Surface entrenched β-sitosterol niosomes for enhanced cardioprotective activity against isoproterenol induced cardiotoxicity in rats

Cardiotoxicity (CT) is a severe condition that negatively impacts heart function. β-sitosterol (BS) is a group of phytosterols and known for various pharmacological benefits, such as managing diabetes, cardiac protection, and neuroprotection. This study aims to develop niosomes (NS) containing BS, utilizing cholesterol as the lipid and Tween 80 as the stabilizer. The research focuses on designing and evaluating both conventional BS-NS and hyaluronic acid (HA) modified NS (BS-HA-NS) to enhance the specificity and efficacy of BS within cardiac tissue. The resulting niosomal formulation was spherical, with a size of about 158.51 ± 0.57 nm, an entrapment efficiency of 93.56 ± 1.48 %, and a drug loading of 8.07 ± 1.62 %. To evaluate cytotoxicity on H9c2 heart cells, the MTT assay was used. The cellular uptake of BS-NS and BS-HA-NS was confirmed by confocal microscopy on H9c2 cardiac cells. Administering BS-NS and BS-HA-NS intravenously at a dose of 10 mg/kg showed the ability to significantly decrease the levels of cardiac troponin-I (cTn-I), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and lipid peroxidation (MDA). Tissue histopathology indicated a substantial potential for repairing cardiac tissue after treatment with BS-NS and BS-HA-NS and strong cardioprotection against ISO induced myocardial tissue damages. Thus, enhancing BS's therapeutic effectiveness through niosome surface modification holds promise for mitigating cardiac damage resulting from CT.

Drug-induced Stevens-Johnson syndrome in Post traumatic facial injury

Stevens-Johnson syndrome is a severe adverse drug reaction affecting the skin and mucous membrane. The causes include Sulfonamides, Anticonvulsants, etc. A patient developed ulcerations in the lips and oral cavity with difficulty in swallowing and rashes over the back, abdomen, and genitalia following administration of injection ceftriaxone 1 g intravenous (IV) b.i.d, injection pantoprazole 40 mg IV b.i.d, tablet aceclofenac + paracetamol 325 mg b.i.d, tablet cetirizine 10 mg b.i.d, chlorhexidine mouth wash, and injection metronidazole 500 mg IV t.i.d for the treatment of traumatic facial injury after 4 days of treatment. Injection ceftriaxone and tablet aceclofenac + paracetamol were suspected as the cause of this reaction. The two drugs were stopped. The patient was treated with corticosteroids, other antimicrobials, and oral topical anesthetics. Health-care providers should be careful about the possible adverse drug reactions even to commonly used drugs.

Pentapeptide cRGDfK-Surface Engineered Nanostructured Lipid Carriers as an Efficient Tool for Targeted Delivery of Tyrosine Kinase Inhibitor for Battling Hepatocellular Carcinoma

Background

Antitumor research aims to efficiently target hepatocarcinoma cells (HCC) for drug delivery. Nanostructured lipid carriers (NLCs) are promising for active tumour targeting. Cell-penetrating peptides are feasible ligands for targeted cancer treatment.

Methods

In this study, we optimized gefitinib-loaded NLCs (GF-NLC) for HCC treatment. The NLCs contained cholesterol, oleic acid, Pluronic F-68, and Phospholipon 90G. The NLC surface was functionalized to enhance targeting with the cRGDfK-pentapeptide, which binds to the αvβ3 integrin receptor overexpressed on hepatocarcinoma cells.

Results

GF-NLC formulation was thoroughly characterized for various parameters using differential scanning calorimetry and X-ray diffraction analysis. In-vitro and in-vivo studies on the HepG2 cell line showed cRGDfK@GF-NLC's superiority over GF-NLC and free gefitinib. cRGDfK@GF-NLC exhibited significantly higher cytotoxicity, growth inhibition, and cellular internalization. Biodistribution studies demonstrated enhanced tumour site accumulation without organ toxicity. The findings highlight cRGDfK@GF-NLC as a highly efficient carrier for targeted drug delivery, surpassing non-functionalized NLCs. These functionalized NLCs offer promising prospects for improving hepatocarcinoma therapy outcomes by specifically targeting HCC cells.

Conclusion

Based on these findings, cRGDfK@GF-NLC holds immense potential as a highly efficient carrier for targeted drug delivery of anticancer agents, surpassing the capabilities of non-functionalized NLCs. This research opens up new avenues for effective treatment strategies in hepatocarcinoma.

c(RGDfK) anchored surface manipulated liposome for tumor-targeted Tyrosine Kinase Inhibitor (TKI) delivery to potentiate liver anticancer activity

Current anticancer drug research includes tumor-targeted administration as a critical component because it is the best strategy to boost efficacy and decrease toxicity. Low drug concentration in cancer cells, nonspecific distribution, rapid clearance, multiple drug resistance, severe side effects, and other factors contribute to the disappointing results of traditional chemotherapy. As an innovative technique of treatments for hepatocellular carcinoma (HCC) in recent years, nanocarrier-mediated targeted drug delivery systems can overcome the aforesaid limitations via enhanced permeability and retention effect (EPR) and active targeting. Epidermal growth factor receptor (EGFR) inhibitor Gefitinib (Gefi) has dramatic effects on hepatocellular carcinoma. Herein, we developed and assessed an α_vβ₃ integrin receptor targeted c(RGDfk) surface modified liposomes for better targeting selectivity and therapeutic efficacy of Gefi on HCC cells. The conventional and modified Gefi loaded liposomes, i.e., denoted as Gefi-L and Gefi-c(RGDfK)-L, respectively, were prepared through the ethanol injection method and optimized via Box Behnken design (BBD). The FTIR and ¹H-NMR spectroscopy verified that the c(RGDfK) pentapeptides had formed an amide bond with the liposome surface. In addition, the particle size, Polydispersity index, zeta potential, encapsulation efficiency, and in-vitro Gefi release of the Gefi-L and Gefi-c(RGDfK)-L were measured and analyzed. As indicated by the MTT assay on HepG2 cells, Gefi-c(RGDfK)-L displayed considerably higher cytotoxicity than Gefi-L or Gefi alone. Throughout the incubation period, HepG2 cells took up significantly more Gefi-c(RGDfK)-L than Gefi-L. According to the in vivo biodistribution analysis, Gefi-c(RGDfK)-L accumulated more strongly at the tumor site than Gefi-L and free Gefi. Furthermore, HCC-bearing rats treated with Gefi-c(RGDfK)-L showed a substantial drop in liver marker enzymes (alanine transaminase, alkaline phosphatase, aspartate transaminase, and total bilirubin levels) compared to the disease control group. Gefi-c(RGDfK)-L suppresses tumour growth more effectively than Gefi-L and free Gefi, according to an in vivo analysis of their anticancer activities. Thus, c(RGDfk)-surface modified liposomes, i.e., Gefi-c(RGDfK)-L may serve as an efficient carrier for the targeted delivery of anticancer drugs.

Novel Synergistic Approach: Tazarotene-Calcipotriol-Loaded-PVA/PVP-Nanofibers Incorporated in Hydrogel Film for Management and Treatment of Psoriasis

Psoriasis is an autoimmune skin disease that generally affects 1%-3% of the total population globally. Effective treatment of psoriasis is limited because of numerous factors, such as ineffective drug delivery and efficacy following conventional pharmaceutical treatments. Nanofibers are widely being used as nanocarriers for effective treatment because of their multifunctional and distinctive properties, including a greater surface area, higher volume ratio, increased elasticity and improved stiffness and resistance to traction, favorable biodegradability, high permeability, and sufficient oxygen supply, which help maintain the moisture content of the skin and improve the bioavailability of the drugs. Similar to the extracellular matrix, nanofibers have a regeneration capacity, promoting cell growth, adhesion, and proliferation, and also have a more controlled release pattern compared with that of other conventional therapies at the psoriatic site. To ensure improved drug targeting and better antipsoriatic efficacy, this study formulated and evaluated a tazarotene (TZT)-calcipotriol (CPT)-loaded nanofiber and carbopol-based hydrogel film. The nanofiber was prepared using electrospinning with a polyvinyl alcohol/polyvinylpyrrolidone (PVA/PVP) K-90 polymeric blend that was later incorporated into a carbopol base to form hydrogel films. The prepared nanofibers were biochemically evaluated and in vitro and in vivo characterized. The mean diameters of the optimized formulation, i.e., TZT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-PVA/PVP-NF) and TZT-CPT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-CPT-PVA/PVP-NF) were 244.67 ± 58.11 and 252.31 ± 35.50 nm, respectively, as determined by scanning electron microscopy, and their tensile strength ranged from 14.02 ± 0.54 to 22.50 ± 0.03 MPa. X-ray diffraction revealed an increase in the amorphous nature of the nanofibers. The biodegradability studies of prepared nanofiber formulations, irrespective of their composition, showed that these completely biodegraded within 2 weeks of their application. The TZT-CPT-PVA/PVP-NF nanofibers exhibited 95.68% ± 0.03% drug release at the end of 72 h, indicating a controlled release pattern and following Higuchi release kinetics as a best-fit model. MTT assay, antioxidant and lipid profile tests, splenomegaly assessment, and weight fluctuation were all performed in the in vitro as well as in vivo studies. We found that the TZT-CPT-PVA/PVP-NF-based hydrogel film has high potential for antipsoriatic activity in imiquimod-induced Wistar rats in comparison with that of TT-PVA/PVP-NF nanofibers.

Morphological groupings within Euphlyctis (Anura: Dicroglossidae) and description of a new species from the surroundings of Thattekad Bird Sanctuary, Kerala, India

The skittering frog genus Euphlyctis is known to have a distribution range from Arabian Peninsula to Bangladesh through India and Sri Lanka. Although species descriptions were initiated about two centuries ago in the genus with a small number of species described, taxonomic identities and genetic information for many species are still incomplete / inaccurate. Here, we report the systematic status of this group, discuss a series of taxonomic issues, and describe a new species. Based on morphological characters and colour patterns, and their reciprocal monophyly in the molecular tree, two morphological groups, 'cyanophlyctis group' and 'hexadactylus group' are established within the genus Euphlyctis. We discuss the genetic identity for E. cyanophlyctis, described 220 years ago from the Indian subcontinent, from the surroundings of its type locality. E. mudigere is proposed as a junior synonym of E. cyanophlyctis as it was described from populations here considered to originate from the general distribution area of the latter taxon, and without substantial genetic divergence from other populations here attributed to E. cyanophlyctis. The potential of resurrection of Euphlyctis seistanica due to distinct genetic population in Iran is discussed; this lineage appears to be genetically rather similar to E. kalasgramensis, and the species distinctness of these two lineages requires further study. The validity of E. kalasgramensis is also discussed in the context of the historically earlier nomina, Rana bengalensis and Rana leschenaultii due to distribution range overlaps. The prospects of establishing either Rana cyanophlictis variety fulvus or Rana cyanophlictis variety flavens from Sri Lanka are also mentioned. Based on a comparative account, we report the discovery of a new species of skittering frog Euphlyctis kerala sp. nov. which has a restricted distribution in the western coastal plains of India, south of the Palghat gap. [http://zoobank.org/urn:lsid:zoobank.org:act:02B1DE04-C40C-4AAD-AC87-EF97673A4BF5].

A distributional semantics-based information retrieval framework for online social networks

Online social networks are considered to be one of the most disruptive platforms where people communicate with each other on any topic ranging from funny cat videos to cancer support. The widespread diffusion of mobile platforms such as smart-phones causes the number of messages shared in such platforms to grow heavily, thus more intelligent and scalable algorithms are needed for efficient extraction of useful information. This paper proposes a method for retrieving relevant information from social network messages using a distributional semantics-based framework powered by topic modeling. The proposed framework combines the Latent Dirichlet Allocation and distributional representation of phrases (Phrase2Vec) for effective information retrieval from online social networks. Extensive and systematic experiments on messages collected from Twitter (tweets) show this approach outperforms some state-of-the-art approaches in terms of precision and accuracy and better information retrieval is possible using the proposed method.

A Review on Novel Ligand Targeted Delivery for Cardiovascular Disorder

Cardiovascular disease covers the various disorders like ischemic heart disease, hyperlipidemia, atherosclerosis, myocardial infarction, and hypertension etc. There are many synthetic drugs are available for the treatment of cardiovascular therapy, but they have several drawbacks like high dosing, toxicity, elevated blood potassium levels, low blood pressure, and gastrointestinal issues etc. To overcome these side effects of synthetic drugs by targeting the drug to the specific cardiac tissue is the best novel method in the cardiovascular therapy. The highest targeting efficacy of Ligand-based therapy with proper mechanisms and improved expandability provides a novel therapeutic strategy in the cardiovascular disease. Ligand therapy is cost-effective compared to cell-based therapy. The surface area of protein has much larger than the orally bioavailable drug. So, the targeting of various less active drug molecules to the particular ligand can be possible. The efficacy of ligands to induce cardiomyocytes proliferation has been ratified and point out the fact that ligand-based approaches are effective for cardiac transformation. Ligands interact with proteins in target cells, which are influenced through the chemical signals. These various receptors possess selective binding of biased ligands and also energizing the intracellular signaling pathway. The ligands can directly stabilize the active receptor conformations by a non-standard connective site. The key function of ligands is functional selectivity, which enhances the therapeutic efficacy and minimizes the side effects of drugs through the interpretation of signal transduction pathways. This review covers the role and effectiveness of novel ligands in the cardiovascular disorders.

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Curcumin loaded polycaprolactone-/polyvinyl alcohol-silk fibroin based electrospun nanofibrous mat for rapid healing of diabetic wound: An in-vitro and in-vivo studies

Electrospinning is emerging as a versatile technique nanofibers fabrication because due to their unique properties such as large surface area to volume ratio, porosity and maintaining moist wound environment, the nanofibers are able to deliver sustained drug release and oxygen to the wound for rapid healing of diabetic wound. The present work was aimed to prepare and evaluate silk fibroin-curcumin based nanofiber in combination with polycaprolactone (PCL) and polyvinyl alcohol (PVA) which helped to strengthen the wound healing properties of nanofiber. Silk fibroin is a naturally occurring polymer was selected one polymer for making nanofibrous mat due to its unique properties such as biodegradability, permeability, oxygen supply and maintain moisture content in the wound. SEM results showed diameters of fibers varied in the range between 200 and 350 nm and their tensile strength ranged from 12.41 to 16.80 MP. The nanofibers were causing sustained release of curcumin for many hours. The in-vivo wound healing studies in streptozotocin-induced diabetic mice showed rapid wound healing efficacy as compared to conventional formulations. Furthermore, the histopathological studies evidenced its ability to restore the normal skin structure and histological conditions of tissues. The silk fibroin-based nanofiber wound dressing, therefore appears to be an ideal preparation, in combination with curcumin, because it blends the anti-oxidant, anti-inflammatory properties of curcumin. Therefore, it was concluded that the silk fibroin-based nanofiber loaded with curcumin has great healing potential in diabetic wound.

Distribution status of the Western Burrowing Frog, Sphaerotheca pashchima in India

In a recent study, Hortal et al. (2015) recognized seven shortfalls of knowledge that hamper our understanding of biodiversity. Three of these are of particular importance for drawing conservation strategies for ecological indicator species, among which we can count the amphibians (Simon et al. 2011): the Linnean shortfall describes 'the knowledge incongruity between the described species and the remaining species yet to be described' (Brown Lomolino 1998); the Wallacean shortfall defines 'paucity of knowledge about the actual distribution range of the species' (Lomolino 2004); and the Darwinian shortfall refers to 'lack of knowledge about the tree of life and evolution of lineages, species and traits' (Diniz-Filho et al. 2013).

A new species of Sphaerotheca Günther, 1859 (Anura: Dicroglossidae) from the degraded urban ecosystems of Bengaluru, Deccan Plateau, India

The dicroglossid genus Sphaerotheca was erected by Günther in 1859, with its range of distribution in South Asia. Since then, 13 species have been described and 10 species are considered valid. Many of these descriptions were from low to mid-elevation ranges of homestead areas, agroecosystems and degraded landscapes with a few from forested areas. In the present account, a new species of Sphaerotheca, a genetically distinct lineage with a morphological character set distinguishable from its congeners, is described from the surroundings of Bengaluru city, India. Based on evidence for the origin of the original specimen, we also designated a neotype for Rana variegata Gravenhorst, 1829, a junior primary homonym of Rana variegata Linnaeus, 1758, and permanently invalid name, so that it is now a subjective synonym of Rana (Tomopterna) breviceps rolandae Dubois, 1983.

Importance of genetic data in resolving cryptic species: A century old problem of understanding the distribution of Minervarya syhadrensis Annandale 1919, (Anura: Dicroglossidae)

Frogs of the genus Minervarya are cryptic and widely distributed in South Asia. However, many of them lack information about the precise type locality, genetic data, and distribution range. The present study aimed to examine the genetic affinities of a widely distributed species Minervarya syhadrensis around its type locality in the northern Western Ghats (Pune, Maharashtra). We studied the type specimen of M. syhadrensis and collected similar sized Minervarya frogs from Pune district. In the field, we observed two different calls from morphologically similar (M. syhadrensis like) males suggesting the sympatric occurrence of two cryptic species (that we initially named Minervarya species A and Minervarya species B). We analyzed morphology, call pattern, and mitochondrial 16S rRNA gene sequence of both species. Minervarya species A has a long call with a low pulse repetition rate and higher dominant frequency compared to that of the Minervarya species B. These species cannot be differentiated based on morphometric data. However, they can be sorted out using morphological characters such as the presence of longitudinal skin folds on the dorsal side (Minervarya species A) and differences in foot webbing. DNA sequences of Minervarya species A and Minervarya species B are matching with those of M. caperata and M. agricola respectively. After studying the type specimens of M. syhadrensis and M. caperata, we found morphological similarities (longitudinal skin folds) with the samples of Minervarya species A collected during the present study. Based on the results of our study (morphology and genetic) and available literature, we propose to redefine M. syhadrensis as applying to the lineage initially named Minervarya species A, and to treat the species M. caperata as a junior synonym of M. syhadrensis. Our study will be helpful in further taxonomic revision of the genus, and provides natural history information for M. syhadrensis and M. agricola.

Effectiveness of Semantic-based Treatment in Persons with Aphasia

Background

Semantic-based treatment is the salient approach used to remediate word retrieval deficits in persons with aphasia (PWAs). It is deemed to improve semantic attributes around the target word, thus aids in restoring word retrieval abilities. Hence, the present study has developed a semantic-based therapy named semantic cueing of verbs and its thematic role (SCVTr). Also, this therapy uses verbs as a core element accompanied by graded levels of semantic cues.

Aim

The current study Semantic Cueing of Verbs and its Thematic role (SCVTr) aimed to evaluate the effect of word retrieval abilities in PWAs.

Methods and Procedure

Three participants (n = 3) with aphasia were recruited for the study. All the participants in the study received SCVTr therapy, and the responses were analyzed at three distinct time points. That is pre-therapy assessment (before initiation of therapy), mid-therapy assessment (10^th session), and post-therapy assessment (20^th session). Nouns, verbs, and discourse abilities of PWAs were evaluated using standardized test batteries.

Outcomes and Results

The study results have discerned positive gains across trained conditions and discourse genres across all the participants. However, participants exhibited marginal gains with untrained stimuli. In addition, SCVTr therapy aids in modifying the error pattern exhibited by PWAs. Concurrently, researchers noted that all participants showed ameliorated performance on the standardized language test batteries during post-therapy evaluation.

Conclusions

SCVTr therapy has found to be effective in remediating word retrieval deficits in PWAs. This study extends the knowledge about strengthening the semantic network associated with the target word and its effect on generalization.

Generation of synthetic surface electromyography signals under fatigue conditions for varying force inputs using feedback control algorithm

Surface electromyography is a non-invasive technique used for recording the electrical activity of neuromuscular systems. These signals are random, complex and multi-component. There are several techniques to extract information about the force exerted by muscles during any activity. This work attempts to generate surface electromyography signals for various magnitudes of force under isometric non-fatigue and fatigue conditions using a feedback model. The model is based on existing current distribution, volume conductor relations, the feedback control algorithm for rate coding and generation of firing pattern. The result shows that synthetic surface electromyography signals are highly complex in both non-fatigue and fatigue conditions. Furthermore, surface electromyography signals have higher amplitude and lower frequency under fatigue condition. This model can be used to study the influence of various signal parameters under fatigue and non-fatigue conditions.

HSP70 Modulates the Enhanced Production of Reactive Intermediate Metabolites and a Proinflammatory Cytokine TNF-α Expression in a T Cell Lymphoma

Heat shock proteins are intracellular soluble proteins expressed consecutively in all cells. They are immunogenic proteins able to activate antigen-presenting cells by binding through the CD91 receptor and activate both CD4+ and CD8+ T-cells. Macrophage plays a pivotal role in innate immune response and secretes a number of regulatory molecules upon activation. In the present study, we investigate the activation of normal and tumor-associated macrophage to produce the effector molecules which have a role in immunomodulation, especially in the killing of the transformed or tumor cells. In vitro and in vivo treatment of NMO and TAMs (from T-Cell Lymphoma) with optimum dose 10 μg of hsp70 produce effector molecules such as nitric oxide (NO), hydrogen peroxide (H2O2) and tumor necrosis factor-α (TNF α). The results of our experiments reveal that the production of effector molecules is dose-dependent, and the result of immunoblots also confirms the increased expression of iNOS. These findings suggest that autologous hsp70 are highly immunogenic and potent activating agents for the enhanced production of effector molecules in NMO and TAMs in a T-cell lymphoma.

IL-13 Neutralization Modulates Function of Type II Polarized Macrophages in vivo in a Murine T-Cell Lymphoma

IL-13 is a Th2 cytokine that suppresses the effector function and alters the phenotype and function of macrophages switching to alternatively activated or type II polarized macrophages. The type II polarized macrophages or M2 phenotype differ from normal macrophages greatly in terms of receptor expression, cytokine and NO production, that show tumor promoting function rather than tumoricidal function of classically activated macrophages. The chemokines CCL-22 and CCL-17 produced by either tumor cells or alternatively activated macrophages attract Th2 cells preferentially, which increase the local concentration of Th2 cytokines including IL-13 that further skewed the normal phenotype of macrophages at the site of the tumor micro-environment. Therefore, it is possible to restore the phenotype and function of alternatively activated macrophages by eliminating or blocking the activities of these cytokines. In the present investigation, we show that by blocking the activity/signaling of one of its major constituents IL-13, the iNOS expression and correspondingly NO production increases. The observation signifies its efficacy towards a novel approach for cancer therapy by modulating the function of tumor-associated macrophages (TAM) in vivo for the first time.

Heat Shock Proteins (HSP): Future Trends in Cancer Immunotherapy

Heat Shock Proteins (HSPs) are a large family of highly conserved proteins involved in assisting protein folding and unfolding in the cells. HSPs are expressed constitutively as well as inducibly and, interacting with antigen presenting cells, induce the expression of various cytokines and chemokines as well as the maturation and migration of dendritic cells, thus acting themselves as cytokines. HSP-chaperoned antigenic peptides are also generated within the tumor cells. Such chaperoned peptides are released in the extra cellular medium with an association of HSPs by cell stress, death or tumor cell lyses. HSP-peptide complexes from extra cellular medium are taken up by antigen presenting cells through CD91 receptor and are represented or cross-presented by their MHC class I molecules for specific anti-tumor immune response. In addition, HSPs expressed on the cell surface of tumor cells stimulate αβ T-cells and γδ T-cells as well as natural killer (NK) cells that are first-line defense mechanisms. In this manner, HSPs have the ability to stimulate both arms of the effecter mechanism of the immune system. These unique immunological attributes of HSPs are presently becoming the basis for tumor immunotherapy. Tumor-derived HSP-peptide complexes have been demonstrated to serve as anti-tumor vaccines. To date various approaches of vaccination using HSPs have been developed and tested clinically. These HSP-based vaccine approaches can be combined with hyperthermia and CTLA-4 blockade to enhance their anti-tumor potentiality.

Maternal and foetal adverse events with tumour necrosis factor-alpha inhibitors in inflammatory bowel disease

BACKGROUND

Transplacental transfer of tumour necrosis factor-alpha (TNF-α) inhibitors has been shown in mothers receiving therapy for inflammatory bowel disease (IBD).

AIM

To examine reports of adverse events of these medications in pregnancy.

METHODS

Individual Safety Reports of adverse events (Jan 2003-June 2012) were accessed from the Food and Drug Administration Adverse Event Reporting System. The study data set was constructed by searching for cases with an indication for medication usage of IBD. The data set was then queried for key terms indicating pregnancy, followed by elimination of cases with potentially teratogenic exposures (FDA category X concomitant medications) as well exposures to study medications through partner or if the medications were discontinued prior to pregnancy. Logistic regression analysis was performed to detect signals for maternal/foetal adverse events with TNF-α inhibitors and/or thiopurines (compared to aminosalicylates).

RESULTS

A total of 1097 individual Safety Reports in pregnant IBD patients were identified with the majority reported among patients receiving TNF-α inhibitor monotherapy (783 cases, 71.4%). Thiopurine monotherapy (OR 2.55, CI 0.95-6.88) and in combination with TNF-α inhibitors (OR 0.97, CI 0.49-1.93) were not associated with increased odds of maternal/foetal adverse events. Decreased odds for maternal/foetal adverse events were seen with TNF-α inhibitor monotherapy (overall) and specifically with certolizumab monotherapy (OR 0.11, CI 0.05-0.23).

CONCLUSIONS

In this analysis of adverse events from the Food and Drug Administration Adverse Event Reporting System, use of thiopurine monotherapy or in combination with TNF-α inhibitors was not associated with an increase in maternal/foetal adverse events. Certolizumab monotherapy was associated with a decrease in maternal/foetal adverse events.

Neurological events with tumour necrosis factor alpha inhibitors reported to the Food and Drug Administration Adverse Event Reporting System

BACKGROUND

The association between inhibition of tumour necrosis factor alpha (TNF-α) and new onset of neurological adverse events (AEs) is unclear.

AIMS

To evaluate neurological AEs with TNF-α inhibitors reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) utilising a standardised scoring tool for drug-induced AEs.

METHODS

A search of FAERS for neurological AEs (January 1, 2000 to December 31, 2009) reported with infliximab, adalimumab, certolizumab and etanercept was performed. Full-text reports were accessed using the Freedom of Information Act and scored using Naranjo score, while accounting for temporal association, previous conclusive reports of the neurological AE with any TNF-α inhibitor, and alternate explanations including underlying disease, concomitant medications and comorbidities, such as diabetes mellitus.

RESULTS

There were 772 reports. Most were in patients who had rheumatoid arthritis (393, 50.9%) followed by inflammatory bowel disease (140, 18.1%). No significant differences in age or gender were seen between IBD patients compared with rheumatological diseases (P = 0.584 and P = 0.055 respectively). Etanercept was reported most (327, 42.4%) followed by infliximab (276, 35.8%) (P = 0.008). Peripheral neuropathy was the most common neurological AE (296 reports, 38.3%) followed by central nervous system and/or spinal cord demyelination (153 reports, 19.8%). Majority (551, 71.4%) of the reports were of 'possible' AE with the remaining 'probable' AE and none identified as 'definite' AE.

CONCLUSION

While several neurological AEs have been described, definite association between de novo development of these AEs and exposure to TNF-α inhibitors was not established using the Naranjo score.

Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome

We sought to determine whether patients with irritable bowel syndrome (IBS) have an increased risk of osteoporosis and related fractures using the Nationwide Emergency Department Sample (NEDS). Patients with IBS had increased adjusted odds of osteoporosis and osteoporotic fractures compared to the non-IBS control group, controlling for known risk factors for osteoporosis. Screening measures to identify osteoporosis in this group are advised.

INTRODUCTION

Ulcerative colitis, Crohn's disease, and celiac disease have well-described augmented risk of osteoporosis and related fractures. We sought to determine whether IBS also indicates an increased risk of osteoporosis and related fractures.

METHODS

The 2008 NEDS database was used to determine the adjusted odds of osteoporosis and related fractures in IBS patients. Only fractures (pathologic wrist (733.12), vertebrae (733.13), and femur fractures (733.14), traumatic wrist (813.x), vertebrae (805.x-806.x), and hip fractures (820.x-821.x)) with a secondary diagnosis of osteoporosis (733.0x) were included in the analysis. A multivariate logistic regression analysis was performed, controlling for known risk factors for osteoporosis and related fractures.

RESULTS

We identified 317,857 ED visits in patients with a diagnosis of IBS. Of these, 17,752 carried a diagnosis of osteoporosis and 694 IBS patients had a concurrent diagnosis of a pathologic fracture of the wrist, hip, or vertebrae. A total of 1,503 IBS patients had a concurrent diagnosis of a traumatic fracture of the wrist, hip, or vertebra. Overall, patients with IBS had an increased adjusted odds of osteoporosis (odds ratio (OR) 4.28, 95% confidence interval (CI) 4.21-4.35) and osteoporotic fractures (OR 2.36, CI 2.26-2.47) compared to the non-IBS control group. The highest adjusted odds of fracture was seen at the wrist (OR 2.41, CI 2.10-2.77 compared to controls).

CONCLUSIONS

IBS patients are at an increased risk of osteoporosis and related fractures. Screening measures to identify osteoporosis and prevent fractures are advised.

Role of Macrophage in Tumor Microenvironment: Prospect in Cancer Immunotherapy

Current evidence suggests an increasing role of macrophages in inflammation and tumor progression. Most tumors contain an abundant number of macrophages as a major component of their leukocyte infiltrate, which co-exist with tumor cells at the tumor microenvironment. Upon activation with soluble tumor antigens, macrophages release a distinct repertoire of growth factor, cytokines, chemokines and enzymes that inhibit growth of the tumor. However, the anti-tumor immune response induced by macrophages does not always ensue. Tumor cells themselves are capable of down-regulating macrophage phenotype and functions and anti-tumor immune responses in the tumor-bearing host. The present review aims to elucidate the role of macrophages in tumor growth and progression, invasion, metastasis, and angiogenesis at the site of tumor growth. Moreover, the effect of tumor microenvironment on the phenotype and function of macrophages, which are altered due to the continuous exposure of various soluble and non-soluble tumor promoting factors secreted by tumor cells, and implication of macrophages in cancer immunotherapy have been discussed in detail.

Association of shorter telomere length with essential hypertension in Indian population

OBJECTIVES

Essential hypertension is known to be associated with growth, development, and aging of humans. Telomeres are specialized nucleoprotein complexes consisting of tandem repeats of DNA sequences (TTAGGG)n that serve as protective caps of human chromosomes. Telomere length is considered as a biomarker of aging in somatic cells. In the present investigation, leukocyte telomere length was determined among hypertensive and normal individuals to find out the association, if any, with hypertension.

MATERIALS AND METHODS

Venous blood samples were collected from normal and hypertensive individuals with written informed consent approved by ethic committee of Department of Genetics, Osmania University Hyderabad, India. Genomic DNA was isolated from blood samples of 98 normal (age range: 30-70 years, mean age: 51.01 ± 10.12 years) and 96 hypertensive individuals (age range: 35-75 years, mean age: 49.18 ± 6.46 years). Using a SYBR green-based real time quantitative PCR relative telomere length was determined among these individuals.

RESULTS

The relative telomere length (T/S ratio) in hypertensive individuals was observed to be 0.91 ± 0.16 which was significantly different (P < 0.001) from normal individuals where the relative telomere length was 0.99 ± 0.13. No significant difference was observed between relative telomere length of male and female individuals, although there is negative correlation between age and telomere length was observed in both normal and hypertensive individuals. The systolic and diastolic blood pressure was negatively correlated with relative telomere length, though not significant.

CONCLUSION

Shorter telomere length is associated with hypertensive individuals in Indian population.

Interleukin-13 induces T helper type 2 immune responses in OVA-immunized BALB/c mice bearing a T cell lymphoma

T lymphocytes play a crucial role in the regulation of immune responses against the tumour cells. Tumour progression results in dysfunction and inhibition of T cells, which ultimately leads to impairment in the antitumour immune response. The impaired antitumour immune response in the host is represented by the decreased number of T cells and their incomplete and improper function. The immunosuppressive network in tumour-bearing host mediated by tumour cells also leads to the inequities of T cell subsets and imbalance of Th1/Th2 dichotomy. Therefore, in the present study, we sought to investigate the role of tumour progression in the development of T cell phenotype and the involvement of interleukin-13 thereof selecting Dalton's lymphoma (DL) as a tumour model. It was observed that a significant increase in the number of CD4(+) T cell population, whereas a significant decline in the CD8(+) T cells among lymphoid cell population of OVA-immunized DL-bearing BALB/c mice occurs. Similar observation was found following the administration of IL-13 to the normal healthy mice. It was further confirmed that expansion in Th2 type cells among CD4(+) T cell population occurs following the progression of tumour and administration of IL-13 to normal healthy mice by an yet to define mechanism. Therefore, it can be concluded that IL-13 has immense role in polarizing the immune responses by inducing the differentiation of Th2 type of cells.

Evaluation of efficacy of duloxetine in stress urinary incontinence in women

Objective:

The purpose of this study has been to assess the efficacy of duloxetine, a selective inhibitor of serotonin and norepinephrine reuptake, in the treatment of stress urinary incontinence (SUI) in women.

Materials and Methods:

The study included 50 women aged above 18 years with a predominant symptom of stress urinary incontinence (SUI). The case definition included a predominant symptom of SUI with a weekly incontinence episode frequency (IEF) of seven or greater and a positive cough stress test. All the patients received duloxetine 20 mg twice daily for 12 weeks. The primary outcome variables included the IEF and improvement in quality of life. Paired Student's ‘t’ test was used to analyze changes in IEF.

Results:

The improvement with duloxetine treatment was found in 40 out of 50 patients. Remaining 10 patients did not show any improvement with duloxetine and discontinued the treatment. In 40 patients, the mean baseline IEF was 12.5/week. At the end of three months treatment, IEF was six/week. This shows a statistically significant reduction in the IEF. Also, there was a good improvement in quality of life with 65% of patients in the “very much better” and “much better” categories according to PGI-I scale. In the remaining 10 patients, there was no significant improvement after one month of treatment and patients underwent surgery.

Conclusions:

The findings support duloxetine as a potential treatment for women with stress urinary incontinence.

Gender variation in interleukin-13 production: a possible mechanism of differential in vivo growth of a T-cell lymphoma

Interleukin (IL)-13 is a T(H)2 type of cytokine that plays a crucial role in the pathophysiology of different type of infections, autoimmune diseases and malignancies. It has been shown to dampen the T(H)1 type of immune responses and favours tumour growth. In the present investigation, we have determined IL-13 level in serum and ascitic fluid in both the sexes of BALB/c strain of mice bearing a T-cell lymphoma of spontaneous origin, designated as Dalton's Lymphoma (DL). Further, we have studied the involvement of gender hormones on the IL-13 level and NKT-cell production of IL-13. It has been observed that there exists a gender variation or gender dimorphism in the IL-13 production. IL-13 level in serum is directly correlated with in vivo progressive growth of DL cells. We observed a tendency in female DL-bearing mice to have higher serum IL-13 level and faster growth of DL cells. This study, therefore, indicates that sex hormones are directly involved in the differential production of IL-13 that may be a factor responsible, at least in part, for the differential in vivo progressive growth of a T-cell lymphoma.

IL-13 Ralpha2-mediated interleukin-13 neutralization represses in vivo progressive growth of a T-cell lymphoma

Dalton's lymphoma (DL) is a T-cell lymphoma of spontaneous origin, characterized by highly invasive and malignant nature, killing the host in a very short period of life span. DL-bearing host is reflected by very high titer of IL-13 in serum. Therefore, we hypothesized that over expression of IL-13 may greatly affect the growth of DL-cells in a tumor-bearing host. In this study, to assess the involvement of IL-13 in DL-cell progression, we have blocked the IL-13 activity/signalling by the systemic delivery of non-signaling decoy receptor IL-13 Ralpha2, and IL-13 level vs DL-cell proliferation were measured. We observed that systemic delivery of IL-13 Ralpha2 inhibits the DL-cell progression in much extent and enhances the survival and longevity of DL-bearing mice. Further, this study re-inforce the therapeutic advantage of IL-13 Ralpha2 in a T-cell lymphoma tumor system.

Interleukin-13-induced type II polarization of inflammatory macrophages is mediated through suppression of nuclear factor-kappaB and preservation of IkappaBalpha in a T cell lymphoma

Spontaneously arising transplantable T cell lymphoma, designated as Dalton's lymphoma (DL), is characterized by a highly invasive and deleterious nature almost completely paralysing the host immune system. The level of interleukin (IL)-13 is elevated in serum and ascitic fluid of the DL-bearing host. IL-13 is a potent immunosuppressive cytokine and is an alternative activator of macrophages that suppresses the production of nitric oxide (NO) and expression of inducible nitric oxide synthase (iNOS), and proinflammatory cytokines. The expression of iNOS and proinflammatory cytokines are dependent largely upon the activation of nuclear factor-kappaB (NF-kappaB). Activation of NF-kappaB involves the degradation of cytoplasmic inhibitor IkappaBalpha, allowing the nuclear translocation of NF-kappaB and thereby transcription of the iNOS gene. Therefore, in this study we sought to determine whether the alternative activation or type II polarization of macrophages induced by IL-13 is mediated by the suppression of NF-kappaB and cytoplasmic preservation of IkappaBalpha. Western blot analysis and electrophoretic mobility shift assay (EMSA) indicate that tumour-associated macrophages (TAM) or polarized type II macrophages are due to preserved protein expression of IkappaBalpha, and therefore suppressed NF-kappaB nuclear translocation. These findings suggest that IL-13 may operate through the suppression of NF-kappaB activation and preservation of IkappaBalpha.

Hsp70 induces Th1 polarization through tumor-associated macrophages in a T-cell lymphoma

Tumor progression produces immunoregulatory phenotype of macrophages in tumor bearing host (TBH), that mediate immunosuppression through increased production of soluble factors. These factors obviously suppress the T-cell responsiveness and underproduction of Th1-polarizing cytokines. Here, we reported that in vitro treatment of TAMs with autologous Hsp70 purified from DL-bearing mice reverse back the tumor induced macrophage suppressor activity, suggesting that Hsp70 can restore TAMs production of Th1-polarizing cytokines. LPS stimulation failed to overcome tumor-induced dysregulation of IL-1, IL-12, IL-15 and IFN-gamma production. In contrary, Hsp70 significantly enhanced IL12, IL-15, IL-1 and IFN-gamma production by TAMs in vitro and in vivo, but also enhanced the LPS and IFN-gamma responsiveness of TAMs. These Th1 polarizing effects of cytokines of TAMs are dose dependent and reach the maximal values at 24 hrs of incubation. Though, we found a significant release of IFN-gamma in TAMs without T-cells, and increased level of IFN-gamma with T-cells suggests that Hsp70 stimulates T-cells. Summarizing, these data demonstrates that Hsp70 restore Th1 polarizing cytokines production in the TBH and thus ascribe a possibility to develop a novel immunotherapeutic regime by using TAMs that could contribute well to the correction of tumor induced immune dysfunction.