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Biruete A, Shin A, Kistler BM, Moe SM. Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis. Semin Dial 2024; 37:334-349. [PMID: 34708456 PMCID: PMC9043041 DOI: 10.1111/sdi.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon M. Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Sharon M. Moe
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology, and Anatomy, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Wu T, Zhang H, Jin Y, Zhang M, Zhao Q, Li H, Wang S, Lu Y, Chen S, Du H, Liu T, Guo W, Liu W. The active components and potential mechanisms of Wuji Wan in the treatment of ethanol-induced gastric ulcer: An integrated metabolomics, network pharmacology and experimental validation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117901. [PMID: 38341112 DOI: 10.1016/j.jep.2024.117901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Wuji Wan (WJW) is a traditional Chinese medicine formula that can be found in the "Prescriptions of Taiping Benevolent Dispensary" that has been employed in treating gastric discomfort, burning epigastric pain, and gastric reflux for hundreds of years and has shown promise for treating gastric ulcers (GUs). However, the active components and mechanism of action against GUs remain unclear. AIM OF THE STUDY The aim of this study was to explore the active components of WJW and elucidate the underlying mechanism involved in treating GUs. MATERIALS AND METHODS Initially, cell viability was measured by a cell counting kit 8 (CCK-8) assay to evaluate the efficacy of WJW-containing serum in vitro. The gastric ulcer index, ulcer inhibition rate, hematoxylin and staining (H&E), and periodic acid-Schiff (PAS) staining were used to evaluate the therapeutic effect of WJW in vivo. Subsequently, the levels of inflammatory factors and oxidative stress factors were determined using an enzyme-linked immunosorbent assays (ELISA) on in vitro and in vivo samples. Additionally, UPLC-Q Exactive Plus Orbitrap HRMS was used to analyze the components that were absorbed into the blood of WJW and its metabolites. Network pharmacology and metabolomics were subsequently used to identify the targets and pathways. Real-time quantitative PCR (RT‒qPCR) and Western blotting were used to verify the mRNA and protein levels of the key targets and pathways. Finally, the active components were identified by molecular docking to verify the binding stability of the components and key targets. RESULTS WJW-containing serum ameliorated ethanol-induced damage in GES-1 cells and promoted cell healing. WJW-containing serum reduced IL-6, TNF-α, MDA, and LDH levels while increasing IL-10, SOD, and T-AOC levels in the cells. Moreover, WJW treatment resulted in decreased IL-6, TNF-α, and MDA levels and increased IL-10, SOD, PGE2, and NO levels in GUs rats. In addition, eight components of WJW were absorbed into the blood. The network pharmacology results revealed 192 common targets for blood entry components and GUs, and KEGG analysis revealed that apoptosis signaling pathways were the main pathways involved in WJW activity against GUs. Metabolomic screening was used to identify 13 differential metabolites. There were 23 common targets for blood entry components, GUs, and differential metabolites, with the key targets TNF (TNF-α), AKT1, PTGS2 (COX2) and MAPK1. WJW significantly inhibited the expression of Bax, Caspase-9, Caspase-3, cleaved Caspase-9, cleaved Caspase-3, TNF-α, COX2, and p-p44/42 MAPK while promoting the expression of Bcl-2 and p-AKT1. Molecular docking revealed that the active components of WJW for the treatment of GUs are berberine, palmatine, coptisine, evodiamine, rutaecarpine, evocarpine, and paeoniflorin. CONCLUSIONS WJW treatment reduces inflammation and oxidative stress injury and inhibits apoptosis signaling pathways. The main active components are berberine, palmatine, coptisine, evodiamine, rutaecarpine, evocarpine, and paeoniflorin. In this paper, we provide a new strategy for exploring the active components of traditional Chinese medicine formulas for the treatment of diseases based on target mechanisms.
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Affiliation(s)
- Tiantai Wu
- School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550004, China
| | - Huan Zhang
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Yang Jin
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China; State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Ming Zhang
- School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550004, China; Natural Products Research Center of Guizhou Province, Guiyang, 550014, China
| | - Qing Zhao
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Herong Li
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Shouli Wang
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Yuan Lu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Shuaishuai Chen
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Huakang Du
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Ting Liu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Weiyu Guo
- School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China
| | - Wen Liu
- School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, Guiyang, 550004, China.
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Raouf Z, Steinway SN, Scheese D, Lopez CM, Duess JW, Tsuboi K, Sampah M, Klerk D, El Baassiri M, Moore H, Tragesser C, Prindle T, Wang S, Wang M, Jang HS, Fulton WB, Sodhi CP, Hackam DJ. Colitis-Induced Small Intestinal Hypomotility Is Dependent on Enteroendocrine Cell Loss in Mice. Cell Mol Gastroenterol Hepatol 2024; 18:53-70. [PMID: 38438014 PMCID: PMC11127033 DOI: 10.1016/j.jcmgh.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND & AIMS The abdominal discomfort experienced by patients with colitis may be attributable in part to the presence of small intestinal dysmotility, yet mechanisms linking colonic inflammation with small-bowel motility remain largely unexplored. We hypothesize that colitis results in small intestinal hypomotility owing to a loss of enteroendocrine cells (EECs) within the small intestine that can be rescued using serotonergic-modulating agents. METHODS Male C57BL/6J mice, as well as mice that overexpress (EECOVER) or lack (EECDEL) NeuroD1+ enteroendocrine cells, were exposed to dextran sulfate sodium (DSS) colitis (2.5% or 5% for 7 days) and small intestinal motility was assessed by 70-kilodalton fluorescein isothiocyanate-dextran fluorescence transit. EEC number and differentiation were evaluated by immunohistochemistry, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling staining, and quantitative reverse-transcriptase polymerase chain reaction. Mice were treated with the 5-hydroxytryptamine receptor 4 agonist prucalopride (5 mg/kg orally, daily) to restore serotonin signaling. RESULTS DSS-induced colitis was associated with a significant small-bowel hypomotility that developed in the absence of significant inflammation in the small intestine and was associated with a significant reduction in EEC density. EEC loss occurred in conjunction with alterations in the expression of key serotonin synthesis and transporter genes, including Tph1, Ddc, and Slc6a4. Importantly, mice overexpressing EECs revealed improved small intestinal motility, whereas mice lacking EECs had worse intestinal motility when exposed to DSS. Finally, treatment of DSS-exposed mice with the 5-hydroxytryptamine receptor 4 agonist prucalopride restored small intestinal motility and attenuated colitis. CONCLUSIONS Experimental DSS colitis induces significant small-bowel dysmotility in mice owing to enteroendocrine loss that can be reversed by genetic modulation of EEC or administering serotonin analogs, suggesting novel therapeutic approaches for patients with symptomatic colitis.
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Affiliation(s)
- Zachariah Raouf
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steve N Steinway
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Scheese
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carla M Lopez
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Johannes W Duess
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Koichi Tsuboi
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maame Sampah
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daphne Klerk
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mahmoud El Baassiri
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah Moore
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cody Tragesser
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Prindle
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanxia Wang
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Menghan Wang
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hee-Seong Jang
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William B Fulton
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chhinder P Sodhi
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - David J Hackam
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Todd J, Saboori S, Zeidan J, Ahrens W, Jacobs C, Moshiree B. Sevelamer-Induced Gastrointestinal Disease in 12 Patients with End-Stage Renal Disease: A Case Series. Clin Transl Gastroenterol 2024; 15:e00679. [PMID: 38251689 PMCID: PMC10962893 DOI: 10.14309/ctg.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Isolated case reports and case series have linked the use of sevelamer to severe gastrointestinal (GI) inflammation and perforation among patients with end-stage renal disease. METHODS In this study, we identified 12 cases of biopsy-proven sevelamer-induced gastrointestinal disease from a large urban community hospital over the course of 5 years. We described baseline characteristics, sites and types of injury, histological findings, timing and dosing of sevelamer initiation compared with symptom onset, and in a smaller subset, endoscopic resolution post drug cessation. We also reviewed preexisting conditions to identify trends in populations at risk. RESULTS Several of the patients reviewed had preexisting conditions of decreased motility and/or impaired mucosal integrity. The presentation of disease was broad and included both upper-GI and lower-GI pathologies and in varying severity. DISCUSSION There is a broad phenotypic range of sevelamer-induced gastrointestinal disease. As this becomes a more frequently recognized pathology, clinicians should be aware of how it may present and which populations may be more susceptible.
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Affiliation(s)
- James Todd
- Department of Internal Medicine, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Shadab Saboori
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Joseph Zeidan
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - William Ahrens
- Department of Pathology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Carl Jacobs
- Department of Pathology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Baha Moshiree
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
- Wake Forest School of Medicine-Carolinas Campus, Charlotte, North Carolina, USA
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Taheri Mirghaed M, Ghasemian SO, Mousavi Nasab SF, Rahimi K. Effects of fish oil on ethanol-induced gastric ulcer in rats: inflammatory responses and oxidative stress. Ann Med Surg (Lond) 2024; 86:819-825. [PMID: 38333309 PMCID: PMC10849447 DOI: 10.1097/ms9.0000000000001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/18/2023] [Indexed: 02/10/2024] Open
Abstract
Background The prevalence of peptic ulcers is increasing due to lifestyle changes and harmful diets. Objective The aim of this study was to investigate the effect of fish oil (FO) on gastric ulcers induced by ethanol in rats. Methods The pharmacological efficacy of FO with doses of 5 and 10 mg/kg investigated using the gastric ulcer index, the acidity of gastric secretions, pro-inflammatory cytokine assessment, and oxidative stress examination. Results Ethanol-induced gastric ulcer improves with FO 5 or 10 mg/kg pretreatment (P<0.05). FO did have acid-neutralizing activity. FO also increased the levels of glutathione and catalase and decreased the malondialdehyde levels (P<0.05). Moreover, FO reduced the levels of tumour necrosis factor alpha (TNF-α) interleukin-6 (IL-6), through downregulation of nuclear factor kappa B (NF-κB) (P<0.05). Pretreatment with FO attenuates ethanol-induced gastric ulceration. Conclusion The observed effects may be due to the role of FO in regulating gastric secretions, changes in the expression of NF-κB, and changes in the levels of oxidative stress factors.
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Affiliation(s)
| | | | | | - Kaveh Rahimi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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6
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Drury AM, Albunni H, Al-Haddad M, Powelson JA, Lutz A, Fridell JA. Role of gastric peroral endoscopic myotomy (GPOEM) in chronic gastroparesis management after pancreas transplantation. Clin Transplant 2024; 38:e15176. [PMID: 37922244 DOI: 10.1111/ctr.15176] [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: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023]
Abstract
Gastroparesis is a common complaint among patients with diabetes. Symptoms tend to improve following successful pancreas transplantation (PTx), but persist despite euglycemia in a subset of patients. We aimed to assess the benefit of gastric peroral endoscopic myotomy (G-POEM) in persistent gastroparesis following PTx. This was a single center retrospective review of all patients who underwent G-POEM for persistent gastroparesis following PTx. Patient demographics, pre and post procedure perception of symptom severity according to the patient assessment of upper gastrointestinal symptoms severity index (PAGI-SYM), gastroparesis cardinal symptom index (GCSI) score, and 36-item short form survey (SF36) score along with gastric emptying scintigraphy (GES) were analyzed. Seven PTx recipients underwent G-POEM for persistent gastroparesis symptoms. The majority were female. All reported nausea/vomiting, abdominal pain, bloating, and post prandial fullness prior to G-POEM. The post procedure survey scores improved in all patients although this was not significant. The improvement in gastric emptying on GES was statistically significant. G-POEM is a relatively new treatment option for gastroparesis. While it requires specialized proceduralist and training, we have documented improvement in the management of symptoms. With increasing experience, we anticipate more significant benefit in post PTx patients with persistent symptoms of gastroparesis undergoing G-POEM.
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Affiliation(s)
- Allison M Drury
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hashem Albunni
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mohammad Al-Haddad
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John A Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Lutz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Maher S, Geoghegan C, Brayden DJ. Safety of surfactant excipients in oral drug formulations. Adv Drug Deliv Rev 2023; 202:115086. [PMID: 37739041 DOI: 10.1016/j.addr.2023.115086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Surfactants are a diverse group of compounds that share the capacity to adsorb at the boundary between distinct phases of matter. They are used as pharmaceutical excipients, food additives, emulsifiers in cosmetics, and as household/industrial detergents. This review outlines the interaction of surfactant-type excipients present in oral pharmaceutical dosage forms with the intestinal epithelium of the gastrointestinal (GI) tract. Many surfactants permitted for human consumption in oral products reduce intestinal epithelial cell viability in vitro and alter barrier integrity in epithelial cell monolayers, isolated GI tissue mucosae, and in animal models. This suggests a degree of mis-match for predicting safety issues in humans from such models. Recent controversial preclinical research also infers that some widely used emulsifiers used in oral products may be linked to ulcerative colitis, some metabolic disorders, and cancers. We review a wide range of surfactant excipients in oral dosage forms regarding their interactions with the GI tract. Safety data is reviewed across in vitro, ex vivo, pre-clinical animal, and human studies. The factors that may mitigate against some of the potentially abrasive effects of surfactants on GI epithelia observed in pre-clinical studies are summarised. We conclude with a perspective on the overall safety of surfactants in oral pharmaceutical dosage forms, which has relevance for delivery system development.
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Affiliation(s)
- Sam Maher
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland.
| | - Caroline Geoghegan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland
| | - David J Brayden
- UCD School of Veterinary Medicine and UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
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Blaszczyk A, Brandt N, Ashley J, Tuders N, Doles H, Stefanacci RG. Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations. Drugs Aging 2023; 40:895-907. [PMID: 37707775 PMCID: PMC10511598 DOI: 10.1007/s40266-023-01056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/15/2023]
Abstract
Dysphagia is increasingly common in older adults; it is especially prevalent in long-term care settings. Patients with dysphagia likely require pharmacologic treatment for multiple comorbidities but may find it difficult or impossible to swallow oral medications. Administering crushed medications mixed with a soft food or liquid vehicle, or via a feeding tube, is a common strategy to circumvent swallowing difficulties in patients with dysphagia. However, inappropriate medication use and improper crushing technique can reduce the medication dose a patient receives, alter medication pharmacokinetics and pharmacodynamics, and compromise treatment efficacy and patient safety. Clinical judgment is needed to identify medications that can and cannot be crushed, select a crushing methodology and vehicle for administering crushed medications, and create a strategy for administering multiple medications. A coordinated effort from the entire care team-including physicians, pharmacists, nurses, advanced practice providers, speech therapists, patients, and caregivers-is necessary to develop and implement an individualized plan for administering medications to patients with dysphagia. This review details the current literature regarding the administration of medications that have been altered, such as by crushing tablets or opening capsules, for patients with dysphagia or who are receiving enteral feeding and provides recommendations on best practices.
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Affiliation(s)
- Amie Blaszczyk
- Division of Geriatrics and Pediatrics, Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Nicole Brandt
- Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Jeremy Ashley
- Fisch College of Pharmacy, University of Texas at Tyler, Tyler, TX, USA
| | - Nancy Tuders
- National Association of Directors of Nursing Administration of Long-Term Care, Springdale, OH, USA
| | - Hannah Doles
- Division of Geriatrics and Pediatrics, Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Richard G Stefanacci
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA, 19107, USA.
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Duffy M, Boggiano VL, Ganesh R, Mueller M. Functional Gastrointestinal Disorders. Prim Care 2023; 50:429-446. [PMID: 37516512 DOI: 10.1016/j.pop.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Functional gastrointestinal disorders (FGIDs) are an extremely common set of more than 50 disorders characterized by persistent and recurring gastrointestinal symptoms. Most of these patients can be diagnosed and managed by primary care physicians. Treatment includes patient education and reassurance, eliminating triggers, dietary modification, and pharmacologic management. Primary care physicians should consider referral to gastroenterologists when patients exhibit red flag symptoms such as blood in stool, abnormal laboratory findings, involuntary weight loss, age of presentation greater than 50 years, or certain concerning family history.
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Affiliation(s)
- Molly Duffy
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Victoria L Boggiano
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27514, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, 200 1(st) Street Southwest Rochester, MN 55906, USA
| | - Michael Mueller
- Division of General Internal Medicine, Mayo Clinic, 200 1(st) Street Southwest Rochester, MN 55906, USA
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Yamamoto J, Yamamoto M, Hara H, Hiroi Y. Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure. Heart Vessels 2023; 38:938-948. [PMID: 36799967 DOI: 10.1007/s00380-023-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
Constipation has been reported to increase the risk of cardiovascular mortality. Patients with atrial fibrillation (AF) and heart failure (HF) have more comorbidities and an increased bleeding risk. However, it remains unclear whether constipation is associated with an increased risk of incident bleeding complications in AF with HF. Here, we investigated the association between constipation requiring laxatives and major bleeding in AF and HF. We retrospectively analyzed the medical records of 370 consecutive patients hospitalized for AF and congestive HF. Constipation was defined as regularly taking laxatives or having at least two prescriptions for a ≥ 30-day supply of laxatives. Sixty patients experienced major bleeding events during a median follow-up of 318 days. The most common sites of bleeding were lower gastrointestinal (28%, 17/60), upper gastrointestinal (27%, 16/60), and intracranial (20%, 12/60). There were 33 (55%) patients with constipation in the bleeding group and 107 (35%) in the non-bleeding group (P = 0.004). Multivariate Cox regression analysis adjusted for HAS-BLED score, hemoglobin, and direct oral anticoagulant use showed that constipation (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11-3.08; p = 0.019) was a significant risk factor for major bleeding. We found a significant association between constipation requiring laxatives and major bleeding in patients with AF and HF. These findings indicate the need for constipation prevention in these patients to avoid reliance on invasive defecation management, including laxatives.
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Affiliation(s)
- Jumpei Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
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White E, Mutalib M. Parenteral Nutrition in Pediatric Patients with Neurodisability: Current Perspectives. Pediatric Health Med Ther 2023; 14:11-17. [PMID: 36776411 PMCID: PMC9912341 DOI: 10.2147/phmt.s366635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/31/2023] [Indexed: 02/06/2023] Open
Abstract
Pediatric neurodisability describes functional limitations in children with varied severity and complexity often attributed to brain or neuromuscular abnormalities. The life expectancy of children with neurodisability is improving, but many will require significant medical support. The gastrointestinal tract is usually affected in children with neurodisability and can lead to a wide range of symptoms. In gastrointestinal (GI) dystonia, a newly coined term, feeding will trigger a distressing dystonia and symptoms can improve with cessation of feed. Parenteral nutrition (PN) is often viewed as a viable option in severe GI dystonia or when enteral feeding does not support sufficient nutrition. The use of PN in children with severe neurodisability is complex. It involves an intricate interplay between medical, psychological and ethical factors. In the absence of a universally agreed guidance on the use of PN in this cohort, paediatricians should maintain the individual need of the child at the centre of the decision-making process and work closely with families and other healthcare professionals before initiating or withholding PN in children with severe neurodisability. In this article, we discuss the complex and multifaceted approach to the use of PN in children with severe neurodisability and aimed to explore the medical, psychological and ethical aspect dilemmas facing clinicians looking after children with declining gut function who may require PN support.
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Affiliation(s)
- Emily White
- Department of Paediatric Gastroenterology, Evelina London Children’ Hospital, London, UK
| | - Mohamed Mutalib
- Department of Paediatric Gastroenterology, Evelina London Children’ Hospital, London, UK,Faculty of Life Sciences and Medicine, King’s College London, London, UK,Correspondence: Mohamed Mutalib, Department of Paediatric Gastroenterology, Evelina London Children’ Hospital, London, SE1 7EH, UK, Email
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12
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Rhee D, Jones M, Mitchell KM, Segal J, Rice T, Coffey BJ. Clozapine and Constipation: Considerations in an Obese Adolescent Girl. J Child Adolesc Psychopharmacol 2022; 32:543-547. [PMID: 36548360 DOI: 10.1089/cap.2022.29231.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Diane Rhee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Kate M Mitchell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
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13
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Xu K, Mittal K, Ewald J, Rulli S, Jakubowski JL, George S, Basu N. Transcriptomic points of departure calculated from human intestinal cells exposed to dietary nanoparticles. Food Chem Toxicol 2022; 170:113501. [DOI: 10.1016/j.fct.2022.113501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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14
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Jiang M, Zhou B, Chen L. Identification of drug side effects with a path-based method. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:5754-5771. [PMID: 35603377 DOI: 10.3934/mbe.2022269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The study of drug side effects is a significant task in drug discovery. Candidate drugs with unaccepted side effects must be eliminated to prevent risks for both patients and pharmaceutical companies. Thus, all side effects for any candidate drug should be determined. However, this task, which is carried out through traditional experiments, is time-consuming and expensive. Building computational methods has been increasingly used for the identification of drug side effects. In the present study, a new path-based method was proposed to determine drug side effects. A heterogeneous network was built to perform such method, which defined drugs and side effects as nodes. For any drug and side effect, the proposed path-based method determined all paths with limited length that connects them and further evaluated the association between them based on these paths. The strong association indicates that the drug has a side effect with a high probability. By using two types of jackknife test, the method yielded good performance and was superior to some other network-based methods. Furthermore, the effects of one parameter in the method and heterogeneous network was analyzed.
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Affiliation(s)
- Meng Jiang
- College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China
| | - Bo Zhou
- Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China
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15
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Burclaff J, Bliton RJ, Breau KA, Ok MT, Gomez-Martinez I, Ranek JS, Bhatt AP, Purvis JE, Woosley JT, Magness ST. A Proximal-to-Distal Survey of Healthy Adult Human Small Intestine and Colon Epithelium by Single-Cell Transcriptomics. Cell Mol Gastroenterol Hepatol 2022; 13:1554-1589. [PMID: 35176508 PMCID: PMC9043569 DOI: 10.1016/j.jcmgh.2022.02.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Single-cell transcriptomics offer unprecedented resolution of tissue function at the cellular level, yet studies analyzing healthy adult human small intestine and colon are sparse. Here, we present single-cell transcriptomics covering the duodenum, jejunum, ileum, and ascending, transverse, and descending colon from 3 human beings. METHODS A total of 12,590 single epithelial cells from 3 independently processed organ donors were evaluated for organ-specific lineage biomarkers, differentially regulated genes, receptors, and drug targets. Analyses focused on intrinsic cell properties and their capacity for response to extrinsic signals along the gut axis across different human beings. RESULTS Cells were assigned to 25 epithelial lineage clusters. Multiple accepted intestinal stem cell markers do not specifically mark all human intestinal stem cells. Lysozyme expression is not unique to human Paneth cells, and Paneth cells lack expression of expected niche factors. Bestrophin 4 (BEST4)+ cells express Neuropeptide Y (NPY) and show maturational differences between the small intestine and colon. Tuft cells possess a broad ability to interact with the innate and adaptive immune systems through previously unreported receptors. Some classes of mucins, hormones, cell junctions, and nutrient absorption genes show unappreciated regional expression differences across lineages. The differential expression of receptors and drug targets across lineages show biological variation and the potential for variegated responses. CONCLUSIONS Our study identifies novel lineage marker genes, covers regional differences, shows important differences between mouse and human gut epithelium, and reveals insight into how the epithelium responds to the environment and drugs. This comprehensive cell atlas of the healthy adult human intestinal epithelium resolves likely functional differences across anatomic regions along the gastrointestinal tract and advances our understanding of human intestinal physiology.
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Affiliation(s)
- Joseph Burclaff
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - R Jarrett Bliton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill/North Carolina State University, Chapel Hill, North Carolina
| | - Keith A Breau
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meryem T Ok
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill/North Carolina State University, Chapel Hill, North Carolina
| | - Ismael Gomez-Martinez
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jolene S Ranek
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aadra P Bhatt
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeremy E Purvis
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John T Woosley
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott T Magness
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill/North Carolina State University, Chapel Hill, North Carolina; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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16
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Iatrogenic constipation in gastrointestinal surgery. J Visc Surg 2022; 159:S51-S57. [DOI: 10.1016/j.jviscsurg.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Enomoto K, Kosaka C, Kimura T, Watanuki S, Kurihara M, Watari T, Schaye V. Pharmacists can improve diagnosis and help prevent diagnostic errors. Diagnosis (Berl) 2022; 9:385-389. [PMID: 35089657 DOI: 10.1515/dx-2021-0138] [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: 10/18/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
We present two cases that highlight the role of pharmacists in the diagnostic process and illustrate how a culture of safety and teamwork between pharmacists and physicians can help prevent diagnostic errors.
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Affiliation(s)
- Kiichi Enomoto
- Department of Pharmacy, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Chintaro Kosaka
- Department of Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toru Kimura
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Satoshi Watanuki
- Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University, Nagoya, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University, Shimane, Japan
| | - Verity Schaye
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
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18
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Tesic-Rajkovic S, Radovanovic-Dinic B. Lesions in the oral cavity and esophagus caused by prescribed drugs: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:21-27. [PMID: 34747416 DOI: 10.5507/bp.2021.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
Almost all drugs, including some plant-based compounds, can have adverse effects, about 10% of which are expressed at the level of the digestive tract and in some cases resemble gastrointestinal diseases. Most commonly manifest as difficult and/or painful swallowing, nausea, vomiting, diarrhea and constipation. In rare cases, lesions caused by medications may be complicated by bleeding, strictures and perforations and can manifest in all segments of the gastrointestinal tract (GIT). The diagnosis is made from a detailed medical history and clinical examination inter alia. and best confirmed by proximal or distal endoscopy.
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Affiliation(s)
- Snezana Tesic-Rajkovic
- Faculty of Medicine, University of Nis, Serbia.,Clinic for Gastroenterology and Hepatology, University Clinical Center, Nis, Serbia
| | - Biljana Radovanovic-Dinic
- Faculty of Medicine, University of Nis, Serbia.,Clinic for Gastroenterology and Hepatology, University Clinical Center, Nis, Serbia
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19
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Genova E, Stocco G, Decorti G. Induced pluripotent stem cells as an innovative model to study drug induced pancreatitis. World J Gastroenterol 2021; 27:5796-5802. [PMID: 34629803 PMCID: PMC8475012 DOI: 10.3748/wjg.v27.i35.5796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/27/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-induced pancreatitis is a gastrointestinal adverse effect concerning about 2% of drugs. The majority of cases are mild to moderate but severe episodes can also occur, leading to hospitalization or even death. Unfortunately, the mechanisms of this adverse reaction are still not clear, hindering its prevention, and the majority of data available of this potentially life-threatening adverse effect are limited to case reports leading to a probable underestimation of this event. In particular, in this editorial, special attention is given to thiopurine-induced pancreatitis (TIP), an idiosyncratic adverse reaction affecting around 5% of inflammatory bowel disease (IBD) patients taking thiopurines as immunosuppressants, with a higher incidence in the pediatric population. Validated biomarkers are not available to assist clinicians in the prevention of TIP, also because of the inaccessibility of the pancreatic tissue, which limits the possibility to perform dedicated cellular and molecular studies. In this regard, induced pluripotent stem cells (iPSCs) and the exocrine pancreatic differentiated counterpart could be a great tool to investigate the cellular and molecular mechanisms underlying the development of this undesirable event. This particular type of stem cells is obtained by reprogramming adult cells, including fibroblasts and leukocytes, with a set of transcription factors known as the Yamanaka’s factors. Maintaining unaltered the donors’ genetic heritage, iPSCs represent an innovative model to study the mechanisms of adverse drug reactions in individual patients’ tissues not easily obtainable from human probands. Indeed, iPSCs can differentiate under adequate stimuli into almost any somatic lineage, opening a new world of opportunities for researchers. Several works are already available in the literature studying liver, central nervous system and cardiac cells derived from iPSCs and adverse drug effects. However, to our knowledge no studies have been performed on exocrine pancreas differentiated from iPSCs and drug-induced pancreatitis, so far. Hence, in this editorial we focus specifically on the description of the study of the mechanisms of TIP by using IBD patient-specific iPSCs and exocrine pancreatic differentiated cells as innovative in vitro models.
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Affiliation(s)
- Elena Genova
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste 34127, Italy
| | - Giuliana Decorti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste 34137, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste 34127, Italy
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20
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Han N, Oh JM, Kim IW. Adverse Events Related to Off-Label Drugs Using Spontaneous Adverse Event Reporting Systems. Ther Clin Risk Manag 2021; 17:877-887. [PMID: 34456568 PMCID: PMC8387311 DOI: 10.2147/tcrm.s321789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study was to investigate the adverse events (AEs) related to the use of off-label drugs. Materials and Methods A cross-sectional study was carried out using available data pertaining to off-label drug were sourced from U.S. FDA spontaneous adverse drug reaction reporting database (FAERS) and Korea Adverse Event Reporting System database (KIDS-KD) for the years 2014 to 2018. The number and frequencies of AE cases were calculated. Disproportionality was analyzed using the proportional reporting ratio (PRR), the reporting odds ratio (ROR), the information component (IC), and the empirical Bayes geometric mean (EBGM) methods. Results The reported AEs associated with off-label drug use were more common among older patients compared with younger patients. Gastric nonspecific symptoms and therapeutic procedure (4.16–4.57%) and haemorrage term (4.16–5.29%) were the most common AE symptoms and antithrombotic agents and immunosuppressants were the drugs most commonly reported to cause AEs in FAERS. Secondary term events (43.45–48.62%) including inappropriate schedule of drug administration and medication error were the most common AEs, and immunosuppressants and antipsychotics were the most common AE-related drugs from KIDS-KD. The numbers of reported AEs in new drug categories such as other antineoplastic agents trended to increase from 2014 to 2018 in both datasets. Conclusion The numbers of reported AEs with off-label drug increased annually. AEs associated with off-label drugs may have a significant impact on older patients. Healthcare experts should be concerned about prescriptions of off-label drugs, especially anticoagulants and newly developed drugs such as immunosuppressants and antineoplastic agents.
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Affiliation(s)
- Nayoung Han
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.,College of Pharmacy, Jeju National University, Jejusi, Jeju Special Self-Governing Province, Republic of Korea
| | - Jung Mi Oh
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.,College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - In-Wha Kim
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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21
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Abdul Wahab P, Mohd Yusoff D, Abdul Kadir A, Ali SH, Yeong Yeh L. Prevalence, Symptoms, and Associated Factors of Chronic Constipation Among Older Adults in North-East of Peninsular Malaysia. Clin Nurs Res 2021; 31:348-355. [PMID: 34340590 DOI: 10.1177/10547738211033934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to determine the prevalence, symptoms, and associated factors of chronic constipation among older adults in the North-East of Peninsular Malaysia. A cross-sectional study was conducted among older patients from four health clinics. A total of 400 older patients participated, with a mean age of 68.7 (SD = 6.4) years. The prevalence of chronic constipation was 14.8%. The highest symptom reported was the inability to pass stool (98.3%). Chronic constipation was significantly associated with older age (OR = 2.97; 95% CI [1.17, 7.54]; p = .022), inadequate plain water intake per day (OR = 2.13; 95% CI [1.13, 4.02]; p = .020), hypertension (OR = 2.22; 95% CI [1.07, 4.61]; p = .033), and hyperlipidemia (OR = 2.52; 95% CI [1.24, 5.11]; p = .010). Identification of chronic constipation should be done as part of routine clinic visits, especially for older patients with cardiovascular disease.
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Affiliation(s)
| | | | | | - Siti Hawa Ali
- Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Lee Yeong Yeh
- Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia
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22
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Mutalib M. Parenteral nutrition in children with severe neurodisability: a panacea? Arch Dis Child 2021; 106:736-738. [PMID: 33597181 DOI: 10.1136/archdischild-2020-319278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/03/2022]
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23
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Raish M, Shahid M, Bin Jardan YA, Ansari MA, Alkharfy KM, Ahad A, Abdelrahman IA, Ahmad A, Al-Jenoobi FI. Gastroprotective Effect of Sinapic Acid on Ethanol-Induced Gastric Ulcers in Rats: Involvement of Nrf2/HO-1 and NF-κB Signaling and Antiapoptotic Role. Front Pharmacol 2021; 12:622815. [PMID: 33716749 PMCID: PMC7946842 DOI: 10.3389/fphar.2021.622815] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background: In the current study, we evaluated the therapeutic potential of sinapic acid (SA) in terms of the mechanism underlying its gastroprotective action against ethanol-induced gastric ulcers in rats. Methods: These effects were examined through gross macroscopic evaluation of the stomach cavity [gastric ulcer index (GUI)], alteration in pH, gastric juice volume, free acidity, total acidity, total gastric wall mucus, and changes in PGE2. In addition, we evaluated lipid peroxidation (malondialdehyde), antioxidant systems (catalase and glutathione), inflammatory markers [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and myeloperoxidase (MPO)], apoptotic markers (caspase-3, Bax, and Bcl-2), nuclear factor-κB [NF-κB (p65)], NO levels, and histopathological staining (H and E and PAS). Results: In rats with ethanol-induced ulcers, pre-treatment with SA (40 mg/kg p. o.) decreased the sternness of ethanol-induced gastric mucosal injuries by decreasing the GUI, gastric juice volume, free acidity, and total acidity. In addition, the pH and total gastric mucosa were increased, together with histopathological alteration, neutrophil incursion, and increases in PGE2 and NO2. These effects were similar to those observed for omeprazole, a standard anti-ulcer drug. SA was shown to suppress gastric inflammation through decreasing TNF-α, IL-6, and MPO, as well as curbing gastric oxidative stress through the inhibition of lipid peroxidation (MDA) and restoration of depleted glutathione and catalase activity. SA inhibited Bcl-2-associated X (Bax) and caspase-3 activity, and restored the antiapoptotic protein Bcl-2; these findings indicate the antiapoptotic potential of SA, leading to enhanced cell survival. SA also repressed NF-κB signaling and increased IκBα. Moreover, SA upregulated the nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), thereby restoring depleted antioxidant defense enzymes and implicating the NRF2/HO-1 signaling pathways. Conclusion: These results suggest that the prophylactic administration of SA (40 mg/kg) can ameliorate ethanol-induced gastric ulcers in rats primarily via the modulation of Nrf2/HO-1 and NF-κB signaling and subsequent enhancement of cell viability.
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Affiliation(s)
- Mohammad Raish
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mudassar Shahid
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousef A Bin Jardan
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mushtaq Ahmad Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Alkharfy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Ahad
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fahad I Al-Jenoobi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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24
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Ahlawat S, Kumar P, Mohan H, Goyal S, Sharma KK. Inflammatory bowel disease: tri-directional relationship between microbiota, immune system and intestinal epithelium. Crit Rev Microbiol 2021; 47:254-273. [PMID: 33576711 DOI: 10.1080/1040841x.2021.1876631] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human gut microbiota contributes to host nutrition and metabolism, sustains intestinal cell proliferation and differentiation, and modulates host immune system. The alterations in their composition lead to severe gut disorders, including inflammatory bowel disease (IBD) or inflammatory bowel syndrome (IBS). IBD including ulcerative colitis (UC) and Crohn's disease (CD) are gamut of chronic inflammatory disorders of gut, mediated by complex interrelations among genetic, environmental, and internal factors. IBD has debateable aetiology, however in recent years, exploring the central role of a tri-directional relationship between gut microbiota, mucosal immune system, and intestinal epithelium in pathogenesis is getting the most attention. Increasing incidences and early onset explains the exponential rise in IBD burden on health-care systems. Industrialization, hypersensitivity to allergens, lifestyle, hygiene hypothesis, loss of intestinal worms, and gut microbial composition, explains this shifted rise. Hitherto, the interventions modulating gut microbiota composition, microfluidics-based in vitro gastrointestinal models, non-allergic functional foods, nutraceuticals, and faecal microbiota transplantation (FMT) from healthy donors are some of the futuristic approaches for the disease management.
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Affiliation(s)
- Shruti Ahlawat
- Department of Microbiology, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Pramod Kumar
- Ministry of Health and Family Welfare, Government of India, Indian Council of Medical Research, New Delhi, India
| | - Hari Mohan
- Centre for Medical Biotechnology, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Sandeep Goyal
- Department of Medicine, Pt. BD Sharma Post-graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Krishna Kant Sharma
- Department of Microbiology, Maharshi Dayanand University, Rohtak, Haryana, India
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25
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Javelot H, Llorca PM, Drapier D, Fakra E, Hingray C, Meyer G, Dizet S, Egron A, Straczek C, Roser M, Masson M, Gaillard R, Fossati P, Haffen E. [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]. Encephale 2020; 46:S14-S34. [PMID: 32376004 PMCID: PMC7196532 DOI: 10.1016/j.encep.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.
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Affiliation(s)
- H Javelot
- Établissement Public de Santé Alsace Nord, Brumath, France; Laboratoire de toxicologie et pharmacologie neuro-cardiovasculaire, université de Strasbourg, Strasbourg, France.
| | - P-M Llorca
- CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, Rennes, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, Saint-Étienne, France
| | - C Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, Laxou, France; Département de neurologie, CHU de Nancy, Nancy, France
| | - G Meyer
- Service de pharmacie, Établissement Public de Santé Alsace Nord, Brumath, France; Service de pharmacie, CHU de Strasbourg, Strasbourg, France
| | - S Dizet
- Service de pharmacie, CHS de Sevrey, Chalon-sur-Saône, France
| | - A Egron
- Service de pharmacie, centre hospitalier de Cadillac, Cadillac, France
| | - C Straczek
- Département de pharmacie, CHU Henri-Mondor, Créteil, France; Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France
| | - M Roser
- Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France; Service de psychiatrie sectorisée, hôpital Albert-Chenevier, Créteil, France
| | - M Masson
- Nightingale Hospitals-Paris, clinique du Château de Garches, Garches, France; SHU, GHU psychiatrie et neurosciences, Paris, France
| | - R Gaillard
- GHU psychiatrie et neurosciences, université de Paris, Paris, France; Sous-section 49-03, Conseil national des universités (CNU), Paris, France
| | - P Fossati
- Inserm U1127, service de psychiatrie adultes, ICM, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France
| | - E Haffen
- CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, Besançon, France; Laboratoire de neurosciences, université de Franche-Comté, Besançon, France
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26
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Gisi C, Munteanu A, Ku L, French S, Fleischman M, Eysselein V. Atypical Presentation of Acquired Hypoganglionosis in a Patient Taking Clozapine. Case Rep Gastrointest Med 2020; 2020:1272567. [PMID: 32670642 PMCID: PMC7333039 DOI: 10.1155/2020/1272567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 01/22/2023] Open
Abstract
Acquired hypoganglionosis (HG) is a rare enteric gastrointestinal neuromuscular disorder previously associated with chronic inflammation that can lead to constipation, ileus, and even death. There is little known about the pathophysiology of acquired hypoganglionosis, and it is unclear if medications are related to the development of the disease. Clozapine is an atypical antipsychotic used to treat refractory schizophrenia that is well known for its side effects including agranulocytosis and gastrointestinal dysmotility. This is an unusual case of acquired hypoganglionosis in a patient with anticholinergic toxicity on clozapine therapy.
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Affiliation(s)
- Catherine Gisi
- 1Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Anamaria Munteanu
- 2Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Lawrence Ku
- 1Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Samuel French
- 2Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Michael Fleischman
- 3Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Viktor Eysselein
- 3Department of Internal Medicine, Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA
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27
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Dethloff F, Vargas F, Elijah E, Quinn R, Park DI, Herzog DP, Müller MB, Gentry EC, Knight R, Gonzalez A, Dorrestein PC, Turck CW. Paroxetine Administration Affects Microbiota and Bile Acid Levels in Mice. Front Psychiatry 2020; 11:518. [PMID: 32581888 PMCID: PMC7287167 DOI: 10.3389/fpsyt.2020.00518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Recent interest in the role of microbiota in health and disease has implicated gut microbiota dysbiosis in psychiatric disorders including major depressive disorder. Several antidepressant drugs that belong to the class of selective serotonin reuptake inhibitors have been found to display antimicrobial activities. In fact, one of the first antidepressants discovered serendipitously in the 1950s, the monoamine-oxidase inhibitor Iproniazid, was a drug used for the treatment of tuberculosis. In the current study we chronically treated DBA/2J mice for 2 weeks with paroxetine, a selective serotonin reuptake inhibitor, and collected fecal pellets as a proxy for the gut microbiota from the animals after 7 and 14 days. Behavioral testing with the forced swim test revealed significant differences between paroxetine- and vehicle-treated mice. Untargeted mass spectrometry and 16S rRNA profiling of fecal pellet extracts showed several primary and secondary bile acid level, and microbiota alpha diversity differences, respectively between paroxetine- and vehicle-treated mice, suggesting that microbiota functions are altered by the drug. In addition to their lipid absorbing activities bile acids have important signaling activities and have been associated with gastrointestinal diseases and colorectal cancer. Antidepressant drugs like paroxetine should therefore be used with caution to prevent undesirable side effects.
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Affiliation(s)
- Frederik Dethloff
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Fernando Vargas
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA , United States.,Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States.,Division of Biological Science, University of California, San Diego, La Jolla, CA, United States
| | - Emmanuel Elijah
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA , United States.,Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Robert Quinn
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA , United States.,Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Dong Ik Park
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - David P Herzog
- Laboratory of Translational Psychiatry, Department of Psychiatry and Psychotherapy & Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Marianne B Müller
- Laboratory of Translational Psychiatry, Department of Psychiatry and Psychotherapy & Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Emily C Gentry
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA , United States.,Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Rob Knight
- Department of Pediatrics, Bioengineering and Computer Science and Engineering, and Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, United States
| | - Antonio Gonzalez
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Pieter C Dorrestein
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA , United States.,Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Christoph W Turck
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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28
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Al Rawahi Y, Dutt S. Doxycycline-induced oesophageal ulcer in a teenager: A case report. J Paediatr Child Health 2019; 55:1499-1500. [PMID: 31290206 DOI: 10.1111/jpc.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Yusriya Al Rawahi
- Department of Gastroenterology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Paediatrics, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoma Dutt
- Department of Gastroenterology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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29
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Espenschied ST, Cronan MR, Matty MA, Mueller O, Redinbo MR, Tobin DM, Rawls JF. Epithelial delamination is protective during pharmaceutical-induced enteropathy. Proc Natl Acad Sci U S A 2019; 116:16961-16970. [PMID: 31391308 PMCID: PMC6708343 DOI: 10.1073/pnas.1902596116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intestinal epithelial cell (IEC) shedding is a fundamental response to intestinal damage, yet underlying mechanisms and functions have been difficult to define. Here we model chronic intestinal damage in zebrafish larvae using the nonsteroidal antiinflammatory drug (NSAID) Glafenine. Glafenine induced the unfolded protein response (UPR) and inflammatory pathways in IECs, leading to delamination. Glafenine-induced inflammation was augmented by microbial colonization and associated with changes in intestinal and environmental microbiotas. IEC shedding was a UPR-dependent protective response to Glafenine that restricts inflammation and promotes animal survival. Other NSAIDs did not induce IEC delamination; however, Glafenine also displays off-target inhibition of multidrug resistance (MDR) efflux pumps. We found a subset of MDR inhibitors also induced IEC delamination, implicating MDR efflux pumps as cellular targets underlying Glafenine-induced enteropathy. These results implicate IEC delamination as a protective UPR-mediated response to chemical injury, and uncover an essential role for MDR efflux pumps in intestinal homeostasis.
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Affiliation(s)
- Scott T Espenschied
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
| | - Mark R Cronan
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
| | - Molly A Matty
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
| | - Olaf Mueller
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
| | - Matthew R Redinbo
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
- Department of Biochemistry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599
| | - David M Tobin
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710
| | - John F Rawls
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710;
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710
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30
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Abstract
Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.
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31
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Malik OA, Khan AS. Do we use antibiotics judiciously enough? A study in Accident & Emergency Department of tertiary care hospital in Pakistan. Pak J Med Sci 2018; 34:1498-1501. [PMID: 30559811 PMCID: PMC6290189 DOI: 10.12669/pjms.346.15542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine whether antibiotics are necessary for all minor wounds presenting to the Accident and Emergency Department at a tertiary care Centre in Pakistan. Methods: One hundred and five patients presenting to the Accident & Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, with open wounds were included in the study and divided into two: Groups A (study) and B (control), with Group-A receiving conservative therapy. Eighty-four patients were included in the final analysis as the rest were lost to follow up. Follow up was done after one week to see how many patients had developed infection. Results: The average age of patients was 27.3 +/-9.7 years with similar baseline characteristics. From these, 51% had superficial wounds; average number of wounds was 1.63 +/-0.99, with an average length of 2.7 +/-1.6 cm. A total of 10 out of 84 patients developed infection at 7-10 days after presentation to the A&E. From these, 3 patients receiving conservative treatment (A, 10%, OR=0.107), and seven patients receiving prophylactic antibiotics (B, 12.96%, OR=0.149) developed an infection. Calculated odds ratio for increased risk of infection in Group-A = 0.72. Conclusion: A conservative approach to antibiotic prescription for minor trauma may be appropriate despite absence of strict asepsis during emergency wound care.
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Affiliation(s)
- Omar Abbas Malik
- Omar Abbas Ahmed Malik, Student, MBBS, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Saeed Khan
- Asim Saeed Khan, MBBS (SMC), House Officer (2015-16 during the period of the study), Jinnah Post Graduate Medical Centre, Karachi, Pakistan
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32
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Maier L, Typas A. Systematically investigating the impact of medication on the gut microbiome. Curr Opin Microbiol 2018; 39:128-135. [PMID: 29169088 DOI: 10.1016/j.mib.2017.11.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023]
Abstract
In the recent years, there is accumulating evidence for a strong impact of medication on the gut microbiota composition. This evidence comes from metagenomics-based associations and extends beyond classical antibacterials to a handful of human-targeted drugs. To answer whether such effects are direct and explore their consequences in human health, we need to develop experimental platforms that will allow for systematic profiling of drug-microbiota interactions. Here, we discuss approaches, considerations, experimental setups and strategies that can be used to tackle this need, but can be also readily transmitted to related questions in the microbiome field. A comprehensive understanding of how therapeutics interact with gut microbes will open up the path for further mechanistic dissection of such interactions, and ultimately improve not only our understanding of the gut microbiome, but also drug safety and efficacy.
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Affiliation(s)
- Lisa Maier
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Athanasios Typas
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany; European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany.
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33
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Nightmare and Abnormal Dreams: Rare Side Effects of Metformin? Case Rep Endocrinol 2018; 2018:7809305. [PMID: 29581904 PMCID: PMC5822903 DOI: 10.1155/2018/7809305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background. Metformin is widely known as an antidiabetic agent which has significant gastrointestinal side effects, but nightmares and abnormal dreams as its adverse reactions are not well reported. Case Presentation. Herein we present a case of 56-year-old male patient with no known history of recurrent nightmares and sleep disorder, experiencing nightmare and abnormal dreams directly after consumption of 750 mg extended release metformin. He reported his dream as an unpleasant experience which awakened him at night with negative feelings. The nightmare only lasted for a night, but his dreams every night thereafter seemed abnormal. The dreams were vivid and indescribable. The disappearance and occurrence of abnormal dreams ensued soon after the drug was discontinued and rechallenged. The case was assessed using Naranjo Adverse Drug Reaction (ADR) probability scale and resulted as probable causality. Conclusion. Metformin might be the underlying cause of nightmare and abnormal dreams in this patient. More studies are needed to confirm the association and causality of this findings.
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