1
|
Massimo G, Khambata RS, Chapman T, Birchall K, Raimondi C, Shabbir A, Dyson N, Rathod K, Borghi C, Ahluwalia A. Corrigendum to "Natural mutations of human XDH promote the nitrite (NO 2-)-reductase capacity of xanthine oxidoreductase: A novel mechanism to promote redox health?" [Redox Biol. 4 (67) (2023) 102864]. Redox Biol 2023; 67:102925. [PMID: 37867029 PMCID: PMC10638451 DOI: 10.1016/j.redox.2023.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
- G Massimo
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R S Khambata
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - T Chapman
- LifeArc, Accelerator Building Open Innovation Campus, Stevenage, SG1 2FX, UK
| | - K Birchall
- LifeArc, Accelerator Building Open Innovation Campus, Stevenage, SG1 2FX, UK
| | - C Raimondi
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - A Shabbir
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nicki Dyson
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Rathod
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - C Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Via Massarenti, N.9, 40138, Italy
| | - A Ahluwalia
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| |
Collapse
|
2
|
Massimo G, Khambata RS, Chapman T, Birchall K, Raimondi C, Shabbir A, Dyson N, Rathod KS, Borghi C, Ahluwalia A. Natural mutations of human XDH promote the nitrite (NO 2-)-reductase capacity of xanthine oxidoreductase: A novel mechanism to promote redox health? Redox Biol 2023; 67:102864. [PMID: 37713777 PMCID: PMC10511815 DOI: 10.1016/j.redox.2023.102864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/17/2023] Open
Abstract
Several rare genetic variations of human XDH have been shown to alter xanthine oxidoreductase (XOR) activity leading to impaired purine catabolism. However, XOR is a multi-functional enzyme that depending upon the environmental conditions also expresses oxidase activity leading to both O2·- and H2O2 and nitrite (NO2-) reductase activity leading to nitric oxide (·NO). Since these products express important, and often diametrically opposite, biological activity, consideration of the impact of XOR mutations in the context of each aspect of the biochemical activity of the enzyme is needed to determine the potential full impact of these variants. Herein, we show that known naturally occurring hXDH mutations do not have a uniform impact upon the biochemical activity of the enzyme in terms of uric acid (UA), reactive oxygen species (ROS) and nitric oxide ·NO formation. We show that the His1221Arg mutant, in the presence of xanthine, increases UA, O2·- and NO generation compared to the WT, whilst the Ile703Val increases UA and ·NO formation, but not O2·-. We speculate that this change in the balance of activity of the enzyme is likely to endow those carrying these mutations with a harmful or protective influence over health that may explain the current equipoise underlying the perceived importance of XDH mutations. We also show that, in presence of inorganic NO2-, XOR-driven O2·- production is substantially reduced. We suggest that targeting enzyme activity to enhance the NO2--reductase profile in those carrying such mutations may provide novel therapeutic options, particularly in cardiovascular disease.
Collapse
Affiliation(s)
- G Massimo
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R S Khambata
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - T Chapman
- LifeArc, Accelerator Building Open Innovation Campus, Stevenage, SG1 2FX, UK
| | - K Birchall
- LifeArc, Accelerator Building Open Innovation Campus, Stevenage, SG1 2FX, UK
| | - C Raimondi
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - A Shabbir
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nicki Dyson
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K S Rathod
- William Harvey Research Institute, Barts & the London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - C Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Via Massarenti, N.9, 40138, Italy
| | - A Ahluwalia
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Via Massarenti, N.9, 40138, Italy.
| |
Collapse
|
3
|
Hikin LJ, Ho J, Morley SR, Ahluwalia A, Smith PR. Sodium nitrite poisoning: A series of 20 fatalities in which post-mortem blood nitrite and nitrate concentrations are reported. Forensic Sci Int 2023; 345:111610. [PMID: 36848754 DOI: 10.1016/j.forsciint.2023.111610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
Sodium nitrite has several industrial applications however its accidental or intentional ingestion has been associated with severe toxicity and death. We present a series of 20 cases over 2 years in which evidence of sodium nitrite ingestion was found at the scene and supported by biochemical analysis of post-mortem blood nitrite and nitrate levels. Routine toxicological screening was performed on post-mortem blood samples received at University Hospitals of Leicester (UHL) NHS Trust, including ethanol analysis by headspace gas chromatography-flame ionisation detection (HS GC-FID), drug screening by high resolution accurate mass-mass spectrometry (HRAM-MS) and confirmatory drug quantitation by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cases in which the history indicated the possibility of nitrite salts present at the scene, purchase of a suicide kit or a dusky-ash appearance of skin on post-mortem were referred to a specialist laboratory for nitrite and nitrate analysis. Analysis was based upon the gas-phase chemiluminescent reaction between nitric oxide (NO) and ozone; NO levels were determined using an NOA 280A, Sievers NO analyser. Twenty post-mortem cases in which sodium nitrite ingestion was the most probable cause of death were reported between January 2020 and February 2022; mean age was 31 years (range 14-49) with 9/20 (45%) female. 16/20 (80%) of cases had a history of depression and / or mental health issues. In half of the cases, anti-depressant / anti-psychotic drugs were prescribed; these drugs were detected in 8/20 (40%) cases. Ethanol was detected in 4/20 (20%) cases and anti-emetic drugs in 7/20 (35%) cases; anti-emetic drugs may be used to aid retention of sodium nitrite. Illicit drugs (amphetamine, cannabis and cocaine) were present in 3/20 cases (15%). Nitrite was found to be elevated in all but one case (95%), and nitrate was elevated in 17/20 (85%) cases. This paper highlights a surge in numbers of deaths across England and Wales due to sodium nitrite toxicity. Although, nitrite poisoning remains a rare cause of death, it is worthwhile considering its use in individuals with suicidal ideation given its unregulated availability online. The detection and quantitation of nitrite and nitrate requires specialised, highly reliable methodology currently only available in research laboratories. Implication of sodium nitrite ingestion also relies heavily upon circumstantial evidence combined with quantification. The provision of a quantitative nitrite / nitrate analytical service greatly assists in determining the cause of death in these cases.
Collapse
Affiliation(s)
- L J Hikin
- Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK.
| | - J Ho
- Centre for Cardiovascular Medicines & Devices, William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - S R Morley
- Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| | - A Ahluwalia
- Centre for Cardiovascular Medicines & Devices, William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - P R Smith
- Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| |
Collapse
|
4
|
Narang V, Jindal S, Soni A, Kaur H, Ahluwalia A, Kakkar C, Chahal HS. Synchronous Clear Cell and Papillary Renal Cell Carcinoma: Dual Tumour of Same Kidney. Indian J Surg Oncol 2022; 13:780-782. [PMID: 36687224 PMCID: PMC9845462 DOI: 10.1007/s13193-022-01559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Vikram Narang
- Department of Pathology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana, Punjab 141001 India
| | - Saveena Jindal
- Department of Pathology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana, Punjab 141001 India
| | - Ankita Soni
- Department of Pathology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana, Punjab 141001 India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana, Punjab 141001 India
| | - Archana Ahluwalia
- Department of Radiology, Dayanand Medical College & Hospital, Ludhiana, Punjab India
| | - Chandan Kakkar
- Department of Radiology, Dayanand Medical College & Hospital, Ludhiana, Punjab India
| | - Harmandeep S. Chahal
- Department of Urology, Dayanand Medical College & Hospital, Ludhiana, Punjab India
| |
Collapse
|
5
|
Mittal A, Mahajan N, Pal Singh Dhanota D, Paul BS, Ahluwalia S, Ahluwalia S, Galhotra A, Gupta V, Puri S, Verma R, Munjal M, Goel S, Chopra S, Mahajan R, Ahluwalia A, Saggar K, Singh G. SARS-CoV-19-associated Rhino-orbital and cerebral Mucormycosis: Clinical and Radiological Presentations. Med Mycol 2022; 60:6677975. [PMID: 36029277 PMCID: PMC9494327 DOI: 10.1093/mmy/myac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.
Collapse
Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitika Mahajan
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Devinder Pal Singh Dhanota
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Srishti Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Saumya Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arnav Galhotra
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjeev Puri
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rohit Verma
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manish Munjal
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sahil Goel
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumeet Chopra
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajesh Mahajan
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, Queen Square Institute of Neurology, London, UK
| |
Collapse
|
6
|
Mittal A, Dhanota DPS, Saggar K, Ahluwalia A. Brachial plexopathy with ulnar nerve abscess in leprosy: A case showing importance of magnetic resonance neurography with clinical, imaging and histopathological correlation. Indian J Dermatol Venereol Leprol 2022; 88:385-388. [PMID: 35389025 DOI: 10.25259/ijdvl_405_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/01/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | | | - Kavita Saggar
- Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
7
|
Hussain SA, Walters S, Ahluwalia A, Trompeter A. Diagnosis and management of arterial injuries associated with limb fracture or dislocation. Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
Collapse
Affiliation(s)
- SA Hussain
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - S Walters
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - A Ahluwalia
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - A Trompeter
- Orthopaedic Trauma/Limb Reconstruction Unit, St George's University Hospital, London, UK
| |
Collapse
|
8
|
Saxena A, Paul BS, Singh G, Ahluwalia A, Paul G. Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes. J Neurosci Rural Pract 2021; 12:751-757. [PMID: 34737511 PMCID: PMC8559086 DOI: 10.1055/s-0041-1735324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective
Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes.
Materials and Methods
Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival).
Statistical Analysis
Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's
t
-test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized.
Results
We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection (
Aspergillus
) was associated with anterior SBO (10%), while bacteria (
Pseudomonas
) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies (
p
= 0.04), suboptimal duration of medical treatment (
p
= 0.03), surgical intervention during clinical course (
p
= 0.02), and development of intracranial or extracranial complications (
p
= 0.03) were the predictors of mortality.
Conclusion
Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.
Collapse
Affiliation(s)
- Alisha Saxena
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Birinder Singh Paul
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gunchan Paul
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
9
|
Mittal A, Singh Dhanota DP, Saggar K, Singh G, Ahluwalia A. Role of Interictal Arterial Spin Labeling Magnetic Resonance Perfusion in Mesial Temporal Lobe Epilepsy. Ann Indian Acad Neurol 2021; 24:495-500. [PMID: 34728940 PMCID: PMC8513983 DOI: 10.4103/aian.aian_1274_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/31/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Context: Electrophysiological and hemodynamic data can be integrated to accurately identify the generators of abnormal electrical activity in drug-resistant focal epilepsy. Arterial Spin Labeling (ASL), a magnetic resonance imaging (MRI) technique for quantitative noninvasive measurement of cerebral blood flow (CBF), can provide a direct measure of variations in cerebral perfusion associated with the epileptogenic zone. Aims: 1. To evaluate usefulness of ASL for detecting interictal temporal hypoperfusion to localize the epileptogenic zone in patients of drug resistant mesial temporal lobe epilepsy (MTLE). 2. Correlation of localization of epileptogenic zone on ASL MR perfusion with structural MRI and EEG. Methods and Materials: 30 patients with MTLE and10 age and gender matched normal controls were studied. All patients underwent ictal video EEG monitoring non-invasively, MR imaging with epilepsy protocol and pseudocontinuous ASL (PCASL) perfusion study. Relative CBF (rCBF) values in bilateral mesial temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region. Results: In patients, ipsilateral mesial temporal rCBF was significantly decreased compared with contralateral mesial temporal rCBF (p = 0.021). Mesial temporal blood flow was more asymmetric in patients than in normal control participants (p = 0.000). Clear perfusion asymmetry on PCASL-MRI was identified despite normal structural-MRI in 5 cases, agreeing with EEG laterality. Conclusions: Pseudo-continuous ASL offers a promising approach to detect interictal hypoperfusion in TLE and as a clinical alternative to SPECT and PET due to non-invasiveness and easy accessibility. Incorporation of ASL into routine pre-surgical evaluation protocols can help to localize epileptogenic zone in surgical candidates.
Collapse
Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Devinder Pal Singh Dhanota
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
10
|
Lau C, Shabbir A, Rathod KS, Chhetri I, Ono M, Hamers AJP, Amarin JJ, Ibrahim A, Nuredini G, Godec T, Kapil V, Ahluwalia A. Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain.
Purpose
To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction.
Methods
62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635.
Results
Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p<0.0001) compared to placebo. There were significant increases in urine nitrite (p<0.0001) and nitrate (p<0.0001) in addition to salivary nitrite (p<0.0001) and nitrate (p<0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048).
Conclusions
Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation
Collapse
Affiliation(s)
- C Lau
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Shabbir
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - K S Rathod
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - I Chhetri
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - M Ono
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A J P Hamers
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - J J Amarin
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Ibrahim
- University of Southampton, Southampton, United Kingdom
| | - G Nuredini
- Barts Health NHS Trust, London, United Kingdom
| | - T Godec
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - V Kapil
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Ahluwalia
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
11
|
Primus C, Masucci M, Whitear C, Montalvo Moreira SA, Ajit Kumar N, Chhetri I, Rathod KS, Khambata R, Kapil V, Ahluwalia A. A pro-resolving phenotype underpins the anti-inflammatory effects of inorganic nitrate. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Increasing evidence highlights the critical role of chronic inflammation in cardiovascular disease (CVD). Targeting inflammatory pathways in patients with CVD has been associated with improved CV function in pre-clinical (Gee, 2017), early clinical (Yndestad, 2006; Velmurugan 2013; Jones, 2016) and large phase III studies (Ridker, 2017).
The resolution of inflammation is an active process and its failure has also been proposed to contribute to CVD progression. At least one mechanism thought to underlie this failure is dysfunction of the canonical pathway for anti-inflammatory nitric oxide (NO) production. Restoring NO through provision of inorganic nitrate (NO3-) and subsequent bioactivation via the non-canonical pathway may offer therapeutic benefit.
Aim
To test whether dietary NO3–derived NO accelerates resolution of inflammation.
Methods
Randomised, double-blind, placebo-controlled, parallel limb study of 8–10mmol dietary NO3- supplementation versus NO3–deplete placebo beetroot juice in 36 healthy male volunteers (NCT03183830). Using a cantharadin-induced skin blister model (Day, 2001), acute (24h) and chronic (72h)-phase blisters were harvested pre- and post-treatment. Blister exudate was analysed for leucocyte activation state (CD11b, CD62L, CD162) by flow cytometry and cytokine/chemokine composition by ELISA. Ozone chemiluminescence established NO3-/NO2- levels in key biological matrices: plasma, urine and saliva.
Results
9.3mmol inorganic NO3- led to a significant rise (versus placebo, p<0.001) of NO3-/NO2- in plasma, saliva and urine NO2- (p<0.02). No differences were seen in blister volumes, cell counts or markers of systemic inflammation. Whilst no differences were seen in the proportions of cellular infiltrate in 24h blisters, there were significant reductions of neutrophil (p=0.017) and intermediate monocyte proportions (p=0.001) and cellular adhesion molecules across inflammatory, intermediate and resolving monocytes at 72h (Figure 1). Generally, no differences in blister cytokine/chemokine profile was evident except for borderline significant suppression of TNFα at 24hrs with dietary NO3- treatment (P=0.057).
Conclusion
Whilst dietary inorganic NO3- does not impair the essential host defence response it does accelerate resolution: enhanced pro- to anti-inflammatory monocyte subtype switching and curtailed neutrophil recruitment, likely via attenuated TNFα production. These actions offer a novel, easy to administer, approach to influence inflammatory responses without impairing host defence.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Derek Willoughby Trust and British Heart Foundation
Collapse
Affiliation(s)
- C Primus
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - M Masucci
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - C Whitear
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - S A Montalvo Moreira
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - N Ajit Kumar
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - I Chhetri
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - K S Rathod
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - R Khambata
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - V Kapil
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - A Ahluwalia
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| |
Collapse
|
12
|
Shabbir A, Lau C, Rathod KS, Chhetri I, Haque A, Godec T, Khambata RS, Kapil V, Ahluwalia A. Inorganic nitrate attenuates the systemic inflammatory response in typhoid vaccine-induced endothelial dysfunction in healthy volunteers. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Inflammatory responses underlie the development of endothelial dysfunction in CVD, however, therapeutics that might target this pathway have not been forthcoming. A key pathogenic mechanism mediating endothelial dysfunction is a reduction in bioavailable (eNOS-derived) nitric oxide (NO). Activation of the non-canonical pathway for in-vivo NO generation might offer an approach to improve NO levels and recover vascular function in pre-clinical models of CVD. Whether this might occur in humans is unknown.
Purpose
We hypothesize that consumption of inorganic nitrate will lead to increases in bioavailable NO and thus attenuate the inflammatory pathways leading to typhoid vaccine-induced endothelial dysfunction in healthy volunteers.
Methods
Healthy male volunteers were recruited (n=78) and randomized to receive either beetroot juice containing 8–10mmol nitrate or placebo (nitrate-deplete) juice once daily for 6 days. Participants underwent serial measurements of BP, FMD and GTN-induced brachial artery dilatation, and haematology and biochemistry, before and after typhoid vaccination. Blood, urine and saliva nitrite and nitrate were quantified using ozone chemiluminescence, and leukocyte flow cytometry analysis was conducted.
Results
8-hours post-vaccine endothelial function was depressed in placebo-treated volunteers, however this was prevented in nitrate-treated volunteers. This dysfunction was due to impaired endothelial function since responses to GTN were unaffected either by vaccination or dietary intervention (p=0.981). Dietary nitrate resulted in an increase in plasma (p<0.0001), urine (p=0.0006) and saliva (p<0.0001) nitrate, and urine (p=0.0354) and saliva (p<0.0001) nitrite levels. There was a reduction in the proportions of CD14++/CD16+intermediate monocytes in nitrate-treated participants after vaccine (p=0.016, change from baseline between groups). In the nitrate-treated group, less CD14++/CD16+ intermediate monocyte CD62L expression was identified post-vaccine (p=0.0122), compared to placebo, with no difference in soluble plasma CD62L between groups (p=0.875). CD11b median fluorescence intensity was increased in CD3+/CD4+ T-lymphocytes in nitrate-treated volunteers (p=0.0095).
Conclusions
Dietary nitrate reduced BP, as previously shown, indicating efficacy of the intervention. Importantly, we also now show for the first time that inorganic nitrate suppresses the systemic inflammatory response, specifically by reducing the numbers and activation state of CD14++/CD16+ intermediate monocytes. Furthermore, an increased expression of CD3+/CD4+ T-cell CD11b and preserved FMD in healthy volunteers treated with nitrate, suggests an anti-inflammatory phenotype, induced by the intervention, leading to improved endothelial function. Inorganic dietary nitrate modulates endothelial function through the attenuation of inflammatory responses and may be of potential therapeutic benefit in patients with established CAD.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Shabbir
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - C Lau
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - K S Rathod
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - I Chhetri
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - A Haque
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - T Godec
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - R S Khambata
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - V Kapil
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - A Ahluwalia
- St Bartholomews and Queen Mary University, London, United Kingdom
| |
Collapse
|
13
|
Affiliation(s)
- K Saggar
- Department of Radiodiagnosis, Dyanand Medical College & Hospital, Ludhiana - 141001, India
| | - A Ahluwalia
- Department of Radiodiagnosis, Dyanand Medical College & Hospital, Ludhiana - 141001, India
| | - P Sandhu
- Department of Radiodiagnosis, Dyanand Medical College & Hospital, Ludhiana - 141001, India
| | - V Kalia
- Department of Radiodiagnosis, Dyanand Medical College & Hospital, Ludhiana - 141001, India
| |
Collapse
|
14
|
Kapil V, Khambata RS, Jones DA, Rathod K, Primus C, Massimo G, Fukuto JM, Ahluwalia A. The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway. Pharmacol Rev 2020; 72:692-766. [DOI: 10.1124/pr.120.019240] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
15
|
Ingram JR, Ahluwalia A. The pharmacology of itch. Br J Pharmacol 2019; 176:4419-4420. [PMID: 31612462 DOI: 10.1111/bph.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The article has been co-published with permission in British Journal of Dermatology and British Journal of Pharmacology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
Collapse
Affiliation(s)
- J R Ingram
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - A Ahluwalia
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
16
|
Ingram JR, Ahluwalia A. The pharmacology of itch. Br J Dermatol 2019; 184:e1-e2. [PMID: 31578709 DOI: 10.1111/bjd.18525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J R Ingram
- Division of Infection & Immunity, Cardiff University, Cardiff, U.K
| | - A Ahluwalia
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, U.K
| |
Collapse
|
17
|
Cacopardo L, Costa J, Giusti S, Buoncompagni L, Meucci S, Corti A, Mattei G, Ahluwalia A. Real-time cellular impedance monitoring and imaging of biological barriers in a dual-flow membrane bioreactor. Biosens Bioelectron 2019; 140:111340. [PMID: 31154254 DOI: 10.1016/j.bios.2019.111340] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022]
Abstract
The generation of physiologically relevant in-vitro models of biological barriers can play a key role in understanding human diseases and in the development of more predictive methods for assessing toxicity and drug or nutrient absorption. Here, we present an advanced cell culture system able to mimic the dynamic environment of biological barriers while monitoring cell behaviour through real-time impedance measurements and imaging. It consists of a fluidic device with an apical and a basal flow compartment separated by a semi-permeable membrane. The main features of the device are the integration of sensing through transepithelial electrical impedance (TEEI) measurements and transparent windows for optical monitoring within a dual flow system. Caco-2 cells were cultured in the TEEI bioreactor under both flow and static conditions. Although no differences in the expression of peripheral actin and occludin were visible, the cells in dynamic conditions developed higher impedance values at low frequencies, indicative of a higher paracellular electrical impedance with respect to the static cultures. TEEI measurements at high frequency also enabled monitoring monolayer formation, which can be correlated with the observation of an RC behaviour in the impedance spectra. In particular, the cells subject to flow showed accelerated barrier formation and increased vitality with respect to the static controls, again highlighting the importance of dynamic conditions for epithelial cells.
Collapse
Affiliation(s)
- L Cacopardo
- Research Centre 'E. Piaggio', University of Pisa, Italy; Department of Information Engineering, University of Pisa, Italy
| | - J Costa
- Research Centre 'E. Piaggio', University of Pisa, Italy; Department of Information Engineering, University of Pisa, Italy
| | - S Giusti
- Research Centre 'E. Piaggio', University of Pisa, Italy; IVTech S.r.l, Pisa, Italy
| | | | - S Meucci
- Micronit Microtechnologies, Enschede, the Netherlands
| | - A Corti
- Research Centre 'E. Piaggio', University of Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - G Mattei
- Department of Information Engineering, University of Pisa, Italy
| | - A Ahluwalia
- Research Centre 'E. Piaggio', University of Pisa, Italy; Department of Information Engineering, University of Pisa, Italy.
| |
Collapse
|
18
|
Jones DA, Whittaker P, Rathod KS, Richards AJ, Andiapen M, Antoniou S, Mathur A, Ahluwalia A. P2564Sodium nitrite-mediated cardioprotection in primary percutaneous coronary intervention for ST-elevation myocardial infarction: a cost-effectiveness analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D A Jones
- Barts Health NHS Trust, London, United Kingdom
| | - P Whittaker
- Wayne State University, Detroit, United States of America
| | - K S Rathod
- Barts Health NHS Trust, London, United Kingdom
| | | | - M Andiapen
- Barts Health NHS Trust, London, United Kingdom
| | - S Antoniou
- Barts Health NHS Trust, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, London, United Kingdom
| | - A Ahluwalia
- Queen Mary University of London, London, United Kingdom
| |
Collapse
|
19
|
Goraya JS, Berry S, Saggar K, Ahluwalia A. Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy? J Child Neurol 2018; 33:146-152. [PMID: 29334856 DOI: 10.1177/0883073817750501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors retrospectively reviewed charts of the children with basal ganglia stroke who either had preceding minor head injury or showed basal ganglia calcification on computed tomography (CT) scan. Twenty children, 14 boys and 6 girls were identified. Eighteen were aged between 7 months to 17 months. Presentation was with hemiparesis in 17 and seizures in 3. Preceding minor head trauma was noted in 18. Family history was positive in 1 case. Bilateral basal ganglia calcification on CT scan was noted in 18. Brain magnetic resonance imaging done in 18 infants showed acute or chronic infarcts in basal ganglia. Results of other laboratory and radiological investigations were normal. Four infants were lost to follow-up, 9 achieved complete or nearly completely recovery, and 7 had persistent neurological deficits. Basal ganglia calcification likely represents mineralized lenticulostriate arteries, a marker of lenticulostriate vasculopathy. Abnormal lenticulostriate vessels are vulnerable to injury and thrombosis after minor head trauma resulting in stroke.
Collapse
Affiliation(s)
- Jatinder Singh Goraya
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Shivankshi Berry
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Kavita Saggar
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
20
|
Ahluwalia A, Jones MK, Brzozowska I, Tarnawski AS. In vitro model of vasculo-angiogenesis: demonstration that bone marrow derived endothelial progenitor cells form new hybrid capillary blood vessels jointly with gastric endothelial cells. J Physiol Pharmacol 2017; 68:841-846. [PMID: 29550796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023]
Abstract
Regeneration of blood vessels (neovascularization) is critical for tissue injury healing. The contribution of bone marrow-derived endothelial progenitor cells (BMD-EPCs) to neovascularization during tissue injury healing is not fully elucidated and it is not clear whether BMD-EPCs can form new capillary blood vessels independently or jointly with fully differentiated endothelial cells (ECs). The aim of this study was to establish an in vitro model of vasculogenesis/angiogenesis by co-culture of BMD-EPCs and gastric endothelial cells (GECs) on Matrigel, examine direct interactions of these cells; and, identify the mechanisms involved. We isolated BMD-EPCs and GECs from bone marrow and stomach of rats, respectively. In these cells, we examined the expression of CD34, CD133, CD31, VEGF-R2, stromal derived factor 1 (SDF-1) and CXCR4, and, their ability to form capillary-like tubes when cultured separately or when co-cultured (1:5 ratio) on growth factor-reduced Matrigel. Fluorescence-labeled BMD-EPCs seeded alone on Matrigel formed capillary-like tubes reflecting in vitro vasculogenesis, and when co-cultured with GECs on Matrigel, formed 'hybrid' tubes containing BMD-EPCs nested between GECs thus reflecting in vitro angio-vasculogenesis. These 'hybrid' tubes were 1.5-fold wider (P < 0.001) and had more extensive (5.1-fold increase) loops (P < 0.01) at the junctions of BMD-EPCs and GECs versus tubes formed by GECs alone. GECs expressed SDF-1 that likely mediated homing of BMD-EPCs (which expressed the SDF-1 receptor, CXCR4) and their incorporation during neovascularization. BMD-EPCs can independently form capillary-like tubes on Matrigel, and when co-cultured with fully differentiated ECs on Matrigel, form capillary-like 'hybrid' tubes comprised of both cell types. Both BMD-EPCs and GECs express SDF-1 and CXCR4, which indicate direct paracrine interactions between these cells during neovascularization.
Collapse
Affiliation(s)
- A Ahluwalia
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, CA, USA
| | - M K Jones
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, CA, USA
- Department of Medicine, University of California, Irvine, CA, USA
| | - I Brzozowska
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - A S Tarnawski
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, CA, USA. ;
- Department of Medicine, University of California, Irvine, CA, USA
| |
Collapse
|
21
|
Ahluwalia A, Brzozowski T, Jones MK, Ichikawa Y, Tarnawski AS. Formation of new blood vessels during gastric ulcer healing. Role of bone marrow derived endothelial progenitor cells. J Physiol Pharmacol 2017; 68:585-589. [PMID: 29151075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
Regeneration of blood vessels (neovascularization) is critical for gastric ulcer (GU) healing. The contributions of bone marrow-derived endothelial progenitor cells (BMD-EPCs) to neovascularization during GU healing are not fully elucidated. Our specific aims were to determine whether in GU, BMD-EPCs are incorporated into blood vessels of GU granulation tissue jointly with ECs, thus forming hybrid vessels; or, form separate vessels consisting of only BMD-EPCs. GUs were induced in rats by serosal application of acetic acid. Vascular cast studies were performed at 7, 21 and 60 days after GU induction and tissue specimens were immunostained for CD34, CD133, VEGFR2, and SDF-1 at 14 days. Human relevance was determined using archival human GU specimens. In rat GU granulation tissue BMD-EPCs constituted 28 ± 3% of all cells lining newly formed blood vessels, and were nested between fully differentiated ECs. In rat GU granulation tissue, expression of stromal derived factor-1 (SDF-1) - the major chemoattractant for BMD-EPCs was strongly upregulated. In human GU specimens, BMD-EPCs were also present in granulation tissue constituting 34 ± 3% of all cells lining blood vessels and jointly formed hybrid vessels with differentiated ECs. Our study uncovered that BMD-EPCs incorporate into newly formed blood vessels in GU granulation tissue; and, together with ECs of pre-existing vessels, contribute to and support neovascularization through vasculogenesis. This study is the first demonstration that vasculogenesis occurs during GU healing in both humans and in rats.
Collapse
Affiliation(s)
- A Ahluwalia
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, California, USA
| | - T Brzozowski
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| | - M K Jones
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, California, USA
- Department of Medicine, University of California, Irvine, CA, USA
| | - Y Ichikawa
- Department of Oncology, Yokohama City University, Graduate School of Medicine,Yokohama, Japan
| | - A S Tarnawski
- Medical and Research Services, Veterans Affairs Medical Center, Long Beach, California, USA. ;
- Department of Medicine, University of California, Irvine, CA, USA
| |
Collapse
|
22
|
Lissel A, Ottenberg F, Bracio BR, Ravizza A, De Maria C, Ahluwalia A, Di Pietro L, Trommler P. Status and solutions to medical device regulations for improving the healthcare landscape in Africa. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:4329-4332. [PMID: 28269236 DOI: 10.1109/embc.2016.7591685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For different reasons most African countries have a poor public healthcare system compared to developed countries. Despite an increasing number of patients they often lack skilled health workers as well as basic medical equipment. This paper focuses on the development of an affordable and sustainable system for medical device regulations to provide safe, effective and quality healthcare products for Africa. Furthermore, it is determined whether Open Source Medical Devices are an effective alternative for medical device regulations to increase innovations in Africa.
Collapse
|
23
|
Ali T, McCabe A, Ahluwalia A, Fairburn K, Racey M, Jutley G. Predicting temporal artery biopsy results … offering insights into temporal arteritis. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
24
|
Tarnawski AS, Ahluwalia A, Jones MK, Brzozowski T. Expression of nerve growth factor in rat stomach. Implications for interactions between endothelial, neural and epithelial cells. J Physiol Pharmacol 2016; 67:879-883. [PMID: 28195068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
Abstract
UNLABELLED This study was aimed to determine the expression and localization of nerve growth factor (NGF) in the gastric mucosa. Transmural gastric specimens were obtained from euthanized rats. STUDIES 1) expression of NGF and TrkA receptor by Western blotting; 2) histological evaluation of gastric wall architecture; 3) expression of NGF using immunostaining. Immunostaining showed strong and differential expression of NGF in neural elements of gastric myenteric and submucosal plexuses; in epithelial cells: mainly in chief and progenitor cells, in enterochromaffin-like (ECL) cells; and, in endothelial cells (ECs) lining blood vessels. We concluded that NGF expression in neural elements, epithelial cells and endothelial cells of blood vessels indicated a complex local interaction between neural, epithelial and endothelial cells that regulated gastric mucosal homeostasis and, likely, the protection against gastric injury and ulcer healing.
Collapse
Affiliation(s)
- A S Tarnawski
- Medical and Research Services, Veterans Affairs Long Beach Healthcare System (VALBHS), Long Beach, California, USA.
- Department of Medicine, University of California, Irvine, California, USA
| | - A Ahluwalia
- Medical and Research Services, Veterans Affairs Long Beach Healthcare System (VALBHS), Long Beach, California, USA
| | - M K Jones
- Medical and Research Services, Veterans Affairs Long Beach Healthcare System (VALBHS), Long Beach, California, USA
- Department of Medicine, University of California, Irvine, California, USA
| | - T Brzozowski
- Department of Physiology, Jagiellonian University Medical College, Cracow, Poland
| |
Collapse
|
25
|
Kakkar C, Kakkar S, Saggar K, Goraya JS, Ahluwalia A, Arora A. Paediatric brainstem: A comprehensive review of pathologies on MR imaging. Insights Imaging 2016; 7:505-22. [PMID: 27216793 PMCID: PMC4956624 DOI: 10.1007/s13244-016-0496-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/13/2016] [Accepted: 04/22/2016] [Indexed: 01/29/2023] Open
Abstract
The brainstem is a midline structure formed by the midbrain, pons and medulla and is a home for various vital neurological centres of the human body. A diverse spectrum of disease entities can involve the brainstem, which includes infections, metabolic disorders, demyelination, vascular conditions, neurodegenerative disorders and tumours. Brainstem involvement can be primary or secondary, i.e., as part of systemic disorders. Due to the overlapping clinical presentation and symptomatology, imaging plays a decisive role in the detection, localisation and characterisation of brainstem pathologies. Magnetic resonance imaging (MRI) is the modality of choice and the use of advanced MR techniques such as diffusion-weighted imaging and spectroscopy can be especially helpful in providing a tenable diagnoses. This article is a compilation of the MR imaging manifestations of a spectrum of common and uncommon brainstem pathologies that can be encountered in the paediatric age group. Teaching Points • The paediatric brainstem can be afflicted by many pathologies that may overlap clinico-radiologically. • MRI is the best modality for the localisation and diagnosis of brainstem pathologies. • Diffusion-weighted imaging is useful in the diagnosis of vascular and metabolic disorders. • Occasionally, demyelination and neoplasms can be indistinguishable on imaging.
Collapse
Affiliation(s)
- Chandan Kakkar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, India.
| | - Shruti Kakkar
- Division of Pediatric Haemato-oncology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, India
| | - Jatinder S Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, India
| | - Ankur Arora
- Worthing Hospital, Western Sussex NHS Foundation Trust, Lyndhurst Road, Worthing, BN112DH, UK
| |
Collapse
|
26
|
Gupta K, Banerjee A, Saggar K, Ahluwalia A, Saggar K. A prospective study of magnetic resonance imaging patterns of central nervous system infections in pediatric age group and young adults and their clinico-biochemical correlation. J Pediatr Neurosci 2016; 11:46-51. [PMID: 27195033 PMCID: PMC4862288 DOI: 10.4103/1817-1745.181244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Infections of the central nervous system (CNS) are common and routinely encountered. Our aim was to evaluate the neuroimaging features of the various infections of the CNS so as to differentiate them from tumoral, vascular, and other entities that warrant a different line of therapy. Aims: Our aim was to analyze the biochemical and magnetic resonance imaging (MRI) features in CNS infections. Settings and Design: This was a longitudinal, prospective study over a period of 1½ years. Subjects and Methods: We studied cerebrospinal fluid (CSF) findings and MRI patterns in 27 patients of 0–20 years age group with clinical features of CNS infections. MRI was performed on MAGNETOM Avanto 18 Channel 1.5 Tesla MR machine by Siemens India Ltd. The MRI protocol consisted of diffusion-weighted and apparent diffusion coefficient imaging, turbo spin echo T2-weighted, spin echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), and gradient-echo in axial, FLAIR in coronal, and T2-weighted in sagittal plane. Contrast-enhanced T1-weighted sequence and MR spectroscopy were done whenever indicated. Results and Conclusions: We found that most of the children belong to 1–10 years age group. Fungal infections were uncommon, mean CSF adenosine deaminase values specific for tuberculosis and mean CSF glucose-lowered in pyogenic. Hemorrhagic involvement of thalamus with/without basal ganglia and brainstem involvement may indicate Japanese encephalitis or dengue encephalitis. Diffusion restriction or hemorrhage in not expected in the brainstem afflicted lesions of rabies. Congenital cytomegalovirus can cause cortical malformations. T1 hyperintensities with diffusion restriction may represent viral encephalitis. Lesions of acute disseminated encephalomyelitis (ADEM) may mimic viral encephalitis. Leptomeningeal enhancement is predominant in pyogenic meningitis. Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.
Collapse
Affiliation(s)
- Kamini Gupta
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Avik Banerjee
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Karan Saggar
- Department of Dentistry, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
| |
Collapse
|
27
|
Affiliation(s)
- Mandeep Singh Ghuman
- Department of Radiodiagnosis, Post-graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | | | | | | | | | | |
Collapse
|
28
|
Galhotra R, Attri A, Ahluwalia A, Saggar K. Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography. Med J DY Patil Univ 2016. [DOI: 10.4103/0975-2870.186049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
29
|
Tanigawa T, Ahluwalia A, Watanabe T, Arakawa T, Tarnawski AS. Nerve growth factor injected into the gastric ulcer base incorporates into endothelial, neuronal, glial and epithelial cells: implications for angiogenesis, mucosal regeneration and ulcer healing. J Physiol Pharmacol 2015; 66:617-21. [PMID: 26348086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/20/2015] [Indexed: 02/06/2023]
Abstract
A previous study has demonstrated that locally administered growth factors such as epidermal growth factor, basic fibroblast growth factor and hepatocyte growth factor can accelerate healing of experimental gastric ulcers in rats. That study indicates that locally administered growth factors can exert potent biological effects resulting in enhanced gastric ulcers healing. However, the fate of injected growth factors, their retention and localization to specific cellular compartments have not been examined. In our preliminary study, we demonstrated that local injection of nerve growth factor to the base of experimental gastric ulcers dramatically accelerates ulcer healing, increases angiogenesis - new blood vessel formation, and improves the quality of vascular and epithelial regeneration. Before embarking on larger, definitive and time sequence studies, we wished to determine whether locally injected nerve growth factor is retained in gastric ulcer's tissues and taken up by specific cells during gastric ulcer healing. Gastric ulcers were induced in anesthetized rats by local application of acetic acid using standard methods; and, 60 min later fluorescein isothiocyanate-labeled nerve growth factor was injected locally to the ulcer base. Rats were euthanized 2, 5 and 10 days later. Gastric specimens were obtained and processed for histology. Unstained paraffin sections were examined under a fluorescence microscope, and the incorporation of fluorescein isothiocyanate-labeled nerve growth factor into various gastric tissue cells was determined and quantified. In addition, we performed immunostaining for S100β protein that is expressed in neural components. Five and ten days after ulcer induction labeled nerve growth factor (injected to the gastric ulcer base) was incorporated into endothelial cells of blood vessels, neuronal, glial and epithelial cells, myofibroblasts and muscle cells. This study demonstrates for the first time that during gastric ulcer healing locally administered exogenous nerve growth factor is retained in gastric tissue and is taken up by endothelial, neural, muscle and epithelial cells. This is likely the basis for the therapeutic action of locally administered nerve growth factor and its stimulation of angiogenesis, tissue regeneration and gastric ulcer healing.
Collapse
Affiliation(s)
- T Tanigawa
- Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, California and the University of California-Irvine, CA, USA
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - A Ahluwalia
- Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, California and the University of California-Irvine, CA, USA
| | - T Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Arakawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - A S Tarnawski
- Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, California and the University of California-Irvine, CA, USA.
| |
Collapse
|
30
|
Ghuman MS, Kaur S, Bhandal SK, Ahluwalia A, Saggar K. Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding. J Neurosci Rural Pract 2015; 6:403-4. [PMID: 26167027 PMCID: PMC4481798 DOI: 10.4103/0976-3147.158790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.
Collapse
Affiliation(s)
| | - Shabdeep Kaur
- Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | | | - Archana Ahluwalia
- Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kavita Saggar
- Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India
| |
Collapse
|
31
|
Mattei G, Gruca G, Rijnveld N, Ahluwalia A. The nano-epsilon dot method for strain rate viscoelastic characterisation of soft biomaterials by spherical nano-indentation. J Mech Behav Biomed Mater 2015; 50:150-9. [PMID: 26143307 DOI: 10.1016/j.jmbbm.2015.06.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022]
Abstract
Nano-indentation is widely used for probing the micromechanical properties of materials. Based on the indentation of surfaces using probes with a well-defined geometry, the elastic and viscoelastic constants of materials can be determined by relating indenter geometry and measured load and displacement to parameters which represent stress and deformation. Here we describe a method to derive the viscoelastic properties of soft hydrated materials at the micro-scale using constant strain rates and stress-free initial conditions. Using a new self-consistent definition of indentation stress and strain and corresponding unique depth-independent expression for indentation strain rate, the epsilon dot method, which is suitable for bulk compression testing, is transformed to nano-indentation. We demonstrate how two materials can be tested with a displacement controlled commercial nano-indentor using the nano-espilon dot method (nano-ε̇M) to give values of instantaneous and equilibrium elastic moduli and time constants with high precision. As samples are tested in stress-free initial conditions, the nano-ε̇M could be useful for characterising the micro-mechanical behaviour of soft materials such as hydrogels and biological tissues at cell length scales.
Collapse
Affiliation(s)
- G Mattei
- Research Centre "E. Piaggio", University of Pisa, Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - G Gruca
- Optics11, De Boelelaan 108, 1081 HV Amsterdam, The Netherlands
| | - N Rijnveld
- Optics11, De Boelelaan 108, 1081 HV Amsterdam, The Netherlands
| | - A Ahluwalia
- Research Centre "E. Piaggio", University of Pisa, Largo Lucio Lazzarino 1, 56122 Pisa, Italy.
| |
Collapse
|
32
|
Samarasena JB, Ahluwalia A, Tarnawski AS, Shinoura S, Choi KD, Lee JG, Chang KJ. Expression of nerve growth factor, its TrkA receptor, and several neuropeptides in porcine esophagus. Implications for interactions between neural, vascular and epithelial components of the esophagus. J Physiol Pharmacol 2015; 66:415-20. [PMID: 26084223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED This study was aimed to determine the expression and localization of nerve growth factor (NGF) and several neural peptides in porcine esophagus. Transmural esophageal specimens were obtained from euthanized pigs. STUDIES 1) histologic evaluation, 2) expressions of NGF and its tropomyosin receptor kinase A (TrkA) receptor, calcitonin generelated peptide (CGRP), neuronal nitric oxide synthase (nNOS), and neuronal enolase using immunostaining and quantification of signal distribution and intensity. Immunostaining for NGF, CGRP, nNOS and neuronal specific enolase (NSE) showed their strong and differential expression and localization in the neuronal network. NGF was strongly expressed in the majority of neurons and nerves, distribution of TrkA was complementary; its signal was 1.5-fold weaker P < 0.001 than NGF). Quantitatively the signal intensity was: CGRP > nNOS > NGF > NES > TrkA. In addition to neural structures, nNOS, NGF and TrkA were expressed in keratinocyte progenitor cells of esophageal mucosa and in endothelial cells of blood vessels. We conclude that a strong expression of NGF in majority of esophageal neurons and nerves indicates important, but previously unrecognized regulatory roles in the esophagus; 2) This study showed expression of NGF and some of the neuropeptides in neural elements, keratinocyte progenitor cells and endothelial cells of blood vessels, which indicates local interactions between neural, epithelial and endothelial cells.
Collapse
Affiliation(s)
- J B Samarasena
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA
| | - A Ahluwalia
- Division of Gastroenterology, Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, California, USA
| | - A S Tarnawski
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA
- Division of Gastroenterology, Department of Medicine, Long Beach Veterans Affairs Healthcare System, Long Beach, California, USA
| | - S Shinoura
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA
| | - K D Choi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA
| | - J G Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA
| | - K J Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - Irvine, Orange, California, USA.
| |
Collapse
|
33
|
Mattei G, Cristiani I, Magliaro C, Ahluwalia A. Profile analysis of hepatic porcine and murine brain tissue slices obtained with a vibratome. PeerJ 2015; 3:e932. [PMID: 25945319 PMCID: PMC4419543 DOI: 10.7717/peerj.932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/14/2015] [Indexed: 11/28/2022] Open
Abstract
This study is aimed at characterizing soft tissue slices using a vibratome. In particular, the effect of two sectioning parameters (i.e., step size and sectioning speed) on resultant slice thickness was investigated for fresh porcine liver as well as for paraformaldehyde-fixed (PFA-fixed) and fresh murine brain. A simple framework for embedding, sectioning and imaging the slices was established to derive their thickness, which was evaluated through a purposely developed graphical user interface. Sectioning speed and step size had little effect on the thickness of fresh liver slices. Conversely, the thickness of PFA-fixed murine brain slices was found to be dependent on the step size, but not on the sectioning speed. In view of these results, fresh brain tissue was sliced varying the step size only, which was found to have a significant effect on resultant slice thickness. Although precision-cut slices (i.e., with regular thickness) were obtained for all the tissues, slice accuracy (defined as the match between the nominal step size chosen and the actual slice thickness obtained) was found to increase with tissue stiffness from fresh liver to PFA-fixed brain. This quantitative investigation can be very helpful for establishing the most suitable slicing setup for a given tissue.
Collapse
Affiliation(s)
- G Mattei
- Research Center "E. Piaggio," University of Pisa , Pisa , Italy
| | - I Cristiani
- Research Center "E. Piaggio," University of Pisa , Pisa , Italy
| | - C Magliaro
- Research Center "E. Piaggio," University of Pisa , Pisa , Italy
| | - A Ahluwalia
- Research Center "E. Piaggio," University of Pisa , Pisa , Italy ; Institute of Clinical Physiology, National Research Council , Pisa , Italy
| |
Collapse
|
34
|
Lara J, Ashor AW, Oggioni C, Ahluwalia A, Mathers JC, Siervo M. Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis. Eur J Nutr 2015; 55:451-459. [DOI: 10.1007/s00394-015-0872-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/02/2015] [Indexed: 01/19/2023]
|
35
|
Abstract
Splenosis is a benign condition among patients with a history of splenic trauma or surgery. Most cases of splenosis are intra abdominal due to direct seeding of surrounding structures, although these heterotopic rests may occur almost anywhere in the body, and its diffuse nature may raise the suspicion of metastatic cancer. The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever. We, in this article emphasize the crucial role of taking a thorough patient's medical history concerning splenic trauma in the past and the use of novel non invasive diagnostics modalities that allow accurate diagnosis.
Collapse
Affiliation(s)
- Kamini Gupta
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, India
| | - Tanica Jain
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kavita Saggar
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, India
| |
Collapse
|
36
|
Tirella A, Magliaro C, Penta M, Troncone M, Pimentel R, Ahluwalia A. Sphyga: a multiparameter open source tool for fabricating smart and tunable hydrogel microbeads. Biofabrication 2014; 6:025009. [PMID: 24694569 DOI: 10.1088/1758-5082/6/2/025009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hydrogel microbeads are used in many biological applications, particularly for cell, protein or drug encapsulation. Although there are several methods for fabricating microbeads with controlled shapes and dimensions, many are limited to a small range of materials or sizes. We describe a compact open source tool-the spherical hydrogel generator (Sphyga)-for the fabrication of highly reproducible hydrogel based microbeads with predictable shapes and diameters ranging from 100 to 2000 µm. The unique feature of the system is the ability to modulate multiple parameters independently, so as to create a wide range of working conditions for fabricating tailored microbeads. Hence, by combining the different fabrication parameters, hydrogel beads with chosen shapes, sizes and materials can be generated with Sphyga. A multiparameter working-window was obtained by fixing the concentration of the base material, alginate, and varying the viscosity of the solution along with Sphyga's fabrication parameters (needle size, external air pressure, and material outflow). To validate the multiparameter working window, components such as proteins, cells, dyes and nanoparticles were also used to fabricate composite microbeads. The results show that the architecture of hydrogel microbeads can be engineered by considering the viscosity of the initial solution, which depends principally on the pH and composition of alginate solution. Coupled with Sphyga's multiple working parameters, material viscosity can then be used to tune hydrogel domains and thereby generate complex biologically relevant microenvironments for many biomedical applications.
Collapse
Affiliation(s)
- A Tirella
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Via Moruzzi 1, I-56124, Italy. Research Center 'E Piaggio', University of Pisa, Research Center '"E. Piaggio'", Largo Lazzarino 1, I-56122, Italy
| | | | | | | | | | | |
Collapse
|
37
|
Ahluwalia A, Jones MK, Szabo S, Tarnawski AS. Aging impairs transcriptional regulation of vascular endothelial growth factor in human microvascular endothelial cells: implications for angiogenesis and cell survival. J Physiol Pharmacol 2014; 65:209-15. [PMID: 24781730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023]
Abstract
In some tissues, aging impairs angiogenesis and reduces expression of vascular endothelial growth factor A (VEGF), a fundamental regulator of angiogenesis. We previously examined angiogenesis in aging and young gastric mucosa in vivo and in vitro and showed that an imbalance between expressions of VEGF (pro-angiogenic factor) and endostatin (anti-angiogenic protein) results in an aging-related impairment of angiogenesis in rats. However, the human relevance of these findings, and whether these mechanisms apply to endothelial cells derived from other tissues, is not clear. Since P-STAT3 and P-CREB are transcription factors that, in association with HIF-1α, can activate VEGF gene expression in some cells (e.g., liver cancer cells, vascular smooth muscle cells), we examined the expression of these two proteins in human dermal microvascular endothelial cells (HMVECs) derived from aging and neonatal individuals. We examined and quantified in vitro angiogenesis, expression of VEGF, P-STAT3, P-CREB and importin-α in HMVECs isolated from neonates (neonatal) and a 66 year old subject (aging). We also examined the effects of treatment with exogenous VEGF and endostatin on in vitro angiogenesis in these cells. Endothelial cells isolated from aging individuals had impaired angiogenesis (vs. neonatal endothelial cells) and reduced expression of VEGF mRNA and protein. Aged HMVECs also had reduced importin-α expression, and reduced expression and nuclear translocation of P-STAT3 and P-CREB. Reduced VEGF gene expression in aged HMVECs strongly correlated with the decreased levels of P-STAT3, P-CREB and importin-α in these cells. Our study clearly demonstrates that endothelial cells from aging individuals have impaired angiogenesis and reduced expression of VEGF likely due to impaired nuclear transport of P-STAT3 and P-CREB transcription factors in these cells.
Collapse
Affiliation(s)
- A Ahluwalia
- Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA.
| | | | | | | |
Collapse
|
38
|
Gupta K, Gupta R, Mittal P, Ahluwalia A. Role of GRE imaging in cerebral diseases with hemorrhage: A case series. J Mahatma Gandhi Inst Med Sci 2014. [DOI: 10.4103/0971-9903.138445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
39
|
Tirella A, Mattei G, Ahluwalia A. Strain rate viscoelastic analysis of soft and highly hydrated biomaterials. J Biomed Mater Res A 2013; 102:3352-60. [PMID: 23946054 PMCID: PMC4304325 DOI: 10.1002/jbm.a.34914] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 08/05/2013] [Indexed: 11/07/2022]
Abstract
Measuring the viscoelastic behavior of highly hydrated biological materials is challenging because of their intrinsic softness and labile nature. In these materials, it is difficult to avoid prestress and therefore to establish precise initial stress and strain conditions for lumped parameter estimation using creep or stress-relaxation (SR) tests. We describe a method ( ɛ˙M or epsilon dot method) for deriving the viscoelastic parameters of soft hydrated biomaterials which avoids prestress and can be used to rapidly test degradable samples. Standard mechanical tests are first performed compressing samples using different strain rates. The dataset obtained is then analyzed to mathematically derive the material's viscoelastic parameters. In this work a stable elastomer, polydimethylsiloxane, and a labile hydrogel, gelatin, were first tested using the ɛ˙M, in parallel SR was used to compare lumped parameter estimation. After demonstrating that the elastic parameters are equivalent and that the estimation of short-time constants is more precise using the proposed method, the viscoelastic behavior of porcine liver was investigated using this approach. The results show that the constitutive parameters of hepatic tissue can be quickly quantified without the application of any prestress and before the onset of time-dependent degradation phenomena.
Collapse
Affiliation(s)
- A Tirella
- Research Centre "E. Piaggio", University of Pisa, Via Diotisalvi 2, 56124, Pisa, Italy; National Research Council, IFC, Via Moruzzi 1, 56122, Pisa, Italy
| | | | | |
Collapse
|
40
|
|
41
|
Jones DA, Andiapen M, Van-Eijl TJA, Webb AJ, Antoniou S, Schilling RJ, Ahluwalia A, Mathur A. The safety and efficacy of intracoronary nitrite infusion during acute myocardial infarction (NITRITE-AMI): study protocol of a randomised controlled trial. BMJ Open 2013; 3:bmjopen-2013-002813. [PMID: 23550096 PMCID: PMC3641434 DOI: 10.1136/bmjopen-2013-002813] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major cause of death and disability in the UK and worldwide. Presently, timely and effective reperfusion with primary percutaneous coronary intervention (PPCI) remains the most effective treatment strategy for limiting infarct size, preserving left ventricular ejection fraction (LVEF) and improving clinical outcomes. However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is currently no effective therapy. Extensive preclinical evidence exists to suggest that sodium nitrite (as a source of endogenous nitric oxide) is an effective therapeutic strategy for preventing myocardial reperfusion injury. The purpose of NITRITE-AMI is to test whether sodium nitrite reduces reperfusion injury and subsequent infarct size in patients undergoing PPCI for MI. METHODS AND DESIGN NITRITE-AMI is a double-blind, randomised, single-centre, placebo-controlled trial to determine whether intracoronary nitrite injection reduces infarct size in patients with myocardial infarction undergoing primary angioplasty. The study will enrol 80 patients presenting with ST-elevation myocardial infarction. Patients will be randomised to receive either a bolus of intracoronary sodium nitrite or placebo (sodium chloride) at the time of PPCI. The primary outcome is infarct size assessed by creatine kinase area under the curve (AUC) over 48 h. Secondary endpoints include troponin T AUC and infarct size, LV dimensions and myocardial salvage index assessed by cardiac MR (CMR), markers of platelet reactivity and inflammation, the safety and tolerability of intracoronary nitrite, and 1 year major adverse cardiac events. ETHICS AND DISSEMINATION The study is approved by the local ethics committee (NRES Committee London West London: 11/LO/1500) and by the Medicines and Healthcare Products Regulatory Agency (MHRA) (EudraCT nr. 2010-022460-12). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION United Kingdom Clinical Research Network (Study ID 12117), http://clinicaltrials.gov (NCT01584453) and Current Controlled Trials (ISRCTN:38736987).
Collapse
Affiliation(s)
- D A Jones
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - M Andiapen
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - T J A Van-Eijl
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
| | - A J Webb
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
| | - S Antoniou
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - R J Schilling
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - A Ahluwalia
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
| | - A Mathur
- Centre of Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
42
|
Giusti S, Pagliari F, Vozzi F, Tirella A, Mazzei D, Cabiati M, Del Ry S, Ahluwalia A. SQPR 3.0: A Sensorized Bioreactor for Modulating Cardiac Phenotype. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.proeng.2013.05.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Nakai Y, Shinoura S, Ahluwalia A, Tarnawski AS, Chang KJ. In vivo visualization of epidermal growth factor receptor and survivin expression in porcine pancreas using endoscopic ultrasound guided fine needle imaging with confocal laser-induced endomicroscopy. J Physiol Pharmacol 2012; 63:577-80. [PMID: 23388473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 02/06/2023]
Abstract
UNLABELLED The aims of this pilot study were to establish a principle of molecular imaging of the pancreas and determine in vivo expression of epidermal growth factor receptor (EGF-R) and survivin using a novel endoscopic ultrasound-guided fine needle imaging (EUS-FNI) technique, which incorporates needle based confocal laser-induced endomicroscopy (nCLE) after intrapancreatic injection of FTIC-labeled antibodies. Studies were performed in anesthetized pigs. FITC-labeled specific antibodies against EGF-R and survivin were injected into the tail and neck of the pancreas using a 19 gauge needle introduced under EUS guidance. Thirty minutes later, nCLE was performed using a prototype needle-based confocal laser-induced endomicroscopy probe (Cellvizio AQ-Flex-19, Mauna Kea Technologies, Paris, France) to determine cellular and tissue localization of EGF-R and survivin in the pancreas. Then pigs were euthanized and specimens of pancreas from areas injected with antibodies were obtained for histologic examination under epifluorescence microscope. RESULTS EUS-guided nCLE enabled visualization of EGF-R and survivin in pancreatic tissue. Expression of EGF-R and survivin in pancreas was confirmed by histology. EGF-R immunoreactivity was localized to majority of duct-lining cells and to the surface and cytoplasm of many acinar cells. Survivin was localized mainly to the acinar cells. This study demonstrated the feasibility of in vivo, real time visualization of EGF-R and survivin in the pancreas by local injection of FITC-labeled antibodies via EUS-guided fine needle injection, followed by EUS-guided needle based confocal laser-induced endomicroscopy.
Collapse
Affiliation(s)
- Y Nakai
- Division of Gastroenterology and Hepatology, H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine School of Medicine, CA, USA
| | | | | | | | | |
Collapse
|
44
|
Singh P, Goraya JS, Saggar K, Ahluwalia A. Aicardi syndrome. Singapore Med J 2012; 53:e153-e155. [PMID: 22815034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aicardi syndrome is a rare neurodevelopmental disease characterised by congenital chorioretinal lacunae, corpus callosum dysgenesis, seizures, polymicrogyria, cerebral callosum, chorioretinopathy and electroencephalogram abnormality. We present a case of Aicardi syndrome with callosal hypogenesis in a 4.5-month-old baby who presented with infantile spasms. Ophthalmoscopy revealed chorioretinal lacunae. The clinical and magnetic resonance imaging features were diagnostic of Aicardi syndrome.
Collapse
Affiliation(s)
- Paramdeep Singh
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Punjab, India.
| | | | | | | |
Collapse
|
45
|
Nakai Y, Shinoura S, Ahluwalia A, Tarnawski AS, Chang KJ. Molecular imaging of epidermal growth factor-receptor and survivin in vivo in porcine esophageal and gastric mucosae using probe-based confocal laser-induced endomicroscopy: proof of concept. J Physiol Pharmacol 2012; 63:303-7. [PMID: 22791645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/20/2012] [Indexed: 02/06/2023]
Abstract
UNLABELLED Confocal laser-induced endomicroscopy (CLE) enables in vivo, real time visualization of the subsurface cells and tissue structures in gastrointestinal mucosa at a subcellular resolution of ≈1000x magnification. The aims of this pilot study were to establish a principle of molecular imaging and determine in vivo expression of epidermal growth factor receptor (EGF-R) and survivin in porcine esophageal and gastric mucosa using probe-based CLE (pCLE) and topically applied FITC-labeled antibodies. Studies were performed in anesthetized pigs. During endoscopy FITC-labeled antibodies against EGF-R and survivin were either sprayed onto esophageal and gastric mucosa in preselected areas or administered via submucosal injection. Thirty minutes later pCLE was performed using a through-the-scope probe (GastroFlex UHD, Cellvizio, Mauna Kea Technologies, Paris, France) to determine cellular and tissue localization of EGF-R and survivin. Then the pigs were euthanized and esophageal and gastric walls from the areas sprayed or injected with antibodies were collected for histologic examination under epifluorescence microscopy. RESULTS CLE enabled visualization of EGF-R and survivin in esophageal and gastric mucosa and this was confirmed by histology. In the esophagus both EGF-R and survivin were localized predominantly to the keratinocyte progenitor cells. In the stomach, EGF-R was localized to progenitor zone cells and some epithelial cells. Localization of survivin was similar, but involved more surface epithelial cells. This study demonstrated feasibility of using CLE and topical administration of FITC labeled antibodies for in vivo localization of EGF-R and survivin in esophageal and gastric mucosa.
Collapse
Affiliation(s)
- Y Nakai
- Division of Gastroenterology and Hepatology, H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, School of Medicine, CA, USA
| | | | | | | | | |
Collapse
|
46
|
Bianchi F, Vassalle C, Simonetti M, Vozzi G, Domenici C, Ahluwalia A. Endothelial cell function on 2D and 3D micro-fabricated polymer scaffolds: applications in cardiovascular tissue engineering. Journal of Biomaterials Science, Polymer Edition 2012; 17:37-51. [PMID: 16411597 DOI: 10.1163/156856206774879117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polymeric structures of a polylactide-polycaprolactone blend were micro-fabricated using the Pressure Assisted Microsyringe (PAM) system. Human umbilical vein endothelial cells were cultured on the scaffolds, and apoptosis, cell adhesion, proliferation and metabolism were evaluated. In addition, more specific indicators of endothelial cell function, namely nitric oxide and endothelin production, were also assessed. Thin films of the blend, as well as gelatine-coated glass slides (as controls) were used. The results show that as far as adhesion, apoptosis and metabolism are concerned, the scaffolds do not interfere with cell function compared with gelatin controls. However, the nitric oxide/endothelin ratio was higher than that observed on the gelatin films, suggesting that the scaffolds could be used for engineering small diameter blood vessels without risk of occlusion.
Collapse
Affiliation(s)
- F Bianchi
- Interdepartmental Research Center E Piaggio, Faculty of Engineering, University of Pisa, Italy
| | | | | | | | | | | |
Collapse
|
47
|
Perez-Pomares JM, Ruiz-Villalba A, Ziogas A, Segovia JC, Ehrbar M, Munoz-Chapuli R, De La Rosa A, Dominguez JN, Hove-Madsen L, Sankova B, Sedmera D, Franco D, Aranega Jimenez A, Babaeva G, Chizh N, Galchenko S, Sandomirsky B, Schwarzl M, Seiler S, Steendijk P, Huber S, Maechler H, Truschnig-Wilders M, Pieske B, Post H, Simrick S, Kreutzer R, Rao C, Terracciano CM, Kirchhof P, Fabritz L, Brand T, Theveniau-Ruissy M, Parisot P, Francou A, Saint-Michel E, Mesbah K, Kelly RG, Wu HT, Sie SS, Chen CY, Kuan TC, Lin CS, Ismailoglu Z, Guven M, Yakici A, Ata Y, Ozcan S, Yildirim E, Ongen Z, Miroshnikova V, Demina E, Rodygina T, Kurjanov P, Denisenko A, Schwarzman A, Rubanenko A, Shchukin Y, Germanov A, Goldbergova M, Parenica J, Lipkova J, Pavek N, Kala P, Poloczek M, Vasku A, Parenicova I, Spinar J, Gambacciani C, Chiavacci E, Evangelista M, Vesentini N, Kusmic C, Pitto L, Chernova A, Nikulina SUY, Arvanitis DA, Mourouzis I, Pantos C, Kranias EG, Cokkinos DV, Sanoudou D, Vladimirskaya TE, Shved IA, Kryvorot SG, Schirmer IM, Appukuttan A, Pott L, Jaquet K, Ladilov Y, Archer CR, Bootman MD, Roderick HL, Fusco A, Sorriento D, Santulli G, Trimarco B, Iaccarino G, Hagenmueller M, Riffel J, Gatzoulis MA, Stoupel EG, Garcia R, Merino D, Montalvo C, Hurle MA, Nistal JF, Villar AV, Perez-Moreno A, Gilabert R, Bernhold E, Ros E, Amat-Roldan I, Katus HA, Hardt SE, Maqsood A, Zi M, Prehar S, Neyses L, Ray S, Oceandy D, Khatami N, Wadowski P, Wagh V, Hescheler J, Sachinidis A, Mohl W, Chaudhry B, Burns D, Henderson DJ, Bax NAM, Van Marion MH, Shah B, Goumans MJ, Bouten CVC, Van Der Schaft DWJ, Bax NAM, Van Oorschot AAM, Maas S, Braun J, Van Tuyn J, De Vries AAF, Gittenberger-De Groot AC, Goumans MJ, Bageghni S, Drinkhill MJ, Batten TFC, Ainscough JFX, Onate B, Vilahur G, Ferrer-Lorente R, Ybarra J, Diez-Caballero A, Ballesta-Lopez C, Moscatiello F, Herrero J, Badimon L, Martin-Rendon E, Clifford DM, Fisher SA, Brusnkill SJ, Doree C, Mathur A, Clarke M, Watt SM, Hernandez-Vera R, Badimon L, Kavanagh D, Yemm AI, Frampton J, Kalia N, Terajima Y, Shimizu T, Tsuruyama S, Ishii H, Sekine H, Hagiwara N, Okano T, Vrijsen KR, Chamuleau SAJ, Sluijter JPG, Doevendans PFM, Madonna R, Delli Pizzi S, Di Donato L, Mariotti A, Di Carlo L, D'ugo E, Teberino MA, Merla A, T A, De Caterina R, Kolker L, Ali NN, Maclellan K, Moore M, Wheeler J, Harding SE, Fleck RA, Rowlinson JM, Kraenkel N, Ascione R, Madeddu P, O'sullivan JF, Leblond AL, Kelly G, Kumar AHS, Metharom P, Buneker CK, Alizadeh-Vikali N, Hynes BG, O'connor R, Caplice NM, Noseda M, De Smith AJ, Leja T, Rao PH, Al-Beidh F, Abreu Pavia MS, Blakemore AI, Schneider MD, Stathopoulou K, Cuello F, Ehler E, Haworth RS, Avkiran M, Morawietz H, Eickholt C, Langbein H, Brux M, Goettsch C, Goettsch W, Arsov A, Brunssen C, Mazilu L, Parepa IR, Suceveanu AI, Suceveanu AP, De Man FS, Guignabert C, Tu L, Handoko ML, Schalij I, Fadel E, Postmus PE, Vonk-Noordegraaf A, Humbert M, Eddahibi S, Sorriento D, Santulli G, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Fazal L, Azibani F, Bihry N, Merval R, Polidano E, Samuel JL, Delcayre C, Zhang Y, Mi YM, Ren LL, Cheng YP, Guo R, Liu Y, Jiang YN, Mourouzis I, Pantos C, Kokkinos AD, Cokkinos DV, Tretjakovs P, Jurka A, Bormane I, Mikelsone I, Reihmane D, Elksne K, Krievina G, Verbovenko J, Bahs G, Lopez-Andres N, Rousseau A, Calvier L, Akhtar R, Labat C, Cruickshank K, Diez J, Zannad F, Lacolley P, Rossignol P, Hamesch K, Subramanian P, Li X, Thiemann A, Heyll K, Dembowsky K, Chevalier E, Weber C, Schober A, Yang L, Kim G, Gardner B, Earley J, Hofmann-Bowman M, Cheng CF, Lian WS, Lin H, Jinjolia NJ, Abuladze GA, Tvalchrelidze SHT, Khamnagadaev I, Shkolnikova M, Kokov L, Miklashevich I, Drozdov I, Ilyich I, Bingen BO, Askar SFA, Ypey DL, Van Der Laarse A, Schalij MJ, Pijnappels DA, Roney CH, Ng FS, Chowdhury RA, Chang ETY, Patel PM, Lyon AR, Siggers JH, Peters NS, Obergrussberger A, Stoelzle S, Bruggemann A, Haarmann C, George M, Fertig N, Moreira D, Souza A, Valente P, Kornej J, Reihardt C, Kosiuk J, Arya A, Hindricks G, Adams V, Husser D, Bollmann A, Camelliti P, Dudhia J, Dias P, Cartledge J, Connolly DJ, Terracciano CM, Nobles M, Sebastian S, Tinker A, Opel A, Tinker A, Daimi H, Haj Khelil A, Be Chibani J, Barana A, Amoros I, Gonzalez De La Fuente M, Caballero R, Aranega A, Franco D, Kelly A, Bernus O, Kemi OJ, Myles RC, Ghouri IA, Burton FL, Smith GL, Del Lungo M, Sartiani L, Spinelli V, Baruscotti M, Difrancesco D, Mugelli A, Cerbai E, Thomas AM, Aziz Q, Khambra T, Tinker A, Addlestone JMA, Cartwright EJ, Wilkinson R, Song W, Marston S, Jacquet A, Mougenot NM, Lipskaia AJ, Paalberends ER, Stam K, Van Dijk SJ, Van Slegtenhorst M, Dos Remedios C, Ten Cate FJ, Michels M, Niessen HWM, Stienen GJM, Van Der Velden J, Read MI, Andreianova AA, Harrison JC, Goulton CS, Kerr DS, Sammut IA, Schwarzl M, Seiler S, Wallner M, Huber S, Steendijk P, Maechler H, Truschnig-Wilders M, Von Lewinski D, Pieske B, Post H, Kindsvater D, Saes M, Morano I, Muegge A, Jaquet K, Buyandelger B, Kostin S, Gunkel S, Vouffo J, Ng K, Chen J, Eilers M, Isaacson R, Milting H, Knoell R, Cattin ME, Crocini C, Schlossarek S, Maron S, Hansen A, Eschenhagen T, Carrier L, Bonne G, Coppini R, Ferrantini C, Olivotto I, Del Lungo M, Belardinelli L, Poggesi C, Mugelli A, Cerbai E, Leung MC, Messer AE, Copeland O, Marston SB, Mills AM, Collins T, O'gara P, Thum T, Regalla K, Lyon AR, Macleod KT, Harding SE, Rao C, Prodromakis T, Chaudhry U, Darzi A, Yacoub MH, Athanasiou T, Terracciano CM, Bogdanova A, Makhro A, Hoydal M, Stolen TO, Johnssen AB, Alves M, Catalucci D, Condorelli G, Koch LG, Britton SL, Smith GL, Wisloff U, Bito V, Claus P, Vermeulen K, Huysmans C, Ventura-Clapier R, Sipido KR, Seliuk MN, Burlaka AP, Sidorik EP, Khaitovych NV, Kozachok MM, Potaskalova VS, Driesen RB, Galan DT, Vermeulen K, Claus P, Sipido KR, De Paulis D, Arnoux T, Schaller S, Pruss RM, Poitz DM, Augstein A, Braun-Dullaeus RC, Schmeisser A, Strasser RH, Micova P, Balkova P, Hlavackova M, Zurmanova J, Kasparova D, Kolar F, Neckar J, Novak F, Novakova O, Pollard S, Babba M, Hussain A, James R, Maddock H, Alshehri AS, Baxter GF, Dietel B, Altendorf R, Daniel WG, Kollmar R, Garlichs CD, Sirohi R, Roberts N, Lawrence D, Sheikh A, Kolvekar S, Yap J, Arend M, Walkinshaw G, Hausenloy DJ, Yellon DM, Posa A, Szabo R, Szalai Z, Szablics P, Berko MA, Orban K, Murlasits ZS, Balogh L, Varga C, Ku HC, Su MJ, Chreih RM, Ginghina C, Deleanu D, Ferreira ALBJ, Belal A, Ali MA, Fan X, Holt A, Campbell R, Schulz R, Bonanad C, Bodi V, Sanchis J, Morales JM, Marrachelli V, Nunez J, Forteza MJ, Chaustre F, Gomez C, Chorro FJ, Csont T, Fekete V, Murlasits Z, Aypar E, Bencsik P, Sarkozy M, Varga ZV, Ferdinandy P, Duerr GD, Zoerlein M, Dewald D, Mesenholl B, Schneider P, Ghanem A, Rittling S, Welz A, Dewald O, Duerr GD, Dewald D, Becker E, Peigney C, Ghanem A, Welz A, Dewald O, Bouleti C, Galaup A, Monnot C, Ghaleh B, Germain S, Timmermans A, Ginion A, De Meester C, Sakamoto K, Vanoverschelde JL, Horman S, Beauloye C, Bertrand L, Maroz-Vadalazhskaya N, Drozd E, Kukharenko L, Russkich I, Krachak D, Seljun Y, Ostrovski Y, Martin AC, Le Bonniec B, Lecompte T, Dizier B, Emmerich J, Fischer AM, Samama CM, Godier A, Mogensen S, Furchtbauer EM, Aalkjaer C, Choong WL, Jovanovic A, Khan F, Daniel JM, Dutzmann JM, Widmer-Teske R, Guenduez D, Sedding D, Castro MM, Cena JJC, Cho WJC, Goobie GG, Walsh MPW, Schulz RS, Daniel JM, Dutzmann J, Widmer-Teske R, Preissner KT, Sedding D, Aziz Q, Khambra T, Sones W, Thomas AM, Kotlikoff M, Tinker A, Serizawa K, Yogo K, Aizawa K, Hirata M, Tashiro Y, Ishizuka N, Varela A, Katsiboulas M, Tousoulis D, Papaioannou TG, Vaina S, Davos CH, Piperi C, Stefanadis C, Basdra EK, Papavassiliou AG, Hermenegildo C, Lazaro-Franco M, Sobrino A, Bueno-Beti C, Martinez-Gil N, Walther T, Peiro C, Sanchez-Ferrer CF, Novella S, Ciccarelli M, Franco A, Sorriento D, Del Giudice C, Dorn GW, Trimarco B, Iaccarino G, Cseplo P, Torok O, Springo ZS, Vamos Z, Kosa D, Hamar J, Koller A, Bubb KJ, Ahluwalia A, Stepien EL, Gruca A, Grzybowska J, Goralska J, Dembinska-Kiec A, Stepien EL, Stolinski J, Grzybowska J, Goralska J, Partyka L, Gruca A, Dembinska-Kiec A, Zhang H, Sweeney D, Thomas GN, Fish PV, Taggart DP, Watt SM, Martin-Rendon E, Cioffi S, Bilio M, Martucciello S, Illingworth E, Caporali A, Shantikumar S, Marchetti M, Martelli F, Emanueli C, Marchetti M, Meloni M, Caporali A, Al Haj Zen A, Sala-Newby G, Emanueli C, Del Turco S, Saponaro C, Dario B, Sartini S, Menciassi A, Dario P, La Motta C, Basta G, Santiemma V, Bertone C, Rossi F, Michelon E, Bianco MJ, Castelli A, Shin DI, Seung KB, Seo SM, Park HJ, Kim PJ, Baek SH, Shin DI, Seung KB, Seo SM, Park HJ, Choi YS, Her SH, Kim DB, Kim PJ, Lee JM, Park CS, Rocchiccioli S, Cecchettini A, Pelosi G, Kusmic C, Citti L, Parodi O, Trivella MG, Michel-Monigadon D, Burger F, Dunoyer-Geindre S, Pelli G, Cravatt B, Steffens S, Didangelos A, Mayr U, Yin X, Stegemann C, Shalhoub J, Davies AH, Monaco C, Mayr M, Lypovetska S, Grytsenko S, Njerve IU, Pettersen AA, Opstad TB, Bratseth V, Arnesen H, Seljeflot I, Dumitriu IE, Baruah P, Antunes RF, Kaski JC, Forteza MJ, Bodi V, Trapero I, Benet I, Alguero C, Chaustre FJ, Gomez C, Sanchis J, Chorro FJ, Mangold A, Puthenkalam S, Distelmaier K, Adlbrecht C, Preissner KT, Lang IM, Koizumi T, Inoue I, Komiyama N, Nishimura S, Korneeva ON, Drapkina OM, Fornai L, Angelini A, Kiss A, Giskes F, Eijkel G, Fedrigo M, Valente ML, Thiene G, Heeren RMA, Vilahur G, Padro T, Casani L, Suades R, Badimon L, Bertoni B, Carminati R, Carlini V, Pettinari L, Martinelli C, Gagliano N, Noppe G, Buchlin P, Marquet N, Baeyens N, Morel N, Vanoverschelde JL, Bertrand L, Beauloye C, Horman S, Baysa A, Sagave J, Dahl CP, Gullestad L, Carpi A, Di Lisa F, Giorgio M, Vaage J, Valen G, Vafiadaki E, Papalouka V, Arvanitis DA, Terzis G, Spengos K, Kranias EG, Manta P, Sanoudou D, Gales C, Genet G, Dague E, Cazorla O, Payre B, Mias C, Ouille A, Lacampagne A, Pathak A, Senard JM, Abonnenc M, Da Costa Martins P, Srivastava S, Didangelos A, Yin X, Gautel M, De Windt L, Mayr M, Comelli L, Rocchiccioli S, Lande C, Ucciferri N, Trivella MG, Citti L, Cecchettini A, Ikonen L, Vuorenpaa H, Kujala K, Sarkanen JR, Heinonen T, Ylikomi T, Aalto-Setala K, Capros H, Sprincean N, Usurelu N, Egorov V, Stratu N, Matchkov V, Bouzinova E, Moeller-Nielsen N, Wiborg O, Aalkjaer C, Gutierrez PS, Aparecida-Silva R, Borges LF, Moreira LFP, Dias RR, Kalil J, Stolf NAG, Zhou W, Suntharalingam K, Brand N, Vilar Compte R, Ying L, Bicknell K, Dannoura A, Dash P, Brooks G, Tsimafeyeu I, Tishova Y, Wynn N, Oyeyipo IP, Olatunji LA, Maegdefessel L, Azuma J, Toh R, Raaz U, Merk DR, Deng A, Spin JM, Tsao PS, Lande C, Cecchettini A, Tedeschi L, Taranta M, Naldi I, Citti L, Trivella MG, Grimaldi S, Cinti C, Bousquenaud M, Maskali F, Poussier S, Marie PY, Boutley H, Karcher G, Wagner DR, Devaux Y, Torre I, Psilodimitrakopoulos S, Iruretagoiena I, Gonzalez-Tendero A, Artigas D, Loza-Alvarez P, Gratacos E, Amat-Roldan I, Murray L, Carberry DM, Dunton P, Miles MJ, Suleiman MS, Kanesalingam K, Taylor R, Mc Collum CN, Parniczky A, Solymar M, Porpaczy A, Miseta A, Lenkey ZS, Szabados S, Cziraki A, Garai J, Koller A, Myloslavska I, Menazza SM, Canton MC, Di Lisa FDL, Schulz RS, Oliveira SHV, Morais CAS, Miranda MR, Oliveira TT, Lamego MRA, Lima LM, Goncharova NS, Naymushin AV, Kazimli AV, Moiseeva OM, Lima LM, Carvalho MG, Sabino AP, Mota APL, Sousa MO, Niessner A, Richter B, Hohensinner PJ, Rychli K, Zorn G, Berger R, Moertl D, Pacher R, Wojta J, Huelsmann M, Kukharchik G, Nesterova N, Pavlova A, Gaykovaya L, Krapivka N, Konstantinova I, Sichinava L, Prapa S, Mccarthy KP, Kilner PJ, Xu XY, Johnson MR, Ho SY. Poster session 2. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
48
|
Coron E, Mosnier JF, Ahluwalia A, Le Rhun M, Galmiche JP, Tarnawski AS, Matysiak-Budnik T. Colonic mucosal biopsies obtained during confocal endomicroscopy are pre-stained with fluorescein in vivo and are suitable for histologic evaluation. Endoscopy 2012; 44:148-53. [PMID: 22271025 DOI: 10.1055/s-0031-1291534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Confocal laser endomicroscopy (CLE) with intravenous infusion of fluorescein allows noninvasive, real-time in vivo visualization of gastrointestinal mucosa at ~ × 1000 magnification ("virtual biopsy"). Conventional biopsies obtained during these procedures serve as the reference and established diagnostic standard. The aim of the present study was to assess whether the standard histologic biopsies that are obtained during CLE retain fluorescein in the tissues and allow the visualization of mucosal structures without any additional staining. PATIENTS AND METHODS CLE optical imaging of the mucosa was performed in 16 patients who were undergoing CLE colonoscopy. Standard conventional biopsies were also obtained from both normal colonic mucosa and colonic polyps. De-paraffinized mucosal sections were examined under a fluorescence microscope for the presence and distribution of fluorescein, and then underwent immunostaining for expression of vascular endothelial growth factor (VEGF). RESULTS Standard mucosal biopsy sections from patients undergoing CLE displayed a strong fluorescence and showed well-delineated mucosal structures. In colonic adenomas, there was a 4.6-fold increased vascular permeability compared with normal mucosa (P<0.001), indicated by fluorescein leakage to the extravascular space. Immunostaining demonstrated an aberrantly increased expression of VEGF in the epithelium of colonic adenomas but not in the epithelium of normal mucosa or hyperplastic polyps. CONCLUSIONS This study shows for the first time that standard colonic biopsies obtained during CLE retain fluorescein, show excellent delineation of mucosal structures without additional staining, allow the evaluation of mucosal microvasculature and vascular permeability, and are suitable for immunostaining.
Collapse
Affiliation(s)
- E Coron
- Institut des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France
| | | | | | | | | | | | | |
Collapse
|
49
|
Ahluwalia A, Tarnawski AS. Critical role of hypoxia sensor--HIF-1α in VEGF gene activation. Implications for angiogenesis and tissue injury healing. Curr Med Chem 2012; 19:90-7. [PMID: 22300081 DOI: 10.2174/092986712803413944] [Citation(s) in RCA: 466] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/07/2011] [Accepted: 11/10/2011] [Indexed: 02/06/2023]
Abstract
Vascular injury of esophageal and gastrointestinal mucosa caused by injurious and ulcerogenic factors leads to the cessation of blood flow, ischemia, and hypoxia and tissue necrosis in form of erosions or ulcers. The re-establishment of blood vessels through the process of angiogenesis--formation of new blood vessels--is critical for healing of tissue injury because is essential for delivery of oxygen and nutrients to the healing site. Hypoxia increases expression of hypoxia inducible factor (HIF-1), which serves as hypoxia sensor and activates compensatory and adaptive mechanisms. However, the molecular mechanisms and the role of HIF-1α in hypoxia-driven cellular and molecular events of angiogenesis in gastrointestinal injury healing have not been fully explored. The review discusses the novel molecular mechanisms of angiogenesis in gastric and esophageal mucosa with focus on HIF1α and VEGF interactions during healing of gastric mucosal injury and esophageal ulcers. HIF-1α is upregulated by gastric mucosal injury and esophageal ulcers; this upregulation correlates with VEGF gene activation and initiation of angiogenesis. The non-steroidal anti-inflammatory drugs (NSAIDs) interfere with hypoxia-induced HIF-1α accumulation, VEGF gene activation and angiogenesis through upregulation of von Hippel- Lindau (VHL) tumor suppressor, which activates degradation of HIF-1α protein. HIF-1α is a transcription factor that under hypoxic conditions, accumulates in endothelial cells and can bind to VEGF gene promoter and induce VEGF gene expression. In order to activate the VEGF gene, HIF-1α must be transported to the nucleus. Recent evidence implicates importins as key mechanism in this process.
Collapse
Affiliation(s)
- A Ahluwalia
- VA Long Beach Healthcare System & the University of California, Irvine, 5901 E. 7th Street, Long Beach, CA 90822-5201, USA.
| | | |
Collapse
|
50
|
Tarnawski AS, Ahluwalia A. Molecular mechanisms of epithelial regeneration and neovascularization during healing of gastric and esophageal ulcers. Curr Med Chem 2012; 19:16-27. [PMID: 22300072 DOI: 10.2174/092986712803414088] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 02/06/2023]
Abstract
In this paper we reviewed and updated current views on the cellular and molecular mechanisms of gastric and esophageal ulcer healing. Gastric ulcer healing encompasses inflammation, cell proliferation, epithelial regeneration, gland reconstruction, formation of granulation tissue, neovascularization (new blood vessel formation), interactions between various cells and the matrix and tissue remodeling, resulting in scar formation. All these events are controlled by the cytokines and growth factors, GI hormones including gastrin, CCK, and orexigenic peptides such as ghrelin, orexin-A and obestatin as well as Cox2 generated prostaglandins. These growth factors and hormones trigger cell proliferation, migration, and survival utilizing Ras, MAPK, PI-3K/AKT, PLC-γ and Rho/Rac/actin signaling pathways. Hypoxia triggers activation of some of these genes (e.g., VEGF) via hypoxia inducible factor (HIF). Growth factors: EGF, HGF, IGF-1, their receptors and Cox2 are important for epithelial cell proliferation, migration, re-epithelialization and regeneration of gastric glands during gastric ulcer healing. Serum response factor (SRF) is also essential for re-epithelialization and muscle restoration. VEGF, bFGF, angiopoietins, nitric oxide, endothelin, prostaglandins and metalloproteinases are important for angiogenesis, vascular remodeling and mucosal regeneration within gastric ulcer scar. SRF is critical limiting factor for VEGF-induced angiogenesis. Esophageal ulcer healing follows similar pattern to gastric ulcer, but KGF and its receptor are the key players in regeneration of the epithelium. In addition to local mucosal cells from viable mucosa bordering necrosis, circulating bone marrow derived stem and progenitor cells are potentially important for ulcer healing, contributing to the regeneration of epithelial and connective tissue components and neovascularization.
Collapse
Affiliation(s)
- A S Tarnawski
- Veterans Administration Long Beach Healthcare System, 5901 E. 7th Street, Long Beach, CA 90822-5201, USA.
| | | |
Collapse
|