Renal tissue damage after experimental pyelonephritis: role of antioxidants and selective cyclooxygenase-2 inhibitors

Preventive Effect of L-Carnitine on Scar Formation During Acute Pyelonephritis: A Randomized Placebo-Controlled Trial

BACKGROUND

Urinary tract infection and pyelonephritis are clinical problems that frequently occur in children. Several factors are responsible for renal tissue injury, morbidity, and renal scarring after pyelonephritis. The aim of this study was to evaluate the preventive effect of L-carnitine on renal scarring in acute pyelonephritis.

METHODS

A randomized double-blind clinical trial was conducted on 65 children aged 6 months to 10 years. Patients were randomized into 2 groups to receive 7-day treatment with only antibiotics without L-carnitine (control group; n = 32) and 7-day treatment with L-carnitine (case group; n = 33) during the acute phase of infection. Technetium-99m-labeled dimercaptosuccinic acid (DMSA) scintigraphy was performed for all children during the acute phase (in 2-7 days of hospitalization) and late phase. P-value less than 0.05 was statistically significant.

RESULTS

We recruited 65 participants in the study: 32 children in control group and 33 children in case group. Three children in the control group and 2 children in the case group refused to perform the second DMSA scan. Overall, data analysis at the end of the study was done on 60 patients. Age distribution of girl patients with upper urinary infection was 6.5% in girl children aged between 6 months and 12 months, 41.1% aged between 1 and 5 years, 33.3% aged between 5 and 10 years, respectively. There was no significant difference between 2 groups in age and sex. There was no significant difference between 2 groups in systolic blood pressure, diastolic blood pressure, the lab data including urine white blood cells and serum erythrocyte sedimentation rate, and antibiogram profiles. Voiding dysfunction was detected in 10% of the participants. The baseline DMSA was not significantly difference in 2 groups, but worsening of kidney lesions was significantly higher in control group after 6 months (P = 0.012).

CONCLUSION

Our study showed that L-carnitine significantly decreased renal scarring because of acute pyelonephritis.

PEGylated meloxicam-loaded nanocapsules reverse in vitro damage on caspase activity and do not induce toxicity in cultured human lymphocytes and mice

Meloxicam is an anti-inflammatory drug that has a potential protective effect in many common diseases. However, this molecule is quickly eliminated from the body due to it short half-life. One way to overcome this problem is to incorporate meloxicam into lipid-core nanocapsules which may increase it anti-inflammatory effects. In view of this, the objective of this work was to evaluate the potential toxicity and safety of these novel nanomaterials both in vitro and in vivo. Here, we evaluated the effects of uncoated meloxicam-loaded nanocapsules (M-NC), uncoated and not loaded with meloxicam or blank (B-NC), PEGylated meloxicam-loaded lipid-core nanocapsules (M-NCPEG), blank PEGylated lipid-core nanocapsules (B-NCPEG) and free meloxicam (M-F) in vitro through the analysis of cell viability, caspase activity assays and gene expression of perforin and granzyme B. Meanwhile, the in vivo safety was assessed using C57BL/6 mice that received nanocapsules for seven days. Thus, no change in cell viability was observed after treatments. Furthermore, M-NC, M-NCPEG and M-F groups reversed the damage caused by H₂O₂ on caspase-1, 3 and 8 activities. Overall, in vivo results showed a safe profile of these nanocapsules including hematological, biochemical, histological and genotoxicity analysis. In conclusion, we observed that meloxicam nanocapsules present a safe profile to use in future studies with this experimental protocol and partially reverse in vitro damage caused by H₂O₂.

Evaluation of oxidant-antioxidant balance and total antioxidant capacity of serum in children with urinary tract infection

Background:

Urinary tract infection (UTI) is the most common bacterial infections in children. This studyaimed to investigate the oxidative and antioxidate status of plasma in patients with UTI and to compare them with those of the controls.

Methods:

This case–control study of 50–75 children in the given order was performed in 2013 at the Pediatric Clinic of infections in Zahedan Hospital of Ali Ibn Abi Talib. The antioxidative status of plasma were evaluated by measuring the total antioxidant capacity (TAC) The oxidative status of samples was assessed by measuring the total peroxide and the oxidative stress index (OSI) levels. The means of the parameters were compared and the relationship among them was determined. Data were analyzed using SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Student's t-test and Mann–Whitney U-test were applied in various situations of our questions; 95% confidence interval was considered for the level of significance.

Results:

The results showed that total oxidant serum status in UTI patients was higher compared to controls when total antioxidant serum was lower. The balance of oxidant-antioxidant serum was in favor of oxidant serum and this term was confirmed by OSI.

Conclusion:

Our results showed that the plasma levels of TAC in patients with UTI were decreased compared to controls, and oxidant-antioxidant balance and OSI caused increased OS in patients.

Use of antioxidants in urinary tract infection

Pyelonephritis is an inflammatory process, and oxidative stress plays a major role in it. Anti-inflammatory or antioxidant therapy given concomitantly with antibiotics should lower the risk of postpyelonephritic scarring. As the lack of review studies in the use of antioxidants in urinary tract infections was detected, this study was designed. We conducted a review of available articles in PubMed and Google Scholar with a simple review, using keywords of “antioxidant” and “pyelonephritis” with all their possible synonyms and combinations. Only interventional studies were collected. There were neither limitations on time, nor the location of the study, type of subjects, administration rout of the antioxidant drug, and the antioxidant drug used. After studying the abstracts or in some cases the full text of articles, they were categorized based on the type of antioxidant, type and number of subjects, rout of administration, dosing, duration of treatment, year of publication of the paper, and the results. A total of 66 articles published from 1991 to 2015 were found by studying just the title of the papers. Studying the abstracts reduced this number to 51 studies. Antioxidants used for this condition were Vitamins A, E, and C, cytoflavin, caffeic acid phenethyl ester, ebselen, allopurinol, melatonin, N-acetylcysteine, oleuropein, montelukast, oxytocin, ozon, dapsone, pentoxifyllin, tadalafil, bilirubin, cranberry, meloxicam, L-carnitine, colchicine, perfluoran, methylprednisolone, and dexamethasone. Studies show that antioxidants are capable of reducing oxidative stress and can be used effectively along with antibiotics to reduce the scar formation.

Meloxicam inhibits fipronil-induced apoptosis via modulation of the oxidative stress and inflammatory response in SH-SY5Y cells

Oxidative stress and inflammatory responses have been identified as key elements of neuronal cell apoptosis. In this study, we investigated the mechanisms by which inflammatory responses contribute to apoptosis in human neuroblastoma SH-SY5Y cells treated with fipronil (FPN). Based on the cytotoxic mechanism of FPN, we examined the neuroprotective effects of meloxicam against FPN-induced neuronal cell death. Treatment of SH-SY5Y cells with FPN induced apoptosis via activation of caspase-9 and -3, leading to nuclear condensation. In addition, FPN induced oxidative stress and increased expression of cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) via inflammatory stimulation. Pretreatment of cells with meloxicam enhanced the viability of FPN-exposed cells through attenuation of oxidative stress and inflammatory response. FPN activated mitogen activated protein kinase (MAPK) and inhibitors of MAPK abolished FPN-induced COX-2 expression. Meloxicam also attenuated FPN-induced cell death by reducing MAPK-mediated pro-inflammatory factors. Furthermore, we observed both nuclear accumulation of p53 and enhanced levels of cytosolic p53 in a concentration-dependent manner after FPN treatment. Pretreatment of cells with meloxicam blocked the translocation of p53 from the cytosol to the nucleus. Together, these data suggest that meloxicam may exert anti-apoptotic effects against FPN-induced cytotoxicity by both attenuating oxidative stress and inhibiting the inflammatory cascade via inactivation of MAPK and p53 signaling.

DNA-damage response associated with occupational exposure, age and chronic inflammation in workers in the automotive industry

The evaluation of genome integrity in populations occupationally exposed to combine industrial factors is of medical importance. In the present study, the DNA-damage response was estimated by means of the alkaline comet assay in a sizeable cohort of volunteers recruited among workers in the automotive industry. For this purpose, freshly collected lymphocytes were treated with hydrogen peroxide (100μM, 1min, 4°C) in vitro, and the levels of basal and H(2)O(2)-induced DNA damage, and the kinetics and efficiency of DNA repair were measured during a 180-min interval after exposure. The parameters studied in the total cohort of workers were in a range of values prescribed for healthy adult residents of Belarus. Based on the 95th percentiles, individuals possessing enhanced cellular sensitivity to DNA damage were present in different groups, but the frequency was significantly higher among elderly persons and among individuals with chronic inflammatory diseases. The results indicate that the inter-individual variations in DNA-damage response should be taken into account to estimate adequately the environmental genotoxic effects and to identify individuals with an enhanced DNA-damage response due to the influence of some external factors or intrinsic properties of the organism. Underling mechanisms need to be further explored.

Meloxicam Modulates Oxidative Stress Status, Inhibits Prostaglandin E2, and Abrogates Apoptosis in Carbon Tetrachloride–Induced Rat Hepatic Injury

The current study aimed at investigating the potential hepatoprotective property and mechanism of meloxicam (MEL) against carbon tetrachloride (CCl4)-induced hepatocellular damage in rats. Subcutaneous administration of CCl4 (2 mL/kg, twice/week for 8 weeks) induced hepatocellular damage substantiated by hematoxylin and eosin staining and significant elevation in serum aspartate transaminase, alanine transaminase, and total bilirubin. In addition, CCL4 treatment led to elevation in liver contents of lipid peroxidation marker (malondialdehyde), prostaglandin E2, active caspase 3, and Terminal deoxynucleotidyl transferase dUTP nick end labeling–positive cells and reduction in the activities of superoxide dismutase, catalase, glutathione- S-transferase, and reduced glutathione in the liver tissue. Prior oral treatment with MEL (5 mg/kg, twice/week) retained the normal liver histology and significantly restored all of these parameters close to normal values. These results demonstrated the hepatoprotective utility of MEL against the CCl4-induced liver injury which might ascribe to its antioxidant, free radical scavenging, antiapoptotic and anti-inflammatory effects.