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Barakat M, Thiab S, Farha RA, Alshweiki AO, Thaher R, Alsughaier A, Malaeb D. An evaluation of pharmacists' general attitudes, knowledge, and phobias regarding medications that include corticosteroids: a cross-sectional study. J Pharm Health Care Sci 2024; 10:8. [PMID: 38303076 PMCID: PMC10832149 DOI: 10.1186/s40780-024-00329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Corticosteroid-containing medications are widely accessible in various forms, including topical, injectable, and inhaled formulations. Due to uncertain safety profiles, healthcare providers, including pharmacists, often express apprehension when dispensing these drugs. This cross-sectional study assesses the knowledge, attitudes, and phobia of Jordanian pharmacists regarding corticosteroid-containing medications. METHODS Conducted through a self-administered online questionnaire. RESULTS the study reveals that dermatological conditions and respiratory disorders are the primary indications for prescribing corticosteroid-containing drugs. The most reported side effects among pharmacists' patients include increased appetite, diabetes, and skin thinning. Pharmacists generally exhibit acceptable knowledge, with a median score of 9.0 out of 11.0 (IQR = 3.0). Over two-thirds of pharmacists (69.9%) achieve a high knowledge score (Bloom's cut-off point ≥ 8.8). However, only 55.7% are aware that corticosteroids may induce mood changes. High phobia scores, particularly concerning increased blood pressure and osteoporosis risks, indicate pharmacist reservations in corticosteroid dispensing. Interestingly, pharmacists in rural areas display lower knowledge scores, while those working outside community pharmacies exhibit lower phobia scores compared to their counterparts in urban areas and community pharmacies, respectively. CONCLUSION Despite generally good knowledge levels, the study underscores high phobia scores among Jordanian pharmacists regarding corticosteroid dispensing, particularly due to concerns about blood pressure elevation and osteoporosis risks. This suggests a potential need for targeted educational interventions and support systems to enhance pharmacist confidence and optimize corticosteroid usage while minimizing associated risks.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, School of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Samar Thiab
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, School of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Anas O Alshweiki
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Roa'a Thaher
- Medical Intern, Hamad Medical Corporation, Hamad, Qatar
| | | | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, P.O. Box 4184, Ajman, United Arab Emirates
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Pofi R, Caratti G, Ray DW, Tomlinson JW. Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad? Endocr Rev 2023; 44:975-1011. [PMID: 37253115 PMCID: PMC10638606 DOI: 10.1210/endrev/bnad016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
It is estimated that 2% to 3% of the population are currently prescribed systemic or topical glucocorticoid treatment. The potent anti-inflammatory action of glucocorticoids to deliver therapeutic benefit is not in doubt. However, the side effects associated with their use, including central weight gain, hypertension, insulin resistance, type 2 diabetes (T2D), and osteoporosis, often collectively termed iatrogenic Cushing's syndrome, are associated with a significant health and economic burden. The precise cellular mechanisms underpinning the differential action of glucocorticoids to drive the desirable and undesirable effects are still not completely understood. Faced with the unmet clinical need to limit glucocorticoid-induced adverse effects alongside ensuring the preservation of anti-inflammatory actions, several strategies have been pursued. The coprescription of existing licensed drugs to treat incident adverse effects can be effective, but data examining the prevention of adverse effects are limited. Novel selective glucocorticoid receptor agonists and selective glucocorticoid receptor modulators have been designed that aim to specifically and selectively activate anti-inflammatory responses based upon their interaction with the glucocorticoid receptor. Several of these compounds are currently in clinical trials to evaluate their efficacy. More recently, strategies exploiting tissue-specific glucocorticoid metabolism through the isoforms of 11β-hydroxysteroid dehydrogenase has shown early potential, although data from clinical trials are limited. The aim of any treatment is to maximize benefit while minimizing risk, and within this review we define the adverse effect profile associated with glucocorticoid use and evaluate current and developing strategies that aim to limit side effects but preserve desirable therapeutic efficacy.
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Affiliation(s)
- Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Giorgio Caratti
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - David W Ray
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Kavli Centre for Nanoscience Discovery, University of Oxford, Oxford OX37LE, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
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Swastha D, Varsha N, Aravind S, Samyuktha KB, Yokesh MM, Balde A, Ayilya BL, Benjakul S, Kim SK, Nazeer RA. Alginate-based drug carrier systems to target inflammatory bowel disease: A review. Int J Biol Macromol 2023:125472. [PMID: 37336375 DOI: 10.1016/j.ijbiomac.2023.125472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
Inflammatory bowel disease (IBD) is an inflammatory disorder that affects the gastrointestinal tract. IBD has become an increasingly common condition in both developed and developing nations over the last few decades, owing to a variety of factors like a rising population and diets packed with processed and junk foods. While the root pathophysiology of IBD is unknown, treatments are focused on medications aimed to mitigate symptoms. Alginate (AG), a marine-derived polysaccharide, is extensively studied for its biocompatibility, pH sensitivity, and crosslinking nature. This polymer is thoroughly researched in drug delivery systems for IBD treatment, as it is naturally available, non-toxic, cost effective, and can be easily and safely cross-linked with other polymers to form an interconnected network, which helps in controlling the release of drugs over an extended period. There are various types of drug delivery systems developed from AG to deliver therapeutic agents; among them, nanotechnology-based systems and hydrogels are popular due to their ability to facilitate targeted drug delivery, reduce dosage, and increase the therapeutic efficiency. AG-based carrier systems are not only used for the sustained release of drug, but also used in the delivery of siRNA, interleukins, and stem cells for site directed drug delivery and tissue regenerating ability respectively. This review is focussed on pathogenesis and currently studied medications for IBD, AG-based drug delivery systems and their properties for the alleviation of IBD. Moreover, future challenges are also be discoursed to improve the research of AG in the field of biopharmaceuticals and drug delivery.
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Affiliation(s)
- Dinakar Swastha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Nambolan Varsha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Suresh Aravind
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Kavassery Balasubramanian Samyuktha
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Muruganandam Mohaneswari Yokesh
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Akshad Balde
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Bakthavatchalam Loganathan Ayilya
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India
| | - Soottawat Benjakul
- Department of Food Technology, Faculty of Agro-Industry, Prince of Songkhla University, 90112 Hat Yai, Songkhla, Thailand
| | - Se-Kwon Kim
- Department of Marine Science and Convergence Engineering, Hanyang University, Ansan, 11558, Gyeonggi-do, South Korea
| | - Rasool Abdul Nazeer
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRMInstitute of Science and Technology, Kattankulathur, Chennai, 603203, Tamilnadu, India.
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4
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Ouyang Y, Zhao J, Wang S. Multifunctional hydrogels based on chitosan, hyaluronic acid and other biological macromolecules for the treatment of inflammatory bowel disease: A review. Int J Biol Macromol 2023; 227:505-523. [PMID: 36495992 DOI: 10.1016/j.ijbiomac.2022.12.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Hydrogel is a three-dimensional network polymer material rich in water. It is widely used in the biomedical field because of its unique physical and chemical properties and good biocompatibility. In recent years, the incidence of inflammatory bowel disease (IBD) has gradually increased, and the disadvantages caused by traditional drug treatment of IBD have emerged. Therefore, there is an urgent need for new treatments to alleviate IBD. Hydrogel has become a potential therapeutic platform. However, there is a lack of comprehensive review of functional hydrogels for IBD treatment. This paper first summarizes the pathological changes in IBD sites. Then, the action mechanisms of hydrogels prepared from chitosan, sodium alginate, hyaluronic acid, functionalized polyethylene glycol, cellulose, pectin, and γ-polyglutamic acid on IBD were described from aspects of drug delivery, peptide and protein delivery, biologic therapies, loading probiotics, etc. In addition, the advanced functions of IBD treatment hydrogels were summarized, with emphasis on adhesion, synergistic therapy, pH sensitivity, particle size, and temperature sensitivity. Finally, the future development direction of IBD treatment hydrogels has been prospected.
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Affiliation(s)
- Yongliang Ouyang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093,China
| | - Jiulong Zhao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai 200433, China
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093,China.
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Poitou C, Holland A, Höybye C, de Graaff LCG, Bottius S, Otterlei B, Tauber M. The transition from pediatric to adult care in individuals with Prader-Willi syndrome. Endocr Connect 2023; 12:e220373. [PMID: 36347048 PMCID: PMC9782397 DOI: 10.1530/ec-22-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022]
Abstract
Prader-Willi syndrome (PWS), the most common form of syndromic obesity, is a complex neurodevelopmental genetic disorder including obesity with hyperphagia, endocrine and metabolic disorders and also psychiatric disorders. The most frequent endocrine disturbances include hypogonadism and growth hormone (GH) deficiency. Hypothyroidism and central adrenal insufficiency can also be observed but are less frequent. The transition of individuals with PWS from adolescence to adult life is challenging because of multiple comorbidities and complex disabilities. Individuals and caregivers face psychological, medical and social issues. This period of profound changes is thus prone to disruptions, and the main risks being the worsening of the medical situation and loss to follow-up of the individuals. Medical care may be poorly adapted to the needs of individuals because of a lack of knowledge concerning the syndrome and also lack of the necessary specific skills. A multidisciplinary panel composed of several experts in PWS met in November 2021 during an European Reference Network on Rare Endocrine Conditions (Endo-ERN) webinar. They presented complementary aspects of PWS from the perspective of the transition including psychiatric, pediatric and adult endocrinological and parent's and patient's points of view and shed light on the best way to approach this pivotal period.
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Affiliation(s)
- Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Charlotte Höybye
- Department of Endocrinology and Department of Molecular Medicine and Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Laura C G de Graaff
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sandrine Bottius
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Berit Otterlei
- Landsforeningen for Prader-Willis Syndrom Hiltonåsen, Slependen, Norway
| | - Maithé Tauber
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, Toulouse, France
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Berg BB, Soares JS, Paiva IR, Rezende BM, Rachid MA, Cau SBDA, Romero TRL, Pinho V, Teixeira MM, Castor MGME. Cannabidiol Enhances Intestinal Cannabinoid Receptor Type 2 Receptor Expression and Activation Increasing Regulatory T Cells and Reduces Murine Acute Graft-versus-Host Disease without Interfering with the Graft-versus-Leukemia Response. J Pharmacol Exp Ther 2021; 377:273-283. [PMID: 33658314 DOI: 10.1124/jpet.120.000479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/22/2021] [Indexed: 01/05/2023] Open
Abstract
Cannabidiol (CBD) is a highly lipidic phytocannabinoid with remarkable anti-inflammatory effects. The aim of this study was to evaluate CBD's effects and mechanisms of action in the treatment of mice subjected to acute graft-versus-host disease (aGVHD). aGVHD was induced by the transplantation of bone marrow cells and splenocytes from C57BL-6j to Balb-c mice. The recipient mice were treated daily with CBD, and the treatment reduced mouse mortality by decreasing inflammation and injury and promoting immune regulation in the jejunum, ileum, and liver. Analysis of the jejunum and ileum showed that CBD treatment reduced the levels of C-C motif chemokine ligand (CCL) 2, CCL3, CCL5, tumor necrosis factor α, and interferon γ (IFNγ). CCL3 and IFNγ levels were also decreased in the liver. Mechanistically, CBD also increased the number of cannabinoid receptor type 2 (CB2) receptors on CD4+ and forkhead box P3+ cells in the intestine, which may explain the reduction in proinflammatory cytokines and chemokines. Antagonists of the CB2 receptor reduced the survival rates of CBD-treated mice, suggesting the participation of this receptor in the effects of CBD. Furthermore, treatment with CBD did not interfere with the graft-versus-leukemia response. CBD treatment appears to protect aGVHD mice by anti-inflammatory and immunomodulatory effects partially mediated by CB2 receptor interaction. Altogether, our study suggests that CBD represents an interesting approach in the treatment of aGVHD, with potential therapeutic applications in patients undergoing bone marrow transplantation. SIGNIFICANCE STATEMENT: This study provides for the first time a mechanism by which cannabidiol, a phytocannabinoid with no psychoactive effect, induces immunomodulation in the graft-versus-host disease. Enhancing intestinal cannabinoid receptor type 2 (CB2) receptor expression on CD4+ and forkhead box P3+ cells and increasing the number of these regulatory cells, cannabidiol decreases proinflammatory cytokines and increases graft-versus-host disease mice survival. This effect is dependent of CB2 receptor activation. Besides, cannabidiol did not interfere with graft-versus-leukemia response, a central response to avoid primary disease relapse.
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Affiliation(s)
- Bárbara Betônico Berg
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Jaqueline Silva Soares
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Isabela Ribeiro Paiva
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Barbara Maximino Rezende
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Milene Alvarenga Rachid
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Stêfany Bruno de Assis Cau
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Thiago Roberto Lima Romero
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Vanessa Pinho
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Mauro Martins Teixeira
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Marina Gomes Miranda E Castor
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
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Jacob EM, Borah A, Pillai SC, Kumar DS. Inflammatory Bowel Disease: The Emergence of New Trends in Lifestyle and Nanomedicine as the Modern Tool for Pharmacotherapy. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E2460. [PMID: 33316984 PMCID: PMC7764399 DOI: 10.3390/nano10122460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Abstract
The human intestine, which harbors trillions of symbiotic microorganisms, may enter into dysbiosis when exposed to a genetic defect or environmental stress. The naissance of chronic inflammation due to the battle of the immune system with the trespassing gut bacteria leads to the rise of inflammatory bowel disease (IBD). Though the genes behind the scenes and their link to the disease are still unclear, the onset of IBD occurs in young adults and has expanded from the Western world into the newly industrialized countries. Conventional drug deliveries depend on a daily heavy dosage of immune suppressants or anti-inflammatory drugs targeted for the treatment of two types of IBD, ulcerative colitis (UC) and Crohn's disease (CD), which are often associated with systemic side effects and adverse toxicities. Advances in oral delivery through nanotechnology seek remedies to overcome the drawbacks of these conventional drug delivery systems through improved drug encapsulation and targeted delivery. In this review, we discuss the association of genetic factors, the immune system, the gut microbiome, and environmental factors like diet in the pathogenesis of IBD. We also review the various physiological concerns required for oral delivery to the gastrointestinal tract (GIT) and new strategies in nanotechnology-derived, colon-targeting drug delivery systems.
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Affiliation(s)
| | | | | | - D. Sakthi Kumar
- Bio-Nano Electronics Research Centre, Graduate School of Interdisciplinary New Science, Toyo University, Kawagoe, Saitama 350-8585, Japan; (E.M.J.); (A.B.); (S.C.P.)
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8
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Hp-s1 Ganglioside Suppresses Proinflammatory Responses by Inhibiting MyD88-Dependent NF-κB and JNK/p38 MAPK Pathways in Lipopolysaccharide-Stimulated Microglial Cells. Mar Drugs 2020; 18:md18100496. [PMID: 33003399 PMCID: PMC7600735 DOI: 10.3390/md18100496] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Hp-s1 ganglioside is isolated from the sperm of sea urchin (Hemicentrotus pulcherrimus). In addition to neuritogenic activity, the biological function of Hp-s1 in neuroinflammation is unknown. In this study, we investigated the anti-neuroinflammatory effect of Hp-s1 on lipopolysaccharide (LPS)-stimulated microglial cells. MG6 microglial cells were stimulated with LPS in the presence or absence of different Hp-s1 concentrations. The anti-inflammatory effect and underlying mechanism of Hp-s1 in LPS-activated microglia cells were assessed through a Cell Counting kit-8 assay, Western blot analysis, and immunofluorescence. We found that Hp-s1 suppressed not only the expression of inducible nitric oxide synthase and cyclooxygenase-2 but also the expression of proinflammatory cytokines, such as TNF-α, IL-1β, and IL-6. Hp-s1 inhibited the LPS-induced NF-κB signaling pathway by attenuating the phosphorylation and translocation of NF-κB p65 and by disrupting the degradation and phosphorylation of inhibitor κB-α (IκBα). Moreover, Hp-s1 inhibited the LPS-induced phosphorylation of p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK). Hp-s1 also reduced the expression of myeloid differentiation factor 88 (MyD88) and TNF receptor-associated factors 6 (TRAF6), which are prerequisites for NF-κB and MAPKs activation. These findings indicated that Hp-s1 alleviated LPS-induced proinflammatory responses in microglial cells by downregulating MyD88-mediated NF-κB and JNK/p38 MAPK signaling pathways, suggesting further evaluation as a new anti-neuroinflammatory drug.
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Sun W, Cheng Z, Chen H, Lin G, Chen H. Tetrahydropyrimidines, ZL-5015 Alleviated Lipopolysaccharide (LPS)-Induced Acute Pneumonia in Rats by Activating the NRF-2/HO-1 Pathway. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e924482. [PMID: 32844782 PMCID: PMC8147033 DOI: 10.12659/msm.924482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute pneumonia is a severe inflammatory disease of the respiratory system. Drugs used to treat acute pneumonia often have strong side effects. Recent studies have shown that tetrahydropyrimidines, ZL-5015 has anti-inflammatory and antitumor effects. However, whether ZL-5015 can relieve symptoms of acute pneumonia is unclear. MATERIAL AND METHODS In this study, we used lipo-polysaccharide (LPS) to stimulate SD rats to simulate conditions of acute pneumonia. Diverse doses of ZL-5015 were used for treatment of these rats. After the rates were sacrificed, serum, lung tissue, and bronchoalveolar lavage fluid were collected for the next study. Hematoxylin-eosin (H&E) staining then was used to detect pathologic changes in lung tissues. Enzyme-linked immunosorbent assay was performed to assess levels of inflammatory factors in serum. Commercial kits were used to assess levels of reactive oxygen species (ROS) in bronchoalveolar lavage fluid. RESULTS Treatment of ZL-5015 relieved stenosis of the alveolar space and pulmonary edema. Furthermore, levels of inflammatory factors (TNF-alpha, IL-1ß and IL-18) in the lung tissues and serum were downregulated after treatment with ZL-5015. Production of ROS also was suppressed after application of ZL-5015. Moreover, inhibition of expression of NRF-2 and HO-1 was relieved after treatment with ZL-5015. The therapeutic effect of ZL-5015 showed a dose-response relationship. CONCLUSIONS ZL-5015 alleviated LPS-induced inflammatory injury and oxidative damage by activating the NRF-2/HO-1 pathway.
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Affiliation(s)
- Wei Sun
- Department of Emergency, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (mainland)
| | - Zhou Cheng
- Department of Emergency, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (mainland)
| | - Hanyan Chen
- Department of Emergency, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (mainland)
| | - Guifen Lin
- Department of Emergency, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (mainland)
| | - Hongxing Chen
- Department of Emergency, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (mainland)
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10
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Rosenberg AGW, Pellikaan K, Poitou C, Goldstone AP, Høybye C, Markovic T, Grugni G, Crinò A, Caixàs A, Coupaye M, Van Den Berg SAA, Van Der Lely AJ, De Graaff LCG. Central Adrenal Insufficiency Is Rare in Adults With Prader-Willi Syndrome. J Clin Endocrinol Metab 2020; 105:5813913. [PMID: 32232324 PMCID: PMC7211032 DOI: 10.1210/clinem/dgaa168] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/27/2020] [Indexed: 01/25/2023]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is associated with several hypothalamic-pituitary hormone deficiencies. There is no agreement on the prevalence of central adrenal insufficiency (CAI) in adults with PWS. In some countries, it is general practice to prescribe stress-dose hydrocortisone during physical or psychological stress in patients with PWS. Side effects of frequent hydrocortisone use are weight gain, osteoporosis, diabetes mellitus, and hypertension-already major problems in adults with PWS. However, undertreatment of CAI can cause significant morbidity-or even mortality. OBJECTIVE To prevent both over- and undertreatment with hydrocortisone, we assessed the prevalence of CAI in a large international cohort of adults with PWS. As the synacthen test shows variable results in PWS, we only use the metyrapone test (MTP) and insulin tolerance test (ITT). DESIGN Metyrapone test or ITT in adults with PWS (N = 82) and review of medical files for symptoms of hypocortisolism related to surgery (N = 645). SETTING Outpatient clinic. PATIENTS OR OTHER PARTICIPANTS Eighty-two adults with genetically confirmed PWS. MAIN OUTCOME MEASURE For MTP, 11-deoxycortisol > 230 nmol/L was considered sufficient. For ITT, cortisol > 500 nmol/L (Dutch, French, and Swedish patients) or > 450 nmol/L (British patients) was considered sufficient. RESULTS Central adrenal insufficiency was excluded in 81 of 82 patients. Among the 645 patients whose medical files were reviewed, 200 had undergone surgery without perioperative hydrocortisone treatment. None of them had displayed any features of hypocortisolism. CONCLUSIONS Central adrenal insufficiency is rare (1.2%) in adults with PWS. Based on these results, we recommend against routinely prescribing hydrocortisone stress-doses in adults with PWS.
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Affiliation(s)
- Anna G W Rosenberg
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karlijn Pellikaan
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christine Poitou
- Assistance Publique-Hopitaux de Paris, Nutrition Department, Institute of Cardiometabolism and Nutrition, Pitie-Salpetriere Hospital, Sorbonne Universite, Paris, France
- International Network for Research, Management & Education on Adults with PWS
- European Reference Network on Rare Endocrine Conditions
| | - Anthony P Goldstone
- International Network for Research, Management & Education on Adults with PWS
- PsychoNeuroEndocrinology Research Group, Neuropsychopharmacology Unit, Division of Psychiatry, Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Charlotte Høybye
- International Network for Research, Management & Education on Adults with PWS
- European Reference Network on Rare Endocrine Conditions
- Department of Molecular Medicine and Surgery, Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Tania Markovic
- International Network for Research, Management & Education on Adults with PWS
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Boden Collaboration, University of Sydney, Sydney, Australia
| | - Graziano Grugni
- International Network for Research, Management & Education on Adults with PWS
- European Reference Network on Rare Endocrine Conditions
- Divison of Auxology, Italian Auxological Institute, IRCCS, Piancavallo, Italy
| | - Antonino Crinò
- International Network for Research, Management & Education on Adults with PWS
- Reference Center for Prader–Willi Syndrome, Bambino Gesu Hospital, Research Institute, Palidoro (Rome), Italy
| | - Assumpta Caixàs
- International Network for Research, Management & Education on Adults with PWS
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí (UAB), Institut d’Investigacio i Innovacio Parc Taulí (I3PT), Sabadell, Spain
| | - Muriel Coupaye
- Assistance Publique-Hopitaux de Paris, Nutrition Department, Institute of Cardiometabolism and Nutrition, Pitie-Salpetriere Hospital, Sorbonne Universite, Paris, France
- International Network for Research, Management & Education on Adults with PWS
| | - Sjoerd A A Van Den Berg
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aart Jan Van Der Lely
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network on Rare Endocrine Conditions
| | - Laura C G De Graaff
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- International Network for Research, Management & Education on Adults with PWS
- European Reference Network on Rare Endocrine Conditions
- Academic Center for Growth, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Correspondence and Reprint Requests: Laura de Graaff, MD, PhD, Department of Internal Medicine-Endocrinology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. E-mail:
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Kračun D, Klop M, Knirsch A, Petry A, Kanchev I, Chalupsky K, Wolf CM, Görlach A. NADPH oxidases and HIF1 promote cardiac dysfunction and pulmonary hypertension in response to glucocorticoid excess. Redox Biol 2020; 34:101536. [PMID: 32413743 PMCID: PMC7226895 DOI: 10.1016/j.redox.2020.101536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular side effects are frequent problems accompanying systemic glucocorticoid therapy, although the underlying mechanisms are not fully resolved. Reactive oxygen species (ROS) have been shown to promote various cardiovascular diseases although the link between glucocorticoid and ROS signaling has been controversial. As the family of NADPH oxidases has been identified as important source of ROS in the cardiovascular system we investigated the role of NADPH oxidases in response to the synthetic glucocorticoid dexamethasone in the cardiovascular system in vitro and in vivo in mice lacking functional NADPH oxidases due to a mutation in the gene coding for the essential NADPH oxidase subunit p22phox. We show that dexamethasone induced NADPH oxidase-dependent ROS generation, leading to vascular proliferation and angiogenesis due to activation of the transcription factor hypoxia-inducible factor-1 (HIF1). Chronic treatment of mice with low doses of dexamethasone resulted in the development of systemic hypertension, cardiac hypertrophy and left ventricular dysfunction, as well as in pulmonary hypertension and pulmonary vascular remodeling. In contrast, mice deficient in p22phox-dependent NADPH oxidases were protected against these cardiovascular side effects. Mechanistically, dexamethasone failed to upregulate HIF1α levels in these mice, while vascular HIF1α deficiency prevented pulmonary vascular remodeling. Thus, p22phox-dependent NADPH oxidases and activation of the HIF pathway are critical elements in dexamethasone-induced cardiovascular pathologies and might provide interesting targets to limit cardiovascular side effects in patients on chronic glucocorticoid therapy.
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Affiliation(s)
- Damir Kračun
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany
| | - Mathieu Klop
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany
| | - Anna Knirsch
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany
| | - Andreas Petry
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany
| | - Ivan Kanchev
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany
| | - Karel Chalupsky
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany; Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the ASCR, v. v. i., Prague, Czech Republic
| | - Cordula M Wolf
- Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Agnes Görlach
- Experimental and Molecular Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Munich at the Technical University Munich, Munich, 80636, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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12
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Gummi RR, Kukulka NA, Deroche CB, Govindarajan R. Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 2019; 60:693-699. [DOI: 10.1002/mus.26689] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Chelsea B. Deroche
- Health Management and InformaticsUniversity of Missouri School of Medicine Columbia Missouri
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13
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Wu Y, Lu X, Ma Y, Zeng Y, Bao X, Xiong H, Shen B. Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty. BMC Musculoskelet Disord 2018; 19:428. [PMID: 30501618 PMCID: PMC6271578 DOI: 10.1186/s12891-018-2359-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/22/2018] [Indexed: 02/05/2023] Open
Abstract
Background The purpose of this study was to investigate the efficacy and safety of multiple low-dose dexamethasones in primary total knee arthroplasty (TKA). Methods One hundred fifty patients were equally randomized into 3 groups: Group A (n = 50) received 2 doses of normal saline only; Group B (n = 50) received with 1 dose of intravenous dexamethasone and 1 dose of normal saline; Group C (n = 50) received with 2 doses of intravenous dexamethasone. The clinical outcomes and complications were assessed. Results The CRP and IL-6 were significantly lower in Group C and B than Group A at 24, 48, and 72 h postoperatively (P < 0.001 for all). The intensity of postoperative nausea and vomiting (PONV) in Group C was lower than Group A at 24 (P < 0.001, P = 0.002), 48 (P = 0.005, P = 0.041) and 72 h (P = 0.017, P = 0.031) postoperatively and Group B at 24 h (P = 0.027, P = 0.019) postoperatively. Pain were significantly less in Group C than Group A at 24 (P < 0.001), 48 h (P = 0.037) postoperatively and Group B 24 h (P = 0.030) postoperatively. Patients in Group C had better range of motion (ROM) and satisfaction than Group A (P < 0.001, P = 0.002) and B (P = 0.001, P = 0.043). No differences were found in complications. Conclusions The administration of 10 mg dexamethasone 1 h before the surgery, and repeated at 6 h postoperatively can significantly reduce the level of postoperative CRP and IL-6 and the incidence of PONV, relieve pain, achieve an additional analgesic effect, and improve the early ROM compared with the other two groups in TKA. Level of Evidence Therapeutic Level I. Trial registration The Chinese Clinical Trial Registry (ChiCTR1800017036). Registered on July 9, 2018.
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Affiliation(s)
- Yuangang Wu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaoxi Lu
- Department of Pediatrics, West China University Second Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yimei Ma
- Department of Pediatrics, West China University Second Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xianchao Bao
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Huazhang Xiong
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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14
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Byrne CJ, Khurana S, Kumar A, Tai TC. Inflammatory Signaling in Hypertension: Regulation of Adrenal Catecholamine Biosynthesis. Front Endocrinol (Lausanne) 2018; 9:343. [PMID: 30013513 PMCID: PMC6036303 DOI: 10.3389/fendo.2018.00343] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/07/2018] [Indexed: 12/24/2022] Open
Abstract
The immune system is increasingly recognized for its role in the genesis and progression of hypertension. The adrenal gland is a major site that coordinates the stress response via the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal system. Catecholamines released from the adrenal medulla function in the neuro-hormonal regulation of blood pressure and have a well-established link to hypertension. The immune system has an active role in the progression of hypertension and cytokines are powerful modulators of adrenal cell function. Adrenal medullary cells integrate neural, hormonal, and immune signals. Changes in adrenal cytokines during the progression of hypertension may promote blood pressure elevation by influencing catecholamine biosynthesis. This review highlights the potential interactions of cytokine signaling networks with those of catecholamine biosynthesis within the adrenal, and discusses the role of cytokines in the coordination of blood pressure regulation and the stress response.
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Affiliation(s)
- Collin J. Byrne
- Department of Biology, Laurentian University, Sudbury, ON, Canada
| | - Sandhya Khurana
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Aseem Kumar
- Department of Chemistry and Biochemistry, Laurentian University, Sudbury, ON, Canada
- Biomolecular Sciences Program, Laurentian University, Sudbury, ON, Canada
| | - T. C. Tai
- Department of Biology, Laurentian University, Sudbury, ON, Canada
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON, Canada
- Department of Chemistry and Biochemistry, Laurentian University, Sudbury, ON, Canada
- Biomolecular Sciences Program, Laurentian University, Sudbury, ON, Canada
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15
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Biancone L, Annese V, Ardizzone S, Armuzzi A, Calabrese E, Caprioli F, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Frieri G, Fries W, Gionchetti P, Kohn A, Latella G, Milla M, Orlando A, Papi C, Petruzziello C, Riegler G, Rizzello F, Saibeni S, Scribano ML, Vecchi M, Vernia P, Meucci G, Bossa F, Cappello M, Cassinotti A, Chiriatti A, Fiorino G, Formica V, Guidi L, Losco A, Mocciaro F, Onali S, Pastorelli L, Pica R, Principi M, Renna S, Ricci C, Rispo A, Rogai F, Sarmati L, Scaldaferri F, Spina L, Tambasco R, Testa A, Viscido A. Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2017; 49:338-358. [PMID: 28161290 DOI: 10.1016/j.dld.2017.01.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/19/2016] [Accepted: 01/07/2017] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group.
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Affiliation(s)
- Livia Biancone
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy.
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | - Sandro Ardizzone
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda,Ospedale Policlinico di Milano, Milan, Italy
| | | | - Michele Comberlato
- Department of Gastroenterology and Digestive Endoscopy, Central Hospital, Bolzano, Italy
| | - Mario Cottone
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Silvio Danese
- Humanitas Research Hospital and Humanitas University, Rozzano (Milan), Italy
| | - Marco Daperno
- Hospital "Ordine Mauriziano di Torino", Turin, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Giuseppe Frieri
- University of L'Aquila, Gastroenterology Unit, L'Aquila, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chroric Bowel Disorders, University of Messina, Messina, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Kohn
- San Camillo-Forlanini Hospital, IBD Unit, Rome, Italy
| | | | | | - Ambrogio Orlando
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Carmelina Petruzziello
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Gabriele Riegler
- U.O. of Gastroenterology C.S. - University della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, San Donato Milanese, Milan, Italy
| | - Piero Vernia
- Gastroenterology Unit, Sapienza, University of Rome, Rome, Italy
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16
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Puzserova A, Bernatova I. Blood pressure regulation in stress: focus on nitric oxide-dependent mechanisms. Physiol Res 2017; 65:S309-S342. [PMID: 27775419 DOI: 10.33549/physiolres.933442] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stress is considered a risk factor associated with the development of various civilization diseases including cardiovascular diseases, malignant tumors and mental disorders. Research investigating mechanisms involved in stress-induced hypertension have attracted much attention of physicians and researchers, however, there are still ambiguous results concerning a causal relationship between stress and long-term elevation of blood pressure (BP). Several studies have observed that mechanisms involved in the development of stress-induced hypertension include increased activity of sympathetic nervous system (SNS), glucocorticoid (GC) overload and altered endothelial function including decreased nitric oxide (NO) bioavailability. Nitric oxide is well known neurotransmitter, neuromodulator and vasodilator involved in regulation of neuroendocrine mechanisms and cardiovascular responses to stressors. Thus NO plays a crucial role in the regulation of the stress systems and thereby in the BP regulation in stress. Elevated NO synthesis, especially in the initial phase of stress, may be considered a stress-limiting mechanism, facilitating the recovery from stress to the resting levels via attenuation of both GC release and SNS activity as well as by increased NO-dependent vasorelaxation. On the other hand, reduced levels of NO were observed in the later phases of stress and in subjects with genetic predisposition to hypertension, irrespectively, in which reduced NO bioavailability may account for disruption of NO-mediated BP regulatory mechanisms and accentuated SNS and GC effects. This review summarizes current knowledge on the role of stress in development of hypertension with a special focus on the interactions among NO and other biological systems affecting blood pressure and vascular function.
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Affiliation(s)
- A Puzserova
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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17
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Dubey H, Singh A, Patole AM, Tenpe CR. Antihypertensive effect of allicin in dexamethasone-induced hypertensive rats. Integr Med Res 2016; 6:60-65. [PMID: 28462145 PMCID: PMC5395682 DOI: 10.1016/j.imr.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/07/2016] [Accepted: 12/01/2016] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Glucocorticoid is among the most commonly prescribed medicine. Unfortunately, Excess glucocorticoid level leads hypertension in 80-90% patients. Garlic (Allium sativum) has been used since ancient times and even nowadays as a part of popular medicine for various ailments and physiological disorders. Hence this study was undertaken to investigate the antihypertensive activity of allicin in dexamethasone induced hypertension in wistar rats. METHODS The animals were randomly divided into four groups comprising of six rats per group. Hypertension was induced by subcutaneous injection of dexamethasone (10 μg/rat/day) in hypertensive rats. Two hypertensive group animals were treated with nicorandil (6 mg/kg/day, po) and allicin (8 mg/kg/day, po) respectively for 8 weeks. While systolic blood pressure (SBP) was measured by the tail-cuff method weekly up to 8 weeks. RESULTS Dexamethasone treatment resulted in significant increase in SBP while allicin treatment significantly decreases the SBP. Thus, this study confirmed that allicin treatment for 8 weeks partially reverse dexamethasone induced hypertension in rats. Allicin treatment also attenuated dexamethasone-induced anorexia and loss of total body weight. CONCLUSION This result suggests antihypertensive effects of allicin in dexamethasone induced hypertension. However, further studies are needed to explore the detailed mechanism of antihypertensive effect of allicin.
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Affiliation(s)
- Harikesh Dubey
- Department of Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.,Department of Pharmacology, Institute of Pharmaceutical Education and Research, Wardha, India
| | - Anamika Singh
- Department of Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Angad M Patole
- Department of Pharmacology, Institute of Pharmaceutical Education and Research, Wardha, India
| | - Chandrashekhar R Tenpe
- Department of Pharmacology, Institute of Pharmaceutical Education and Research, Wardha, India
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Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of the breast. Despite the various treatment approaches described for this disease, a gold standard treatment modality has not yet been defined. In this study, the effect of topical steroids was reviewed and assessed in patients with IGM. METHODS The records of patients with IGM who were treated only with topical steroids were retrospectively reviewed. Patients were grouped as "completely healed," "inadequately healed," "stable," "worsened," or "recurred" if they had once healed but their symptoms returned. Patients whose skin changes were completely ameliorated were considered "completely healed." RESULTS All of the patients were women, and the average patient age was 35.7 years (range 24-48 years). During the average follow-up of 37.2 months (range 12-72 months) in patients who received only topical steroid treatment, recurrence was observed in three patients (3/28, 10.7 %), and no side effects or steroid-related complications occurred. CONCLUSIONS Topical steroids seem to be effective in the treatment of IGM characterized by skin changes. Prospective clinical studies would be useful in determining the clinical efficacy of topical steroids in the treatment of IGM.
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Anti-inflammatory sesquiterpene pyridine alkaloids from Tripterygium wilfordii. Fitoterapia 2015; 105:49-54. [DOI: 10.1016/j.fitote.2015.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/02/2015] [Accepted: 06/06/2015] [Indexed: 11/23/2022]
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20
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Fardet L, Fève B. Systemic Glucocorticoid Therapy: a Review of its Metabolic and Cardiovascular Adverse Events. Drugs 2014; 74:1731-45. [DOI: 10.1007/s40265-014-0282-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Lun Y, Xia H, Zhang Q, Yu C, Chen N, Li X, Liu S, Lei L. Anti-inflammatory and immunosuppressive activities of 1,3-dicyclopentyl-1,2,3,6-tetrahydropyrimidine-4,5-dicarboxylic acid diethyl ester (ZL-5015). Int Immunopharmacol 2013; 17:168-77. [DOI: 10.1016/j.intimp.2013.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/19/2013] [Accepted: 05/28/2013] [Indexed: 11/26/2022]
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Fardet L. Effets indésirables métaboliques et cardiovasculaires des corticothérapies systémiques. Rev Med Interne 2013; 34:303-9. [DOI: 10.1016/j.revmed.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 02/07/2023]
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Damjanovic SS, Antic JA, Ilic BB, Cokic BB, Ivovic M, Ognjanovic SI, Isailovic TV, Popovic BM, Bozic IB, Tatic S, Matic G, Todorovic VN, Paunovic I. Glucocorticoid receptor and molecular chaperones in the pathogenesis of adrenal incidentalomas: potential role of reduced sensitivity to glucocorticoids. Mol Med 2013. [PMID: 23196783 DOI: 10.2119/molmed.2012.00261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Glucocorticoid (GC) sensitivity depends on glucocorticoid receptor (GR) and heat shock proteins (Hsps). We investigated whether common GR genes (ER22/23EK, N363S, Bcl I, and 9β) and adrenocorticotropin receptor promoter polymorphisms influence susceptibility for unilateral adrenal incidentaloma (AI), plus GR and Hsp expression in tumorous (n = 19), peritumorous (n = 13) and normal adrenocortical (n = 11) tissues. Patients (n = 112), population-matched controls (n = 100) and tumor tissues (n = 32) were genotyped for these polymorphisms. Postdexamethasone serum cortisol was higher in patients (p < 0.001). GR gene variants, larger allele of Bcl I (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.7-5.1; p < 0.001] and minor allele of 9β (OR 3.0; 95% CI 1.6-5.7; p < 0.001) were independent predictors of AI. In patients, the first allele is linked with larger tumors (p = 0.002) and the latter with higher postdexamethasone cortisol levels (p = 0.025). Both allele carriers had lesser waist circumference (p = 0.02), similar adrenocorticotropin and higher basal (p = 0.024) and postdexamethasone cortisol concentrations (p < 0.001). Tumorous and constitutional genotypes were similar. GR-D is the major receptor isoform in normal adrenal cortex by Western blotting. Loss of other receptor isoforms, decrease in immunostaining for GR (p < 0.0001), underexpression of chaperones (p ≤ 0.01) and the presence of inducible Hsp70 were found in adenomas. In conclusion, GR gene variants, C allele of Bcl I and minor allele of 9β, are associated with AIs. Their concurrent presence in patients reduces GC sensitivity. Normal adrenal cortex preferentially expresses GR-D. In adenomas, the lack of other GR isoforms and underexpression of heat shock proteins perhaps permanently impair GC signaling, which could promote dysregulated cortisol production and tumor growth. The innate GC sensitivity probably modifies these effects.
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Affiliation(s)
- Svetozar S Damjanovic
- Centre for Endocrine Oncology and Hereditary Cancer Syndromes, Institute for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.
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Abstract
BACKGROUND Treatment with chronic corticosteroids has been associated with frequent significant adverse effects. We hypothesized that a long-term low-dose prednisone regimen for ocular myasthenia gravis (OMG) would have a low rate of major side effects. METHODS Consecutive OMG patients from a single institution over a 16-year period and treated with ≥1 month of daily prednisone were included. Steroid-related complications were defined as the development/worsening of conditions requiring alteration to medical therapy. Serious complications included conditions requiring emergency care, hospitalization, or surgery. RESULTS Eighty-three patients with follow-up period ranging from 1 to 271 months (median, 58 months) were included. Fifty-eight (70%) patients had follow-up period of ≥24 months. The maximum prednisone dose ranged from 10 to 60 mg. Tapering to ≤10 mg/d required ≤4 months for all but 2 patients. Median average daily dose following the initial course was 5 mg daily (interquartile range, 4-7.5 mg). During the first 2 years, there were 24.5 complications per 100 person-years. Only one patient had a serious complication within the first 2 years (2-year cumulative risk, 1%), but this individual was not following the recommended regimen. CONCLUSIONS Low-dose prednisone for OMG has an acceptable side-effect profile and causes few serious complications (2-year risk, ∼1%). However, patients need monitoring to detect the relatively common, but less serious, complications (2-year risk, ∼39%) to adjust medical therapy in a timely fashion.
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