Micronutrients in support to the one carbon cycle for the modulation of blood fasting homocysteine in PCOS women

PURPOSE

Fasting blood homocysteine is increased in PCOS women and is involved in several of its co-morbidities including cardiovascular disease and infertility. Corrective interventions based on the administration of supra-physiologic doses of folic acid work to a low extent. We aimed to test an alternative approach.

METHODS

This was a prospective, randomized, parallel group, open label, controlled versus no treatment clinical study. PCOS women aged > 18, free from systemic diseases and from pharmacological treatments were randomized with a 2:1 ratio for treatment with activated micronutrients in support to the carbon cycle (Impryl, Parthenogen, Switzerland-n = 22) or no treatment (n = 10) and followed-up for 3 months. Fasting blood homocysteine, AMH, testosterone, SHBGs, and the resulting FTI were tested before and at the end of the follow-up.

RESULTS

The mean baseline fasting blood homocysteine was above the normal limit of 12 μMol/L and inversely correlated with SHBG. AMH was also increased, whereas testosterone, SHBG, and FTI were within the normal limit. The treatment achieved a significant reduction of homocysteine, that did not change in the control group, independently of the starting value. The treatment also caused an increase of AMH and a decrease of SHBGs only in the subgroup with a normal homocysteine at baseline.

CONCLUSIONS

In PCOS ladies, blood homocysteine is increased and inversely correlated with the SHBGs. Physiologic amounts of activated micronutrients in support to the carbon cycle achieve a reduction virtually in all exposed patients. Whether this is of clinical benefit remains to be established.

OxeR1 regulates angiotensin II and cAMP-stimulated steroid production in human H295R adrenocortical cells

Hormone-regulated steroidogenesis and StAR protein induction involve the action of lipoxygenated products. The products of 5-lipoxygenase act on inflammation and immunity by stimulation of a membrane receptor called OxeR1. The presence of OxeR1 in other systems has not been described up to date and little is known about its mechanism of action and other functions. In this context, the aim of this study was the identification and characterization of OxeR1 as a mediator of cAMP-dependent and independent pathways. Overexpression of OxeR1 in MA-10 Leydig cells increased cAMP-dependent progesterone production. Angiotensin II and cAMP stimulation of adrenocortical human H295R cells produced an increase in StAR protein induction and steroidogenesis in cells overexpressing OxeR1 as compared to mock-transfected cells. Additionally, activation of OxeR1 caused a time-dependent increase in ERK1/2 phosphorylation. In summary, membrane receptor OxeR1 is involved in StAR protein induction and activation of steroidogenesis triggered by cAMP or angiotensin II, acting, at least in part, through ERK1/2 activation.

Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis

Sleep is essential for the cellular, organic and systemic functions of an organism, with its absence being potentially harmful to health and changing feeding behavior, glucose regulation, blood pressure, cognitive processes and some hormonal axes. Among the hormonal changes, there is an increase in cortisol (humans) and corticosterone (rats) secretion, and a reduction in testosterone and Insulin-like Growth Factor 1, favoring the establishment of a highly proteolytic environment. Consequently, we hypothesized that sleep debt decreases the activity of protein synthesis pathways and increases the activity of degradation pathways, favoring the loss of muscle mass and thus hindering muscle recovery after damage induced by exercise, injuries and certain conditions associated with muscle atrophy, such as sarcopenia and cachexia.

Helicobacter pylori infection, chronic gastritis, and proton pump inhibitors

The proton pump inhibitors (PPIs) omeprazole, lansoprazole, and pantoprazole are widely used as antisecretory drugs and, in association with antibiotics, for the treatment of Helicobacter pylori infections. PPIs possess antibacterial activity against H. pylori in vitro, and may also exert an anti-inflammatory effect by interfering with the cellular immune response to infection. Their antimicrobial activity is selective for H. pylori. Lansoprazole is the most effective, although its bactericidal activity is similar to that of omeprazole. Pantoprazole is the least effective. The mechanisms that account for the antibacterial effects of PPIs may depend on a structural similarity of PPIs to antibiotics which are active against H. pylori, on the inhibition of bacterial urease exerted by PPIs, or on the possible interaction of PPIs with bacterial ATPases that regulate the transmembrane ion flux. Recent studies have shown that PPIs have anti-inflammatory actions and can interfere with the host-bacteria interactions. Lansoprazole can bind to polymorphonuclear leukocytes that infiltrate the gastric mucosa colonized by H. pylori and can thus inhibit the oxidative burst of activated inflammatory cells. In an in vivo study, lansoprazole reduced the degree of activity of histologic gastritis independently of the presence of H. pylori. In another study, omeprazole was capable of inhibiting the cytotoxic activity of NK T cells. Investigation of PPI interactions with H. pylori activities and the cellular immune response to the infection may help us to understand the pathogenic mechanisms of H. pylori-associated diseases and enable clinicians to better treat them.

Bedtime administration of lansoprazole does not modify its greater efficacy vs ranitidine in the acute and long-term treatment of duodenal ulcer. Results from a multicentre, randomised, double blind clinical trial

BACKGROUND/AIMS

The efficacy of proton pump inhibitors is considered linked to morning, fasting administration. The aim of the present study was to assess efficacy and tolerability of the proton pump inhibitors lansoprazole given at bedtime as compared to ranitidine, both in acute and maintenance treatment of duodenal ulcer.

METHODS

This was a randomised double blind study. The patients were divided into 4 treatment groups as follows (healing/maintenance): 1) lansoprazole 30 mg/lansoprazole 15 mg; 2) lansoprazole 30 mg/placebo; 3) ranitidine 300 mg/ranitidine 150 mg; 4) ranitidine 300 mg/placebo. Healing and relapse of ulcers were assessed by endoscopy at 2, 4 and 8 weeks and then at 3, 6, 9 and 12 months during follow-up.

RESULTS

A total of 132 patients were enrolled in 9 study centres. The cumulative healing rates (per-protocol analysis) at 2, 4 and 8 weeks were 57.4%, 83.9% and 89.2% in the lansoprazole group and 30%, 70.2% and 78.7% in the ranitidine group (p = 0.01 at 2 weeks). The 12-month cumulative relapse rate (intent-to-treat analysis) was lower in the lansoprazole/lansoprazole group (23.3%), than those reported by the other groups of patients lansoprazole/placebo (39.3%); ranitidine/ranitidine (45.8%); ranitidine/placebo (50%). The disease-free time from healing was significantly longer for lansoprazole treated patients (p < 0.05). All treatments were very well tolerated, only few minor adverse events being reported.

CONCLUSIONS

Lansoprazole maintains its greater efficacy vs ranitidine even when administered at bedtime, both for the healing and for the maintenance treatment of duodenal ulcer. Lansoprazole (half dose formulation) may be useful for the treatment of patients requiring long-term acid suppression.

A novel, simplified and cost effective protocol for superovulation and intrauterine insemination

OBJECTIVE

To determine the efficacy and cost of a simplified superovulation regimen compared with traditional control ovarian hyperstimulation with gonadotropins (HMG).

STUDY DESIGN

This was a retrospective study in a university referral center with 99 infertile couples undergoing 225 treatment cycles. The outcome was compared to outcomes of previously published studies. The simplified superovulation regimen included clomiphene citrate 100 mg on cycle days 5 through 9 and HMG 75 IU on cycle days 5, 7, 9, and 11, with estradiol and ultrasound monitoring on day 13. If adequate follicular maturity was documented, HCG 10,000 IU was administered, followed by intrauterine insemination 40 hours later.

RESULTS

Fecundity rates were assessed by life table analysis. Average cycle fecundity was 8%, with a cumulative rate of 29% over 4 cycles, compared to 10% monthly fecundity with HMG/IUI and background rates of 1 to 3%. Costs averaged $662 per cycle compared to $1,854 with HMG/IUI.

CONCLUSION

A simplified protocol of CC/HMG/ IUI is almost as effective as HMG/IUI and costs only one-third as much.

In-vitro activity of lansoprazole against Helicobacter pylori

Lansoprazole is a gastric parietal cell proton pump inhibitor that is also active against Helicobacter pylori in vitro. We aimed to investigate further the mechanism of its antimicrobial effect. The antimicrobial activity of lansoprazole and of its sulfenamide, a rearrangement product occurring spontaneously in acid environments, was studied by determining the MICs and MBCs for 11 cytotoxic and eight non-cytotoxic H. pylori strains and by measuring the rapidity of bacterial killing. The MIC90 and MBC90 were 2.5 mg/L and 10 mg/L, respectively, both for lansoprazole and for its sulfenamide. Cytotoxic strains were as susceptible as non-cytotoxic strains. The sulfenamide exhibited faster bactericidal activity. Lansoprazole did not inhibit the toxin-induced vacuolization of HeLa cells by a cytotoxic strain, hence its anti-H. pylori activity does not depend on inhibition of a v-ATPase-mediated, toxin-induced activity. Sulfenamide formation is likely to occur in vivo in the gastric environment, thus enhancing the bactericidal activity of the drug. Lansoprazole is likely to be useful, in association with antibiotics, in the treatment of H. pylori infection regardless of the cytotoxicity of the infecting strain.

Nicotinamide methylation in patients with cirrhosis

Methylation reactions play an important role in the transformation of endogenous and exogenous substances. Up to 85% of all transmethylation reactions occur in the liver. Several studies have shown that these metabolic processes are greatly influenced by the presence of hepatic diseases. We investigated the methylation of nicotinamide in 16 control subjects and in 29 patients with cirrhosis (19 Child A, 10 Child B). The basal serum value of N-methyl-nicotinamide was measured in all subjects. In seven controls and in nine patients with cirrhosis (5 Child A and 4 Child B), the serum levels and urinary excretion (5 and 24 h) of N-methyl-nicotinamide were also evaluated after oral administration of nicotinamide (1.5 mg/kg body weight). The basal serum levels of N-methyl-nicotinamide were significantly (p < 0.05) higher in patients with cirrhosis (Child A: median 34 ng/ml, 16th percentile 24, 84th percentile 61; Child B median 45, 16th percentile 34, 84th percentile 81) than in controls (median 22, 16th percentile 13, 85th percentile 28). After the nicotinamide load the urinary excretion and the time course of serum N-methyl-nicotinamide in cirrhosis were also higher (p < 0.05) than in controls (24 h urinary excretion = 66.2 mg +/- 5 S.D. in cirrhosis; 47.2 +/- 10.3 in controls) (area under the serum concentration versus time curve = 68 micrograms.ml-1.min-1 +/- 22 S.D. in cirrhosis; 32 +/- 15 in controls). In conclusion, our results show that cirrhosis does not impair the efficiency of nicotinamide methylation.

Intrauterine insemination. Effect of wash media on pregnancy rates and sperm motility

Testyolk Buffer has been shown to enhance sperm penetration in hamster penetration assays and increase fertilization of oocytes in in vitro fertilization. Based on these findings, we compared pregnancy rates and sperm motility in intrauterine inseminations done with sperm samples washed and resuspended in Ham's F10 as compared with Testyolk buffer. Charts were reviewed retrospectively from 1,098 husband and donor intrauterine inseminations performed at the University of Florida. Data were analyzed using life table analysis and the curves compared with the Mantel-Haenszel statistical test. In addition, sperm motility in fresh sperm was observed in samples incubated in Testyolk or Ham's F10, with motility counts performed at 0, 6 and 24 hours. Four hundred ninety-two Testyolk cycles and 579 Ham's F10 cycles were compared, with cumulative pregnancy rates at one year of 53% and 44%, respectively (P = .58). With donor sperm, 229 cycles with Testyolk and 314 cycles with Ham's F10 had cumulative pregnancy rates of 68% and 48%, respectively (P = .52). With husband insemination, 264 Testyolk and 253 Ham's F10 cycles had pregnancy rates of 37% and 35%, respectively (P = .23). Fresh sperm motility in 22 samples compared at 0, 6 and 24 hours in Ham's F10 (76%, 67.8%, 56.6%) versus Testyolk (76%, 67.7%, 58.8%) revealed no significant differences. There was also no difference in total motile sperm inseminated and postwash motility in 1,098 samples with Testyolk versus Ham's F10. This study demonstrates that there is no enhanced pregnancy rate or increased sperm motility when sperm are treated with Testyolk Buffer instead of Ham's F10.