Biofilm-dependent airway infections: a role for ambroxol?

Biofilms are a key factor in the development of both acute and chronic airway infections. Their relevance is well established in ventilator associated pneumonia, one of the most severe complications in critically ill patients, and in cystic fibrosis, the most common lethal genetic disease in Caucasians. Accumulating evidence suggests that biofilms could have also a role in chronic obstructive pulmonary disease and their involvement in bronchiectasis has been proposed as well. When they grow in biofilms, microorganisms become multidrug-resistant. Therefore the treatment of biofilm-dependent airway infections is problematic. Indeed, it still largely based on measures aiming to prevent the formation of biofilms or remove them once that they are formed. Here we review recent evidence suggesting that the mucokinetic drug ambroxol has specific anti-biofilm properties. We also discuss how additional pharmacological properties of this drug could be beneficial in biofilm-dependent airway infections. Specifically, we review the evidence showing that: 1-ambroxol exerts anti-inflammatory effects by inhibiting at multiple levels the activity of neutrophils, and 2-it improves mucociliary clearance by interfering with the activity of airway epithelium ion channels and transporters including sodium/bicarbonate and sodium/potassium/chloride cotransporters, cystic fibrosis transmembrane conductance regulator and aquaporins. As a whole, the data that we review here suggest that ambroxol could be helpful in biofilm-dependent airway infections. However, considering the limited clinical evidence available up to date, further clinical studies are required to support the use of ambroxol in these diseases.

Blood cholesterol concentration measured by CR3000: fingerstick versus venous sampling

Currently, the clinical practice of desktop or Point of Care (PoC) analyzers for lipid measurements has gained wide popularity. Designed to quickly perform measurements on microlitre(microL) quantities of blood, these instruments can be used in non-laboratory settings, such as physicians offices or field-testing sites and can provide measurements in whole blood, serum, or plasma, using either venous or capillary blood samples. The aim of this study is to examine the relationship between cholesterol determinations in venous and capillary samples using the CR3000 PoC system. The study was performed on 21 unselected adult volunteers, and no exclusion criteria was adopted. The mean cholesterol concentration for the venous blood samples measured was 164 mg/dL. The values obtained in the capillary blood samples averaged 168 mg/dL, which is only slightly higher (e.g., 2.87%) than the venous sample measurements. Moreover, the total variance was statistically similar for venous and capillary measurements (F value = 1.199, where the upper critical value of the F distribution is 2.124, p < 0.05). The results of our study support the concept that CR3000 total cholesterol testing can be performed safely and accurately in either venous or capillary specimens.

Accuracy of analyses for lipid profile parameters as measured with the CR3000 system

Total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) levels are positively related to coronary heart disease (CHD), and high-density lipoprotein cholesterol (HDLC) levels are negatively related to CHD. Efforts to identify and treat people at increased risk based on cholesterol and lipoprotein levels have led to more lipid testing and the need for very reliable test results. Point-of-care testing (POCT) has developed from the demand for analytical information more fastly than is available from central laboratories. By carrying the analysis closer to the patient some process steps have been eliminated, facilitating a shorter time to result and faster management response with improved outcomes. Thus benefits include better therapeutic turnaround times (TATs), decreased blood loss as a result of reduced phlebotomy secondary to clinical improvement and diminished resource utilization. These effects depend on acceptable analytical performance in comparison with central laboratory techniques and in relation to clinical criteria.

Duchenne muscle activity evaluation and muscle function preservation: is it possible a prophylactic strategy?

Duchenne muscular dystrophy yields pervasive and progressive muscle mass loss. In the current measures relating to the monitoring of disease progression the following are relevant (i): the type of scale used, (ii) the clinical significance of the attribute being measured and (iii) the mathematical properties of the data provided. The high prevalence of obesity at an early stage of this pathology could result not only from reduced physical activity, but also from low resting energy expenditure, abnormal nutrient utilization or overfeeding. This muscle weakness may be attenuated by regular low-intensity exercise. However, there is a critical lack of data to support appropriate exercise prescription. Because inappropriate activity may exacerbate the dystrophic process, a systematic analysis of muscle function to determine potential exercise load thresholds to avoid injury in dystrophic mice and dogs, and then in humans is recommended.

Oxidative stress tests: overview on reliability and use. Part II

Although the healthcare field is increasingly aware of the importance of free radicals and oxidative stress, screening and monitoring has yet become a routine test since, dangerously, there are no symptoms of this condition. Therefore, in very few cases is oxidative stress addressed. Paradoxically, patients are often advised supplementation with antioxidants and or diets with increased antioxidant profile, which range from vitamins to minerals which is action against oxidative stress states and even more so no test is advised to assess whether the patient is under attack by free radicals or has a depleted antioxidant capacity. Hence oxidative stress is an imbalance between free radicals (ROS, Reactive Oxygen Species) production and existing antioxidant capacity (AC), living organisms have a complex anti-oxidant power. A decrease in ROS formation is often due to an increase in antioxidant capacity whilst an increase in the AC may be associated to decreased ROS values. But this is not always apparently so. Test kits for photometric determinations applicable to small laboratories are increasingly available.

Oxidative stress tests: overview on reliability and use. Part I

Monitoring oxidative stress in humans is achieved by assaying products of oxidative damage or by investigating the potential of an organism, tissue or body fluids to withstand further oxidation. Unfortunately, there is little consensus concerning the selection of parameters of oxidative stress or antioxidant state to be determined in defined patients or diseases. This is not only due to the uncertainty wheter or not a certain parameter is playing a causative role. Moreover, the methods of determination described in the literature represent very different levels of analytical practicability, costs, and quality. Generally accepted reference ranges and interpretations of pathological situations are lacking as well as control materials. At present, the situation is changing dramatically and sophisticated methods like HPLC (High Performance Liquid Chromatography) and immunochemical determinations have become more and more common standard.

Oxidative stress detection: what for? Part II

Oxygen-free radicals, more generally known as reactive oxygen species (ROS) along with nitrogen species (RNS) are well recognised for playing a dual role both deleterious and beneficial species. The cumulative generation of ROS/RNS through either endogenous or exogenous insults is termed oxidative stress and is common for many types of diseases that are linked with altered redox regulation of cellular signalling pathways.

Oxidative stress detection: what for? Part I

In this paper we review the diseases, such as cancer, arteriosclerosis, arthritis, neurodegenerative disorders, whose emerging pathogenetic evidence by Free Radicals has been shown either from experimental or from clinical point of view. In the last 10 years the growing evidence of a co-causative responsibility of oxidative stress in some chronic and acute illnesses highlighted the need to improve the diagnostic potential as well as the algorythm of an effective treatment plan. An exhaustive basic description of the Free Radicals action mechanism in different parenchymas to produce damage and clinical symptoms is the very preliminary background to any further investigation as to the specific diseases-oriented diagnostic tests as well as to a rationale therapy.