Metoclopramide nanoparticles modulate immune response in a diabetic rat model: association with regulatory T cells and proinflammatory cytokines

Common Pathophysiological Mechanisms and Treatment of Diabetic Gastroparesis

Diabetic gastroparesis (DGP) is a common complication of diabetes mellitus, marked by gastrointestinal motility disorder, a delayed gastric emptying present in the absence of mechanical obstruction. Clinical manifestations include postprandial fullness and epigastric discomfort, bloating, nausea, and vomiting. DGP may significantly affect the quality of life and productivity of patients. Research on the relationship between gastrointestinal dynamics and DGP has received much attention because of the increasing prevalence of DGP. Gastrointestinal motility disorders are closely related to a variety of factors including the absence and destruction of interstitial cells of Cajal, abnormalities in the neuro-endocrine system and hormone levels. Therefore, this study will review recent literature on the mechanisms of DGP and gastrointestinal motility disorders as well as the development of prokinetic treatment of gastrointestinal motility disorders in order to give future research directions and identify treatment strategies for DGP.

Mesenchymal stem cell therapy in diabetic foot ulcer: An updated comprehensive review

Background

Diabetes has evolved into a worldwide public health issue. One of the most serious complications of diabetes is diabetic foot ulcer (DFU), which frequently creates a significant financial strain on patients and lowers their quality of life. Up until now, there has been no curative therapy for DFU, only symptomatic relief or an interruption in the disease's progression. Recent studies have focused attention on mesenchymal stem cells (MSCs), which provide innovative and potential treatment candidates for several illnesses as they can differentiate into various cell types. They are mostly extracted from the placenta, adipose tissue, umbilical cord (UC), and bone marrow (BM). Regardless of their origin, they show comparable features and small deviations. Our goal is to investigate MSCs' therapeutic effects, application obstacles, and patient benefit strategies for DFU therapy.

Methodology

A comprehensive search was conducted using specific keywords relating to DFU, MSCs, and connected topics in the databases of Medline, Scopus, Web of Science, and PubMed. The main focus of the selection criteria was on English-language literature that explored the relationship between DFU, MSCs, and related factors.

Results and Discussion

Numerous studies are being conducted and have demonstrated that MSCs can induce re-epithelialization and angiogenesis, decrease inflammation, contribute to immunological modulation, and subsequently promote DFU healing, making them a promising approach to treating DFU. This review article provides a general snapshot of DFU (including clinical presentation, risk factors and etiopathogenesis, and conventional treatment) and discusses the clinical progress of MSCs in the management of DFU, taking into consideration the side effects and challenges during the application of MSCs and how to overcome these challenges to achieve maximum benefits.

Conclusion

The incorporation of MSCs in the management of DFU highlights their potential as a feasible therapeutic strategy. Establishing a comprehensive understanding of the complex relationship between DFU pathophysiology, MSC therapies, and related obstacles is essential for optimizing therapy outcomes and maximizing patient benefits.

Pathogenesis and management of diabetic gastroparesis: An updated clinically oriented review

BACKGROUND AND AIMS

Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients. Diagnosis and management present as a clinical challenge due to the disease's complexity and limited effective therapeutic options. This review aims to comprehensively outline the pathogenesis, diagnosis, and management of diabetic gastroparesis, evaluating evolving approaches to guide clinicians and provide future recommendations.

METHODS

A literature review was conducted on scholarly databases of PubMed, Google Scholar, Scopus and Web of Science encompassing published articles, gray literature and relevant clinical guidelines. Data were synthesized and analyzed to provide a comprehensive overview of diabetic gastroparesis, focusing on pathogenesis, diagnosis, and management.

RESULTS

The review intricately explores the pathogenesis contributing to diabetic gastroparesis, emphasizing autonomic neuropathy, oxidative stress, inflammation, hormonal dysregulation, microbiota alterations, and gastrointestinal neuropathy. Primary management strategies are underscored, including lifestyle modifications, symptom relief, and glycemic control. The discussion encompasses pharmacological and surgical options, highlighting the importance of a multidisciplinary approach involving various healthcare professionals for comprehensive patient care.

CONCLUSION

This review offers a thorough understanding of pathogenesis, diagnosis, and management of diabetic gastroparesis, underlining evolving approaches for clinicians. A multidisciplinary approach is crucial to address both the physical and mental health aspects of diabetes and its complications.

Factors Affecting the Synthesis of Bovine Serum Albumin Nanoparticles Using the Desolvation Method

Currently, protein-based nanoparticles are in high demand as drug delivery systems due to their exceptional qualities, including nontoxicity, nonantigenicity, and biodegradability. Other qualities include high nutritional value, abundance of renewable resources, excellent drug binding capacity, greater stability during storage and in vivo, as well as ease of upgrading during manufacture. Examples of protein suitable for this purpose include ovalbumin (OVA) derived from egg white, human serum albumin (HSA), and bovine serum albumin (BSA). To create albumin nanoparticles, six different processes have been investigated in depth and are frequently used in drug delivery systems. These included desolvation, thermal gelation, emulsification, NAB technology, self-assembly, and nanospray drying. Several experimental conditions in the synthesis of albumin nanoparticles can affect the physicochemical characterization. Therefore, this study aimed to provide an overview of various experimental conditions capable of affecting the physicochemical characteristics of BSA nanoparticles formed using the desolvation method. By considering the variation in optimal experimental conditions, a delivery system of BSA nanoparticles with the best physicochemical characterization results could be developed.

Diabetes Mellitus and Gastric Cancer: Correlation and Potential Mechanisms

This review summarizes the correlation between diabetes mellitus (DM) and gastric cancer (GC) from the perspectives of epidemiology, drug use, and potential mechanisms. The association between DM and GC is inconclusive, and the positive direction of the association reported in most published meta-analyses suggests that DM may be an independent risk factor for GC. Many clinical investigations have shown that people with DM and GC who undergo gastrectomy may have better glycemic control. The potential link between DM and GC may involve the interaction of multiple common risk factors, such as obesity, hyperglycemia and hyperinsulinemia, H. pylori infection, and the use of metformin. Although in vitro and in vivo data support that H. pylori infection status and metformin can influence GC risk in DM patients, there are conflicting results. Patient survival outcomes are influenced by multiple factors, so further research is needed to identify the patients who may benefit.

Nanotechnology-Based Strategies to Combat Multidrug-Resistant Candida auris Infections

An emerging multidrug-resistant pathogenic yeast called Candida auris has a high potential to spread quickly among hospitalized patients and immunodeficient patients causing nosocomial outbreaks. It has the potential to cause pandemic outbreaks in about 45 nations with high mortality rates. Additionally, the fungus has become resistant to decontamination techniques and can survive for weeks in a hospital environment. Nanoparticles might be a good substitute to treat illnesses brought on by this newly discovered pathogen. Nanoparticles have become a trend and hot topic in recent years to combat this fatal fungus. This review gives a general insight into the epidemiology of C. auris and infection. It discusses the current conventional therapy and mechanism of resistance development. Furthermore, it focuses on nanoparticles, their different types, and up-to-date trials to evaluate the promising efficacy of nanoparticles with respect to C. auris.

Ahmed E, Battah B, Abd Ellah NH, Zanetti S, Donadu MG. Nanotechnology as a Promising Approach to Combat Multidrug Resistant Bacteria: A Comprehensive Review and Future Perspectives

The wide spread of antibiotic resistance has been alarming in recent years and poses a serious global hazard to public health as it leads to millions of deaths all over the world. The wide spread of resistance and sharing resistance genes between different types of bacteria led to emergence of multidrug resistant (MDR) microorganisms. This problem is exacerbated when microorganisms create biofilms, which can boost bacterial resistance by up to 1000-fold and increase the emergence of MDR infections. The absence of novel and potent antimicrobial compounds is linked to the rise of multidrug resistance. This has sparked international efforts to develop new and improved antimicrobial agents as well as innovative and efficient techniques for antibiotic administration and targeting. There is an evolution in nanotechnology in recent years in treatment and prevention of the biofilm formation and MDR infection. The development of nanomaterial-based therapeutics, which could overcome current pathways linked to acquired drug resistance, is a hopeful strategy for treating difficult-to-treat bacterial infections. Additionally, nanoparticles' distinct size and physical characteristics enable them to target biofilms and treat resistant pathogens. This review highlights the current advances in nanotechnology to combat MDR and biofilm infection. In addition, it provides insight on development and mechanisms of antibiotic resistance, spread of MDR and XDR infection, and development of nanoparticles and mechanisms of their antibacterial activity. Moreover, this review considers the difference between free antibiotics and nanoantibiotics, and the synergistic effect of nanoantibiotics to combat planktonic bacteria, intracellular bacteria and biofilm. Finally, we will discuss the strength and limitations of the application of nanotechnology against bacterial infection and future perspectives.

The effect of prolactin on immune cell subsets involved in SLE pathogenesis

The higher frequency of autoimmune diseases in the female population compared to males suggests that certain hormones, such as prolactin (PRL), play a role in determining the prevalence of autoimmunity in women, particularly during childbearing age. PRL can act not only as a hormone but also as a cytokine, being able to modulate immune responses. Hyperprolactinemia has been implicated in the pathogenesis of various autoimmune diseases where it may affect disease activity. One of the conditions where PRL has such a role is systemic lupus erythematosus (SLE). PRL regulates the proliferation and survival of both lymphoid and myeloid cells. It also affects the selection of T-cell repertoires by influencing the thymic microenvironment. In autoimmune conditions, PRL interferes with the activity of regulatory T cells. It also influences B cell tolerance by lowering the activation threshold of anergic B cells. The production of CD40L and cytokines, such as interleukin IL-6, are also promoted by PRL. This, in turn, leads to the production of autoantibodies, one of the hallmarks of SLE. PRL increases the cytotoxic activity of T lymphocytes and the secretion of proinflammatory cytokines. The production of proinflammatory cytokines, particularly those belonging to the type 1 interferon (IFN) family, is part of the SLE characteristic genetic signature. PRL also participates in the maturation and differentiation of dendritic cells, promoting the presentation of autoantigens and high IFNα secretion. It also affects neutrophil function and the production of neutrophil traps. Macrophages and dendritic cells can also be affected by PRL, linking this molecule to the abnormal behavior of both innate and adaptive immune responses.This review aimed to highlight the importance of PRL and its actions on the cells of innate and adaptive immune responses. Additionally, by elucidating the role of PRL in SLE etiopathogenesis, this work will contribute to a better understanding of the factors involved in SLE development and regulation.

Nanosafety vs. nanotoxicology: adequate animal models for testing in vivo toxicity of nanoparticles

Nanotoxicological studies using existing models of normal cells and animals often encounter a paradox: retention of nanoparticles in intracellular compartments for a long time is not accompanied by any significant toxicological effects. Can we expect that the revealed changes will be not harmful after translation to practice, outside of a sterile laboratory and ideally healthy organisms? Age-associated and pathological processes can affect target organs, metabolism, and detoxification in the mononuclear phagocyte system organs and change biodistribution routes, thus making the use of nanomaterial not safe. The potential solution to this issue can be testing the toxic properties of nanoparticles in animal models with chronic diseases. However, current studies of nanotoxicity in animal models with a brain, cardiovascular system, liver, digestive tract, reproductive system, and skin diseases are unsystematic. Even though these studies demonstrate the emergence of new toxic effects that are not present in healthy animals. In this regard, we set the goal of this review as the formulation of the requirements for an animal model capable of assessing the potential toxicity of nanoparticles based on the nanosafety approach.

Targeting immunosuppressor cells with nanoparticles in autoimmunity: How far have we come to?

Autoimmunity is the assault of immune response towards self-antigens, resulting to inflammation and tissue injury. It is staged into three phases and caused by malfunction of immune tolerance. In our body, immune tolerance is synchronized by several immunosuppressor cells such as regulatory T cells and B cells as well as myeloid-derived suppressor cells, which are prominently dysregulated in autoimmunity. Hence, targeting these cell populations serve as a significant potential in the therapy of autoimmunity. Nanotechnology with its advantageous properties is shown to be a remarkable tool as drug delivery system in this field. This review focused on the development of therapeutics in autoimmune diseases utilizing various nanoparticles formulation based on two targeting approaches in autoimmunity, passive and active targeting. Lastly, this review outlined the approved present nanomedicines as well as in clinical evaluations and issues regarding the lack of translation of these nanomedicines into the market, despite the abundant of positive experimental observations.

COVID-19 and Diabetes Mellitus: A Complex Interplay

COVID-19 pandemic, which caused by the newly emerged severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2), puts the entire world in an unprecedented crisis, leaving behind huge human losses and serious socio-economical damages. The clinical spectrum of COVID-19 varies from asymptomatic to multi-organ manifestations. Diabetes mellitus (DM) is a chronic inflammatory condition, which associated with metabolic and vascular abnormalities, increases the risk for SARS-CoV-2 infection, severity and mortality. Due to global prevalence, DM effect on COVID-19 outcomes as well as the potential mechanisms by which DM modulates the host-viral interactions and host-immune responses are discussed in this review. This review also highlights the effects of anti-diabetic drugs on treatment of SARS-CoV-2 infection and vice versa.

Antibiofilm and antivirulence potential of silver nanoparticles against multidrug-resistant Acinetobacter baumannii

We aimed to isolate Acinetobacter baumannii (A. baumannii) from wound infections, determine their resistance and virulence profile, and assess the impact of Silver nanoparticles (AgNPs) on the bacterial growth, virulence and biofilm-related gene expression. AgNPs were synthesized and characterized using TEM, XRD and FTIR spectroscopy. A. baumannii (n = 200) were isolated and identified. Resistance pattern was determined and virulence genes (afa/draBC, cnf1, cnf2, csgA, cvaC, fimH, fyuA, ibeA, iutA, kpsMT II, PAI, papC, PapG II, III, sfa/focDE and traT) were screened using PCR. Biofilm formation was evaluated using Microtiter plate method. Then, the antimicrobial activity of AgNPs was evaluated by the well-diffusion method, growth kinetics and MIC determination. Inhibition of biofilm formation and the ability to disperse biofilms in exposure to AgNPs were evaluated. The effect of AgNPs on the expression of virulence and biofilm-related genes (bap, OmpA, abaI, csuA/B, A1S_2091, A1S_1510, A1S_0690, A1S_0114) were estimated using QRT-PCR. In vitro infection model for analyzing the antibacterial activity of AgNPs was done using a co-culture infection model of A. baumannii with human fibroblast skin cell line HFF-1 or Vero cell lines. A. baumannii had high level of resistance to antibiotics. Most of the isolates harbored the fimH, afa/draBC, cnf1, csgA and cnf2, and the majority of A. baumannii produced strong biofilms. AgNPs inhibited the growth of A. baumannii efficiently with MIC ranging from 4 to 25 µg/ml. A. baumannii showed a reduced growth rate in the presence of AgNPs. The inhibitory activity and the anti-biofilm activity of AgNPs were more pronounced against the weak biofilm producers. Moreover, AgNPs decreased the expression of kpsMII , afa/draBC,bap, OmpA, and csuA/B genes. The in vitro infection model revealed a significant antibacterial activity of AgNPs against extracellular and intracellular A. baumannii. AgNPs highly interrupted bacterial multiplication and biofilm formation. AgNPs downregulated the transcription level of important virulence and biofilm-related genes. Our findings provide an additional step towards understanding the mechanisms by which sliver nanoparticles interfere with the microbial spread and persistence.

Synergistic and Antagonistic Effects of Biogenic Silver Nanoparticles in Combination With Antibiotics Against Some Pathogenic Microbes

The latest advances in green nanoparticle synthesis have preserved natural and non-renewable resources and decreased environmental pollution. The current study was designed to evaluate silver nanoparticles (AgNPs) fabricated using aqueous extracts of two medicinal plants, Anastatica hierochuntica L. (Kaff Maryam) and Artemisia absinthium. The phytochemicals were detected by Fourier-transform infrared spectroscopy (FTIR) and Chromatography/Mass Spectrometry (GC-MS). The effects of the AgNPs on Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Candida albicans as well as the cytotoxicity against MDA-MB-231 cells were examined. The synergistic and antagonistic effects of the biogenic AgNPs in combination with standard antibiotics against several microbes were also investigated. The ability of the plant extracts to transfer silver ions to AgNPs was measured via dynamic light scattering, zeta potential measurement, and transmission electron microscopy. The most sensitive microbes to AgNP treatment were examined via scanning electron microscopy to assess morphological changes. Biogenic AgNPs showed significant antibacterial effects against most of the tested microbes and significant cytotoxicity was noted. Polysaccharides, proteins and Phenolic compounds are likely involved in AgNP biosynthesis since hydroxyl groups and amides were detected via FTIR as well as GC-MS. This study confirmed that plant-based AgNP fabrication with AgNO₃ as the Ag (I) delivering salt can be an economical and practical approach for large-scale production of particles with antimicrobial and cytotoxic potential. The synergistic effects of biogenic AgNPs in combination with some antibiotics support their potential as a safe therapeutic for bacterial infections because they are capped with organic biomolecules.

Nanomedicine: a new paradigm to overcome drug incompatibilities

OBJECTIVES

Drug incompatibilities may compromise the safety and effectiveness of combined drugs and result in mild-to-serious clinical complications, such as catheter obstruction, loss of drug efficacy, formation of toxic derivatives and embolism. Various preventive strategies have been implemented to overcome drug incompatibilities with limited success. This review presents an innovative approach to prevent drug incompatibilities via isolating the incompatible drugs into nanostructures.

KEY FINDINGS

Several examples of incompatible drugs may be loaded separately into nanostructures of various types. Physicochemical characteristics and biocompatibility of the nanomaterials that are being utilized to prevent physicochemical incompatibilities should be carefully considered.

CONCLUSIONS

There is a new era of exploiting nanomaterials in overcoming various types of physicochemical incompatibilities, with additional benefits of further improvements in pharmacokinetic profiles and pharmacological actions of the administered drugs.

Evaluation of the immune memory response to routine HBV vaccine in Egyptian patients with Type 1 diabetes

We aimed to evaluate the immune memory response to HBV vaccine in diabetic patients who had received the full HBV vaccination during infancy and to assess the need for booster doses. Blood samples were collected from children (93 diabetics and 105 controls) and university students (22 diabetics and 20 controls). Anti-HBs titer in serum and after in vitro stimulation of peripheral blood mononuclear cells with HBV vaccine was measured by ELISA. Diabetic groups had significantly lower anti-HBs levels after 10 years of the last HBV vaccine dose. The percentage of diabetic patients having protective anti-HBs titers was significantly lower than controls. In conclusion, diabetic patients had lower immune response to HBV vaccine over time, emphasizing the need for a booster dose.

T follicular helper and T follicular regulatory cells in colorectal cancer: A complex interplay

Colorectal cancer is considered to be one of the major causes of morbidity and mortality all over the world. T Follicular helper (T_FH) and T follicular regulatory (T_FR) cells are specialized providers of T-cells to help B-cells and shaping germinal centers (GC) response. Recent researches reported a high percentage of T_FH and T_FR in different infectious diseases and certain malignancies. However, their functional role in human colorectal cancer (CRC) is relatively unknown. Furthermore, recent studies show that the interaction of both T_FH cells and T_FR cells are essential to promote several diseases. Under the control of specific cytokines and B-cell lymphoma 6 transcription factor (Bcl-6), the major transcription factor of T_FH cells, T_FH, can expand to the other distinct CD4 + T helper cells (TH1, TH2, and TH17) which exert a different role in the development of CRC. This review aims to discuss these suggested roles of the two-opposite subset of follicular T cells in colorectal cancer immune pathogenesis.

Synergistic and Antagonistic Effects of Metal Nanoparticles in Combination with Antibiotics Against Some Reference Strains of Pathogenic Microorganisms

Background and Aim

Nanosized inorganic antibacterial materials have received increasing attention in recent years. The present study aimed to determine the antimicrobial activity of silver (Ag) and zinc oxide (ZnO) nanoparticles alone and in combination with antibiotics against reference strains of pathogenic microorganisms as Staphylococcus aureus (Staph. aureus), Salmonella enterica subsp. Bukuru, Escherichia coli (E.coli) and Candida albicans ( C. albicans).

Methods

The antimicrobial effect of metal-nanoparticles (AgNPs and ZnONPS) and in combination with antibiotics was studied using the normal disc-diffusion method.

Results

Both AgNPs and ZnONPs had increased antibacterial activity with an increase in their concentration against Gram-positive bacterium (Staph. aureus), Gram-negative bacteria (E. coli and Salmonella spp) and no effect on C. albicans. The synergistic effect of antibiotics (azithromycin, cefotaxime, cefuroxime, fosfomycin and chloramphenicol) against E. coli was significantly increased in the presence of AgNPs compared to antibiotic only. However, all antibiotics had a synergistic effect in the presence of AgNps against Salmonella spp. On the other hand, the antibacterial action of AgNPs with oxacillin and neomycin antibiotics against Staph. aureus was significantly decreased in comparison with antibiotics only. The synergistic effect of antibiotics (azithromycin, oxacillin, cefotaxime, cefuroxime, fosfomycin and oxytetracycline) against E. coli was significantly increased in presence of ZnONPs compared to antibiotic only and also the synergistic effect of antibiotics (azithromycin, cefotaxime, cefuroxime, fosfomycin, chloramphenicol and oxytetracycline) against Staph. aureus was significantly increased in the presence of ZnONPs compared to antibiotics only. On the other hand, most antibiotics had an antagonistic effect in presence of ZnONps against Salmonella spp.

Conclusion

AgNPs and ZnONPs demonstrate a good synergistic effect with antibiotics and this may open the door for a future combination therapy against pathogenic bacteria.

Tourette's disorder in children and adolescents

Tourette's disorder (TD) is one of the five American Psychiatric Association's 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifications of tic disorders. Eponymously linked with the noted 19th century French physician, Gilles de la Tourette [1857-1904], this disorder is identified in 0.3% to 0.7% of the population. It is characterized as a familial neuropsychiatric condition with multiple motor tics and vocal tics (one or more) present for more than 1 year with varying severity. The underlying pathophysiology involves dysfunctional activity of the basal ganglia and circuitry of the frontal cortex as well as dorsolateral striatum deficits. Contributory factors include genetic features interacting with milieu influences. A number of comorbid disorders are seen including obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD). Concepts of management are considered including behavioral therapy and pharmacologic approaches with alpha-adrenoceptor agonists, atypical antipsychotics (AAs), haloperidol, pimozide and others. Other management includes botulinum injections and deep brain stimulation in adults.

Does a diabetic retinopathy educational program raise awareness among elderly diabetic patients?

BACKGROUND AND AIM

Diabetic retinopathy is a serious and common complication of diabetes that causes irreversible blindness. The aim of the present study was to assess the knowledge, attitudes, and practice regarding diabetic retinopathy among patients attending a diabetic clinic and identify the effect of an educational program about diabetic retinopathy.

PATIENTS AND METHODS

Two hundred diabetic patients were recruited from the outpatient's diabetic clinic, Assiut University hospitals, Egypt. Quasi-experimental (pretest-posttest) research design was applied using a structured interview questionnaire; including socio-demographic data, assessment of the patients' knowledge, attitude, and practices toward diabetic retinopathy.

RESULTS

The mean score of knowledge and attitude showed significant improvement (5.3 and 15.1, respectively in pretest vs 16.7 and 16.8, respectively in posttest) among the diabetic patients (p<0.001). From multivariate linear regression model; the predictors for knowledge score were educational level, family history of diabetes and diabetic retinopathy and hypertension. Likewise, attitude score predictors were age, residence, and smoking. Predictors for practice score were hypertension, blood sugar level, and weight.

CONCLUSION

There was a statistically significant relationship between educational level and mean knowledge score. The diabetic education program significantly helped to improve awareness of patients in relation to diabetic retinopathy.