Nutraceutical Content and Genetic Diversity Share a Common Pattern in New Pomegranate Genotypes

The nutraceutical value of pomegranate in the treatment of many diseases is well-documented and is linked to its richness in phenolic compounds. This study aims to evaluate the nutraceutical and genetic diversity of novel pomegranate genotypes (G1–G5) in comparison to leading commercial pomegranate varieties, i.e., ‘Wonderful’, ‘Primosole’, ‘Dente di Cavallo’ and ‘Valenciana’. Morphometric measurements were carried out on fruits, accompanied by chemical characterization (total phenolic content, antioxidant activity, carbohydrates and minerals) and the development of four new polymorphic SSR markers involved in the flavonoid pathway. The cultivars displayed a marked variability in the weight and shape of the fruits, as well as in the weight of the arils and juice yield. The highest level of total phenolic content and antioxidant activity was found in ‘Wonderful’ and G4, while the lowest was in ‘Dente di Cavallo’. Furthermore, the results showed that pomegranate juice is an excellent source of minerals, especially potassium, which plays a key role in organ functioning. The new flavonoid-related markers effectively differentiated the cultivars with the same diversity pattern as morpho-chemical characterization, so the SSRs developed in the present study can be used as a rapid tool for the identification of pomegranate cultivars with relevant nutraceutical traits, such as the new genotypes investigated.

MYB5-like and bHLH influence flavonoid composition in pomegranate

The fruit of the pomegranate (Punica granatum L.) is an important nutraceutical food rich in polyphenolic compounds, including hydrolysable tannins, anthocyanins and flavonols. Their composition varies according to cultivar, tissue and fruit development stage and is probably regulated by a combination of MYB and bHLH type transcription factors (TFs). In this study, metabolomics analysis during fruit developmental stages in the main pomegranate cultivars, Wonderful and Valenciana with contrasting colour of their ripe fruits, showed that flavonols were mostly present in flowers while catechins were highest in unripe fruits and anthocyanins in late fruit maturation stages. A novel MYB TF, PgMYB5-like, was identified, which differs from previously isolated pomegranate TFs by unique C-terminal protein motifs and lack of the amino-acid residues conserved among anthocyanins promoting MYBs. In both pomegranate cultivars the expression of PgMYB5-like was high at flowering stage, while it decreased during fruit ripening. A previously identified bHLH-type TF, PgbHLH, also showed high transcript levels at flowering stage in both cultivars, while it showed a decrease in expression during fruit ripening in cv. Valenciana, but not in cv. Wonderful. Functional analysis of both TFs was performed by agro-infiltration into Nicotiana benthamiana leaves. Plants infiltrated with the PgMYB5-like+PgbHLH combined construct showed a specific and significant accumulation of intermediates of the flavonoid pathway, especially dihydroflavonols, while anthocyanins were not produced. Thus, we propose a role for PgMYB5-like and PgbHLH in the first steps of flavonoid production in flowers and in unripe fruits. The expression patterns of these two TFs may be key in determining the differential flavonoid composition in both flowers and fruits of the pomegranate varieties Wonderful and Valenciana.

Histologic evidence of myocardial damage in apparently healthy subjects with ventricular arrhythmias and myocardial dysfunction

The association of ventricular arrhythmias and myocardial dysfunction could be considered an early step toward cardiomyopathy; therefore, we studied 28 patients in NYHA class I and II, characterized by complex ventricular arrhythmias (VA) on 24-h Holter monitoring and volumetric and/or contractile abnormalities on a standard two-dimensional echocardiogram (2-D echo). All patients underwent radioisotopic angiography, 20 patients complete hemodynamic study, and 15 patients endomyocardial biopsy. Ambulatory ECG monitoring showed the presence of frequent premature ventricular contractions in 14 patients (50%) and episodes of ventricular tachycardia in 16 patients (57%). 2-D echo showed mono- or biventricular enlargement and dyssynergies in 25 patients (89%) (left ventricle in 6, right ventricle in 11, both in 8). Two patients showed only left ventricle enlargement and one patient isolated left ventricular dyssynergies. Radioisotopic angiography showed mono- or biventricular ejection fraction reduction in 24 patients (85%) and regional dyssynergies in 24 patients (85%) in accordance with 2-D echo. Hemodynamic study showed in all patients normal coronary arteries, and right and left angiography confirmed enlargement and/or regional dyssynergies. Endomyocardial biopsy was abnormal in 11 of 15 patients: various degrees of hypertrophy, parcellar fibrosis, and adipogenic infiltration were found. Our preliminary data suggest that the simultaneous occurrence of ventricular arrhythmias and ventricular dyssynergies and/or enlargement in patients without apparent clinical heart disease may represent an early stage of dilated cardiomyopathy.

Long-term efficacy of oral encainide in frequent and repetitive ventricular arrhythmias

The short- and long-term efficacy of oral encainide was studied in 14 patients with chronic high-frequency ventricular arrhythmias and in 14 patients with chronic frequent episodes of non-sustained ventricular tachycardia (NSVT). Encainide efficacy was assessed during a dose-titration period and in a 36-month follow-up also studying the drug effects on routine haematologic data and left ventricular function (LVF). During dose-titration, encainide caused a 78.3% decrease in the average hourly frequency of isolated PVC and a 96.1% reduction in NSVT episodes in the two groups of patients. On follow-up (11 patients in each group) the mean percentage reductions were 95.1% in isolated PVC and 99.7% in NSVT episodes. Encainide did not impair LVF as showed by the comparison of echocardiographic fractional shortening before and after 12 months of treatment. Minor adverse effects of encainide were dose-related visual disturbances in two patients. A major adverse effect was the appearance of sustained VT in one NYHA class IV patient. Oral encainide effectively reduces the frequency of PVC and NSVT, it does not impair left ventricular function and it is associated with infrequent minor side effects. Uncommon, but severe, side effects may appear in patients with marked impairment of left ventricular function.

The Italian Heart Transplant Project: organization of a multicenter program

The Italian Heart Transplant Project is a national program coordinated by the Health Ministry and involves eight cardiac surgery centers, two coordination centers for organ procurement, and one national registry. An intercenter network for the solution of logistic problems regarding organ procurement and assignment has been built up. Preintervention and clinical follow-up data are recorded in each center and in a national registry by the implementation of a computerized data base. This is realized by employing low cost and diffuse software and hardware. The complex goal of common data collection and standardization is also being pursued for collateral areas such as cardiac pathology and immunologic surveillance. Data collection is useful for clinical monitoring and also for costs and/or requirements analysis.

[Ambulatory electrocardiography in the screening of patients with palpitations]

The role of 24 hour Holter monitoring in the screening of patients complaining of palpitations is reviewed. The term "palpitations", although not always unequivocally used, implies the presence of an arrhythmia. The clinical-instrumental correlation of an intermittent symptom is made possible by continuous electrocardiographic monitoring. Answers to be expected from a 24 hour Holter monitoring in order to achieve an early characterization of the arrhythmia are related to: site of origin, incidence, circadian distribution, prognostic stratification, events aggregation, presence of other asymptomatic abnormalities (rhythm, ST-T).