Microbiome Profile and Molecular Pathways Alterations in Gastrointestinal Tract by Hydrogen Sulfide-Releasing Nonsteroidal Anti-Inflammatory Drug (ATB-352): Insight into Possible Safer Polypharmacy

Aims: Nonsteroidal anti-inflammatory drugs, including ketoprofen, induce adverse effects within the gastrointestinal (GI)-tract. Hydrogen sulfide (H₂S) is an antioxidative gaseous mediator contributing to GI-protection. We aimed to evaluate the GI safety of a novel H₂S-releasing derivative of ketoprofen (ATB-352) versus classic ketoprofen and the molecular mechanisms of their activity after chronic treatment in experimental animal models. Results: Ketoprofen (10 mg/kg/day) administered intragastrically for 7 days in contrast with ATB-352 (14 mg/kg/day) reduced mucosal H₂S content inducing GI damage with significantly increased injury score, altered intestinal microbiome profile, and modulation of more than 50% of 36 investigated molecular sensors (e.g., mammalian target of rapamycin or suppressor of cytokine signaling 3 [SOCS3]). Polypharmacy with aspirin (10 mg/kg/day) enhanced ketoprofen toxicity not affecting GI safety of ATB-352. Omeprazole (20 mg/kg/day) decreased ketoprofen-induced injury to the level of ATB-352 alone. Both compounds combined or not with aspirin or omeprazole maintained the ability to inhibit cyclooxygenase (COX) activity manifested by decreased prostaglandin production. Innovation and Conclusions: Ketoprofen-induced H₂S-production decrease and intestinal microbiome profile alterations lead to GI toxicity observed on macro-/microscopic and molecular levels. Ketoprofen but not ATB-352 requires concomitant treatment with omeprazole to eliminate GI adverse effects. ATB-352 applied alone or in a polypharmacy setting with aspirin effectively inhibited COX and maintained GI safety due to H₂S-release. Neither compound affected DNA oxidation in the GI mucosa, but ATB-352 had lower impact on molecular oxidative/inflammatory response pathways and intestinal microbiome. The GI safety of ATB-352 could be due to the involvement of heme oxygenase 1 and SOCS3 pathway activation. Antioxid. Redox Signal. 36, 189-210.

Neuroendocrine neoplasms and somatostatin receptor subtypes expression

Neuroendocrine neoplasms (NENs) show wide spectrum of clinical course - from benign biological potential to recurrences and rapidly progressive disease. Somatostatin analogs that bind to somatostatin receptor are part of the therapy; detection and evaluation of activation of somatostatin receptor subtypes are part of the process of new therapy induction. When using RT-PCR method and immunohistochemistry, it is possible to detect more than two SSTR subtypes in majority or all neuroendo-crine neoplasms regardless tumor origin. Generally with some exceptions, from the viewpoint of tumor grade - apart the site of origin, there is a tendency to decrease the percentage of SSTRs expression; 100% (G1, 2)-85.7% (G3) for SSTR 1; 81.8% (G1, 2)-61.9% (G3) for SSTR 2; 54.5% (G1, 2)-52.4% (G3) for SSTR 3; 9% (G1, 2)-4.8% (G3) for SSTR 5. Different studies indi-cate significant differences in the expression of SSTR 1 and 2A and 2B between NEC G3 small cell type and non-small cell type. Further research on SSTRs expression in NEN could serve as base to development and improvement of somatostatin analogs' pharmacotherapy in patients with unsatisfactory course.

Foxp3+ lymphocyte count in Barrett's esophagus tissue is higher than in in amed esophageal tissue

INTRODUCTION

The number of Foxp3+ lymphocytes is increased in patients with esophageal carcinoma. Little is known about Foxp3+ cells count in Barret's esophagus, which is a precancerous state for esophageal cancer. A i m: To count the number of Foxp3+ lymphocytes in tissue samples from patients with Barrett's and compare it with samples from individuals with esophagitis and esophageal cancer.

MATERIALS AND METHODS

43 patients were enrolled to the study: 14 with esophageal carcinoma, 15 with Barrett's esophagus and 14 with non-metaplastic esophagitis. Every patient undergone gastroscopy during which a tissue sample was taken. Foxp3+ lymphocytes and CD4+ lymphocytes were detected by using immunohistochemistry.

RESULTS

Mean density of Foxp3+ cells in patients with esophagitis was 7.37/10HPF (range: 1-9), 18.5/10HPF (range: 5-29) and 26.8/10HPF (range: 16-40) in patients with dysplastic and non-dysplastic BE, respectively and 47.92/10HPF in individuals with esophageal a carcinoma. These intergroup differences turned out to be statistically significant (p = 0.000; Fig. 3). Patients, either with dysplasia or without, presented with significantly higher Foxp3+ cell counts than the subjects with esophagitis (p = 0.0003 and p = 0.0006, respectively). Also the number of Foxp3+ lymphocytes in esophageal adenocarcinoma specimens turned out to be significantly higher than in esophagitis (p = 0.0001), non-dysplastic and dysplastic BE tissue (p = 0.016 and p = 0.00047, respectively).

CONCLUSIONS

Barrett's metaplasia, either with dysplasia or without, is associated with an evident increase in the number of Foxp3 lymphocytes within the esophagogastric junction mucosa. Restoration of lymphocyte balance in esophageal tissue might prevent malignant transformation of Barrett's metaplasia.

[Risk and prophylaxis of venous thromboembolism in the material of 2nd Chair of Surgery JUMC]

INTRODUCTION

Venous thromboembolism (VTE) is one of the most dangerous complication that could occur in patiens treated in surgical ward. Threat is increased due to presence of additional, apart from surgical procedures, risk factors. It is assesed, that approximately 50 000 patients are at risk of VTE yearly in Poland, 20 000 of them develop pulmonary thromboembolism during hospitalisation, which is fatal in 10% of cases.

AIM

Aim of the study was to asses presence of VTE risk factors in the group of patients treated in the 2nd Chair of Surgery Jagiellonian University Medical College and to analyse applied prophylaxis.

MATERIAL AND METHODS

The study enrolled 170 patients, 89 (52%) females and 81 (48%) males. Average age of the studied group was 57.9. Medical history of all patients was taken with an emphasis on presence of VTE risk factors. It had a form of questionnaire and enclosed questions. Apart from the anamnesis, physical examination was performed. Type of applied prophylaxis was assesed on the basis of medical records.

RESULTS

Each patient was charged with 4 risk factors on average. The most common risk factors were: age, surgical procedure lasting longer than 45 minutes, ischaemic heart disease and hipertension. Clinical probability of deep venous thrombosis was assesed according to Wells scale; low: 59% of studied group, intermediate: 41%, high: 0%. Applied prophylaxis included pharmacotherapy, physiotherapy, and mechanical methods (compression).

CONCLUSIONS

The most common risk factor that could be changed was duration of the surgery lasting longer than 45 minutes. Pharmacological prophylaxis should be more often complemented by mechanical methods and physiotherapy, especially in group burdened with high risk of VTE.