Endocannabinoid-related molecules predict the metabolic efficacy of GLP-1 receptor agonism in humans with obesity

OBJECTIVE

N-acylethanolamines (NAEs) include endocannabinoid (EC) and EC-related molecules that impact the anti-obesity and anti-diabetic efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RA) in animal studies. However, the clinical relevance of these findings remains to be determined. Here, we tested whether GLP-1RA treatment affects circulating NAE levels and whether NAEs may predict the efficacy of GLP-1RA treatment in humans with obesity undergoing weight loss maintenance.

MATERIALS AND METHODS

We profiled plasma levels of NAEs in participants with obesity undergoing weight loss maintenance with (n = 23)/or without (n = 20) treatment with the GLP-1RA liraglutide. NAE levels were measured at three different time points: before the start of the study, at the end of the diet-induced weight loss, and after 52-weeks treatment. Linear regression analyses were used to investigate whether pharmacological responses could be predicted by NAEs levels.

RESULTS

Liraglutide treatment reduced plasma concentrations of the NAE and oleoyl-ethanolamide (OEA), without altering arachidonoyl-ethanolamide (AEA) levels and palmitoyl-ethanolamide (PEA) levels. High pre-treatment levels of OEA were predictive of superior compound-mediated effects on fasting insulin and triglyceride levels. High pre-treatment PEA and AEA levels were also predictive of superior Liraglutide-mediated effects on triglyceride levels.

CONCLUSIONS

Our data suggests that specific NAEs such as OEA and AEA are promising biomarkers of GLP-1RA metabolic efficacy in humans with obesity during weight loss maintenance. Plasma profiling of EC-related molecules may be a promising strategy to tailor GLP-1R-based therapies to individual needs in obesity and diabetes management.

Oral bisphosphonate-induced osteonecrosis complications in patients undergoing tooth extraction: a systematic review and literature updates

OBJECTIVE

Bisphosphonates, the most common anti-resorptive medications, are internalized by osteoclasts, where they inhibit the macrophage colony-stimulating factor (M-CSF) pathway, preventing their differentiation, inhibiting anchorage to the cell membrane, and inducing apoptosis. In patients undergoing oral bisphosphonate therapy, oral surgery involves a high risk of developing drug-related osteonecrosis of the jaws (BRONJ/MRONJ), among the possible complications.

MATERIALS AND METHODS

A systematic search was carried out on the PubMed, Scopus and Cochrane Library search engines, using the keywords "oral bisphosphonates AND tooth extraction", "third molar extraction AND oral bisphosphonates". In addition, we manually evaluated the articles included in references from other sources and an analysis of the Gray Literature was performed. A secondary outcome was to evaluate the assessment of pharmacological (antibiotics) use in the BRONJ/MRONJ management. The revision protocol followed the indications of the Cochrane Handbook, and was registered in the INPLASY database, while the drafting of the manuscript was based on PRISMA.

RESULTS

The results of the systematic review, after the study identification and selection process, included a total of 7 studies: 4 retrospective studies, 2 prospective studies and 1 case report. The main complication was represented by osteonecrosis of the jaws, which appears to be related to the duration of treatment with bisphosphonates; in addition, data regarding the anatomical location of post-extraction sites, the sex and age of patients, comorbidities and various systemic risk factors were extrapolated. The most frequent post-extraction complication in patients treated with oral bisphosphonates is osteonecrosis of the jaws, with a significant prevalence in the posterior region of the mandible. In some cases, delayed healing of the surgical wound was also found; moreover, the duration of exposure to oral bisphosphonates influences the onset of complications.

CONCLUSIONS

Ongoing studies continue to unravel the role of the oral environment response in alveolar bone homeostasis and how it might contribute to the induction of BRONJ/MRONJ. Approaching the problem from this perspective could provide new directions for the prevention of BRONJ/MRONJ and expand our understanding of the unique oral microenvironment.

Development of Multifunctional Materials Based on Poly(ether ether ketone) with Improved Biological Performances for Dental Applications

The main target for the future of materials in dentistry aims to develop dental implants that will have optimal integration with the surrounding tissues, while preventing or avoiding bacterial infections. In this project, poly(ether ether ketone) (PEEK), known for its suitable biocompa-tibility and mechanical properties for dental applications, was loaded with 1, 3, and 5 wt.% ZnO nanoparticles to provide antibacterial properties and improve interaction with cells. Sample cha-racterization by X-ray diffraction (XRD), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC) as well as mechanical properties showed the presence of the nanoparticles and their effect in PEEK matrices, preserving their relevant properties for dental applications. Al-though, the incorporation of ZnO nanoparticles did not improve the mechanical properties and a slight decrease in the thermal stability of the materials was observed. Hemocompatibility and osteoblasts-like cell viability tests showed improved biological performances when ZnO was present, demonstrating high potential for dental implant applications.

Atrial strain in cardiacATTR amyloidosis from pathophysiology to prognosis: is it time to rethink our approach to disease?

Background

Left atrial (LA) involvement in cardiac ATTR amyloidosis (ATTR-CM) has never being explored. The aim of the study is to characterize the spectrum of changes in LA structure in ATTR-CM, the functional consequences on LA mechanics and the association with mortality.

Methods

We studied 936 patients with ATTR-CM who underwent prospective protocolized evaluations comprising ECG, full echocardiographic assessment, 6MWT, blood biomarkers sampling and survival assessment between 2000 and 2019. Reservoir (LAr), conduit (LAcd) and booster (LAcont) function were assessed according to current guidelines. LA stiffness (LAstiff) was estimated as the ratio between E/e' and LAr. The presence and extent of amyloid infiltration was assessed in two autopsied hearts from patients ATTR-CM with congo red staining and TTR antibodies.

Results

936 patients with ATTR-CM were included, 567 with wtATTR-CM and 346 with hATTR-CM, of whom 246 had the V122I variant and 100 the T60A variant. LA indexed area was similar across the 3 genotypes, whilst LAr, LAcd and LAcont were significantly reduced in V122I patients compared to Wt and T60A patients (LAr: 10.4±6.4 vs 12.8±8.5 vs 8.59±5.7%, p<0.0001; LAcd: 5.6±5.0 vs 6.9±5.7 vs 4.0±3.6%, p<0.0001; LAcont 7.5±4.1 vs 8.2±4.9 vs 6.7±4.2%, p=0.023; in Wt, T60 and V122I respectively). Similarly, LAstiff was significantly worse in V122I compared to Wt and T60A (LAstiff: 2.39±2.62 vs 2.59±4.83 vs 2.96±2.88, p<0.0001, in Wt, T60 and V122I respectively). In the overall population, LAstiff remained independently associated with mortality, after adjusting for rhythm, systolic and diastolic functional parameters, ventricular longitudinal strain, genotypes, clinical variables and NAC staging system (lnLA stiff: HR=1.26, CI: 1.07–1.57; p=0.009). In the overall population, 584 patients were in sinus rhythm and 344 in atrial fibrillation, atrial flutter or atrial tachycardia (non-sinus rhythm group – NSR). Among patients in SR, 21.6% did not show a measurable LA mechanical contraction on strain analysis (LAcont). Patients in SR without LAcont on strain analysis showed similar structural and functional LA changes, NTproBNP, NYHA class, and 6MWT to NSR patients. Mortality of patients in SR with no LAcont was significantly reduced compared to patients in SR with LAcont and similar to patients in AF (Figure 1). On the two autopsies hearts there was extensive amyloid infiltration of TTR type in the atrial wall as confirmed with CR and TTR antibodies (Figure 1).

Conclusions

ATTR-CM is characterized by primary infiltration of the atrial walls with progressive loss of atrial function and increased stiffness. LA stiffness is a strong independent predictor of mortality after adjusting for known predictors. Atrial electro-mechanical dissociation emerged as a distinctive functional phenotype identifying patients in SR with worse prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

18[F]FDG small animal PET study of sorafenib efficacy in lymphoma preclinical models

AIM

Kinase inhibitors have been proposed as novel therapeutic agents in different forms of solid tumours. The Food and Drug Administration (FDA) approved the use of Sorafenib, an oral multikinase inhibitor, for advanced renal carcinoma and unresectable hepatocellular carcinoma. On-going studies are investigating the efficacy of Sorafenib in other solid tumours such as melanoma and non-small cells lung carcinoma and pre-clinical models showed the efficacy of treatment with Sorafenib in murine models of renal cells carcinoma, breast cancer, colon carcinoma and melanoma. To our knowledge, Sorafenib has never been employed in human lymphoma. The aim of the present study was to assess the efficacy of Sorafenib in murine models of human anaplastic large cells lymphoma (ALCL) and Hodgkin lymphoma (HD).

METHODS

Sorafenib cytotoxicity was assessed in vitro and growth inhibition (IC50) was calculated. Cells were assayed for Caspase-3 to measure apoptosis. Human ALCL and HD xenografts in NOD/SCID mice were monitored by small animal positron emission tomography (PET) and computed tomography (CT) over time. Tumour bearing animals were randomly selected to receive treatment with Sorafenib or no treatment. Pathology was available in all cases.

RESULTS

Sorafenib efficacy on cells proliferation and apoptosis (IC50: HD=0.0343 mg/L; ALCL=0.319 mg/L) was confirmed in vitro. Caspase-3 production showed a dose-dependent trend reaching significantly higher values for 0.046 mg/L and 0.465 mg/L drug concentrations in both cell lines. In vivo experiments showed a progressive increase of tumour lesions metabolism and dimensions regardless treatment.

CONCLUSION

Sorafenib showed a good cytotoxic effect in vitro especially on human HD cell line, but these findings were not confirmed in vivo. The strong discrepancy between in vitro and in vivo results suggests that further studies are needed to better acknowledge the biodistribution and metabolism of Sorafenib in NOD/SCID mice. Factors influencing drug availability at tumour site or differences in the downstream pathways may be responsible for the scarse effect of treatment.

18F-FDG small animal PET for early detection of human anaplastic large cells lymphoma xenograft in immunocompromised mice

The purpose of the present study was to assess if small animal PET is useful for serially monitoring the development of a human anaplastic large cell lymphoma (ALCL) murine xenograft and for the early selection of tumour bearing animals. The human ALCL Karpas 299 cell line was subcutaneously injected in 6-week-old NOD/SCID (non-obese diabetic/NCrCrl- Prkdc) mice (10(7) cells/mouce in 150 pil FBS) at the right flank level. Small animal 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) was serially performed (intravenous injected dose: 20 MBq in < 0.15 ml, uptake time: 60 min, image acquisition: 1 bed position of 15 min): early PET at 2 days after cell inoculation in 4/8 mice and at 4 days in the remainig 4/8, later PET scans were performed in all the animals at 7, 14, 21 and 28 days after inoculation. The images were evaluated visually and the tumour to background ratio (TBR) was used for semiquantitative analysis. Pathology sections were obtained in all cases. PET detected the presence of the tumour as early as seven days after inoculation in 4/8 mice and at 14 days in 2/8. Of the two remaining mice, one died after the first PET scan (thus preventing any evaluation of detection time) while the other showed a microscopic neoplastic infiltration at tracheal level at autopsy. Mean TBR progressively increased in all positive cases, particularly in the first 3 weeks, reaching a plateau afterwards. PET was positive in 6/8 (75%) animals, detecting the presence of viable tumour cells earlier than macroscopic evaluation, thus may be used for the early identification of tumour bearing animals.

Safety, tolerability and efficacy of sublingual allergoid immunotherapy with a 4-day shortened build-up phase

BACKGROUND

Sublingual specific immunotherapy (SLIT) with monomeric allergoid has shown to be safe and effective the studies performed so far. The build-up phase, however, is rather time consuming mainly if performed with the conventional schedule of 14 weeks.

AIMS OF STUDY

We evaluated the possibility of shortening and simplifying this phase, through a new build-up scheme of only 4 days, as well as the persistence of the allergoid SLIT efficacy after 12 months.

METHODS

Thirty-nine patients (26 M, 13 F, mean age 20.5 years, range 6-49) with a history of moderate/severe rhinitis with or without mild asthma due to perennial and/or seasonal allergens entered the study. The posological schedule, adopting only 1,000 AU tablets, was the following: 1/2 tablet the 1st day; 1/2 table twice the second day; 1/2 table plus 1 table the 3rd day, 1 tablet twice the 4th day; 1 tablet twice weekly from the 5th to the 365th day (maintenance therapy).

RESULTS

Only two mild adverse reactions occurred during the initial phase which disappeared with the prosecution of the treatment. During the maintenance therapy no adverse event was observed. Symptoms improved consistently and drug consumption was reduced in most of the patients.

CONCLUSIONS

The 4-day shortened build-up phase resulted to be safe, well tolerated and effective, already after one year of treatment.

The potencial role of rare earths in the pathogenesis of interstitial lung disease: a case report of movie projectionist as investigated by neutron activation analysis

A 60-year-old male subject who worked as a movie projectionist and who was exposed for 12 years to rare earths (RE) containing dusts from cored arc light carbon electrodes was investigated. Chest X-ray films and pulmonary function tests showed an interstitial lung disease, emphysema and a severe obstructive impairment with marked decrease of carbon monoxide diffusion capacity. The histological examination of a transbronchial biopsy confirmed the diffuse interstitial lung fibrosis. Neutron activation analysis (NAA) of the biopsy showed concentrations of cerium (Ce), lanthanum (La), neodimium (Nd), samarium (Sm), terbium (Tb) and ytterbium (Yb) which were high compared to the corresponding elements in the transbronchial biopsies of 5 unexposed subjects as a control group. Thorium (Th) (which is generally present as an impurity of the RE compounds) was also determined in order to estimate the radiation dose in the lung of the worker. On the basis of the clinical observations, of the analytical results by neutron activation analysis of RE and of the presence of Th in the transbronchial biopsy, as well as of the differential diagnosis, which tended to exclude other occupational or non-occupational lung diseases, a relation between the observed interstitial lung fibrosis and occupational exposure to RE is highly probable.

Antibiotic GE37468A: a new inhibitor of bacterial protein synthesis. III. Strain and fermentation study

GE37468A is a new thiazolyl peptide antibiotic acting on Elongation Factor Tu, produced by fermentation of Streptomyces sp. ATCC 55365. The low (< 10 mg/liter) and poorly reproducible antibiotic productivity of the original soil isolate hampered the development of a scalable fermentation process. A tenfold increase of GE37468A productivity was achieved by selection of spontaneous morphochromatic variants, which appeared at high frequency in the wild type population. The higher producing ATCC 55365/O/5 colony was tyrosinase defective and blocked in the aerial mycelium differentiation (Amy-Mel- phenotype). The fermentation process of this stable and purified strain was rapidly optimized to achieve a further fourfold improvement in a fed-batch process.

Isolation and structure determination of a novel complex of the teicoplanin family

A new teicoplanin-like antibiotic was discovered when using Actinoplanes teichomyceticus strain 3/W, the fermentation medium containing Alburex, and the fermentation time 275 hours. The new product was separated from teicoplanin complex by polyamide resin chromatography and purified by Amberlite XAD-7 and affinity resin chromatographies. The structure was established on the basis of the physico-chemical characteristics of the complex and of its aglycone. The new structure is that of teicoplanin with a carbonyl group substituting for the CHNH2 group of amino acid 1. We hypothesize that the novel complex is a transformation product of teicoplanin due to a simple transamination reaction, as supported by its structure and by the concomitant decrease in teicoplanin concentration during its production.

[Risk of exposure to metals in the production and processing of copper alloys]

A study was carried out in 3 copper alloy industries: a foundry for scrap of various origin producing brass and bronze alloys (foundry A) and 2 foundries that used these same alloys (foundries B and C). An environmental investigation and biological monitoring of the employees for Pb, ZPP, Cu, Zn, Be, Sb, Mn, Ni and Cr were performed in each foundry. The results of biological and environmental monitoring showed that the Pb exposure levels were distinctly higher than those of the other metals in all 3 foundries. The highest levels of PbA and PbB were observed in foundry A, especially during scrap grinding operations, where the limit values were exceeded. The environmental concentrations and the levels of the biological indicators for all other metals, except Pb, were within reasonable limits. Therefore, in the investigated working situations and for the metals under study, except Pb, it would appear that a situation exists of exposure to "microdoses" which, even though not implying a risk of appearance of the classic signs and symptoms of intoxication, raises the problem of the possibility of identifying early effects and interpreting the biological indicators. Biological monitoring of exposed subjects has shown that the levels of the indicators for Cu, Ni and Cr are markedly different from the reference values on a group basis, whereas in individual workers the values are generally below the "upper limits". A comparison with the "limit values'' was only possible for the biological indicators of Pb; for the others, although differences were observed indicating that absorption had taken place, no univocal interpretation criteria exist, considering also the relatively low mean increases observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Chromosome 13 deletion syndrome: report of a new case and discussion of the different etiologic patterns of retinoblastoma

A partial monosomy 13 by interstitial deletion was found in the complement of a patient with mental retardation and mild dysmorphic features. Due to the involvement of band q14 in the deletion, an ocular investigation was performed which showed the presence of a retinoblastoma in a preclinical stage. The different patterns of retinoblastoma inheritance are discussed and the importance of an accurate clinical investigation is stressed in all cases in whom chromosomal aberration is known to be associated with neoplasias.