Therapeutic implications of disorders of cell death signalling: membranes, micro-environment, and eicosanoid and docosanoid metabolism

Disruptions of cell death signalling occur in pathological processes, such as cancer and degenerative disease. Increased knowledge of cell death signalling has opened new areas of therapeutic research, and identifying key mediators of cell death has become increasingly important. Early triggering events in cell death may provide potential therapeutic targets, whereas agents affecting later signals may be more palliative in nature. A group of primary mediators are derivatives of the highly unsaturated fatty acids (HUFAs), particularly oxygenated metabolites such as prostaglandins. HUFAs, esterified in cell membranes, act as critical signalling molecules in many pathological processes. Currently, agents affecting HUFA metabolism are widely prescribed in diseases involving disordered cell death signalling. However, partly due to rapid metabolism, their role in cell death signalling pathways is poorly characterized. Recently, HUFA-derived mediators, the resolvins/protectins and endocannabinoids, have added opportunities to target selective signals and pathways. This review will focus on the control of cell death by HUFA, eicosanoid (C20 fatty acid metabolites) and docosanoid (C22 metabolites), HUFA-derived lipid mediators, signalling elements in the micro-environment and their potential therapeutic applications. Further therapeutic approaches will involve cell and molecular biology, the multiple hit theory of disease progression and analysis of system plasticity. Advances in the cell biology of eicosanoid and docosanoid metabolism, together with structure/function analysis of HUFA-derived mediators, will be useful in developing therapeutic agents in pathologies characterized by alterations in cell death signalling.

Alcohol consumption and driving intentions amongst hotel patrons

To examine the extent to which hotel patrons drink in excess of current health recommendations, and to identify risk factors for excessive drinking, hotel patrons were invited to participate in a survey of social drinking, which included a free breath test. Patrons were approached at 15 min. intervals, and 1000 subjects were studied. Amongst this group of hotel patrons interviewed, 1 in 2 had consumed alcohol in excess of the daily limit recommended by the National Health & Medical Research Council. One in 10 intending drivers had a BAC over the legal limit. Excessive drinking and drink driving appear to be prevalent amongst hotel patrons, and hotels should be targets for interventions designed to reduce these problems. For example, the National Guidelines for the Responsible Serving of Alcohol should be more widely practised.

Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren's disease

Post-surgical outcomes in patients with Dupuytren's disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (± 7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ± 5.1°; range: 5-25°) over the course of the treatment (p < .05). Nighttime static extension splinting and soft tissue mobilization techniques appear to delay and possibly prevent the need for surgery in individuals with flexion contractures of the proximal interphalangeal joint due to Dupuytren's disease.

Improved real-time PCR estimation of gene copy number in soil extracts using an artificial reference

Application of polymerase chain reaction (PCR) techniques has developed significantly from a qualitative technology to include powerful quantitative technologies, including real-time PCR, which are regularly used for detection and quantification of nucleic acids in many settings, including community analysis where culture-based techniques are not suitable. Many applications of real-time PCR involve absolute quantification which is susceptible to inaccuracies caused by losses during DNA extraction or inhibition caused by co-extracted compounds. We present here an improvement to this approach involving the addition of an artificial internal standard, prior to nucleic acid extraction. The standard was generated by in-situ mutagenesis from an E. coli template to ensure it both did not amplify with bacterial primers used for quantification and was short enough to minimise possible interference with other analyses. By estimating gene target copies by relative abundance, this approach accounts for both loss during extraction and inhibition effects. We present a novel application of relative real time PCR, using the internal standard as a reference, allowing accurate estimation of total bacterial populations both within and across a wide range of soils and demonstrate its improvement over absolute quantification by comparison of both approaches to ester linked fatty acid analysis of the same soils.

Statin and aspirin therapy for the prevention of cardiovascular events in patients with type 2 diabetes mellitus

Patients with type 2 diabetes mellitus are at 2 to 4 times increased risk of cardiovascular events compared with those without diabetes, both among patients with multiple risk factors only and those with established atherothrombosis. In this review, we provide recommendations for the use of statins and aspirin for the prevention of cardiovascular events in high-risk patients with diabetes mellitus.

PIXE ANALYSIS OF ATMOSPHERIC AEROSOLS IN THE CITY OF BUENOS AIRES

Lead pollution present in atmospheric aerosols in the city of Buenos Aires was measured in 1989, using Heavy Ion PIXE. Since then, environmental conditions have changed significantly. The usage of unleaded gasoline was introduced, and the utilisation of compressed natural gas as car fuel has increased. Recently, a new sampling campaign of atmospheric aerosols has started, partly in collaboration with the Greenpeace Foundation. The present studies reveal that lead pollution in Buenos Aires has significantly decreased since 1989. The concentrations of other elements are determined as well.

Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome

AIM

To describe incidence, aetiology and outcome data for Scotland since the inception of the Scottish Liver Transplant Unit (SLTU) in 1992.

BACKGROUND

Acute liver failure (ALF) is a rare but frequently fatal condition. Few studies have adequate patient numbers to draw convincing conclusions over demographic features, aetiology and outcome.

DESIGN

Statistical analysis of prospectively collected data on aetiology, demographic, clinical and outcome of all admissions, including those with ALF, to the SLTU.

METHODS

Incidence data presented for admissions and ALF. Descriptive frequencies for aetiology, clinical, demographic and outcome data presented; including split analysis for paracetamol and non-paracetamol aetiologies. Univariate and multivariate analysis of admission factors predictive of outcome is described.

RESULTS

Nine hundred and forty-nine patients were admitted to the SLTU between 1992 and 2009. Five hundred and twenty-four patients had ALF. The annual incidence of ALF in the Scottish population is 0.62 per 100,000 and paracetamol overdose (POD) was the largest causative factor; responsible for 0.43 cases of ALF per 100,000 population per year. The odds ratio (OR) of transplantation or death was 0.47 in the POD group compared to other aetiologies; yet of not being a transplant candidate having met the Kings College Hospital poor prognostic criteria OR was 4.9. Of admissions listed for transplant 76.0% were transplanted. Of those listed and not transplanted mortality was approaching 100% and 76.1% of those transplanted survived to discharge.

CONCLUSION

This large, prospective, single centre study with a defined geographical area and well-recorded population provides accurate data regarding ALF between 1992 and 2009.

A new-generation ultra-long-acting basal insulin with a bolus boost compared with insulin glargine in insulin-naive people with type 2 diabetes: a randomized, controlled trial

OBJECTIVE

Insulin degludec/insulin aspart (IDegAsp) is a soluble coformulation of the novel basal analog insulin degludec (IDeg: 70%) and insulin aspart (IAsp: 30%). We compared the safety and efficacy of IDegAsp, an alternative formulation (AF) (55% IDeg and 45% IAsp), and insulin glargine (IGlar) in insulin-naïve subjects with type 2 diabetes inadequately controlled with oral antidiabetic drugs.

RESEARCH DESIGN AND METHODS

In this 16-week, open-label trial, subjects (mean age 59.1 years, A1C 8.5%, BMI 30.3 kg/m(2)) were randomized to once-daily IDegAsp (n = 59), AF (n = 59), or IGlar (n = 60), all in combination with metformin. Insulin was administered before the evening meal and dose-titrated to a fasting plasma glucose (FPG) target of 4.0-6.0 mmol/L.

RESULTS

After 16 weeks, mean A1C decreased in all groups to comparable levels (IDegAsp: 7.0%; AF: 7.2%; IGlar: 7.1%). A similar proportion of subjects achieved A1C <7.0% without confirmed hypoglycemia in the last 4 weeks of treatment (IDegAsp: 51%; AF: 47%; IGlar: 50%). Mean 2-h postdinner plasma glucose increase was lower for IDegAsp (0.13 mmol/L) and AF (0.24 mmol/L) than IGlar (1.63 mmol/L), whereas mean FPG was similar (IDegAsp: 6.8 mmol/L; AF: 7.4 mmol/L; IGlar: 7.0 mmol/L). Hypoglycemia rates were lower for IDegAsp and IGlar than AF (1.2, 0.7, and 2.4 events/patient year). Nocturnal hypoglycemic events occurred rarely for IDegAsp (1 event) and IGlar (3 events) compared with AF (27 events).

CONCLUSIONS

In this proof-of-concept trial, once-daily IDegAsp was safe, well tolerated, and provided comparable overall glycemic control to IGlar at similar low rates of hypoglycemia, but better postdinner plasma glucose control.

Structural and Physical Property Trends of the Hyperstoichiometric Series, La2Ni(1-x)CoxO4+δ

Members of the Ruddlesden-Popper system, La2Ni(1-x)CoxO4+δ (0.00 ≤ × ≤ 1.00), were synthesized and studied for their potential use as cathodes for solid-oxide fuel cells. An unusual structural trend has been noted across the series, which appears to correlate with the oxygen-hyperstoichiometry observed. Details of the structural variance by x-ray and neutron diffraction, as well as selected physical properties for this system will be presented.

Splenic peliosis: an unusual entity

This case of splenic peliosis, describes a rare condition when it presents in the spleen, and is better understood when it occurs in the liver. However, the ultrasound and CT features have a wide differential diagnosis including more common aetiologies, of either a vascular, infective or neoplastic nature, which should be considered. Peliosis is an important condition to be aware of because rupture of the blood-filled cysts on the spleen surface can lead to haemorrhagic peritonitis and ultimately be fatal.

Starting insulin therapy with basal insulin analog or premix insulin analog in T2DM: a pooled analysis of treat-to-target trials

OBJECTIVE

Although the choice of starting insulin for people with type 2 diabetes mellitus (T2DM) is often a basal or premix insulin analog, there is little evidence to base this decision on. This analysis aimed to determine if measurable clinical characteristics prior to starting insulin could predict differences in improved glycemic control between these options.

RESEARCH DESIGN AND METHODS

A thorough literature search was performed for treat-to-target studies in insulin-naïve individuals with T2DM treated with biphasic insulin aspart (BIAsp 30), a basal insulin analog (insulin glargine or insulin detemir) or NPH insulin regimens once or twice daily plus oral glucose-lowering drugs (OGLDs). Patient data were pooled and mean baseline age, diabetes duration, gender, body mass index (BMI), HbA(1c), fasting plasma glucose (FPG), average postprandial plasma glucose over three meals (PPG) and bedtime PG were investigated for prediction of improved HbA(1c), FPG or PPG. Statistical analyses employed a linear mixed model with insulin type, OGLD, time and time-squared as fixed effects and patient and trial as random effects.

RESULTS

Baseline age (p = 0.022) and bedtime PG (p = 0.036) were inter-related predictors of HbA(1c). In older individuals with higher bedtime PG, BIAsp 30 appeared to be more beneficial. In contrast, basal insulin appeared to be a better choice in younger individuals with lower bedtime PG. For FPG, BMI (p = 0.011) and post-breakfast PG (p = 0.042) were identified as predictors. Basal insulin appeared to achieve better FPG in patients with lower BMI and higher post-breakfast PG, while BIAsp 30 appeared to be better in patients with higher BMI and lower post-breakfast PG. Age (p = 0.0347) was the only baseline characteristic associated with differences in average PPG: mean PPG was similar between regimens in younger people, but BIAsp 30 achieved better PPG results in older persons. Minor hypoglycemia was reported by 56% of BIAsp 30- and 45% of basal-treated individuals. The major limitation of the study was that only Novo Nordisk trials were included in the analysis as access to individual patient data was required. As the trials were fairly heterogeneous a strict methodology was used to minimize potential confounding factors.

CONCLUSIONS

Premix analog rather than basal insulin may be an appropriate choice to target HbA(1c) values in older individuals and those with higher bedtime PG, while basal insulin may be more appropriate to target FPG in patients with lower BMI and higher post-breakfast PG.