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Suárez LJ, Arce RM, Gonçalves C, Furquim CP, Santos NCD, Retamal-Valdes B, Feres M. Metronidazole may display anti-inflammatory features in periodontitis treatment: A scoping review. Mol Oral Microbiol 2024; 39:240-259. [PMID: 38613247 DOI: 10.1111/omi.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/15/2023] [Accepted: 02/13/2024] [Indexed: 04/14/2024]
Abstract
AIM Metronidazole (MTZ) is an antimicrobial agent used to treat anaerobic infections. It has been hypothesized that MTZ may also have anti-inflammatory properties, but the evidence is limited and has not been previously reviewed. Thus, this scoping review aimed to answer the following question: "What is the evidence supporting anti-inflammatory properties of metronidazole that are not mediated by its antimicrobial effects?" METHODS A scoping review was conducted according to the PRISMA-ScR statement. Five databases were searched up to January 2023 for studies evaluating the anti-inflammatory properties of MTZ used as monotherapy for treating infectious and inflammatory diseases. RESULTS A total of 719 records were identified, and 27 studies (21 in vivo and 6 in vitro) were included. The studies reported experimental evidence of MTZ anti-inflammatory effects on (1) innate immunity (barrier permeability, leukocyte adhesion, immune cell populations), (2) acquired immunity (lymphocyte proliferation, T-cell function, cytokine profile), and (3) wound healing/resolution of inflammation. CONCLUSION Taken together, this scoping review supported a potential anti-inflammatory effect of MTZ in periodontitis treatment. We recommend that future clinical studies should be conducted to evaluate specific MTZ anti-inflammatory pathways in the treatment of periodontitis.
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Affiliation(s)
- Lina J Suárez
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
- Departamento de Ciencias Básicas y Medicina Oral, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Roger M Arce
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas School of Dentistry at Houston, Houston, Texas, USA
| | - Cristiane Gonçalves
- Department of Periodontology, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Pinheiro Furquim
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
- Department of Basic and Translational Sciences, School of Dental Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nidia Castro Dos Santos
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
- Hospital Albert Einstein, São Paulo, São Paulo, Brazil
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Belén Retamal-Valdes
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
- Department of Periodontology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Sohal A, Kowdley KV. Novel preclinical developments of the primary sclerosing cholangitis treatment landscape. Expert Opin Investig Drugs 2024; 33:335-345. [PMID: 38480008 DOI: 10.1080/13543784.2024.2330738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease associated with inflammation, fibrosis, and destruction of intra- and extrahepatic bile ducts. Despite substantial recent advances in our understanding of PSC, the only proven treatment of PSC is liver transplantation. There is an urgent unmet need to find medical therapies for this disorder. AREAS COVERED Multiple drugs are currently under evaluation as therapeutic options for this disease. This article summarizes the literature on the various novel therapeutic options that have been investigated and are currently under development for the treatment of PSC. EXPERT OPINION In the next decade, more than one drug will likely be approved for the treatment of the disease, and we will be looking at combination therapies for the optimal management of the disease.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, USA
| | - Kris V Kowdley
- Department of Hepatology, Liver Institute Northwest, Seattle, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
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Muacevic A, Adler JR, Hande A, Joshi DA, Bhagat A. Hematological and Biochemical Responses of Newly Formulated Primary Root Canal Obturating Material: An In Vivo Study. Cureus 2022; 14:e32685. [PMID: 36660520 PMCID: PMC9847328 DOI: 10.7759/cureus.32685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Background and objective Any drug or medicinal agent, when implanted into the body, gets biotransformed by various organ systems and the toxic byproducts of this process alter the normal physiological process. In this experimental study, we aimed to quantify the safety of newly formulated primary root canal obturating material by investigating the hematological and biochemical parameters related to liver function. Methodology Forty-eight Wistar rats (weighing 250-350 grams) were classified into three groups (n=16) through random allocation. Preoperative blood samples were collected by puncturing the orbital venous plexus, the values of which were used as control. Zinc oxide eugenol (ZOE), calcium hydroxide iodoform paste (Metapex), and newly formulated triple antibiotic obturating paste (TAOP) were implanted (100 µg) into dorsal connective tissues. Blood samples on the seventh, 15th, and 30th postoperative days were evaluated respectively by analyzing hematological, hepatic, and, renal function tests for acute and chronic inflammatory responses. Results The intra-group and inter-group comparisons among all the test materials after seven days exhibited high significance in terms of hemoglobin (Hb), mean corpuscular volume (MCV), neutrophils, and serum glutamic-oxaloacetic transaminase (SGOT) (p<0.001), while others showed mixed responses (p<0.05 to p>0.05). After 15 days, the comparisons showed high significance with respect to packed cell volume (PCV), mean cell volume (MCV), and serum creatinine (p<0.001), while others showed significant to nonsignificant differences (p<0.05 to p>0.05). At the end of 30 days, all the parameters showed mixed responses (p<0.001 to p>0.05). Conclusion The newly formulated obturating material TAOP showed lower adverse hematological, hepatic, and renal effects in experimental animals compared to other test materials, with most parameters reverting to normal after 30 days.
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Li ZJ, Gou HZ, Zhang YL, Song XJ, Zhang L. Role of intestinal flora in primary sclerosing cholangitis and its potential therapeutic value. World J Gastroenterol 2022; 28:6213-6229. [PMID: 36504550 PMCID: PMC9730442 DOI: 10.3748/wjg.v28.i44.6213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 02/06/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) is an autoimmune disease characterized by chronic cholestasis, a persistent inflammation of the bile ducts that leads to sclerotic occlusion and cholestasis. Gut microbes, consisting of microorganisms colonized in the human gut, play an important role in nutrient intake, metabolic homeostasis, immune regulation, and immune regulation; however, their presence might aid PSC development. Studies have found that gut-liver axis interactions also play an important role in the pathogenesis of PSC. Patients with PSC have considerably reduced intestinal flora diversity and increased abundance of potentially pathogenic bacteria. Dysbiosis of the intestinal flora leads to increased intestinal permeability, homing of intestinal lymphocytes, entry of bacteria and their associated metabolites, such as bile acids, into the liver, stimulation of hepatic immune activation, and promotion of PSC. Currently, PSC effective treatment is lacking. However, a number of studies have recently investigated the targeted modulation of gut microbes for the treatment of various liver diseases (alcoholic liver disease, metabolic fatty liver, cirrhosis, and autoimmune liver disease). In addition, antibiotics, fecal microbiota transplantation, and probiotics have been reported as successful PSC therapies as well as for the treatment of gut dysbiosis, suggesting their effectiveness for PSC treatment. Therefore, this review briefly summarizes the role of intestinal flora in PSC with the aim of providing new insights into PSC treatment.
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Affiliation(s)
- Zhen-Jiao Li
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hong-Zhong Gou
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yu-Lin Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jing Song
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Lei Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Miyachi Y, Yamasaki K, Fujita T, Fujii C. Metronidazole gel (0.75%) in Japanese patients with rosacea: A randomized, vehicle-controlled, phase 3 study. J Dermatol 2021; 49:330-340. [PMID: 34854112 PMCID: PMC9299697 DOI: 10.1111/1346-8138.16254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/26/2021] [Accepted: 11/14/2021] [Indexed: 11/28/2022]
Abstract
Topical metronidazole is not currently approved in Japan as a treatment for the indication of rosacea, although 0.75% metronidazole gel was authorized in 2014 for the management of cancerous skin ulcers. We conducted a randomized, double-blind, vehicle-controlled study to evaluate the efficacy and safety of 0.75% metronidazole gel in Japanese patients with inflammatory lesions (papules/pustules) and erythema associated with moderate to severe rosacea. Overall, 130 patients were randomly assigned to receive 0.75% metronidazole gel (n = 65) or vehicle (n = 65), and 120 patients completed 12 weeks of treatment. The primary efficacy outcome was the proportion of patients who achieved both of the following at week 12: an improvement of >50% in the number of inflammatory lesions (papules/pustules) and a positive change of at least one degree in erythema severity. This composite outcome was achieved by 72.3% of metronidazole-treated patients versus 36.9% of vehicle-treated patients, with the between-group difference demonstrating significant improvement with 0.75% metronidazole gel (p < 0.0001). All secondary efficacy endpoints (patients achieving a score of ≥3 for percent change in the number of inflammatory lesions at week 12; patients achieving a score of ≥3 for change in erythema severity at week 12; patients achieving an Investigator's Global Assessment score of 0 or 1 at week 12; percent change over time in the number of inflammatory lesions; change over time in erythema severity) also showed improvement in the 0.75% metronidazole gel group. The incidence of adverse events was higher with metronidazole (40.0%) than with vehicle (29.2%). Of these, treatment-related, treatment-emergent adverse events occurred in 9.2% and 6.2% in the metronidazole and the vehicle group, respectively, but there were no new safety concerns. Overall, the results of this study have confirmed the efficacy and safety of 0.75% metronidazole gel in Japanese patients with rosacea.
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Affiliation(s)
- Yoshiki Miyachi
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Kenshi Yamasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Chie Fujii
- Clinical Development Department, Maruho Co., Ltd, Kyoto, Japan
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Zancan RF, Ponce JB, Dionisio TJ, Oliveira RCD, Silva RAD, Duque JA, Duarte MAH. Profile of host cell responses to exposure to stressed bacteria in planktonic; dislodged, and intact biofilm mode. Braz Dent J 2021; 32:10-20. [PMID: 34755784 DOI: 10.1590/0103-6440202104503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
The host defense response to microbial challenge emerging from the root canal system leads to apical periodontitis. The aim of this study was to evaluate the expression of inflammatory cytokines and Nitric Oxide (NO) by macrophages after interaction with Enterococcus faecalis in the: plankton and dislodged biofilm mode; intact biofilm mode stimulated by calcium hydroxide (CH), CH and chlorhexidine (CHX) or Triple Antibiotic Paste (TAP). For this purpose, culture of macrophages from monocytes in human peripheral blood (N=8) were exposed to the different modes of bacteria for 24 hours. Subsequently, the cytokines, such as, Tumor Necrotic Factor- alfa (TNF-α), interleukin (IL)-1β, IL-6, IL-10; and NO were quantified by Luminex xMAP and Greiss reaction, respectively. In addition to the potential therapeutic effects of the intracanal medication, their antimicrobial activity against Enterococcus faecalis biofilm were also tested in vitro by confocal microscopy. The experiments` data were analyzed by the Kruskal-Wallis test with the Dunn post hoc test (α < 0.05). Bacteria in dislodged biofilm mode were shown to be more aggressive to the immune system than bacteria in plankton mode and negative control, inducing greater expression of NO and TNF-α. Relative to bacteria in intact biofilm mode, the weakest antimicrobial activity occurred in Group CH. In Groups CH/CHX and TAP the percentage of dead bacteria was significantly increased to the same extent. Interestingly, the biofilm itself did not induce the release of pro-inflammatory cytokines - except for NO - while the biofilm treated with TAP and CH based pastes enhanced the levels of IL-6 and TNF-α; and IL-1 β, respectively. In contrast, the levels of a potent anti-inflammatory (IL-10) were increased in Group TAP.
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Affiliation(s)
- Rafaela Fernandes Zancan
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil- Department of Restorative Dentistry, Dental Materials and Endodontics
| | - José Burgos Ponce
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil - Department of Surgery, Stomatology, Pathology and Radiology
| | - Thiago José Dionisio
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil - Department of Biological Sciences
| | - Rodrigo Cardoso de Oliveira
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil- Department of Pediatric Dentistry, Orthodontics and Public Health
| | - Rafaela Alves da Silva
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil- Department of Pediatric Dentistry, Orthodontics and Public Health
| | - Jussaro Alves Duque
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil- Department of Restorative Dentistry, Dental Materials and Endodontics
| | - Marco Antonio Hungaro Duarte
- Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil- Department of Restorative Dentistry, Dental Materials and Endodontics
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Antibiotics Used in Regenerative Endodontics Modify Immune Response of Macrophages to Bacterial Infection. J Endod 2019; 45:1349-1356. [DOI: 10.1016/j.joen.2019.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
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Therapeutic Effects of Intravitreously Administered Bacteriophage in a Mouse Model of Endophthalmitis Caused by Vancomycin-Sensitive or -Resistant Enterococcus faecalis. Antimicrob Agents Chemother 2019; 63:AAC.01088-19. [PMID: 31451497 DOI: 10.1128/aac.01088-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/16/2019] [Indexed: 01/21/2023] Open
Abstract
Endophthalmitis due to infection with Enterococcus spp. progresses rapidly and often results in substantial and irreversible vision loss. Given that the frequency of this condition caused by vancomycin-resistant Enterococcus faecalis has been increasing, the development of novel therapeutics is urgently required. We have demonstrated the therapeutic potential of bacteriophage ΦEF24C-P2 in a mouse model of endophthalmitis caused by vancomycin-sensitive (EF24) or vancomycin-resistant (VRE2) strains of E. faecalis Phage ΦEF24C-P2 induced rapid and pronounced bacterial lysis in turbidity reduction assays with EF24, VRE2, and clinical isolates derived from patients with E. faecalis-related postoperative endophthalmitis. Endophthalmitis was induced in mice by injection of EF24 or VRE2 (1 × 104 cells) into the vitreous. The number of viable bacteria in the eye increased to >1 × 107 CFU, and neutrophil infiltration into the eye was detected as an increase in myeloperoxidase activity at 24 h after infection. A clinical score based on loss of visibility of the fundus as well as the number of viable bacteria and the level of myeloperoxidase activity in the eye were all significantly decreased by intravitreous injection of ΦEF24C-P2 6 h after injection of EF24 or VRE2. Whereas histopathologic analysis revealed massive infiltration of inflammatory cells and retinal detachment in vehicle-treated eyes, the number of these cells was greatly reduced and retinal structural integrity was preserved in phage-treated eyes. Our results thus suggest that intravitreous phage therapy is a potential treatment for endophthalmitis caused by vancomycin-sensitive or -resistant strains of E. faecalis.
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Speer EM, Diago-Navarro E, Ozog LS, Dowling DJ, Hou W, Raheel M, Fries BC, Levy O. Pentoxifylline Alone or in Combination with Gentamicin or Vancomycin Inhibits Live Microbe-Induced Proinflammatory Cytokine Production in Human Cord Blood and Cord Blood Monocytes In Vitro. Antimicrob Agents Chemother 2018; 62:e01462-18. [PMID: 30275087 PMCID: PMC6256750 DOI: 10.1128/aac.01462-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/22/2018] [Indexed: 01/08/2023] Open
Abstract
Neonatal sepsis and its accompanying inflammatory response contribute to substantial morbidity and mortality. Pentoxifylline (PTX), a phosphodiesterase inhibitor which suppresses transcription and production of proinflammatory cytokines, is a candidate adjunctive therapy for newborn sepsis. We hypothesized that PTX decreases live microbe-induced inflammatory cytokine production in newborn blood. Cord blood was stimulated with live microorganisms commonly encountered in newborn sepsis (Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, or Candida albicans) and simultaneously treated with antimicrobial agents (gentamicin, vancomycin, or amphotericin B) and/or clinically relevant concentrations of PTX. Microbial colony counts were enumerated by plating, supernatant cytokines were measured by multiplex assay, intracellular cytokines and signaling molecules were measured by flow cytometry, and mRNA levels were measured by quantitative reverse transcription-PCR. PTX inhibited concentration-dependent E. coli-, S. aureus-, S. epidermidis-, and C. albicans-induced tumor necrosis factor (TNF) and E. coli-induced interleukin-1β (IL-1β) production in whole blood, with greater suppression of proinflammatory cytokines in combination with antimicrobial agents. Likewise, PTX suppressed E. coli-induced monocytic TNF and IL-1β, whereby combined PTX and gentamicin led to significantly greater reduction of TNF and IL-1β. The anti-inflammatory effect of PTX on microbe-induced proinflammatory cytokine production was accompanied by inhibition of TNF mRNA expression and was achieved without suppressing the production of the anti-inflammatory IL-10. Of note, microbial colony counts in newborn blood were not increased by PTX. Our findings demonstrated that PTX inhibited microbe-induced proinflammatory cytokine production, especially when combined with antimicrobial agents, without enhancing microbial proliferation in human cord blood in vitro, thus supporting its utility as candidate adjunctive agent for newborn sepsis.
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Affiliation(s)
- Esther M Speer
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Elizabeth Diago-Navarro
- Division of Infectious Diseases, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Lukasz S Ozog
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - David J Dowling
- Precision Vaccine Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wei Hou
- Family, Population, and Preventive Medicine Department, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Mahnoor Raheel
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Bettina C Fries
- Division of Infectious Diseases, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ofer Levy
- Precision Vaccine Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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Serebryakova VA, Urazova OI, Novitsky VV, Vengerovskii AI, Kononova TE. In Vitro Study of the Modulatory Effects of Levofloxacin and BCG on Secretion of Proinflammatory Cytokines in Infiltrative Pulmonary Tuberculosis. Bull Exp Biol Med 2018; 166:225-228. [PMID: 30488211 DOI: 10.1007/s10517-018-4319-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/28/2022]
Abstract
The effects levofloxacin (fluoroquinolone) and vaccinal BCG strain on cytokine production by blood mononuclear leukocytes was studied in patients with infiltrative pulmonary tuberculosis. Combined treatment with levofloxacin and vaccinal BCG strain suppressed the production of TNFα in drug-resistant pulmonary tuberculosis and production of IL-12 and IFNγ in drug-sensitive tuberculosis.
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Affiliation(s)
- V A Serebryakova
- Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia.
| | - O I Urazova
- Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - V V Novitsky
- Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - A I Vengerovskii
- Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - T E Kononova
- Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
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Dey S, Bishayi B. Killing of S. aureus in murine peritoneal macrophages by Ascorbic acid along with antibiotics Chloramphenicol or Ofloxacin: Correlation with inflammation. Microb Pathog 2018; 115:239-250. [DOI: 10.1016/j.micpath.2017.12.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/02/2017] [Accepted: 12/18/2017] [Indexed: 01/05/2023]
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Amoureux MC, Hegyi E, Le D, Grandics P, Tong H, Szathmary S. A new method for removing endotoxin from plasma using hemocompatible affinity chromatography technology, applicable for extracorporeal treatment of septic patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519040100020401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pathogenesis of sepsis begins with the proliferation of micro-organisms at a site of infection, followed by invasion of the bloodstream and other organs. Gram-negative bacteria account for a large part of sepsis cases. The structural component of Gram-negative bacteria, endotoxin or lipopolysaccharide (LPS), induces the synthesis and release of endogenous mediators of sepsis. A growing number of investigations of the molecular mechanisms occurring in sepsis, point to endotoxin as a central mediator leading to multi-organ failure and death. In numerous clinical trials, attempts to target molecules downstream of endotoxin have been made, but have not been associated with improved survival. We describe an affinity-based system for the selective removal of endotoxin from plasma. The small-scale device, a 1.5 ml cartridge, contains beads that bind endotoxin with high specificity and efficiency. In addition, evidence is presented that this device does not affect plasma hemostasis, nor does it activate the complement system. Taken together, these results represent a proof of principle for endotoxin removal from plasma, which may be of clinical value to treat sepsis by extracorporeal circulation of the blood through a scaled-up version of this endotoxin-removing device.
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Affiliation(s)
| | - Edit Hegyi
- Clarigen Inc., Carlsbad, California, USA
| | - Dzung Le
- Clarigen Inc., Carlsbad, California, USA
| | | | - Hung Tong
- Clarigen Inc., Carlsbad, California, USA
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Zierath D, Kunze A, Fecteau L, Becker K. Effect of Antibiotic Class on Stroke Outcome. Stroke 2015; 46:2287-92. [PMID: 26138122 DOI: 10.1161/strokeaha.115.008663] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/05/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Infections are common after stroke and associated with worse outcome. Clinical trials evaluating the benefit of prophylactic antibiotics have produced mixed results. This study explores the possibility that antibiotics of different classes may differentially affect stroke outcome. METHODS Lewis rats were subjected to transient cerebral ischemia (2 hours) and survived for 1 month. The day after stroke they were randomized to therapy with ceftiofur (a β-lactam antibiotic), enrofloxacin (a fluoroquinolone antibiotic), or vehicle (as controls) and underwent the equivalent of 7 days of treatment. Behavioral tests were performed weekly until euthanization. In a subset of animals, histology was done. RESULTS There were no differences in outcomes at 24 hours or 1 week after stroke among the different groups. At 1 month after stroke, however, performance on the rotarod was worse in enrofloxacin-treated animals when compared with control animals. CONCLUSIONS Independent of infection, the antibiotic enrofloxacin was associated with worse stroke outcome. These data echo the clinical observations to date and suggest that the secondary effects of antibiotics on stroke outcome should be considered when treating infection in subjects with stroke. The mechanism by which this antibiotic affects outcome needs to be elucidated.
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Affiliation(s)
- Dannielle Zierath
- From the Department of Neurology, University of Washington School of Medicine, Seattle
| | - Allison Kunze
- From the Department of Neurology, University of Washington School of Medicine, Seattle
| | - Leia Fecteau
- From the Department of Neurology, University of Washington School of Medicine, Seattle
| | - Kyra Becker
- From the Department of Neurology, University of Washington School of Medicine, Seattle.
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Clifford V, Zufferey C, Germano S, Ryan N, Leslie D, Street A, Denholm J, Tebruegge M, Curtis N. The impact of anti-tuberculous antibiotics and corticosteroids on cytokine production in QuantiFERON-TB Gold In Tube assays. Tuberculosis (Edinb) 2015; 95:343-9. [PMID: 25837441 DOI: 10.1016/j.tube.2015.02.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The ability to monitor and confirm adequate treatment of latent TB infection (LTBI) would be a major advance. The potential immunomodulatory effects of anti-tuberculous drugs and steroids need to be considered in assessing the utility of cytokine-based assays for this purpose. METHODS We determined whether anti-tuberculous antibiotics or dexamethasone affect the production of IFN-γ and other potential cytokine biomarkers (TNF-α, IL-1ra, IL-2, IL-10, IL-13, IP-10, MIP-1β) in the QuantiFERON-TB Gold In-Tube (QFT-IT) assay. Blood from ten adults with LTBI was added to one standard set of QFT-IT tubes and five further sets containing therapeutic concentrations of either isoniazid, rifampicin, isoniazid and rifampicin, ciprofloxacin or dexamethasone. Resulting supernatants were analysed by ELISA (QFT-IT assay IFN-γ) and xMAP-Luminex assays (all cytokines). RESULTS Anti-tuberculous antibiotics had only a limited effect on categorical QFT-IT assay results and the production of cytokines. In contrast, dexamethasone resulted in a change in categorical results from positive to negative in four of ten patients, and caused a marked reduction in IL-13 and IL-1ra responses. CONCLUSION Substantial changes in TB-antigen-induced IFN-γ and other cytokine responses during treatment likely primarily reflect host immunological changes rather than immunomodulatory effects of anti-tuberculous antibiotics. Results from cytokine-based assays in patients on corticosteroids should be interpreted with caution.
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Affiliation(s)
- Vanessa Clifford
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Christel Zufferey
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Susie Germano
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Norbert Ryan
- Victorian Infectious Diseases Reference Laboratory, Parkville, VIC, Australia
| | - David Leslie
- Victorian Infectious Diseases Reference Laboratory, Parkville, VIC, Australia
| | - Alan Street
- Victorian Infectious Diseases Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Justin Denholm
- Victorian Infectious Diseases Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Academic Unit of Clinical and Experimental Medicine, Faculty of Medicine & National Institute for Health Research Southampton Respiratory Biomedical Research Unit & Institute for Life Sciences, University of Southampton, United Kingdom
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
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15
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Sharma-Kuinkel BK, Zhang Y, Yan Q, Ahn SH, Fowler VG. Host gene expression profiling and in vivo cytokine studies to characterize the role of linezolid and vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) murine sepsis model. PLoS One 2013; 8:e60463. [PMID: 23565251 PMCID: PMC3614971 DOI: 10.1371/journal.pone.0060463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/26/2013] [Indexed: 01/11/2023] Open
Abstract
Linezolid (L), a potent antibiotic for Methicillin Resistant Staphylococcus aureus (MRSA), inhibits bacterial protein synthesis. By contrast, vancomycin (V) is a cell wall active agent. Here, we used a murine sepsis model to test the hypothesis that L treatment is associated with differences in bacterial and host characteristics as compared to V. Mice were injected with S. aureus USA300, and then intravenously treated with 25 mg/kg of either L or V at 2 hours post infection (hpi). In vivo alpha-hemolysin production was reduced in both L and V-treated mice compared to untreated mice but the reduction did not reach the statistical significance [P = 0.12 for L; P = 0.70 for V). PVL was significantly reduced in L-treated mice compared to untreated mice (P = 0.02). However the reduction of in vivo PVL did not reach the statistical significance in V- treated mice compared to untreated mice (P = 0.27). Both antibiotics significantly reduced IL-1β production [P = 0.001 for L; P = 0.006 for V]. IL-6 was significantly reduced with L but not V antibiotic treatment [P<0.001 for L; P = 0.11 for V]. Neither treatment significantly reduced production of TNF-α. Whole-blood gene expression profiling showed no significant effect of L and V on uninfected mice. In S. aureus-infected mice, L altered the expression of a greater number of genes than V (95 vs. 42; P = 0.001). Pathway analysis for the differentially expressed genes identified toll-like receptor signaling pathway to be common to each S. aureus-infected comparison. Expression of immunomodulatory genes like Cxcl9, Cxcl10, Il1r2, Cd14 and Nfkbia was different among the treatment groups. Glycerolipid metabolism pathway was uniquely associated with L treatment in S. aureus infection. This study demonstrates that, as compared to V, treatment with L is associated with reduced levels of toxin production, differences in host inflammatory response, and distinct host gene expression characteristics in MRSA sepsis.
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Affiliation(s)
- Batu K. Sharma-Kuinkel
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail: (BKSK); (SHA)
| | - Yurong Zhang
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Qin Yan
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Sun Hee Ahn
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail: (BKSK); (SHA)
| | - Vance G. Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
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16
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Effect of resveratrol and modulation of cytokine production on human periodontal ligament cells. Cytokine 2012; 60:197-204. [DOI: 10.1016/j.cyto.2012.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/05/2012] [Accepted: 06/02/2012] [Indexed: 11/21/2022]
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17
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Rizzo A, Paolillo R, Guida L, Annunziata M, Bevilacqua N, Tufano MA. Effect of metronidazole and modulation of cytokine production on human periodontal ligament cells. Int Immunopharmacol 2010; 10:744-50. [DOI: 10.1016/j.intimp.2010.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/08/2010] [Accepted: 04/08/2010] [Indexed: 11/26/2022]
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18
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Leffler DA, Lamont JT. Treatment of Clostridium difficile-associated disease. Gastroenterology 2009; 136:1899-912. [PMID: 19457418 DOI: 10.1053/j.gastro.2008.12.070] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/12/2008] [Accepted: 12/22/2008] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the United States. Treatment of patients with C difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. Despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few weeks after treatment is discontinued. Failure to develop specific antibody response has recently been identified as a critical factor in recurrence. The review discusses the different management strategies for initial and recurrent symptomatic C difficile infections.
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Affiliation(s)
- Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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19
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Fararjeh M, Mohammad MK, Bustanji Y, Alkhatib H, Abdalla S. Evaluation of immunosuppression induced by metronidazole in Balb/c mice and human peripheral blood lymphocytes. Int Immunopharmacol 2007; 8:341-50. [PMID: 18182250 DOI: 10.1016/j.intimp.2007.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 10/11/2007] [Accepted: 10/16/2007] [Indexed: 11/25/2022]
Abstract
The immunomodulatory effect of metronidazole (MTZ), a nitroimidazole drug used as an antiprotozoal and antibacterial agent, was investigated using Balb/c mice and human peripheral blood lymphocytes. For in vivo studies, mice were divided into six groups, six animals per group, group I received vehicle alone while the other groups (II-VI) received intraperitoneal injections of MTZ (14, 28, 42, 57, and 114 mg/kg) respectively. For in vitro studies different concentrations of MTZ (5, 10, 50, and 200 microg/ml) were used. MTZ showed a significant decrease in the percentage of circulating neutrophils and monocytes and an increase in the percentage of circulating lymphocytes. The relative weights of spleen as well as the relative body weight gain also decreased. Detectable changes were seen in the histology of spleen and thymus. Splenic plaque-forming cells (PFC), hemagglutination (HA) titer to sheep red blood cells (SRBC), spleenocytes and human peripheral blood lymphocytes proliferation (MLR) were markedly suppressed by MTZ treatment as compared to control group. MTZ also induced a significant decrease in delayed-type hypersensitivity (DTH) reaction, phagocytic activity (assessed by phagocytic capacity and phagocytic index) as well as TNF-alpha secretion by peritoneal macrophages. These observations indicate that MTZ significantly induced immunosuppression in mice and in human peripheral blood lymphocytes.
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Affiliation(s)
- Mohammad Fararjeh
- Department of Biological Sciences, faculty of science, The University of Jordan, Amman 11942, Jordan
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20
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Abstract
Hepatic encephalopathy (HE) is a major complication for acute and chronic liver failure. Despite several decades of intensive clinical and basic research, the pathogenesis of HE is still incompletely understood, and the precise mechanisms causing brain dysfunction in liver failure are still not fully established. Several theories concerning the pathogenesis of HE have been previously suggested, including the ammonia theory, which received the most attention. These theories are not mutually exclusive and the validity of none of them has been definitely proved experimentally. In this review article, an attractive theory concerning the pathogenesis of HE, the tumour necrosis factor-alpha (TNF) theory, is presented and comprehensively discussed after accumulation of sufficient data which indicate that the pro-inflammatory cytokine, TNF, is strongly involved in the pathogenesis of HE associated with both acute and chronic liver failure. This theory seems to be superior to all other previous theories in the pathogenesis of HE, and may induce development of other beneficial therapeutical modalities for HE directed towards inhibition of TNF production and/or action, and towards enhancement of its degradation.
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Affiliation(s)
- M Odeh
- Bnai Zion Medical Centre, and Faculty of Medicine, Technion, Haifa 31063, Israel.
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21
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Kolios G, Manousou P, Bourikas L, Notas G, Tsagarakis N, Mouzas I, Kouroumalis E. Ciprofloxacin inhibits cytokine-induced nitric oxide production in human colonic epithelium. Eur J Clin Invest 2006; 36:720-9. [PMID: 16968468 DOI: 10.1111/j.1365-2362.2006.01710.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The fluoroquinolone ciprofloxacin is a broad-spectrum antibiotic that has been used in the treatment of inflammatory bowel diseases. There is evidence that quinolones have immunomodulating activities via the regulation of cytokine production. MATERIALS AND METHODS We investigated the effect of ciprofloxacin on the nitric oxide (NO) production by colonic epithelium. HT-29 cells and colonic biopsies from patients (n = 4) with ulcerative colitis (UC) and normal controls (n = 4) were cultured with various concentrations of ciprofloxacin (10-100 microg mL(-1)) in the presence and absence of pro-inflammatory cytokines. The production of NO was measured in culture supernatants with a spectrophotometric method and inducible nitric oxide synthase (iNOS) mRNA expression was examined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Ciprofloxacin did not have any effect on the basal NO production by HT-29 cells. In contrast, ciprofloxacin significantly (P < 0.001) inhibited the pro-inflammatory cytokines (interleukin-1alpha + tumour necrosis factor-alpha + interferon-gamma)-induced NO production in HT-29, in a concentration-dependent manner, via the inhibition of the cytokine-induced iNOS mRNA expression. Wortmannin produced a concentration related reversal of the inhibitory effect of ciprofloxacin at both iNOS mRNA expression and NO production in HT-29 cells. A similar inhibitory effect of ciprofloxacin on the cytokine-induced NO production and iNOS mRNA expression was detected in vitro in cultures of normal colonic tissue. In addition, ciprofloxacin significantly inhibited the NO production and iNOS mRNA expression in cultures of colonic tissue from ulcerative colitis patients, in a concentration-dependent manner. CONCLUSIONS These data suggest that ciprofloxacin, in addition to its antimicrobial role, might have an immunoregulatory effect on intestinal inflammation, via the modulation of inflammatory mediators.
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Affiliation(s)
- G Kolios
- Department of Gastroenterology, Faculty of Medicine, University of Crete, Heraklion, Greece.
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22
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Kawai S, Nakagawa T, Sakayori S, Kobayashi O, Kamiya S. Effect of ciprofloxacin on levels of lipopolysaccharide and cytokines in experimentally induced gram-negative bacterial pneumonia in mice. J Infect Chemother 2006; 12:119-23. [PMID: 16826343 DOI: 10.1007/s10156-006-0442-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 03/24/2006] [Indexed: 10/24/2022]
Abstract
This study was performed to examine the ability of ciprofloxacin (CPFX) to suppress the inflammation associated with lipopolysaccharide (LPS) and an inflammatory cytokine in gram-negative bacterial pneumonia. For this purpose we measured viable cell counts in bronchoalveolar lavage fluid (BALF), LPS concentrations in BALF, and BALF levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) in mice exposed to Klebsiella pneumoniae. We used three groups of mice: controls, treated with physiological saline; mice treated with CPFX; and mice treated with ceftadizime (CAZ). The viable cell count in BALF was low in both the CAZ and CPFX groups. LPS values in BALF were significantly lower in the CPFX group than in the CAZ group at 48 and 72 h after K. pneumoniae exposure (48 h, P < 0.001; 72 h, P < 0.05). The BALF TNF-alpha level was significantly higher in the CAZ group at 24, 48, and 72 h compared to levels in the control and CPFX groups (P < 0.05). In conclusion, these results suggest that CPFX inhibited increases of LPS and TNF-alpha in gram-negative bacterial pneumonia, thereby suppressing the lung inflammation that accompanies pneumonia.
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Affiliation(s)
- Shin Kawai
- The First Department of Internal Medicine, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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23
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Bakiyeva LT, Brooks RA, Rushton N. Inter-individual and intra-individual variability in TNF-alpha production by human peripheral blood cells in vitro. Cytokine 2005; 30:35-40. [PMID: 15784410 DOI: 10.1016/j.cyto.2004.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 11/01/2004] [Accepted: 11/24/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Two assays--isolated peripheral blood mononuclear cells (PBMC) and a whole blood assay (WBA)--are commonly used to study TNF-alpha production by an individual in order to distinguish between high and low cytokine producers. We assessed the reliability and reproducibility of these assays. METHODS The PBMC assays (n=5) were performed weekly over a period of 6 weeks and the WBAs (n=4) weekly over a 4-week period. Polymethylmethacrylate particles (approx. 6 x 10(2) particles/cell) and optimal concentrations of endotoxin (6.25 and 12.5 ng/ml) were used as the stimulatory agents in PBMC and WBAs, respectively. TNF-alpha production was measured by ELISA. RESULTS There was a high degree of both intra- and inter-individual variability of TNF-alpha secretion, with unpredictable changes in the amount of the cytokine produced by cells from the same donor. This variability could not be eliminated by correcting for cell numbers. CONCLUSION The PBMC and WBA models of TNF-alpha production by human peripheral blood cells cannot be used for the evaluation of inter-individual variability in cytokine secretion due to the high intra-individual variability observed. In the case of PBMC this is partly due to differences in the confluency of the cells between individuals.
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Affiliation(s)
- L T Bakiyeva
- Orthopaedic Research Unit, Box 180, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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24
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Färkkilä M, Karvonen AL, Nurmi H, Nuutinen H, Taavitsainen M, Pikkarainen P, Kärkkäinen P. Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: a randomized placebo-controlled trial. Hepatology 2004; 40:1379-86. [PMID: 15565569 DOI: 10.1002/hep.20457] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
No effective medical therapy is currently available for primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA) improves liver enzymes, but its effect on liver histology is controversial. Metronidazole (MTZ) prevents PSC-like liver damage in animal models and reduces intestinal permeability. We recruited 80 patients with PSC into a randomized placebo-controlled study to evaluate the effect of UDCA and MTZ (UDCA/MTZ) compared with UDCA/placebo on the progression of PSC. Patients (41 UDCA/placebo and 39 UDCA/MTZ) were followed every third month. Assessment of liver function test, histological stage and grade, and cholangiography (via ERCP) at baseline showed no differences between the groups. After 36 months, serum aminotransferases gamma-glutamyltransferase, and alkaline phosphatase (ALP) decreased markedly in both groups, serum ALP more significantly in the UDCA/MTZ group (-337 +/- 54 U/L, P < .05) compared with the UDCA/placebo group. The New Mayo Risk Score decreased markedly only in the UDCA/MTZ group (-0.50 +/- 0.13, P < .01). The number of patients with improvement of stage (P < .05) and grade (P < .05) was higher in the combination group. ERCP findings showed no progression or improvement in 77% and 68% of patients on UDCA/MTZ and UDCA/placebo, respectively. In conclusion, combining MTZ with UDCA in PSC improved serum ALP levels and New Mayo Risk Score, but no statistically significant effect on disease progression as assessed via liver histology or ERCP was seen. Long-term studies using a higher dose of UDCA combined with MTZ in larger patient populations are indicated.
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Affiliation(s)
- Martti Färkkilä
- Division of Gastroenterology, Department of Medicine, Helsinki University Central Hospital, Finland.
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25
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Matsumoto T, Nieuwenhuis EES, Cisneros RL, Ruiz-Perez B, Yamaguchi K, Blumberg RS, Onderdonk AB. Protective effect of ethyl-3-(3-dimethyl aminopropyl)urea dihydrochloride (EDU) against LPS-induced death in mice. J Med Microbiol 2004; 53:97-102. [PMID: 14729928 DOI: 10.1099/jmm.0.05386-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Evaluation of anti-adhesive gels and bioresorbable films in animal models of intra-abdominal infection has shown that a product of the cross-linking reaction between hyaluronic acid (HA) and CM-cellulose, 1-ethyl-3-(3-dimethyl aminopropyl)urea dihydrochloride (EDU), has immunomodulatory properties. The effects of EDU were evaluated by using an endotoxin-induced shock mouse model. Pre-treatment of mice with EDU (50 mg kg(-1)) in DMSO resulted in a significant reduction in mortality following injection of LPS, compared to vehicle (DMSO) pre-treatment alone. Serum levels of TNF-alpha, IL1beta and IFN-gamma in EDU-treated mice were significantly lower than those in vehicle-treated mice. Nitric oxide (NO) concentrations in the sera of mice after inoculation with LPS were significantly lower in the EDU-treated group than in the vehicle-treated group at various time-points. In contrast, EDU pre-treatment was associated with an enhanced IL10 response after LPS injection, compared to vehicle pre-treatment alone. In vitro studies revealed that IL10 production by RAW 264.7 macrophages, elicited by LPS, was increased significantly when EDU was added to the culture medium. These results suggest that the protective effect of EDU during LPS-induced shock in mice is the result of inhibition of proinflammatory cytokines and NO production and an enhanced IL10 response.
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Affiliation(s)
- Tetsuya Matsumoto
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Edward E S Nieuwenhuis
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Ronald L Cisneros
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Begoña Ruiz-Perez
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Keizo Yamaguchi
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Richard S Blumberg
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
| | - Andrew B Onderdonk
- Channing Laboratory, Department of Pathology1 and Gastroenterology Division2, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA 3Laboratory of Pediatrics, Department of Pediatric Gastroenterology, Erasmus MC, Rotterdam, the Netherlands 4Department of Microbiology, Toho University School of Medicine, Tokyo, Japan
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