Novel application assigned to toluquinol: inhibition of lymphangiogenesis by interfering with VEGF-C/VEGFR-3 signalling pathway

BACKGROUND AND PURPOSE

Lymphangiogenesis is an important biological process associated with the pathogenesis of several diseases, including metastatic dissemination, graft rejection, lymphoedema and other inflammatory disorders. The development of new drugs that block lymphangiogenesis has become a promising therapeutic strategy. In this study, we investigated the ability of toluquinol, a 2-methyl-hydroquinone isolated from the culture broth of the marine fungus Penicillium sp. HL-85-ALS5-R004, to inhibit lymphangiogenesis in vitro, ex vivo and in vivo.

EXPERIMENTAL APPROACH

We used human lymphatic endothelial cells (LECs) to analyse the effect of toluquinol in 2D and 3D in vitro cultures and in the ex vivo mouse lymphatic ring assay. For in vivo approaches, the transgenic Fli1:eGFPy1 zebrafish, mouse ear sponges and cornea models were used. Western blotting and apoptosis analyses were carried out to search for drug targets.

KEY RESULTS

Toluquinol inhibited LEC proliferation, migration, tubulogenesis and sprouting of new lymphatic vessels. Furthermore, toluquinol induced apoptosis of LECs after 14 h of treatment in vitro, blocked the development of the thoracic duct in zebrafish and reduced the VEGF-C-induced lymphatic vessel formation and corneal neovascularization in mice. Mechanistically, we demonstrated that this drug attenuates VEGF-C-induced VEGFR-3 phosphorylation in a dose-dependent manner and suppresses the phosphorylation of Akt and ERK1/2.

CONCLUSIONS AND IMPLICATIONS

Based on these findings, we propose toluquinol as a new candidate with pharmacological potential for the treatment of lymphangiogenesis-related pathologies. Notably, its ability to suppress corneal neovascularization paves the way for applications in vascular ocular pathologies.

Super obese behave different from simple and morbid obese patients in the changes of body composition after tailored one anastomosis gastric bypass (BAGUA)

INTRODUCTION

Super obese patients behave different from simple and morbid obese patients when they reach final changes of body composition (BC) after bariatric surgery. This has led us to tailor One Anastomosis Gastric Bypass (BAGUA) to achieve better results in this group of patients.

PATIENTS AND METHODS

We studied 83 (37 diabetic and 46 nondiabetic BMI 30 and up) patients who completed all evaluation appointment (preoperative, 10 days, 1, 3, 6 and 12 months) after tailored BAGUA for diabesity. We used the Tanita body composition analyzer BC-420 MA by the method of single frequency impedance to analyze the evolution of BC in patients classified by BMI 30 - 34,9, 35 - 50, and >50.

RESULTS

While preoperative excess weight presented dramatic decreases after tailored BAGUA in all the groups, super obese have different final BC. Diabetics retained more fat mass and visceral fat, where super obese have double (14 kg) that simple obese patients (6 kg), they lost more muscle mass, and have higher basal metabolism. The final BC is altered in all parameters if diabetes is added.

CONCLUSIONS

The reduction of the preoperative excess weight is motivated largely by the tailored effect of BAGUA. Patients BMI 30-50 behaved homogeneous in BC after surgery while patients BMI >50 behave different. Super obese lose less weight, retained more fat mass, visceral fat, bone mass, and total water. This effect should be treated by more aggressive surgery by measuring the entire small intestine to make a proper exclusion (tailored) to achieve homogeneous effects.

Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with One Anastomosis Gastric Bypass

INTRODUCTION

Diabetes mellitus type 2 (DMT2) is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics.

MATERIAL AND METHODS

Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA), were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities.

RESULTS

After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height.

CONCLUSIONS

The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels.

Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients

OBJECTIVES

To develop algorithms for a conversion of disease-specific quality-of-life into health state values for morbidly obese patients before or after bariatric surgery.

METHODS

A total of 893 patients were enrolled in a prospective cross-sectional multicenter study. In addition to demographic and clinical data, health-related quality-of-life (HRQoL) data were collected using the disease-specific Moorehead-Ardelt II questionnaire (MA-II) and two generic questionnaires, the EuroQoL-5D (EQ-5D) and the Short Form-6D (SF-6D). Multiple regression models were constructed to predict EQ-5D- and SF-6D-based utility values from MA-II scores and additional demographic variables.

RESULTS

The mean body mass index was 39.4, and 591 patients (66%) had already undergone surgery. The average EQ-5D and SF-6D scores were 0.830 and 0.699. The MA-IIwas correlated to both utility measures (Spearman's r = 0.677 and 0.741). Goodness-of-fit was highest (R(2) = 0.55 in the validation sample) for the following item-based transformation algorithm: utility (MA-II-based) = 0.4293 + (0.0336 x MA1) + (0.0071 x MA2) + (0.0053 x MA3) + (0.0107 x MA4) + (0.0001 x MA5). This EQ-5D-based mapping algorithm outperformed a similar SF-6D-based algorithm in terms of mean absolute percentage error (P = 0.045).

CONCLUSIONS

Because the mapping algorithm estimated utilities with only minor errors, it appears to be a valid method for calculating health state values in cost-utility analyses. The algorithm will help to define the role of bariatric surgery in morbid obesity.

Validity of the Czech, German, Italian, and Spanish version of the Moorehead-Ardelt II questionnaire in patients with morbid obesity

BACKGROUND

The Moorehead-Ardelt II (MA-II) questionnaire is the most frequently applied instrument to assess quality of life (QoL) in bariatric surgery patients. Our aim was to validate the Czech, German, Italian, and Spanish version of the MA-II.

METHODS

A total of 893 patients were enroled in a prospective cross-sectional European study. Two thirds of the patients(n = 591) were postsurgical cases. In addition to demographicand clinical data, QoL data was collected using the MA-II questionnaire, the EuroQoL-5D (EQ-5D), and the Short Form 36 Health Survery (SF-36). Statistical parameters for contingency (Cronbach's alpha), construct and criterion validity(Pearson's r), and responsiveness (standardised effect sizes) were calculated for each language version.

RESULTS

In the different languages, Cronbach's alpha ranged from 0.817 to 0.885 for the MA-II. These values were higher than those obtained for the SF-36 (0.418-0.607). The MA-II was well correlated to the EQ-5D (r = 0.662) and to 3 of the 8 health domains of the SF-36 (0.615, 0.548, and 0.569 for physical functioning,physical role, and general health, respectively). As expected, there was a negative correlation between the MA-II and the BMI (r = -0.404 for all patients), but no significant correlation with age was found.When comparing both the heaviest and the lightest third of the patients, mean responsiveness was higher for the MA-II (-1.138) than for the domains of the SF-36 (range -0.111 to -1.070) and the EQ-5D (-0.874).

CONCLUSION

The Czech, German, Italian, and Spanish version of the MA-II questionnaire are valid instruments and should be preferred to generic questionnaires as they provide better responsiveness.

One-Anastomosis Gastric Bypass by Laparoscopy: Results of the First 209 Patients

BACKGROUND

One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz.

METHODS

The results of our first 209 OAGB patients operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight 66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery (18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation had been performed previously.

RESULTS

2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3 patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%), 1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only 2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80% at 2 years.

CONCLUSION

OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric bypass, quicker return to normal activities, and better quality of life.

Surgery to modify nutritional behaviour

The main aim of obesity surgery is to change the dietary habits of morbidly obese patients. These are patients whose dietary habits nutritionists and psychologists have not been able to change during previous decades. The history of this surgery can teach us many important lessons. For example, procedures that have focused on effecting a malabsorptive state, but without addressing any behavioural mechanism for weight control, such as jejunoileal bypass, have failed. On the other hand, those that have centered on only addressing behavioural issues, the purely restrictive, are also difficult for patients to comply with and also have a high failure rate. To facilitate a change in the nutritional behaviour of morbidly obese patients which can lead to the loss of an adequate amount of weight, and which could be maintained in the long term is difficult. We need to stimulate changes that can be easily followed by the patient, and at the same time, provoke minimal medium and long term alterations in their nutritional state. To achieve and maintain this aim efficiently, it is necessary that the patients have confidence in and respect the physician, so that they can follow strictly their medical advice.

One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity

The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force). Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.

[Dysautonomic seizures in patients admitted to an intensive care unit following severe traumatic brain injury]

AIM

To describe clinical and radiologic features of dysautonomic crisis after severe traumatic brain injury and its influence in the clinical situation six months later.

PATIENTS AND METHODS

Retrospective, observatory study of seven patients after severe head injury, with dysautonomic crisis, admitted in the Critical Care Unit (CCU) during six months. No interventions. Its clinical features, its association with intracranial pressure and the treatment for Dysautonomic crisis they have received were extracted from the computed clinical report. We have evaluated his neurologic prognosis with the Jennet-Bond scale and his radiologic characteristics with the Gennarelly scale.

RESULTS

Dysautonomic crisis began in the first week if the patients didn't received neuromuscular blocks drugs and they continued when the patients were discharged from the CCU in a young population with an initial Glasgow scale coma of 5 points. We didn't wait a special radiologic pattern. After the next six months, crisis were disappeared in 86% of patients and all patients reached a good neurologic level in the Jennet-Bond scale.

CONCLUSIONS

Dysautonomic crisis appeared early in young men after severe head injury. We didn't find a radiologic pattern that predisposes the dysautonomic crisis. They didn't interfere the recovering six months after head injury.

Middle term intestinal adaptation after massive distal small bowel resection in oral feeding dogs

Intestinal adaptation (IA) consists mainly in a increase of the normal cell proliferative rate in the crypts of the intestinal mucosa. Histidine- and ornithine-decarboxylase (HDC and ODC, respectively) are always involved in the rapid growing tissue process. The present experiment studies the relation of HDC and ODC, the morpho-functional changes of the jejunal mucosa remnant and the nutritive state 2, 3 and 4 weeks after performing a 75% distal small bowel resection (DMSBR) in dogs fed with a standard chow. Each animal was its own control measure in a healthy state measured before provoking the DMSBR. The results demonstrated that 14 days after DMSBR, the mucosa of the jejunal remnant showed a loose of the normal characteristics of the villi and enterocyte morphology ("mucosal microinjuries"), accompanied by an increase in the depth of the crypt and in the HDC and ODC levels, while the D-glucose and L-phenylalanine absorptive capacity did not vary compared with that of the mucosa of the same animals in a healthy state. This correspond with a statistically significant altered nutritive state parameters. However, 21 days after DMSBR, the intestinal remnant mucosa initiates a structural recovery process. It was also observed a significant increase in the HDC and ODC enzymatic levels accompanied by an increased absorptive capacity and an improvement in the nutritive state parameters. Twenty eight days after DMSBR, the findings revealed a similar trend. In conclusion, in our model, between the second and fourth week the IA process is accompanied by a progressively increased HDC and ODC activities and an improvement of the nutritive state. The significance of the "mucosal microinjuries" described needs further investigation.

The evolution of postoperative ileus after laparoscopic cholecystectomy. A comparative study with conventional cholecystectomy and sympathetic blockade treatment

Our study is prompted by the arrival of laparoscopic cholecystectomy in connection with the evolution of postoperative ileus (PI) and by its avoidance of the intraabdominal handling implied in conventional cholecystectomy. With this aim a prospective, controlled, randomized, and blind clinical trial was designed using 100 patients divided into five groups (n = 20): I, conventional cholecystectomy (CC): II, CC+injection of 20 ml bupivacaine 0.5% into the mesentery root; III, CC + 7.5 mg propranolol i.v. and 0.5 mg neostigmine s.c., postoperatively until the first defecation; IV, II+III; and V, laparoscopic cholecystectomy. The shortest period of PI was observed in group V. This period increases notably in group IV (53 h), group II (72 h), and group III (84 h) relative to the control group with (89 h). This reduction in PI time runs parallel with an improvement in the patient's general state of well-being. We concluded that after laparoscopic cholecystectomy PI is nonexistent. Furthermore, this study confirms the correlation between the avoidance of intraabdominal manipulation and the evolution of postoperative ileus.

Simultaneous fluorometric determination of intracellular polyamines separated by reversed-phase high-performance liquid chromatography

A reversed-phase HPLC technique in combination with fluorescent detection is described for simultaneous quantification of the precolumn Dansyl derivatives of intracellular amines. The derivatives were stable for at least one week, kept protected from the light at -20 degrees C. The detection limit was between 1 and 5 pmol for all tested polyamines. Serotonin coeluted with tryptamine. The method has a very good reproducibility for both, retention times and chromatographic peak areas. The average recovery of standard amine solutions added to cellular extracts was estimated to be higher than 90%. The described method enables a rapid, reliable and reproducible quantification of biogenic and related polyamines in biological fluids and tissues.

Evaluation of key gluconeogenic enzymes in experimental biliary obstruction

In order to evaluate the usefulness of key gluconeogenic enzymes, in relation to the markers commonly used (alkaline phosphatase and gamma-glutamyl transpeptidase) for the diagnose of cholestasis the serum activity of phosphoenolpyruvate carboxykinase, fructose 1,6-bisphosphatase and glucose-6-phosphatase has been measured in rats with bile-duct ligation. Among the gluconeogenic enzymes studied only phosphoenolpyruvate carboxykinase activity increased significantly in the first 48 hours after cholestasis, decreasing thereafter to normal values. Both alkaline phosphatase and gamma-glutamyl transpeptidase activities showed a very significant increase which persisted throughout the experiment. These results seem to indicate that in spite of the high organ specificity of these enzymes they do not appear to be useful for the diagnosis of cholestasis.

Histamine and serotonin inhibit induction of ornithine decarboxylase by ornithine in perifused Ehrlich ascites tumour cells

Ornithine induced more than 36-fold the ornithine decarboxylase activity in confined Ehrlich ascites tumour cells after 3.5 h of continuous perifusion with 0.5 mM ornithine; arginine and glutamine also induced the activity 3- and 4-fold, respectively. The addition of cycloheximide or actinomycin D antibiotics to the perifusion medium confirmed that the regulation of the enzyme synthesis takes place at the level of translation. Perifusion in the presence of 0.5 mM ornithine and 55, 25, and 10 microM histamine suppressed the induction by 91, 53, and 35% respectively. Similar results were obtained in the presence of serotonin. Histidine also showed inhibitory effect but 5 mM histidine was required to produce 21% inhibition; other basic amino acids were ineffective.