Antioxidant and anti-hepatitis A virus activities of Ecklonia cava Kjellman extracts

Ecklonia cava is a nutrient-rich algae species that contains abundant physiological phytochemicals, including peptides, carotenoids, fucoidans, and phlorotannins. However, elucidation of the antiviral effects of this algae and identification of new functional ingredients warrant further investigation. This study was aimed at investigating the potential anti-hepatitis A virus activities of extracts of E. cava prepared in different solvents. E. cava extracts were prepared using hot water and 70 % ethanol. The antioxidant activities of the extracts were confirmed by analyzing the total phenolic content, as well as 2,2-diphenyl-1-picrylhydrazyl and 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid radical scavenging activities. The inhibitory effects of the extracts against hepatitis A virus were analyzed using real-time polymerase chain reaction. The E. cava extract yield was 22.5-27.2 % depending on the extraction solvent. The 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity was 70.44 % and 91.05 % for hot water and ethanol extracts at a concentration of 1000 ppm. The 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid radical scavenging activity of the ethanol extract was the highest (93.57 %) at 1000 μg/mL. Fourier-transform infrared was used to identify the functional groups (phlorotannin and alginate) in the extraction solvents. Ultra-high performance liquid chromatography with quadrupole time-of-flight tandem mass spectrometry analysis revealed a potential bioactive compound previously unidentified in E. cava. Finally, we identified the antiviral activity of E. cava extracts against hepatitis A virus replication. These findings demonstrate that E. cava could be used as an anti-hepatitis A virus functional food and biological material.

Metabolic shift during fermentation in kimchi according to capsaicinoid concentration

The cultivar of red pepper used in kimchi contributes to spiciness, red color, and fermentation characteristics. Capsaicinoids are the main components of red pepper. Therefore, understanding changes in metabolites during kimchi fermentation according to capsaicinoid concentration is necessary to control the quality of kimchi. The purpose of this study was to investigate the effect of capsaicinoids on metabolites during kimchi fermentation. To profile the effect of capsaicinoid concentrations on kimchi fermentation, five kimchi samples were prepared using different concentrations of capsaicinoids (4, 12, 30.7, 40.9, and 50.3 mg/kg) and stored at 4 °C for 28 days. During kimchi fermentation, pH, titratable acidity, capsaicinoid concentration, total viable and lactic acid bacteria, free sugars, amino acids, and microbial community were evaluated. Each result was statistically analyzed for changes in capsaicin concentration and fermentation time. The capsaicinoid concentration did not change during kimchi fermentation but the growth of lactic acid bacteria changed. According to the growth of lactic acid bacteria, free sugar, amino acids, and microbial community changed with the capsaicinoid concentration. Overall, the results of this study provide preliminary information on the use of red pepper and capsaicinoids in the kimchi industry.

Lobeglitazone inhibits LPS-induced NLRP3 inflammasome activation and inflammation in the liver

Liver inflammation is a common feature of chronic liver disease and is often associated with increased exposure of the liver to lipopolysaccharide (LPS). Kupffer cells (KCs) are macrophages in the liver and produce various cytokines. Activation of KCs through the NLRP3 inflammasome pathway leads to release of proinflammatory cytokines and induces hepatocyte injury and hepatic stellate cell (HSC) activation. Lobeglitazone is a peroxisome proliferator-activated receptor gamma ligand and a type of thiazolidinedione that elicits anti-inflammatory effects. However, there is no clear evidence that it has direct anti-inflammatory effects in the liver. This study showed that lobeglitazone reduces LPS-induced NLPR3 inflammasome activation and production of proinflammatory cytokines in primary KCs and hepatocytes. Cytokines secreted by activated KCs increased hepatocyte inflammation and HSC activation, and lobeglitazone inhibited these responses. In addition, lobeglitazone suppressed liver fibrosis by inhibiting LPS-induced transforming growth factor (TGF)-β secretion and TGF-β-induced CTGF expression. The inhibitory effect of lobeglitazone on inflammasome activation was associated with suppression of liver fibrosis. These results suggest that lobeglitazone may be a treatment option for inflammation and fibrosis in the liver.

Effect of the addition of maltodextrin on metabolites and microbial population during kimchi fermentation

Gelatinized starch sauce, one of the sub-ingredients have been widely used in kimchi for their roles in increasing viscosity of kimchi seasoning, and fermentation. Gelatinized glutinous rice (GGR), which is one of the most used starch sources in kimchi preparation. However, GGR is accelerated to the fermentation process but lead to a reduction in the shelf life of the kimchi. Therefore, in this study, we demonstrate the effectiveness of using maltodextrin (MD) as a novel starch source instead of GGR to slow down the rate of kimchi fermentation. The properties of the kimchi with MD and GGR fermentation (free sugar content, organic acid content, pH, and acidity) as well as their microbial growth rates after 12 days of fermentation were compared. After fermentation of 12 days, the free sugar of GGR-kimchi (GGRK) increased more rapidly than those of MD-kimchi (MDK), while higher sugar alcohol (mannitol) and organic acid contents were observed for GGRK than for MDK. Furthermore, initial aerobic and lactic acid bacteria counts were higher for GGRK than for MDK. These results indicate that fermentation proceeds at a slower rate in MDK than in GGRK, and they will provide a basis for further research into storage of kimchi.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-023-05742-y.

Optimization of extraction and nanoencapsulation of kimchi cabbage by-products to enhance the simulated in vitro digestion of glucosinolates

Kimchi cabbage is a well-known glucosinolate (GLS)-containing vegetable, but its by-products are discarded despite the presence of GLS. The aim of this study was the optimization of the extraction and nanoencapsulation of GLS from kimchi cabbage by-products to enhance the intestinal absorption of GLS. The optimal GLS extraction conditions included steaming thrice as pretreatment, utilizing 70% methanol, and ultrasonication at 20% amplitude for 15 min. Under these conditions, 80.11 ± 4.40 mg/100 g of GLS extraction was obtained and the extraction yield was 81.70 ± 4.73%. The optimized kimchi cabbage by-product extract (KCE) was coated with chitosan-lipid nanoparticles (KCE-NPs) and their stability and release under simulated in vitro gastrointestinal conditions were evaluated. KCE-NPs protected the encapsulated GLS under acidic gastric conditions and released 91.63 ± 0.76% of GLS in the simulated intestinal medium. Therefore, the proposed KCE-NPs are a promising delivery system for increasing GLS absorption.

Comprehensive elucidation of the terroir of Korean kimchi through the study of recipes, metabolites, microbiota, and sensory characteristics

The aim of this study was to investigate the differences in characteristics of the fermented food kimchi based on the regions where it is produced. A total of 108 kimchi samples were collected from five different provinces in Korea to analyze the recipes, metabolites, microbes, and sensory characteristics. Overall, 18 ingredients (including salted anchovy and seaweed), 7 quality indicators (such as salinity and moisture content), 14 genera of microorganisms (mainly Tetragenococcus and Weissella belonging to LAB), and 38 metabolites contributed to the characteristics of kimchi by region. Kimchi from the southern and northern regions showed distinct metabolite profile (collected 108 kimchi) and flavor profile differences (kimchi manufactured using the standard regional recipes). This is the first study to investigate the terroir effect of kimchi by identifying differences in ingredients, metabolites, microbes, and sensory characteristics based on the region of production, and the correlations between these factors.

Antioxidant and anti-inflammatory effects of solar salt brined kimchi

Salt is an essential ingredient in the kimchi fermentation process. Solar salt has antioxidant, anti-cancer, and anti-obesity properties. The aim of this study was to determine the antioxidant and anti-inflammatory effects of solar salt brined kimchi. Purified salt (PS), dehydrated solar salt (DSS), 1-year aged solar salt (SS1), and 3-years aged solar salt (SS3) were investigated. Anti-inflammatory effects were determined by analyzing cytotoxicity, nitric oxide (NO) production, and inflammation-related gene expression in lipopolysaccharide-treated RAW264.7 cells. Antioxidant activities of DSS, SS1, and SS3 were higher than that of PS. Solar salt significantly inhibited NO production with low cytotoxicity and decreased inflammation-related gene expression. Kimchi containing solar salt (DSSK, SS1K, and SS3K) showed higher antioxidant activity than PSK. Additionally, DSSK, SS1K, and SS3K significantly inhibited NO production and decreased the expression of inflammation-related genes. Owing to the antioxidant and anti-inflammatory effects, using solar salt in kimchi preparation could have potential health benefits.

Evogliptin Directly Inhibits Inflammatory and Fibrotic Signaling in Isolated Liver Cells

Chronic liver inflammation can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. Kupffer cells (KC) secrete proinflammatory and fibrogenic cytokines in response to lipopolysaccharide (LPS), and so play an important role in liver inflammation, where they induce hepatocellular damage. LPS also activates hepatic stellate cells and induces extracellular matrix deposition. In this study, we used isolated primary KC, primary hepatocytes, and primary hepatic stellate cells (HSC) to investigate whether evogliptin directly inhibits inflammatory and fibrotic signaling. We found that evogliptin inhibited LPS-induced secretion of inducible nitric oxide synthase and transforming growth factor β (TGF-β) from KC. Moreover, evogliptin inhibited inflammatory mediator release from hepatocytes and hepatic stellate cell activation that were induced by KC-secreted cytokines. In hepatocytes, evogliptin also inhibited LPS-induced expression of proinflammatory cytokines and fibrotic TGF-β. In addition, evogliptin inhibited TGF-β-induced increases in connective tissue growth factor levels and HSC activation. These findings indicate that evogliptin inhibits inflammatory and fibrotic signaling in liver cells. We also showed that the inhibitory effect of evogliptin on inflammatory and fibrotic signaling is associated with the induction of autophagy.

Kahweol Induces Apoptosis in Hepatocellular Carcinoma Cells by Inhibiting the Src/mTOR/STAT3 Signaling Pathway

Kahweol, a coffee-specific diterpene, induces apoptosis in human cancer cells, and some targets of kahweol-mediated apoptosis have been identified. However, the specific apoptotic effects and mechanism of action of kahweol in hepatocellular carcinoma (HCC) cells are unknown. This study was performed to investigate the molecular mechanism by which kahweol induces apoptosis in HCC cells. The Src pathway is associated with apoptosis in cancer. In this study, we found that kahweol induces apoptosis by inhibiting phosphorylation of Src, and also inhibiting p-mTOR and p-STAT3. Therefore, we suggest that kahweol is a potent inhibitor of HCC cell growth.

Effect of capsaicinoids in hot pepper powder on microbial community and free sugar during kimchi fermentation

Effect of capsaicinoids in hot pepper powder (HP) contains various chemical compounds, including capsaicin and dihydrocapsaicin, which are the main ingredients of the spicy taste. To evaluate the effect of HP on the microbial community in kimchi fermentation, kimchi [kimchi-HP, kimchi-HPE and kimchi-HPER made by adding HP, HP alcohol extract (HPE) and HPE residues (HPER)] was fermented at 4°C for 28 days. The pH and titratable acidity of the samples and the number of bacteria changed with fermentation time. Kimchi-HPER had significantly higher total viable and lactic acid bacteria (LAB) than other samples after 28 days of fermentation. The capsaicinoids content did not differ before and after fermentation, whereas the major free sugar content decreased, and the mannitol content increased. The principal component analysis (PCA) biplots showed similar patterns between kimchi-HP and -HPE. It was confirmed that Leuconostoc and Weissella were related to the initial fermentation, and Lactobacillus was involved in late fermentation. Kimchi-HP and kimchi-HPE increased the ratio of Lactobacillus sakei and decreased that of Leuconostoc mesenteroides compared to kimchi-HPER. Overall, these results revealed that capsaicinoids contained in HP affected Lactobacillus proliferation and mannitol increase during kimchi fermentation.

Free Amino Acid and Volatile Compound Profiles of Jeotgal Alternatives and Its Application to Kimchi

Jeotgal containing abundant free amino acids plays an important role in the unique savory taste (umami) and flavor in kimchi. However, it is also responsible for the unpleasant fishy smell and high salt content of kimchi. Therefore, the present study aimed to identify alternative jeotgal sources and investigate the fermentation properties of jeotgal alternatives added to kimchi. The tomato hot-water extract (TH2) and dry-aged beef hot-water extract (DBH) were selected as jeotgal alternatives for kimchi preparation based on their glutamic acid contents. Characteristics of kimchi with TH2 alone (JA1) and TH2 and DBH in combination (1:1, JA2) were compared with kimchi prepared using commercially available anchovy fish sauce (CON). The pH of JA1 and JA2 was slightly decreased during fermentation, whereas the salinity was significantly lower than CON (p < 0.05). Notably, the most effective factor of the savory taste of kimchi, glutamic acid contents of JA1 and JA2 were significantly higher than that of CON (p < 0.05). In conclusion, JA1 showed slower fermentation with lower salinity and higher glutamic acid content than CON. Overall, this study showed that JA1 derived from TH2 could improve the taste and quality of kimchi by increasing glutamic acid content and decreasing the unpleasant flavor.

A colorimetric sensor array for the discrimination of glucosinolates

A novel approach for the discrimination of different glucosinolates (sinigrin, progoitrin, gluconapin, 4-methoxyglucobrassicin, glucoraphanin, glucobrassicin, glucoiberin, glucobrassicanapin, glucoraphenin, and glucoerucin) using a colorimetric sensor array (CSA) is reported herein. The developed CSA technique exhibited an acceptable linearity (r² ≥ 0.97) over a concentration range of 0-150 μM for the 10 glucosinolates. The CSA coupled with principal component analysis and hierarchical cluster analysis correctly distinguished the majority of glucosinolate samples according to their type. In addition, the CSA coupled with linear discriminant analysis correctly classified the majority of 8 kinds of cruciferous vegetable samples with an overall accuracy of 94%. Furthermore, the partial least squares regression results showed that the CSA responses were correlated with the concentration in a correlation coefficient (R_p) range of 0.813-0.964. These results demonstrate that the described procedure based on the CSA technique could be useful for the rapid discrimination of different glucosinolates.

Antioxidant activity and calcium bioaccessibility of Moringa oleifera leaf hydrolysate, as a potential calcium supplement in food

Moringa oleifera leaf (ML) is rich in vitamins and minerals, specially abundant calcium, therefore it is widely used as a calcium supplement for food. This study aimed to investigate the antioxidant activity and calcium bioaccessibility of M. oleifera leaf hydrolysate (MLH) as a calcium supplement for kimchi. MLH was prepared under three different proteases, two different protease contents, and three different incubation times. Total phenol content (TPC), total flavonoid content (TFC), and antioxidant activities were investigated. Cellular activity and calcium bioaccessibility were also investigated. The highest calcium level of MLH was observed in 3% Protamex treatment for 4 h. TPC, TFC, and antioxidant activities of MLH in Protamex and Alcalase treatments were higher than those in Flavourzyme treatment (p < 0.05). Moreover, high cell viability and alkaline phosphatase activity were also observed in C2C12 cells. Kimchi containing MLH showed high calcium accessibility compared to kimchi alone. Taken together, the application of MLH could have potential as a calcium supplement for kimchi production.

Evaluation of onion juices quality following heat-treatment and their application as a sugar substitute in Kimchi

This study was conducted to evaluate the quality of onion juices that had been heat-treated for different times as well as their use as a table sugar substitute in Kimchi. The onions were steamed at 100 ∘C for 30 min and boiled at 90 ∘C for 30, 60, and 120 min. The highest cycloalliin (0.76 mM), free-sugar (sucrose 1.66 g/L, glucose 8.62 g/L, and fructose 7.64 g/L), and malic acid (0.82 g/L) contents were observed in onion boiled at 90 ∘C for 120 min. The possibility of using heat-treated onion juices as an alternative to table sugar in Kimchi was evaluated by comparing the lactic acid bacteria count, pH, acidity, organic acid, and free-sugar in these juices with those in Kimchi prepared using table sugar (control). The total viable bacteria and lactic acid bacteria showed similar growth patterns as in the control. The average pH reduction and increase in titratable acidity (%) in all treated Kimchi samples during fermentation for 4 weeks were 1.18 ± 0.05 and 0.81 ± 0.06, respectively. Kimchi with onion juice heat-treated for 120 min (K120) had the most similar lactic acid and acetic acid contents to that in the control after fermentation for 4 weeks. The highest mannitol level after fermentation for 4 weeks was detected in K120, which showed better sensory qualities compared to the control.

Kahweol activates the Nrf2/HO-1 pathway by decreasing Keap1 expression independently of p62 and autophagy pathways

Kahweol is a diterpene found in coffee beans and unfiltered coffee drinks. Several studies have demonstrated that kahweol induces the nuclear factor erythroid-2 related factor 2/ hemeoxygenase-1 (Nrf2/HO-1) pathway; however, the mechanisms involved are currently unknown. Kelch-like ECH-associated protein 1 (Keap1) is a major regulator of Nrf2 expression and is degraded mostly by autophagy. The p62 protein enhances binding to Keap1 and contributes to the activation of Nrf2. Here, we examined the role of Keap1 regulation in the effect of kahweol on the Nrf2/HO-1 pathway in hepatocytes. In AML12 cells and primary mouse hepatocytes, kahweol increased the levels of Nrf2 and HO-1 protein without increasing expression of the Nrf2 mRNA. In addition, kahweol reduced Keap1 protein levels significantly without decreasing Keap1 mRNA levels. Although regulation of the Keap1-Nrf2-pathway by p62-dependent autophagy is well known, we confirmed here that the reduction of Keap1 protein levels by kahweol does not involve p62-dependent autophagy degradation or ubiquitination. In conclusion, kahweol increases the expression of Nrf2 in hepatocytes by inhibiting translation of the Keap1 mRNA.

Influence of Capsaicinoids Content on the Microbial Community during Kimchi Fermentation

Capsaicinoids in red pepper powder are known to show anti-bacterial effects; however, their effects during kimchi fermentation are not known. This study aimed to investigate the effects of various concentrations of capsaicinoids on kimchi fermentation. Five sets of kimchi samples were prepared using 0 mg/kg (control), 98.34 ± 5.34 mg/kg (mild), 243.47 ± 3.71 mg/kg (medium), 428.63 ± 30.78 mg/kg (hot), and 1,320.49 ± 28.27 mg/kg (extreme) capsaicinoid. The characteristics of each kimchi sample, including pH, acidity, organic acid, sugars, sugar alcohol, capsaicinoid content, and microbial community were periodically investigated during fermentation. Kimchi with red pepper powder shows significantly higher acidity than control kimchi, whereas pH values were the same. Organic acid in kimchi with red pepper powder was higher than in control kimchi, probably caused by higher lactic acid bacteria (LAB) counts in kimchi samples with red pepper powder. Our results show that addition of red pepper powder decreased Leuconostoc spp. counts in the bacterial community. In particular, Lactobacillus sakei and Leuconostoc gelidum counts increased and decreased, respectively, with increasing capsaicinoid content of red pepper powder added to kimchi. Overall, the results of this study indicate that physicochemical properties and LAB such as L. sakei and L. gelidum are influenced by capsaicinoid content. However, further studies are necessary to investigate the effects of the percentage of red pepper powder in kimchi on fermentation to provide practical guidelines for producing standardized kimchi.

Rapid Method for the Determination of Capsaicin and Dihydrocapsaicin in Gochujang Using Ultra-High-Performance Liquid Chromatography

A sensitive and specific heating block method coupled with ultra-HPLC (u-HPLC) was developed for the analysis of capsaicin in Gochujang and validated by comparing with a conventional HPLC (AOAC Method 995.03). The method validation parameters yielded good results, including linearity, precision, accuracy, and recovery. The u-HPLC separation was performed on a reversed C18 column (50 2 mm id, particle size 2 m), followed by fluorescence detection (excitation 280 nm, emission 325 nm). Methanol was used as the extracting solvent, and the amount of sample taken was approximately 0.2 g; the optimum amount of extraction solvent and extraction time were 15 mL and 1 h, respectively. The recovery of capsaicin in Gochujang was more than 93, and the LOD and LOQ of the u-HPLC analysis were 0.05 and 0.16 g/g for capsaicin and 0.05 and 0.16 g/g for dihydrocapsaicin. The calibration graphs for capsaicin and dihydrocapsaicin were linear from 0.2 to 10.0 g/mL for u-HPLC. The interday and intraday precisions (RSD values) were &lt;6.27.

Dietary intake assessment of macro, trace, and toxic elements via consumption of kimchi in South Korea

BACKGROUND

Kimchi, a Korean food, is now produced and consumed in many other countries. In this study, the macro, trace, and toxic element content in varieties of kimchi from Korea and China was evaluated. A health-risk assessment, involving the calculation of estimated dietary intake values, was undertaken. To discriminate among samples with different origins, linear discriminant analysis (LDA) and principal component analysis (PCA) were applied.

RESULTS

The analytical methods used for analyses were successfully validated. In the quantification of elements, no significant differences were detected in the concentrations of the elements that were analyzed. Based on the fresh weight of kimchi, among the macro elements, the concentrations of Na and K were relatively high, with values of 4181.9-9919.8 mg kg^-1 and 1661.8-6623.5 mg kg^-1 , respectively. Among the trace elements that were analyzed, zinc in Korean samples, and strontium in Chinese samples showed the highest concentrations, at 2.67 and 2.98 mg kg^-1 , respectively. Concentration levels of the toxic trace elements were within permissible limits. The amount of daily intake and provisional daily intake of each element calculated based on kimchi intake confirmed its safety for consumption. Linear discriminant analysis and PCA successfully discriminated among the samples of Chinese and Korean origin.

CONCLUSION

The provisional daily intake of the toxic elements was within provisional tolerable daily intake values. The normal intake of kimchi could not pose a threat upon consumption. © 2019 Society of Chemical Industry.

Plasmon-Amplified Endogenous Fluorescence Nanospectroscopic Sensor Based on Inherent Elastic Scattering for Ultratrace Ratiometric Detection of Capsaicinoids

Endogenous fluorescence imaging techniques are key for modern single-molecule quantification without the use of additional labeling probes. However, the drawback of weak fluorescence signal is the primary challenge in meeting the ever-increasing demands of single-molecule detection. Here, we report a simple and reliable method that provides up to ∼100-fold uniform fluorescence enhancement of endogenous fluorescence of the capsaicinoid molecule. The method is based on a single nanoparticle plasmon-amplified endogenous fluorescence nanospectroscopic sensor (PAEFS). This work demonstrated the applicability of PAEFS in refining sensitivity at the single-molecule level by showing ultralow limits of detection (10⁶ times lower than previous reports) of fluorescence-based capsaicinoids with a wide range of linear response (18 zM to 85 pM). Spectrally overlapped capsaicinoid analogues were quantified ratiometrically to detect the analogue percentages in real samples. The novel endogenous fluorescence enhancement approach presented here represents a universal sensor for enhanced detection of single molecules using existing techniques without altering the original molecular features or using add-on labeling probes.

Antioxidant effects of kimchi supplemented with black raspberry during fermentation protect against liver cirrhosis-induced oxidative stress in rats

BACKGROUND/OBJECTIVES

Oxidative stress is a major effector of various diseases; accordingly, antioxidants are frequently ingested in order to prevent or alleviate disease symptoms. Kimchi contains various natural antioxidants, and it is known that the functional activity varies depending on the ingredients and fermentation state. Black raspberries (BR) contain various bioactive compounds with antioxidant effects. This study investigated the antioxidant and liver-protection effects of kimchi supplemented with black raspberry juice powder (BJP).

MATERIALS/METHODS

BJP-added kimchi (BAK; at 0.5%, 1%, and 2% concentrations of BJP) and control (without BJP) were prepared and fermented at 4℃ for 4 weeks. Changes in the antioxidant effects of BAK during fermentation were investigated. In addition, the protective activity of BAK against oxidative stress was investigated in a liver cirrhosis-induced animal model in vivo.

RESULTS

BAK groups showed the acidity and pH of optimally ripened (OR) kimchi at 2 weeks of fermentation along with the highest lactic acid bacterial counts. Additionally, BAK groups displayed a higher content of phenolic compounds and elevated antioxidant activities relative to the control, with the highest antioxidant effect observed at 2 weeks of fermentation of OR 1% BAK. After feeding the OR 1% BAK to thioacetamide-induced liver cirrhosis rats, we observed decreased glutamate oxaloacetate transaminase and glutamate pyruvate transaminase activities and elevated superoxide dismutase activity.

CONCLUSIONS

These findings showed that the antioxidant effects of OR BAK and feeding of OR 1% BAK resulted in liver-protective effects against oxidative stress.

Kahweol Ameliorates the Liver Inflammation through the Inhibition of NF-κB and STAT3 Activation in Primary Kupffer Cells and Primary Hepatocytes

Gut derived bacterial endotoxins, such as lipopolysaccharide (LPS), are involved in one of the important mechanisms that lead to inflammation associated with various liver diseases, including nonalcoholic fatty liver disease and alcoholic liver disease. Kahweol is a coffee-specific diterpene present in coffee bean and exhibits anti-angiogenic and anti-inflammatory activities. However, to date, the effect of kahweol on liver inflammation remains unknown. In this study, we examined whether kahweol exhibits a protective effect by inhibiting liver inflammation in primary Kupffer cells and primary hepatocytes cultures as well as their co-cultures. Kahweol decreased the LPS-induced production of interleukin 1 alpha, interleukin 1 beta, interleukin 6, and tumor necrosis factor alpha. The inhibitory effect of kahweol on the liver inflammation was associated with the down regulation of LPS-stimulated phospho-nuclear factor kappa B and -signal transducer and activator of transcription 3 expression. These results suggest that kahweol might be a novel potent agent to treat liver inflammation induced by LPS.

Kahweol decreases hepatic fibrosis by inhibiting the expression of connective tissue growth factor via the transforming growth factor-beta signaling pathway

Kahweol is a diterpene molecule found in Coffea Arabica beans. Previous studies have shown that coffee reduces liver fibrosis, but it is not clear which component of coffee has the protective effect. In this study, we examined whether kahweol has a protective effect on hepatic fibrosis in vivo and in vitro. Kahweol decreased hepatic fibrosis by inhibiting connective tissue growth factor (CTGF) expression in thioacetamide (TAA)-treated mice. The expression of phospho-Smad3, signal transducer and activator of transcription 3 (STAT3), extracellular signal-regulated kinases (ERK), and c-Jun N-terminal protein kinase (JNK) increased in the livers of TAA-treated mice and decreased in the kahweol-treated group. Kahweol significantly decreased the expression of transforming growth factor beta (TGF-β)-stimulated type I collagen and CTGF expression in vitro. In addition, kahweol significantly decreased the expression of Smad3, STAT3, ERK and JNK, which are involved in the induction of CTGF expression by TGF-β in hepatocytes, but not in HSCs. These results suggest that kahweol may be a new candidate for treatment of liver fibrosis.

A randomized controlled clinical and radiological trial about outcomes of navigation-assisted TKA compared to conventional TKA: long-term follow-up

PURPOSE

Well balanced knees with good alignment are essential for a well-functioning TKA with long survival of its implants. This prospective randomized study comparing navigation-assisted TKA and conventional TKA reported the clinical and radiological outcomes at a follow-up of 9 years. The purpose of this study was to compare the clinical and radiological outcomes for patients who underwent navigation-assisted TKA or conventional TKA after long-term follow-up.

METHODS

A total of 80 patients (88 knees) were available for physical and radiological examination 9 years after TKA. Clinical outcomes were evaluated using HSS, WOMAC, and KS function and pain scores. And radiological outcomes of the component loosening and its survivorship during 9-year follow-up were also evaluated.

RESULTS

There were no significant differences in the field of clinical outcomes between the two groups. In terms of radiological outcomes, the navigation group had fewer alignment outliers (7.3 vs 20 %, p = 0.006). Although the clinical outcomes showed no differences between the two groups, the survival rate was slightly better in the navigation group than in the conventional group without statistical significance (best-case scenario 100 vs 95.3 %, n.s., worst-case scenario 95.6 vs 88.4 %, n.s.).

CONCLUSION

Navigation-assisted TKA produced better alignment outcomes and better survival rates than conventional instruments although some of the differences were not statistically significant.

LEVEL OF EVIDENCE

I.

Fyn deficiency attenuates renal fibrosis by inhibition of phospho-STAT3

The hallmark of renal tubulointerstitial fibrosis is the accumulation of myofibroblasts and extracellular matrix proteins. Fyn, a member of the Src family of kinases, has diverse biological functions including regulation of mitogenic signaling and proliferation and integrin-mediated interaction. Src family proteins promote pulmonary fibrosis by augmenting transforming growth factor-β signaling, but their role in renal fibrosis is less understood. We observed upregulation of Fyn in a renal fibrosis model induced by unilateral ureteral obstruction. Upon ureteral obstruction, Fyn-deficient mice exhibited attenuated renal fibrosis relative to wild-type mice. Furthermore, obstruction-induced renal expression of type I collagen, fibronectin, α-smooth muscle actin, and plasminogen activator inhibitor-1 was suppressed. Pharmacologic inhibition of Fyn blocked induction of extracellular matrix proteins in kidney cell lines. Importantly, the attenuation of renal fibrosis by Fyn deficiency was not accompanied by changes in the Smad pathway. Rather, the antifibrotic effect of Fyn deficiency was associated with downregulation of signal transducer and activator of transcription 3 (STAT3). Small, interfering RNA targeting STAT3 in Fyn-deficient cells further suppressed α-smooth muscle actin expression, whereas a STAT3 activator partially restored plasminogen activator inhibitor-1 expression, indicating that STAT3 signaling is critically involved in this process. Thus, Fyn plays an important role in renal fibrosis. Hence, Fyn kinase inhibitors may be therapeutically useful against renal fibrosis.

Metabolic Risk Profile and Cancer in Korean Men and Women

OBJECTIVES

Metabolic syndrome is a cluster of risk factors for type 2 diabetes mellitus and cardiovascular disease. Associations between metabolic syndrome and several types of cancer have recently been documented.

METHODS

We analyzed the sample cohort data from the Korean National Health Insurance Service from 2002, with a follow-up period extending to 2013. The cohort data included 99 565 individuals who participated in the health examination program and whose data were therefore present in the cohort database. The metabolic risk profile of each participant was assessed based on obesity, high serum glucose and total cholesterol levels, and high blood pressure. The occurrence of cancer was identified using Korean National Health Insurance claims data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for age group, smoking status, alcohol intake, and regular exercise.

RESULTS

A total of 5937 cases of cancer occurred during a mean follow-up period of 10.4 years. In men with a high-risk metabolic profile, the risk of colon cancer was elevated (HR, 1.40; 95% CI, 1.14 to 1.71). In women, a high-risk metabolic profile was associated with a significantly increased risk of gallbladder and biliary tract cancer (HR, 2.05; 95% CI, 1.24 to 3.42). Non-significantly increased risks were observed in men for pharynx, larynx, rectum, and kidney cancer, and in women for colon, liver, breast, and ovarian cancer.

CONCLUSIONS

The findings of this study support the previously suggested association between metabolic syndrome and the risk of several cancers. A high-risk metabolic profile may be an important risk factor for colon cancer in Korean men and gallbladder and biliary tract cancer in Korean women.

The Economic Burden of Cancers Attributable to Metabolic Syndrome in Korea

OBJECTIVES

Metabolic syndrome is an important etiologic factor in the development of certain types of cancers. The economic cost of the treatment of cancer has been steadily increasing. We therefore estimated the economic burden of cancers attributable to metabolic syndrome in Korea.

METHODS

We reviewed metabolic syndrome-related cancers and relative risk and then calculated population attributable fractions. We analyzed insurance claims data for metabolic syndrome-related cancers in 2012 in order to estimate the direct costs associated with these cancers, including hospitalization, outpatient visits, transportation costs, and caregivers' costs as well as indirect costs such as loss of productivity due to cancer treatment and premature death.

RESULTS

In 2012, 18,070 patients in Korea had cancers attributable to metabolic syndrome. The economic burden was USD 199.8 million and the direct and indirect costs were USD 124.5 million and USD 75.3 million, respectively.

CONCLUSIONS

We estimated the economic burden of cancers attributable to metabolic syndrome in Korea and the efforts are necessary to reduce this burden.

The Economic Burden of Breast Cancer in Korea from 2007-2010

Purpose

This study estimates the socioeconomic cost and burden for breast cancer patients in Korea between 2007 and 2010.

Materials and Methods

This study used a prevalence-based approach to estimate the cost of breast cancer. Breast cancer patients were defined as those who were hospitalized or have visited an outpatient clinic during the period from 2007 to 2010. The socioeconomic costs of breast cancer were subdivided into two costs: direct and indirect.

Results

From 2007 to 2010, the prevalence of treated breast cancer increased from 7.9% to 20.4%. The total socioeconomic costs incurred by breast cancer increased by approximately 40.7% from US $668.49 million in 2007 to US $940.75 million in 2010. The direct medical care costs for 2010 were 1.4 times greater (US $399.22 million) than for 2007 (US $278.71 million). The direct non-medical costs rose from US $50.69 million in 2007 to US $75.83 million in 2010, a 49.6% increase. Regarding the economic burden of breast cancer, the total indirect costs were US $339.09 million in 2007 and increased by 37.3% to US $465.70 million in 2010. In the sensitivity analysis, with the annual discount rate for each year ranging from 0%-5%, the costs increased 1.1-1.2 times.

Conclusion

Due to the growing incidence of breast cancer, the annual prevalence and related costs are increasing. We must strive to reduce the socioeconomic burden of breast cancer through preventive measures and early screening.

Cathepsin inhibition-induced lysosomal dysfunction enhances pancreatic beta-cell apoptosis in high glucose

Autophagy is a lysosomal degradative pathway that plays an important role in maintaining cellular homeostasis. We previously showed that the inhibition of autophagy causes pancreatic β-cell apoptosis, suggesting that autophagy is a protective mechanism for the survival of pancreatic β-cells. The current study demonstrates that treatment with inhibitors and knockdown of the lysosomal cysteine proteases such as cathepsins B and L impair autophagy, enhancing the caspase-dependent apoptosis of INS-1 cells and islets upon exposure to high concentration of glucose. Interestingly, treatment with cathepsin B and L inhibitors prevented the proteolytic processing of cathepsins B, D and L, as evidenced by gradual accumulation of the respective pro-forms. Of note, inhibition of aspartic cathepsins had no effect on autophagy and cell viability, suggesting the selective role of cathepsins B and L in the regulation of β-cell autophagy and apoptosis. Lysosomal localization of accumulated pro-cathepsins in the presence of cathepsin B and L inhibitors was verified via immunocytochemistry and lysosomal fractionation. Lysotracker staining indicated that cathepsin B and L inhibitors led to the formation of severely enlarged lysosomes in a time-dependent manner. The abnormal accumulation of pro-cathepsins following treatment with inhibitors of cathepsins B and L suppressed normal lysosomal degradation and the processing of lysosomal enzymes, leading to lysosomal dysfunction. Collectively, our findings suggest that cathepsin defects following the inhibition of cathepsin B and L result in lysosomal dysfunction and consequent cell death in pancreatic β-cells.

Sitagliptin attenuates methionine/choline-deficient diet-induced steatohepatitis

AIMS

Accumulating evidence suggests that inhibitors of dipeptidyl peptidase-4 (DPP-4), such as sitagliptin, may play an important role in the prevention of non-alcoholic steatohepatitis (NASH). This study was conducted to elucidate whether sitagliptin could prevent steatohepatitis by inhibiting pathways involved in hepatic steatosis, inflammation, and fibrosis.

METHODS

C57BL/6 mice were fed a methionine/choline-deficient (MCD) diet with or without supplement with sitagliptin for 5 weeks. Liver and adipose tissue from mice were examined histologically and immunohistochemically to estimate the effect of sitagliptin on the development of NASH.

RESULTS

Supplementation with sitagliptin resulted in significant improvement of MCD diet-induced fat accumulation in the liver. In addition, sitagliptin treatment lowered fatty acid uptake, expression of VLDL receptor and hepatic triglyceride content. Sitagliptin also effectively attenuated MCD diet-induced hepatic inflammation, endoplasmic reticulum (ER) stress, and liver injury, as evidenced by reduced proinflammatory cytokine levels, ER stress markers, and TUNEL staining. Expression of CYP2E1 and 4NHE were strongly increased by the MCD diet, but this effect was successfully prevented by sitagliptin treatment. Furthermore, sitagliptin significantly decreased levels of MCD diet-induced fibrosis-associated proteins such as fibronectin and α-SMA in the liver. Inflammatory and atrophic changes of adipose tissue by MCD diet were restored by sitagliptin treatment.

CONCLUSIONS

Sitagliptin attenuated MCD diet-induced hepatic steatosis, inflammation, and fibrosis in mice through amelioration of mechanisms responsible for the development of NASH, including CD36 expression, NF-κB activation, ER stress, CYP2E1 expression, and lipid peroxidation. Treatment with sitagliptin may represent an effective approach for the prevention and treatment of NASH.

Economic burden of colorectal cancer in Korea

OBJECTIVES

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

METHODS

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

RESULTS

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

CONCLUSIONS

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.

The economic burden of epilepsy in Korea, 2010

Objectives

The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010.

Methods

This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office's records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs.

Results

The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy.

Conclusions

A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.

The autophagy-related marker LC3 can predict prognosis in human hepatocellular carcinoma

Background

Defects of autophagy and endoplasmic reticulum (ER) stress are related to many diseases and tumors. However, only a few studies have examined hepatocellular carcinoma (HCC) as related to these processes. Therefore, in this study, we investigated the expression and extent of autophagy and ER stress-related markers in HCC and their influence on clinical characteristics and prognosis for each protein.

Methodology

The expression of autophagy-related markers (LC3 and Beclin-1) and ER stress-related markers (GRP78 and CHOP) was analyzed by immunohistochemistry on tissues from completely resected specimens of 190 HCC patients. Their influence on clinicopathologic features and prognosis were evaluated using the chi-square test and Kaplan-Meier analysis. Correlations of each protein were determined by Spearman's correlation analysis.

Principal Findings

LC3 expression was not correlated with TNM, BCLC stage, or Edmonson-Steiner grading, whereas it was correlated with longer overall survival (OS) (p = 0.039) and tended to be related with longer time to recurrence (TTR) (p=0.068) although it did not show statistical significance. Multivariate analysis indicated that LC3 expression was a significantly independent prognostic factor of OS (HR, 0.42; 95% CI, 0.22-0.80; p-value=0.009) and TTR (HR, 0.54; 95% CI, 0.33–0.90; p=0.017). Expression of LC3 in advanced stages of TNM (III) (p=0.045) and Edmonson-Steiner Grades (III and IV) (p=0.043) was correlated with longer survival, but not in the early stages. A positive correlation was not observed between the expression of autophagy-related markers and ER stress-related markers.

Conclusion

Our results suggest that the expression and extent of LC3 might be a strong prognostic factor of HCC, especially in patients with surgical resection.

Clusterin decreases hepatic SREBP-1c expression and lipid accumulation

Hepatic steatosis is emerging as the most important cause of chronic liver disease and is associated with the increasing incidence of obesity with insulin resistance. Sterol regulatory binding protein-1c (SREBP-1c) is a master regulator of lipogenic gene expression in the liver. Hyperinsulinemia induces SREBP-1c transcription through liver X receptor (LXR), specificity protein 1, and SREBP-1c itself. Clusterin, an 80-kDa disulfide-linked heterodimeric protein, has been functionally implicated in several physiological processes including lipid transport; however, little is known about its effect on hepatic lipogenesis. The present study examined whether clusterin regulates SREBP-1c expression and lipid accumulation in the liver. Adenovirus-mediated overexpression of clusterin inhibited insulin- or LXR agonist-stimulated SREBP-1c expression in cultured liver cells. In reporter assays, clusterin inhibited SREBP-1c promoter activity. Moreover, adenovirus-mediated overexpression of clusterin in the livers of mice fed a high-fat diet inhibited hepatic steatosis through the inhibition of SREBP-1c expression. Reporter and gel shift assays showed that clusterin inhibits SREBP-1c expression via the repression of LXR and specificity protein 1 activity. This study shows that clusterin inhibits hepatic lipid accumulation through the inhibition of SREBP-1c expression and suggests that clusterin is a negative regulator of SREBP-1c expression and hepatic lipogenesis.

Health and economic burden of major cancers due to smoking in Korea

Cigarette smoking is one of the most important public health concerns in Korea and worldwide. A number of studies have been conducted to measure the health and economic burden of smoking, but these did not reflect recent changes such as the decrease in smoking rate and the increase in the incidence of cancer. The purpose of this study was to provide up-to-date estimates of the health and economic burden of cancer caused by smoking and to compare the results with those of previous studies. Cancer-related burden was assessed with nationally representative data such as claims data from the National Health Insurance Corporation, and cause of death records from the National Statistical Office and the Korea Health Panel. We determined the smoking-attributable burden by multiplying the smoking-attributable fraction by the total burden. As a result, the burden of major cancers due to smoking was found to be substantial despite a recent sharp decrease in smoking by the Korean population. The total economic cost reaches $2,234.0 million in males and $870.0 million in females. Also, the health burden of cancers due to smoking is 2,038.9 disability adjusted life years (DALYs) per 100,000 individuals in men and 732.2 DALYs per 100,000 individuals in women. Among all cancers, cancers of the trachea, lungs and bronchus are the leading causes of health and economic burden. The huge burden caused by cancers linked to smoking makes it imperative that adequate policies to decrease the prevalence of smoking be developed, particularly considering the recent increase in smoking rate among women.

Effects of red pepper powder on microbial communities and metabolites during kimchi fermentation

To investigate the effects of red pepper powder on kimchi fermentation, Baechu (Chinese cabbage) and Mu (radish) kimchi, with and without red pepper powder, were prepared and their characteristics, including pH, colony-forming units (CFU), microbial communities, and metabolites, were periodically monitored for 40days. Measurements of pH and CFU showed that the lag phases of kimchi fermentation were clearly extended by the addition of red pepper powder. Microbial community analysis using a barcoded pyrosequencing analysis showed that the bacterial diversities in kimchi with red pepper powder decreased more slowly than kimchi without red pepper powder as kimchi fermentation progressed. The kimchi microbial communities were represented mainly by the genera Leuconostoc and Lactobacillus in all kimchi, and the abundance of Weissella was negligible in kimchi without red pepper powder. However, interestingly, kimchi with red pepper powder contained much higher proportions of Weissella than kimchi without red pepper powder, while the proportions of Leuconostoc and Lactobacillus were evidently lower in kimchi with red pepper powder compared to kimchi without red pepper powder. Metabolite analysis using a (1)H NMR technique also showed that the fermentation of kimchi with red pepper powder progressed a little more slowly than that of kimchi without red pepper powder. Principle component analysis using microbial communities and metabolites supported the finding that the addition of red pepper powder into kimchi resulted in the slowing of the kimchi fermentation process, especially during the early fermentation period and influenced the microbial succession and metabolite production during the kimchi fermentation processes.

Effects of Leuconostoc mesenteroides starter cultures on microbial communities and metabolites during kimchi fermentation

Kimchi fermentation usually relies upon the growth of naturally-occurring various heterofermentative lactic acid bacteria (LAB). This sometimes makes it difficult to produce kimchi with uniform quality. The use of Leuconostoc mesenteroides as a starter has been considered to produce commercial fermented kimchi with uniform and good quality in Korea. In this study, a combination of a barcoded pyrosequencing strategy and a (1)H NMR technique was used to investigate the effects of Leu. mesenteroides strain B1 as a starter culture for kimchi fermentation. Baechu (Chinese cabbage) and Chonggak (radish) kimchi with and without Leu. mesenteroides inoculation were prepared, respectively and their characteristics that included pH, cell number, bacterial community, and metabolites were monitored periodically for 40 days. Barcoded pyrosequencing analysis showed that the numbers of bacterial operational taxonomic units (OTU) in starter kimchi decreased more quickly than that in non-starter kimchi. Members of the genera Leuconostoc, Lactobacillus, and Weissella were dominant LAB regardless of the kimchi type or starter inoculation. Among the three genera, Leuconostoc was the most abundant, followed by Lactobacillus and Weissella. The use of Leu. mesenteroides as a starter increased the Leuconostoc proportions and decreased the Lactobacillus proportions in both type of kimchi during kimchi fermentation. However, interestingly, the use of the kimchi starter more highly maintained the Weissella proportions of starter kimchi compared to that in the non-starter kimchi until fermentation was complete. Metabolite analysis using the (1)H NMR technique showed that both Baechu and Chonggak kimchi with the starter culture began to consume free sugars earlier and produced a little greater amounts of lactic and acetic acids and mannitol. Metabolite analysis demonstrated that kimchi fermentation using Leu. mesenteroides as a starter was completed earlier with more production of kimchi metabolites compared to that not using a starter, which coincided with the decreases in pH and the increases in bacterial cell number. The PCA strategy using all kimchi components including carbohydrates, amino acids, organic acids, and others also showed that starter kimchi fermented faster with more organic acid and mannitol production. In conclusion, the combination of the barcoded pyrosequencing strategy and the (1)H NMR technique was used to effectively monitor microbial succession and metabolite production and allowed for a greater understanding of the relationships between the microbial community and metabolite production in kimchi fermentation.

The economic burden of inflammatory heart disease in Korea

BACKGROUND AND OBJECTIVES

The incidence of inflammatory heart diseases is not yet as high as those of other cardiovascular diseases; however, inflammatory heart diseases do have relatively high mortality rate. Therefore, update information on the economic burden of inflammatory heart diseases are necessary in order to appropriate policy making on these diseases.

MATERIALS AND METHODS

This study used a number of resources to obtain data, national health insurance statistics, the Korean Health Panel, and the causes of death report by the Korean National Statistical Office. The total costs of inflammatory heart diseases were estimated as the sum of direct medical care costs, direct non-medical care and indirect costs.

RESULTS

The total direct cost of inflammatory heart disease was higher in Korean men than that of Korean women and cost due to inpatient was higher than that of outpatients cost. The costs to cover premature death were highest among all of the components used to determine the total costs for inflammatory heart disease, representing 66.3% of these costs in Korea.

CONCLUSION

Inflammatory heart disease has a relatively high mortality rate, and the costs that are associated with premature deaths consume the greatest proportion of the costs associated with this disease. In spite of some limitations of study, this could be a reliable evidence of economic burden of inflammatory heart disease.

Alpha-lipoic acid attenuates methionine choline deficient diet-induced steatohepatitis in C57BL/6 mice

AIMS

Non-alcoholic steatohepatitis (NASH) is a liver disease that causes fat accumulation, inflammation and fibrosis. Increased oxidative stress contributes to hepatic inflammation and fibrosis by upregulation of Cytochrome P450 2E1 (CYP2E1), endoplasmic reticulum (ER) stress and mitogen-activated protein kinase (MAPK) activity. This study examined whether alpha-lipoic acid (ALA), a naturally occurring thiol antioxidant, prevents steatohepatitis through the inhibition of several pathways involved in hepatic inflammation and fibrosis.

MAIN METHODS

C57BL/6 mice were fed an MCD diet with or without ALA for 4weeks. Liver sections from mice on control or MCD diets with or without ALA were stained with hematoxylin-eosin, oil red O, and anti-4-HNE antibody. The effects of ALA on methionine-choline deficient MCD-diet induced plasma AST and ALT as well as tissue TBARS were measured. The effects of ALA on CYP2E1 expression, ER stress, MAPK levels, and NF-κB activity in MCD diet-fed mice liver were measured by northern and western blot analysis.

KEY FINDINGS

Dietary supplementation with ALA reduced MCD diet-induced hepatic lipid accumulation, hepatic inflammation, TBARS, 4-HNE, and plasma ALT and AST levels. These effects were associated with a reduced expression of CYP2E1 and reduced ER stress and MAPK and NF-κB activity.

SIGNIFICANCE

Taken together, the results of the present study indicate that ALA attenuates steatohepatitis through inhibition of several pathways, and provide the possibility that ALA can be used to prevent the development and progression of non-alcoholic fatty liver disease in patients who have strong risk factors for NASH.

Economic burden of asthma in Korea

Understanding the magnitude of the economic impact of an illness on society is fundamental to planning and implementing relevant policies. South Korea operates a compulsory universal health insurance system providing favorable conditions for evaluating the nationwide economic burden of illnesses. The aim of this study was to estimate the economic costs of asthma imposed on Korean society. The Korean National Health Insurance claims database was used for determining the health care services provided to asthma patients defined as having at least one inpatient or outpatient claim(s) with a primary diagnosis of asthma in 2008. Both direct and indirect costs were included. Direct costs were those associated directly with treatment, medication, and transportation. Indirect costs were assessed in terms of the loss of productivity in asthma patients and their caregivers and consisted of morbidity cost, mortality cost, and caregivers' time cost. The estimated cost for 2,273,290 asthma patients in 2008 was $831 million, with an average per capita cost of $336. Among the cost components, outpatient and medication costs represented the largest cost burden. Although the costs for children accounted for the largest proportion of the total cost, the per capita cost was highest among patients ≥50 years old. The economic burden of asthma in Korea is considerable. Considering that the burden will increase with the rising prevalence, implementation of effective national prevention approaches aimed at the appropriate target populations is imperative.

The economic burden of musculoskeletal disease in Korea: a cross sectional study

BACKGROUND

Musculoskeletal diseases are becoming increasingly important due to population aging. However, studies on the economic burden of musculoskeletal disease in Korea are scarce. Therefore, we conducted a population-based study to measure the economic burden of musculoskeletal disease in Korea using nationally representative data.

METHODS

This study used a variety of data sources such as national health insurance statistics, the Korea Health Panel study and cause of death reports generated by the Korea National Statistical Office to estimate the economic burden of musculoskeletal disease. The total cost of musculoskeletal disease was estimated as the sum of direct medical care costs, direct non-medical care costs, and indirect costs. Direct medical care costs are composed of the costs paid by the insurer and patients, over the counter drugs costs, and other costs such as medical equipment costs. Direct non-medical costs are composed of transportation and caregiver costs. Indirect costs are the sum of the costs associated with premature death and the costs due to productivity loss. Age, sex, and disease specific costs were estimated.

RESULTS

Among the musculoskeletal diseases, the highest costs are associated with other dorsopathies, followed by disc disorder and arthrosis. The direct medical and direct non-medical costs of all musculoskeletal diseases were $4.18 billion and $338 million in 2008, respectively. Among the indirect costs, those due to productivity loss were $2.28 billion and costs due to premature death were $79 million. The proportions of the total costs incurred by male and female patients were 33.8% and 66.2%, respectively, and the cost due to the female adult aged 20-64 years old was highest. The total economic cost of musculoskeletal disease was $6.89 billion, which represents 0.7% of the Korean gross domestic product.

CONCLUSIONS

The economic burden of musculoskeletal disease in Korea is substantial. As the Korean population continues to age, the economic burden of musculoskeletal disease will continue to increase. Policy measures aimed at controlling the cost of musculoskeletal disease are therefore required.