treatment.

No significant financial relationships to disclose.

Percutaneous laser-induced thermoablation (LIT) of non-resectable lung metastases and primary lung tumors: A preliminary evaluation of technical aspects and local efficiency

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Background: Surgical resection remains the standard of care for solitary lung metastasis from colorectal cancer or primitive lung tumors. Nevertheless only a small part of patients can be radically resected. Thermal ablation is a mini-invasive local treatment that can be considered an alternative approach in non-resectable lesions or inoperable patients. Methods: We present a consecutive series of thirteen patients treated with LIT from March 2004 to March 2005. Nine patients had a small (maximum diameter smaller than 5 cm) non-resectable lung carcinoma while four patients had a solitary metastasis from colorectal cancer. Median age was 70-yrs (range 55–87), male-female ratio was 2:1. After mild sedation and local anaesthesia, optical fibers were inserted directly into the tumor with CT-guided percutaneous needle placement. Each optical fiber was connected to a neodymium:yttrium-aluminium-garnet (ND:YAG) laser, which delivers concentrated light at a wave-length of 1064 nm, with a 5-Watt power and a 1800-Joule energy per single fiber. A minimum of two and a maximum of four needles were used, with a 5 to 8 mm distance from one needle to another. Results: All the patients tolerated LIT procedure well, developing a minimal pneumothorax, which did not require any treatment. Easy manageable local side-effects occurred in two cases (a mild self-limiting haemoptysis and a pleural empyema). Post-treatment CT-scan demonstrated complete thermonecrosis in all the lesions smaller than 3 cm and almost complete in the bigger ones (3 to 5 cm). All the patients are still alive, with a local tumor control rate of 100% at radiological follow-up: no local progression was observed in 10 pts with a follow-up of at least 12 months and in 3 pts with a follow-up of at least 6 months. Conclusions: Percutaneous LIT permitted a complete ablation of lung metastases and lung carcinomas with an optimal local tumor control rate at 1-year and a low complication rate. Complete necrosis was achieved only in lesions with maximum diameter smaller than 3 cm.

No significant financial relationships to disclose.

Treatment with botulinum toxin of octo-nonagerians with oesophageal achalasia: a two-year follow-up study

BACKGROUND

Treatment of oesophageal achalasia with intrasphincteric injections of botulinum toxin has proved to be a successful alternative treatment modality. However, little is known about its long-term effects in very old patients.

AIM

To evaluate the effects of such treatment in octo-nonagerians during a 2-year follow-up period.

PATIENTS AND METHODS

Thirty-three patients with idiopathic oesophageal achalasia (range 81-94 years) entered the study. After basal evaluation and screening procedures, 100 U of botulinum toxin was injected at the lower oesophageal sphincter, and the procedure was repeated 1 month later. Data were collected at baseline and were compared after 1 and 2 years following the procedure.

RESULTS

Seventy-eight per cent of patients were considered responders at 1 year and 54% were considered responders at 2 years. The weight gain at the end of the follow-up period was 2 (0-3) kg. No significant relationship was found between baseline lower oesophageal sphincter pressure and symptoms score after 1 and 2 years of follow-up; moreover, no major complications of botulinum toxin therapy were reported.

CONCLUSION

Treatment of very old achalasic patients with botulinum toxin is safe, effective and yields good quality of life in a substantial proportion of these subjects.

Preconditioning effects of levosimendan in coronary artery bypass grafting—a pilot study

BACKGROUND

The calcium sensitizer levosimendan protects against myocardial ischaemia and reperfusion injury in animal models.

METHODS

The present pilot study investigated whether a short infusion before coronary artery bypass grafting (CABG) would protect the myocardium and improve postoperative haemodynamics. Twenty-four patients with stable angina undergoing elective CABG surgery were randomized to receive either placebo or levosimendan (24 microg kg(-1)) infused i.v. over a 10 min period just before placing the patient on cardiopulmonary bypass.

RESULTS

Perioperative haemodynamic variables, concentrations of cardiac troponin I over the 48 h postoperative period, and clinical outcomes were assessed. There were no adverse effects related to levosimendan. Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P<0.05) and a higher cardiac index (P<0.05).

CONCLUSION

Patients receiving a short infusion of levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect. Larger outcome studies are thus indicated to confirm benefit.

Neural coding for the retrieval of multiple memory patterns

We investigate the retrieval dynamics in a feature-based semantic memory model, in which the features are coded by neurons of the Hindmarsh-Rose type in the chaotic regime. We consider the retrieval process as consisting of the synchronized firing activity of the neurons coding for the same memory pattern. The retrieval dynamics is investigated for multiple patterns, with particular attention to the case of overlapping memories. In this case, we hypothesize a dynamical nontransitive mechanism based on synchronization, that allows for a shared feature to participate in multiple memory representations. The problem of the choice of a cognitive plausible time-scale for the retrieval analysis is investigated by analyzing the information that can be inferred from finite-time analyses. Different types of indicators are proposed in order to evaluate the temporal dynamics of the neurons engaged in the retrieval process. We interpret the simulation results as suggestive of a role for chaotic dynamics in allowing for flexible composition of elementary meaningful units in memory representations.

Peripheral regulatory mechanisms in erection

The most important pathway underlying the penile erection is the nonadrenergic/noncholinergic signalling, which through the release of nitric oxide (NO), leads to an intracellular increase of cyclic GMP (cGMP), the main secondary messenger mediating tumescence in the penis. Interestingly, both cGMP formation and degradation are affected by testosterone (T). In fact, beyond the well-known role of T in regulating sexual desire and NO release, recent experimental evidences from our group showed that T also regulates the expression of phosphodiesterase type 5 (PDE5), the hydrolytic enzyme involved in cGMP breakdown. This antithetic role of T seems to be the main way through which the peripheral hormonal regulation of penile erections occurs, allowing an important synchronization between erectile processes and sexual desire. Hence, erections are still possible in hypogonadal conditions where a decreased cGMP formation, because of impaired NO production, is counterbalanced by a reduced cGMP hydrolysis. The purpose of this review is to describe evidences about the peripheral role of T in regulating penile erection and to justify the importance to test T plasma levels in those patients with erectile dysfunction who do not respond to PDE5 inhibitors.

The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation

BACKGROUND

Idiopathic slow transit constipation is one of the most severe and often intractable forms of constipation. As motor abnormalities are thought to play an important pathogenetic role, studies have been performed on the colonic neuroenteric system, which rules the motor aspects of the viscus.

AIMS

We hypothesised that important neuropathological abnormalities of the large bowel are present, that these are not confined to the interstitial cells of Cajal and ganglion cells, and that the previously described reduction of enteric neurones, if confirmed, might be related to an increase in programmed cell death (apoptosis).

PATIENTS AND METHODS

Surgical specimens from 26 severely constipated patients were assessed by conventional and immunohistochemical methods. Specific staining for enteric neurones, glial cells, interstitial cells of Cajal, and fibroblast-like cells associated with the latter were used. In addition, gangliar cell apoptosis was evaluated by means of indirect and direct techniques. Data from patients were compared with those obtained in 10 controls.

RESULTS

Severely constipated patients displayed a significant decrease in enteric gangliar cells, glial cells, and interstitial cells of Cajal. Fibroblast-like cells associated with the latter did not differ significantly between patients and controls. Patients had significantly more apoptotic enteric neurones than controls.

CONCLUSION

Severely constipated patients have important neuroenteric abnormalities, not confined to gangliar cells and interstitial cells of Cajal. The reduction of enteric neurones may in part be due to increased apoptotic phenomena.

The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation

BACKGROUND

Idiopathic slow transit constipation is one of the most severe and often intractable forms of constipation. As motor abnormalities are thought to play an important pathogenetic role, studies have been performed on the colonic neuroenteric system, which rules the motor aspects of the viscus.

AIMS

We hypothesised that important neuropathological abnormalities of the large bowel are present, that these are not confined to the interstitial cells of Cajal and ganglion cells, and that the previously described reduction of enteric neurones, if confirmed, might be related to an increase in programmed cell death (apoptosis).

PATIENTS AND METHODS

Surgical specimens from 26 severely constipated patients were assessed by conventional and immunohistochemical methods. Specific staining for enteric neurones, glial cells, interstitial cells of Cajal, and fibroblast-like cells associated with the latter were used. In addition, gangliar cell apoptosis was evaluated by means of indirect and direct techniques. Data from patients were compared with those obtained in 10 controls.

RESULTS

Severely constipated patients displayed a significant decrease in enteric gangliar cells, glial cells, and interstitial cells of Cajal. Fibroblast-like cells associated with the latter did not differ significantly between patients and controls. Patients had significantly more apoptotic enteric neurones than controls.

CONCLUSION

Severely constipated patients have important neuroenteric abnormalities, not confined to gangliar cells and interstitial cells of Cajal. The reduction of enteric neurones may in part be due to increased apoptotic phenomena.

Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease

BACKGROUND

Colonic diverticular disease (diverticulosis) is a common disorder in Western countries. Although its pathogenesis is probably multifactorial, motor abnormalities of the large bowel are thought to play an important role. However, little is known about the basic mechanism that may underlie abnormal colon motility in diverticulosis.

AIMS

To investigate the interstitial cells of Cajal (the gut pacemaker cells), together with myenteric and submucosal ganglion and glial cells, in patients with diverticulosis.

PATIENTS

Full thickness colonic samples were obtained from 39 patients undergoing surgery for diverticulosis. Specimens from tumour free areas of the colon in 10 age matched subjects undergoing surgery for colorectal cancer served as controls.

METHODS

Interstitial cells of Cajal were assessed using anti-Kit antibodies; submucosal and myenteric plexus neurones and glial cells were assessed by means of anti-PGP 9.5 and anti-S-100 monoclonal antibodies, respectively.

RESULTS

Patients with diverticulosis had normal numbers of myenteric and submucosal plexus neurones compared with controls (p = 0.103 and p = 0.516, respectively). All subtypes of interstitial cells of Cajal were significantly (p = 0.0003) reduced compared with controls, as were glial cells (p = 0.0041).

CONCLUSIONS

Interstitial cells of Cajal and glial cells are decreased in colonic diverticular disease, whereas enteric neurones appear to be normally represented. This finding might explain some of the large bowel motor abnormalities reported to occur in this condition.

Nutritional state and energy balance in cirrhotic patients with or without hypermetabolism. Multicentre prospective study by the 'Nutritional Problems in Gastroenterology' Section of the Italian Society of Gastroenterology (SIGE)

BACKGROUND AND AIMS

A total of 334 stable, compensated cirrhotic patients admitted to 10 Italian Gastroenterology Units were included in a prospective study to evaluate nutritional state and energy balance in liver cirrhosis.

MATERIALS AND METHODS

Nutritional state and calorie intake were examined in the total population, while adequacy of calorie intake versus measured total energy expenditure was evaluated in a comparable subpopulation and in 40 matched controls, by computing the energy balance.

RESULTS

Our data demonstrated that: (i) malnutrition was present in 25% of the total patients and significantly correlated with the Child's group (A=16%; B=25%; C=44%); (ii) the type of malnutrition is influenced by mBEE: normometabolic patients exhibit a significant (p<0.005) reduction of mid-arm fat area while both hypermetabolic and hypometabolic patients show a significant (p<0.005) decline in kg of free fat mass; (iii) normometabolic and hypometabolic patients have a negative energy balance, due to a high level of physical activity (127+/-14 kJ) in the first group and a reduced energy intake/kg body weight (102+/-12 kJ) in the second; (iv) hypermetabolic patients have a positive energy balance due to decreased daily physical activity/kg body weight (108+/-28 kJ); (v) malnourished and normometabolic patients eat a significantly (p<0.05) reduced percentage of protein whereas malnourished and hypermetabolic patients eat a significantly increased percentage of fat (p<0.05).

CONCLUSION

Although multivariate regression analysis confirms that the Child-Pugh's score is a better independent predictor of malnutrition, the measure of REE, TEE, calorie intake and energy balance need to be routinely performed in cirrhotic patients, in order to recognise hypermetabolic and hypometabolic patients (approximately 30%) in whom the nutritional and metabolic parameters are indispensable as a basis for designing and prescribing personalised nutritional strategies that can treat muscle malnutrition and thus improve the morbidity and mortality rates.

Effects of extremely low frequency electromagnetic fields on membrane-associated enzymes

The effects of extremely low frequency electromagnetic fields of 75 Hz were studied on different membrane-associated enzymes. Only the activities of three enzymes out of seven exposed to the field decreased approximately of about 54-61% with field amplitudes above a threshold of 73-151 microT depending on the enzyme. The same field had no effect on the activities of either integral membrane enzymes such as Ca,ATPase, Na/K,ATPase, and succinic dehydrogenase or peripheral membrane enzymes such as photoreceptor PDE. The decrease in enzymatic activity of the field-sensitive enzymes was independent of the time of permanence in the field and was completely reversible. When these enzymes were solubilized with Triton, no effect of the field was obtained on the enzymatic activity, suggesting the crucial role of the membrane in determining the conditions for enzyme inactivation. The role of the particular linkage of the field-sensitive enzymes to the membranes is also discussed.

Erectile dysfunction: molecular biology, pathophysiology and pharmacological treatment

During the past decade, several progresses have been made for a deeper understanding of the regulatory factors that mediate normal erectile function, although the mechanisms involved in pathophysiology of erectile dysfunction (ED) remain to be completely elucidated. However, dramatic advances in the management of ED have occurred. Many drugs are now available, with oral pharmacotherapy representing the first-line option for most patients. ED is a common condition associated with aging but not necessarily a consequence of aging. The most important risk factors are associated to the impaired balance between contractant and relaxant mechanisms of penile structures, resulting in arterial insufficiency and defect smooth muscle relaxation. The normal erectile function involves the synthesis of NO, the main neurotransmitter mediating erectile processes, and the subsequent accumulation of cyclic GMP (cGMP). The NO formation, and therefore the erection, is strictly controlled by the activity of NO synthase (NOS) isoenzymes, whereas cGMP degradation is specifically controlled by phosphodiesterase type 5 (PDE5), which promotes smooth muscle tone and terminates erection. The regulation of the activity of these 2 counteracting enzymes allows the penis to be contracted for the majority of the time. Androgens play a pivotal role in these mechanisms by regulating both NOS and PDE5 activity. This peripheral and antithetic role of androgens seems to regulate penile erections synchronizing erectile processes to sexual desire. Moreover, the androgen-dependent activity of PDE5 mirrors the unresponsiveness of certain patients with ED to PDE5 inhibitors (PDE5i), the most widely prescribed oral drugs. In fact, PDE5i cannot work if the target enzyme is lacking. This suggests the importance to test testosterone plasma levels in those patients with ED who do not respond to PDE5i. In conclusion, a better understanding of the pathogenic factors of ED will be useful to appropriately design pharmacotherapy and improve clinical management depending on the unique condition of each patient.

NIV treatment for acute exacerbation in COPD patients

The authors review the clinical applications of non invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on NIV issues and possible solutions. After briefly reviewing the respiratory mechanics modification during an episode of COPD exacerbation, the authors describe the two crucial technical aspects (choice of the interface and leaks control) that are mostly involved in patient-ventilator interaction. Finally, they briefly review the most important clinical trials on NIV.

Colonic motility studies in severe chronic constipation: an organic approach to a functional problem

Chronic constipation is one of the more frequent functional gastrointestinal symptoms. The more severe cases not infrequently undergo a major surgical approach. However, there is still a need for a better diagnostic and therapeutic approach, since the results are still unpredictable, probably due to a poor selection of candidates. This article focuses on the current diagnostic approach to chronic constipation, with an emphasis on the possible role of colonic manometry to help better choose those patients that may benefit from surgery.