Hypotensive drugs mitigate the high-sodium diet-induced pro-inflammatory activation of mouse macrophages in vivo

Nowadays, there is an increasing emphasis on the need to alleviate the chronic inflammatory response to effectively treat hypertension. However, there are still gaps in our understanding on how to achieve this. Therefore, research on interaction of antihypertensive drugs with the immune system is extremely interesting, since their therapeutic effect could partly result from amelioration of hypertension-related inflammation, in which macrophages seem to play a pivotal role. Thus, current comprehensive studies have investigated the impact of repeatedly administered hypotensive drugs (captopril, olmesartan, propranolol, carvedilol, amlodipine, verapamil) on macrophage functions in the innate and adaptive immunity, as well as if drug-induced effects are affected by a high-sodium diet (HSD), one of the key environmental risk factors of hypertension. Although the assayed medications increased the generation of reactive oxygen and nitrogen intermediates by macrophages from standard fed donors, they reversed HSD-induced enhancing effects on macrophage oxidative burst and secretion of pro-inflammatory cytokines. On the other hand, some drugs increased macrophage phagocytic activity and the expression of surface markers involved in antigen presentation, which translated into enhanced macrophage ability to activate B cells for antibody production. Moreover, the assayed medications augmented macrophage function and the effector phase of contact hypersensitivity reaction, but suppressed the sensitization phase of cell-mediated hypersensitivity under HSD conditions. Our current findings contribute to the recognition of mechanisms, by which excessive sodium intake affects macrophage immune activity in hypertensive individuals, and provide evidence that the assayed medications mitigate most of the HSD-induced adverse effects, suggesting their additional protective therapeutic activity.

Immunomodulatory properties of antihypertensive drugs and digitalis glycosides

INTRODUCTION

The role of chronic inflammatory process in the pathogenesis or exacerbation of hypertension has been already acknowledged.

AREAS COVERED

Therefore, one can speculate that hypotensive drugs may exert some of their therapeutic effects due to immunomodulatory properties. So far, this assumption has been tested in different studies, and the resulting knowledge is summarized in the current review article that is dedicated to different groups of antihypertensives, namely calcium channel blockers, beta blockers, as well as other less commonly used medications, such as hydralazine, agonists of alfa-2 receptor, diazoxide, doxazosin, aliskiren, and sodium nitroprusside. Articles were found in the Pubmed database by entering the name of a specific drug (or group of drugs) together with the words: immunology, cellular response, humoral response, inflammation, interleukin. The 2000-2021 range was used to search for all drugs except propranolol (1980-2021) and calcium blockers (1990-2021).

EXPERT OPINION

Observed decrease in serum/plasma concentration of proinflammatory cytokines, and CRP along with lower expression of adhesion molecules on immune cells strongly suggest that these drugs possess immunomodulatory properties, which seems to be crucial in the medical practice, especially in the therapy of hypertensive patients with other accompanying inflammatory-based diseases, such as type II diabetes, developed metabolic syndrome, allergies or autoimmunity.

Captopril Combined with Furosemide or Hydrochlorothiazide Affects Macrophage Functions in Mouse Contact Hypersensitivity Response

Hypertension is a chronic disease associated with chronic inflammation involving activated macrophages. Antihypertensive drugs (for example, angiotensin-converting enzyme inhibitors—ACEIs) used in the treatment of hypertension have immunomodulatory properties. On the other hand, the immunological effect of diuretics and combined drugs (diuretics + ACEI) is unclear. Therefore, we examined the influence of diuretics and combination drugs (ACEI + diuretic) on cellular response (contact hypersensitivity), production of reactive oxygen intermediates (ROIs), and nitric oxide (NO), and the secretion of interleukin-12 (IL-12). CBA mice were administered i.p. captopril (5 mg/kg) with or without hydrochlorothiazide (10 mg/kg) or furosemide (5 mg/kg) for 8 days. On the third day, the mice were administered i.p. mineral oil, and macrophages were collected 5 days later. In the presented results, we show that diuretics administered alone or with captopril increase the generation of ROIs and reduce the formation of NO by macrophages. Moreover, tested drugs inhibit the secretion of IL-12. Diuretics and combined drugs reduce the activity of contact hypersensitivity (both activation and induction phases). Our research shows that the tested drugs modulate the cellular response by influencing the function of macrophages, which is important in assessing the safety of antihypertensive therapy.

Impact of stress urinary incontinence on female sexual activity

OBJECTIVE

The study aimed to investigate the impact of SUI (Stress Urinary Incontinence) on the sexual activity of women, to assess their sexual functioning, and to show the extent of the problem that SUI poses to the quality of life of women.

PATIENTS AND METHODS

The study involved 70 women aged 20-48 years. The inclusion criteria included the presence of stress urinary incontinence, the sexual activity of the women, and the history of no urogynecological intervention. The authorial questionnaire and the Polish version of the Female Sexual Function Index (FSFI) were used.

RESULTS

SUI contributes to reducing the frequency of intercourse and even complete resignation from sexual intercourse. There is a correlation between the occurrence of urinary leakage during intercourse and the occurrence of sexual dysfunction (p=0.023). The most common factors limiting sexual activity are decreased libido, fatigue, lack of desire, and lack of body acceptance. However, age (p=0.070), marital status (p=0.091), Body Mass Index (BMI) (p=0.436), as well as the duration of stress urinary incontinence (p=0.36) have no effect on women's sexual activity. The most common ways of dealing with the loss of urine during intercourse include micturition before intercourse, intercourse only in safe places, restriction of physical activity during intercourse, and reduction of intercourse frequency and duration.

CONCLUSIONS

SUI in women has a significant effect on their sexual activity. The cause of this state of affairs is multifactorial. Some women try to cope with the problem and have developed a number of strategies that allow them to be sexually active without unpleasant surprises.

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

OBJECTIVES

To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality.

MATERIAL AND METHODS

We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology.

RESULTS

During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5-88.5] vs. 63.5 [51-77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003).

CONCLUSIONS

Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality.

Prognostic factors, symptoms and consequences of dehydration and dyselectrolytemia in patients with terminal stomach cancer

BACKGROUND

Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer.

AIMS

To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer.

METHODS

An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years.

FINDINGS

Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it.

CONCLUSIONS

Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.

fT3:fT4 ratio in Graves' disease - correlation with TRAb level, goiter size and age of onset

INTRODUCTION

Graves' Disease (GD) is an autoimmune hyperthyroidism occurring mostly in young women. The main pathogenic role of the disease is attributed to TSH receptor antibodies (TRAb), which stimulate the thyroid gland to increase production of the most active thyroid hormone- triiodothyronine (T3). High level of TRAb and a large goiter size are commonly known as poor prognostic factors for the disease and are used to predict relapse.

THE AIM

The purpose of our study was to check the correlation between fT3:fT4 ratio with TRAb concentration, total volume of thyroid and age of GD onset.

MATERIALS AND METHODS

114 patients with onset or relapse of GD were analyzed. Those after thyroidectomy or radioiodine therapy were not taken into analysis. The data was retrospectively retrieved from the hospital's records consisting of patients' sex, age, level of TRAb, fT3, fT4 and thyroid volume on ultrasonography. The association between fT3:fT4 and TRAb concentration, thyroid volume and age was evaluated using Pearson correlation coefficient.

RESULTS

The group was predominated by women (19.3% men, 80.7% women). The average age was 47.0. The analysis revealed positive correlation between: 1) fT3:fT4 ratio and total volume of thyroid (correlation ratio: 0.37; p <0.05) 2) fT3:fT4 ratio and level of TRAb (correlation ratio: 0.26; p or <0.05) 3) negative correlation between fT3:fT4 ratio and patient's age (correlation ratio: -0.14; p = 0.144).

CONCLUSIONS

Positive correlations between fT3:fT4 ratio and TRAb level and total volume of thyroid (poor predictors of GD) may confirm that high level of fT3 can also be a prognostic factor for GD severity.

Evaluation of the prognostic value of LMR, PLR, NLR, and dNLR in urothelial bladder cancer patients treated with radical cystectomy

OBJECTIVE

Our aim was to evaluate the association between preoperative LMR, PLR, NLR, dNLR, and survival of urothelial bladder cancer (UBC) patients treated with radical cystectomy (RC). We also analyzed the relationship between preoperative blood-based inflammatory biomarkers' levels and postoperative in-hospital complications.

PATIENTS AND METHODS

This retrospective study included 144 UBC patients, who underwent RC between 2003 and 2015. The study endpoints were cancer-specific survival (CSS) and overall survival (OS).

RESULTS

Univariable analysis revealed that continuous LMR, PLR, NLR and dNLR were significantly associated with CSS and OS. On multivariable regression model analysis, continuous LMR, NLR, and dNLR independently predicted both endpoints. Furthermore, the group of patients with lower LMR values had a greater chance of developing postoperative in-hospital complications.

CONCLUSIONS

Our findings indicate that the cheap and simple blood-based biomarkers may be valuable in identifying UBC patients treated with RC, who are at higher risk of all-cause and cancer-related mortality.

Evaluation of prognostic factors, symptoms and consequences of dehydration in patients with cancer based on retrospective data analysis of 102 patients treated in the Department of Palliative Medicine at the University Hospital in Cracow - preliminary report

INTRODUCTION

Dehydration is a common problem in patients with terminal cancer patients. It worsens the quality of life and increases the amount of complications. Factors associated with dehydration need further exploration. The aim of our study was to determine the predictors of dehydration.

PATIENTS AND METHODS

102 terminal cancer patients admitted to Palliative Care Unit were retrospectively analyzed. Detailed physical examination, medical history including history taken from family and care givers was taken upon admission. Laboratory parameters including morphology, sodium, potassium, total and ionized calcium, LDH were taken on admission. We used univariate and multivariate logistic regression analysis to determine factors associated with dehydration.

RESULTS

On admission 39% of patients were diagnosed with dehydration. Multivariate logistic regression analysis after adjustment for possible confounders reviled that lack of family care (p = 0.006; OR = 0.147; CI 95% = 0.038-0.577), higher level of PS (p = 0.0426; OR = 1.65; CI 95% = 1.017-2.667), lack of prior opioid use (p = 0.0233; OR = 0.386; CI 95% = 0.17-0.897), occurrence of nausea and vomiting at admission (p = 0.0077; OR = 3.297; CI 95% = 1.372-7.922), occurrence of dyselectrolytemia (p = 0.0012; OR = 4.462; CI 95% = 1.81-10.997), lack of prior GKS use (p = 0.0362; OR = 0.339; CI 95% = 0.123-0.933); lack of prior NSAID use (p = 0.0255; OR = 0.265; CI 95% = 0.082-0.849) remained independently associated with dehydration.

CONCLUSIONS

Lack of family care, lack of prior opioid use, higher level of PS, occurrence of nausea and vomiting at admission, occurrence of dyselectrolytemia, lack of prior GKS use and lack of prior NSAID use in patients with terminal cancer are factors associated with dehydration.

The role of macrophages in anti-inflammatory activity of antidepressant drugs

Depression is a common disease influencing patients' quality of life, whose etiology involves complex interactions of environmental, genetic and immunological factors. The latter factors include proinflammatory activation of monocytes and macrophages and increased serum levels of proinflammatory cytokines, altogether formulated as the "macrophage theory of depression". Our current review summarizes the impact of the most commonly used antidepressant drugs on the immune response with special emphasis on the role of macrophages in the clinically observed effects. The anti-inflammatory action of antidepressants mainly results from their direct interaction with immune cells and from changes in the concentration and the relations of neurotransmitters sensed by these cells. The summarized data revealed that Mφs are one of the leading cell populations involved in drug-mediated immune effects that can be observed both in subjects with depression as well as in individuals not suffering from depression. Thus, currently reviewed immunomodulatory effects of the experimental use of different antidepressant drugs suggest the possibility of utilizing them in complex therapeutic strategies dedicated to various inflammatory and immune-mediated diseases. It is worth noting that an excessive inflammatory reaction is also associated with the pathogenesis of various cardiovascular, metabolic and neuro-endocrine diseases. Thus, the inclusion of antidepressants in the complex therapy of these disorders may have beneficial effects through the enhancement of the mood of the patient and alleviation of chronic inflammation. On the other hand, presented data suggest that the influence of chronically used antidepressants on anti-microbial and anti-tumor immunity could also be taken into consideration.

An inherited NBN mutation is associated with poor prognosis prostate cancer

BACKGROUND

To establish the contribution of eight founder alleles in three DNA damage repair genes (BRCA1, CHEK2 and NBS1) to prostate cancer in Poland, and to measure the impact of these variants on survival among patients.

METHODS

Three thousand seven hundred fifty men with prostate cancer and 3956 cancer-free controls were genotyped for three founder alleles in BRCA1 (5382insC, 4153delA, C61G), four alleles in CHEK2 (1100delC, IVS2+1G>A, del5395, I157T), and one allele in NBS1 (657del5).

RESULTS

The NBS1 mutation was detected in 53 of 3750 unselected cases compared with 23 of 3956 (0.6%) controls (odds ratio (OR)=2.5; P=0.0003). A CHEK2 mutation was seen in 383 (10.2%) unselected cases and in 228 (5.8%) controls (OR=1.9; P<0.0001). Mutation of BRCA1 (three mutations combined) was not associated with the risk of prostate cancer (OR=0.9; P=0.8). In a subgroup analysis, the 4153delA mutation was associated with early-onset (age ≤ 60 years) prostate cancer (OR=20.3, P=0.004). The mean follow-up was 54 months. Mortality was significantly worse for carriers of a NBS1 mutation than for non-carriers (HR=1.85; P=0.008). The 5-year survival for men with an NBS1 mutation was 49%, compared with 72% for mutation-negative cases.

CONCLUSION

A mutation in NBS1 predisposes to aggressive prostate cancer. These data are relevant to the prospect of adapting personalised medicine to prostate cancer prevention and treatment.