Therapeutic potential of NADPH oxidase 1/4 inhibitors

The NADPH oxidase (NOX) family of enzymes produces ROS as their sole function and is becoming recognized as key modulators of signal transduction pathways with a physiological role under acute stress and a pathological role after excessive activation under chronic stress. The seven isoforms differ in their regulation, tissue and subcellular localization and ROS products. The most studied are NOX1, 2 and 4. Genetic deletion of NOX1 and 4, in contrast to NOX2, has revealed no significant spontaneous pathologies and a pathogenic relevance of both NOX1 and 4 across multiple organs in a wide range of diseases and in particular inflammatory and fibrotic diseases. This has stimulated interest in NOX inhibitors for therapeutic application. GKT136901 and GKT137831 are two structurally related compounds demonstrating a preferential inhibition of NOX1 and 4 that have suitable properties for in vivo studies and have consequently been evaluated across a range of disease models and compared with gene deletion. In contrast to gene deletion, these inhibitors do not completely suppress ROS production, maintaining some basal level of ROS. Despite this and consistent with most gene deletion studies, these inhibitors are well tolerated and slow or prevent disease progression in a range of models of chronic inflammatory and fibrotic diseases by modulating common signal transduction pathways. Clinical trials in patients with GKT137831 have demonstrated excellent tolerability and reduction of various markers of chronic inflammation. NOX1/4 inhibition may provide a safe and effective therapeutic strategy for a range of inflammatory and fibrotic diseases.

LINKED ARTICLES

This article is part of a themed section on Redox Biology and Oxidative Stress in Health and Disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.12/issuetoc.

Acquired cell-mediated immunodepression in acute Chagas' disease

In this study two groups of patients with acute Chagas' disease were identified. Group one consisted of five patients with apparent acute Chagas' disease. These patients showed symptoms and signals of an acute illness, such as high fever and enlarged spleen. One of these patients developed severe myocarditis and heart failure. Group two consisted of seven patients with inapparent acute Chagas' disease. This was a nonclinical entity, not perceived by the patient who did not seek medical care. The diagnosis was made by the shift of a serologic test which indicates the presence of immunoglobulin M antibodies to Trypanosoma cruzi. The patients with apparent acute Chagas' disease showed positive delayed-type skin response to T. cruzi antigen. Also, their leukocytes showed significant inhibition of migration in the presence of this antigen. By contrast, the patients with the inapparent acute Chagas' disease did not show positive delayed-type skin response to T. cruzi antigen and no significant inhibition was observed when their cells migrated in the presence of this antigen. Of interest, none of these patients was capable of developing contact sensitivity to 2,4-dinitrochlorobenzene. However, three out of five patients with the apparent acute disease and all the normal control subjects showed positive contact reaction after sensitization to this drug. The results of these experiments would suggest that the thymus-derived (T)-lymphocyte function is depressed in patients with the clinically inapparent acute Chagas' disease. This immunodepression seems to be acquired in the course of the T. cruzi infection because all patients showed positive delayed-type skin response to at least one ubiquitous microbial extract, thus indicating previously normal T-cell function. We hypothesize that T. cruzi antigens may directly stimulate T cells with the concomitant release of factors that might become supressive for T-cell responses. Furthermore, the suppressive effect might interfere with the T-cell response to other antigens, such as to 2,4-dinitrochlorobenzene.

Trypanosoma cruzi-sensitized T-lymphocyte mediated 51CR release from human heart cells in Chagas' disease

Cytotoxicity of T-lymphocytes from patients with Chagas' disease to parasitized and non-parasitized human heart cells labelled with 51Cr was demonstrated. The highest ratio of 51Cr released from the normal, non-parasitized heart cells was observed when the T-lymphocytes were collected from patients with acute Chagas' disease. The quantity of 51Cr released from the normal heart cells that were destroyed by T-lymphocytes collected from patients with chronic Chagas' disease was also significantly higher than the quantity of 51Cr released from normal heart cells incubated with lymphocytes from normal donors. The specific release of 51Cr from the heart cell cultures destroyed by the immune T-lymphocytes from patients with acute Chagas' disease and from patients with chronic disease was 38.1% and 25.8%, respectively, compared to the release of 51Cr observed in control studies. A small particle human heart cell antigen was shown to inhibit the migration of Trypanosoma cruzi-immune peripheral blood leukocytes. The findings appear to indicate that T-lymphocytes from patients with Chagas' disease are susceptible to activation by a cross-reactive heart cell antigen and suggest that an autoimmune mechanism can be established in some cases of acute Chagas' disease and can be perpetuated in the chronic phase of this disease by the continuous antigenic stimulation. Further, these experimental data indicate that the autoimmune destruction of heart cells in Chagas' disease is produced by delayed-type hypersensitivity mediated by T. cruzi-sensitized T-lymphocytes.

BK virus encephalitis with thrombotic microangiopathy in an allogeneic hematopoietic stem cell transplant recipient

BK virus (BKV) infection occurs most often in immunocompromised hosts, in the setting of renal or bone marrow transplantation. Hemorrhagic cystitis is the commonest manifestation but in recent years infections in other organ systems have been reported. We report an unusual case of biopsy-proven BKV encephalitis in a hematopoietic stem cell transplant patient who subsequently developed thrombotic microangiopathy. As far as we know, this is the first report of such an association in a transplant patient.

Argyrophilic nucleolar organizer regions staining is useful in predicting recurrence-free interval in oral tongue and floor of mouth squamous cell carcinoma

BACKGROUND

Argyrophilic nucleolar organizer regions (AgNORs) represent a tissue marker of cell proliferative activity. The purpose of this study was to assess the prognostic value of AgNORs expression in oral squamous cell carcinoma (SCC).

METHODS

The AgNORs area/nucleus was studied in paraffin sections by means of digital image analysis in 43 cases of stage II oral tongue and floor of the mouth SCC.

RESULTS

Time free of disease was considered a dependent variable of a binary indicator of AgNORs expression (7.77 microns2/nucleus as a cut-off point). High AgNORs level was associated with a statistically significant negative effect on recurrence-free interval of disease in a Cox proportional hazards models controlled for occult lymph node metastasis, involvement of the surgical margins, thickness of the lesion, and vascular invasion.

CONCLUSIONS

The AgNORs area increased the capability of predicting which patients have a high risk of recurrence of cancer, and its evaluation may provide useful information for the therapeutic approach to the oral tongue and floor of the mouth SCC.

Modulation of mucosal immunity in a murine model of food-induced intestinal inflammation

BACKGROUND

Hypersensitivity or uncontrolled responses against dietary antigens can lead to inflammatory disorders like food allergy and current models reflect a variety of causes but do not reveal the detailed modulation of gut immunity in response to food antigens after breakdown in mucosal tolerance.

OBJECTIVE

To develop and characterize a murine model for food-induced intestinal inflammation and to demonstrate the modulation of gut immune response by dietary allergenic antigens.

METHODS

C57BL/6 mice were sensitized with peanut proteins, challenged with peanut seeds and their sera and gut segments were collected for subsequent analyses.

RESULTS

Sensitization and challenged with peanut seeds led to alterations in gut architecture with inflammatory response characterized by oedema in lamina propria and cell infiltrate composed mainly by eosinophils, mast cells, phagocytes, natural killer and plasma cells, together with low percentage of gammadelta+ and CD4+CD25+Foxp3+ cells in Peyer's patches. These animals also presented high levels of specific IgE and IgG1 in sera and modulation of mucosal immunity was mediated by increased expression of GATA-3, IL-4, IL-13 and TNF-alpha in contrast to low IFN-gamma in the gut.

CONCLUSION

A murine model for food-induced intestinal inflammation was characterized in which modulation of gut immunity occurs by peanut antigens in consequence of T-helper type 2 (Th2) allergic response and failure of regulatory mechanisms necessary for mucosa homeostasis, resembling food allergy. This work shed some light on the understanding of the pathogenesis of gastrointestinal disorders and intolerance in the gut and supports the development of therapies for food-related enteropathies like food allergy, focusing on gut-specific immune response.

Caseinolytic activity of fruit extract from Opuntia ficus-indica on bovine, caprine, and ovine sodium caseinates

The rates and extents of hydrolysis of alpha(S)- and beta-caseins from bovine, caprine, and ovine sodium caseinates produced by an enzymatic extract of the fruit of Opuntia ficus-indica, (L.) Miller were evaluated and compared with those produced by a commercial animal rennet. A mechanistic model based on a pseudo-first-order enzymatic reaction, in the presence of first-order deactivation of the enzyme, was postulated and successfully fitted to the experimental data. The animal rennet exhibited higher enzymatic efficiency than the fruit extract, irrespective of the source (i.e., bovine, caprine, or ovine) and the type (i.e., alpha(S)- or beta-casein) of substrate. The enzymatic efficiency (k(cat)/K(m)) for alpha(S)-casein ranged from 72 to 220 and from 43 to 65 L g(-1) h(-1), and for beta-casein from 242 to 742 and from 55 to 164 L g(-1) h(-1), for the animal rennet and the enzymatic extract of O. ficus-indica, respectively. Finally, it was observed that beta-casein from caprine and ovine caseinates was degraded by O. ficus-indica faster than its alpha(S) counterpart, but the reverse was observed for bovine caseinate.

Immunological evaluation of harvested stem cells obtained by leukapheresis after chemotherapy

Some patients suffering from malignancies may benefit of myeloablative chemotherapy followed by hematological reconstitution with autologous peripheral blood reinfusion. A quick evaluation of the number of hematopoietic progenitors present in leukapheresis blood samples is necessary to ensure the collection of a sufficient number of these cells. A study was performed on a series of 25 leukapheresis following initial chemotherapy. The number of granulomonocytic colony-forming unit (CFU-GM) and the number of CD34+ cells were evaluated simultaneously, in each sample. Results have shown a relatively strong linear correlation between both methods of evaluation of hematopoietic progenitors, suggesting that immunophenotyping could be a useful method to estimate the number of progenitors.

Long-term weight gain and economic impact in pigs castrated under local anaesthesia

Castration is a controversial practice in swine production because in some countries is still performed without anaesthesia, and therefore causes intense suffering and stress to animals. This study investigated the effect of pre-surgical administration of local anaesthesia (LA) on the growth performance of piglets until the end of the growth phase (102 days). Piglets aged 3 to 5 days were selected in pairs of similar weights and same age. They were originated from 22 litters. The groups were randomly assigned to one of two treatments. Castration was performed with (LA; n = 45) or without (NLA; n = 45) intra-testicular administration of 0.5 mL of 2% lidocaine plus adrenaline per testicle, administered by an automatic repeating vaccinator. Castration was performed 10 min later. Average daily weight gain and economic impact were evaluated between the intervals before castration until 21 (weaning phase), before castration until 60 (end of the initial nursery phase) and before castration until 102 (growth phase) days of age. Average daily weight gain data were analyzed by comparing the average daily weight gain between the weaning phase, 60 and 102 days of age versus the initial weight (pre-castration). At the end of the growing phase, animals treated with LA showed greater weight gain than animals castrated without anaesthesia. LA also showed improved cost:benefit ratio and theore might provide greater economic benefit under the conditions used in this study. Our findings have proved that castration with LA improves long-term weight gain of piglets.

B cells are involved in the modulation of pathogenic gut immune response in food-allergic enteropathy

Food enteropathies involve uncontrolled or hypersensitivity reactions to ingested nutrients and may result in IgE and T-helper type 2 (Th2) responses as in food allergy. However, the precise role of B cells in the development of food enteropathies remains uncertain. In this work, we used B cell-deficient mice (B KO) and a model of peanut sensitization to examine the involvement of B lymphocytes in the pathogenesis of food allergy. Results showed that priming of wild-type (WT) mice with peanut proteins induced specific IgG1 and IgE responses in serum, with edema, tissue destruction, epithelial exulceration and inflammatory infiltrate in the gut of sensitized and challenged (S + Peanut) WT animals. In contrast, there was no sera immunoglobulin detection and absence of tissue destruction in the gut of B KO mice, which presented moderate inflammatory infiltrate and villous enlargement after peanut challenge. These animals presented marked decrease in IL-4 and TNF-alpha and high levels of IL-10, TGF-beta, IL-12p40 and IFN-gamma mRNA in the gut. Moreover, the expression of CCL5, CCL11 and CXCL1 was reduced in the gut of B KO mice, in contrast to elevated messages of CCL2 or similar detection of Th1-related chemokines in S + Peanut WT mice. Finally, we provided evidence that B cells are necessary to the development of food-related enteropathies and induction of gut inflammation during allergic reactions to food.

Hg and Se composition in demersal deep-sea fish from the North-East Atlantic

It has been emphasized that seafood consumers may have a higher risk of mercury (Hg) exposure. Nevertheless, the co-occurrence of selenium (Se) in organisms may affect the toxicity and bioavailability of Hg. In this work, we aim to demonstrate the possible role of Se as a potential protective element against Hg in muscle and liver tissues of three demersal deep-sea fish species: common mora Mora moro, birdbeak dogfish Deania calcea, and smooth lanternshark Etmopterus pusillus. Comparing species, the birdbeak dogfish D. calcea showed the highest Hg concentrations, the lowest Se levels, the lowest mean Se:Hg molar ratio, a negative HBV-Se index, and no correlation between total length. On the other hand, smooth lanternshark E. pusillus showed the lowest Hg concentrations, the highest Se concentrations, the highest mean Se:Hg molar ratio, a positive HBV-Se index, and a significant positive correlation between total length and Se concentrations in muscle. Comparing tissues, the common mora Mora moro seems to accumulate more Hg and Se in liver than shark species D. calcea and E. pusillus that showed to accumulate Hg and Se preferentially in muscle. Our results indicate that these three species for having Hg concentrations near and above the EU regulatory thresholds and for presenting low Se:Hg ratios, and negative (or low positive) HBV-Se index may pose a real risk of Hg toxicity for the consumer.

Dietary total antioxidant capacity is positively associated with muscular strength in cirrhotic outpatients: a cross-sectional study

BACKGROUND

Cirrhosis is the end-stage of progressive fibrosis, in which oxidative stress and inflammation-related pathways can modulate the cellular and tissue events involved in the pathogenesis of liver fibrosis. Dietary intake of antioxidants has been suggested to protect against oxidative damage and related clinical complications. The present study aimed to investigate the potential association of the dietary total antioxidant capacity (dTAC) with anthropometric, functional and biochemical markers, as well as the severity of the disease, in cirrhotic outpatients.

METHODS

Sixty-two outpatients (38 men and 24 women) with a mean (SD) age of 59.1 (9.9) years were evaluated. Dietary TAC was estimated from a food frequency questionnaire. Aetiology and severity of liver cirrhosis, lifestyle characteristics, occurrence of comorbidities and oedema, and anthropometric, functional and biochemical markers were all assessed.

RESULTS

Cirrhotic outpatients with higher dTAC also had higher values of the hand-grip strength (P = 0.029) and arm muscle area (P = 0.027). After adjusting by sex, age, smoking and alcohol intake, the addition of 1 mmol day^-1 of dTAC contributed to increase 0.552 kg f^-1 in hand-grip strength (P < 0.05). The addition of one mmol day^-1 of dTAC contributed to an arm muscle area increase 0.565 cm² (P < 0.05) on average.

CONCLUSIONS

The dTAC was positively associated with hand-grip strength and arm muscle area in cirrhotic outpatients. The implications of the present study are important in clinical practice because a diet rich in antioxidants may be an ally in the control of excessive reactive oxygen species production in cirrhotic outpatients with repercussion on muscle mass and strength.

Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis

BACKGROUND

ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220).

METHODS

We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform, without restrictions on publication date.

SELECTION CRITERIA

randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD.

RESULTS

Eight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = -0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02; and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed.

LIMITATIONS

Methodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes.

CONCLUSION

Our study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.

UNEXPECTED FINDINGS DURING LAPAROTOMY SURGERY AND URGENT SURGICAL INDICATIONS ARE ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE

BACKGROUND

Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.

AIMS

The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.

METHODS

This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.

RESULTS

There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).

CONCLUSIONS

Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.

Treatment of South American blastomycosis (paracoccidioidomycosis) with miconazole by the oral route: an on-going study

Results are presented from 12 patients of both sexes, whose ages range from 34 to 65 years, observed over a period of 16 months and receiving miconazole treatment for South-American blastomycosis. Ten of them were being treated for the first time and the remaining 2 presented relapses after treatment with other chemotherapeutic agents. The blastomycotic lesions were localized in skin, mucosa, lung and lymphatics. The drug was administered orally, at a dosage of 1 g three times daily. One relapsing patient had his first daily oral dose replaced by an intravenous dose of 200 mg of miconazole diluted in 250 ml of glucose solution during the initial four weeks. The criterion for diagnosis was finding of the fungus in sputum and/or in the material collected through scrapings or biopsy of the lesions. All patients were treated in hospital until the cure was apparent, clinical examinations being conducted weekly and bi-weekly. Bi-weekly laboratory examinations were performed to evaluate the patient's tolerance to the drug. All treated patients presented complete healing of cutaneomucous lesions (mean time: 4 weeks) and involution of lymphatic and pulmonary features (mean time: 4 months). Two of them still presented palpable lymphatics after 5 months of treatment, in spite of the cure of mucosal and pulmonary lesions. Monitoring the progress of the cured patients was and is being carried out quarterly. Currently, this observation period ranges from three to 15 months. Nine patients are still returning and none have shown the reappearance of mycotic lesions. Diarrhoea was the only side-effect observed after a period of therapy, but it was easily controlled by specific medication (kaolin, pectin, &c.). In a single case the treatment was interrupted because of this symptom.(ABSTRACT TRUNCATED AT 250 WORDS)

P–073 High-intensity interval training modulates the effects of hypertension on inflammatory mediators in testis in adult spontaneously hypertensive rats

Study question

Is the high-intensity interval training (HIIT) able to prevent the increase of the inflammatory proteins in the testis of spontaneously hypertensive rats (SHR)?

Summary answer

HIIT for 8 weeks inhibits the increase of the tumor necrosis factor alpha (TNFα) and the interleukin 6 (IL6) in the testis of SHR.

What is known already

Hypertension increases the inflammatory cytokines of the cardiovascular system, causing damage in the microcirculation and in the testes. Hypertension is a cause of low fertility in men and exercises are indicated to decrease blood pressure and improve overall health. HIIT is characterized by short periods of exercise, with an intensity equal to or greater than the anaerobic threshold, separated by recovery periods. HIIT can be indicated for cardiac patients, as this type of training improves the cardiac autonomic nervous system and lipemic control in both hypertensive and normotensive individuals.

Study design, size, duration

Male Wistar-Kyoto rats without hypertension and SHRs were divided into 3 groups (n = 4): WKY (Wistar-Kyoto); SHR; and SHR-HIIT (SHRs that performed HIIT). The HIIT was realized in treadmill for 5 days/week for 8 weeks. HIIT started with 5 times of 4 minutes of 100% of the maximum exhaust speed, with active rest intervals of 3 minutes at 60%. There was an increase of once every week until reaching 7 times each session.

Participants/materials, setting, methods

Samples from testicles were used for immunostainig IL6 and TNFα. After the blocking, the sections were subjected to reaction of specific antibodies IL6 (1:50, E–4, sc–28343) and TNFα (1:50, 52B83, sc–257) at 4ºC overnight, and with secondary antibodies m-IgGK (1:200, IgG-HRP, sc–516) at room temperature for 2 hours. Diaminobenzidine (1:50) was used against Harris stained with Hematoxylin and evaluated in the photomicroscope. Data were analyzed by One-Way ANOVA followed by Tukey post test (P &lt; 0.05).

Main results and the role of chance

The immunostainig of IL6 was higher in SHR (10.23 ± 0.47) than in SHR-HIIT (8.69 ± .44) group (P = 0,0237). From the same perspective, immunoexpression of TNFα was higher in SHR (10.10 ± 0.42) than WKY (8.24 ± 0.24) and SHR-HIIT (7.82 ± 0.39) groups (P = 0.0018).

Limitations, reasons for caution

As a limitation of the study, we have no measurement of fertility parameters to affirm that the HIIT improve the fertility because of the reduction of inflammatory mediators.

Wider implications of the findings: The hypertension drugs have a negative effect on fertility. HIIT can be suggested as a treatment for hypertension as an alternative to medication, since HIIT can inhibit the increase of the inflammatory mediators in testis and its consequences to the reproduction. Financial support by São Paulo Research foundation, FAPESP (2018/22682–0).

Trial registration number

2018/22682–0

Correction to: Hg and Se composition in demersal deep-sea fish from the North-East Atlantic

The correct Table 2 is presented in this paper.