4-(3-Phenyl-4-(3,4,5-trimethoxybenzoyl)-1H-pyrrol-1-yl)benzenesulfonamide, a Novel Carbonic Anhydrase and Wnt/β-Catenin Signaling Pathway Dual-Targeting Inhibitor with Potent Activity against Multidrug Resistant Cancer Cells

We synthesized new pyrrole and indole derivatives as human carbonic anhydrase (hCA) inhibitors with the potential to inhibit the Wnt/β-catenin signaling pathway. The presence of both N1-(4-sulfonamidophenyl) and 3-(3,4,5-trimethoxyphenyl) substituents was essential for strong hCA inhibitors. The most potent hCA XII inhibitor 15 (Ki = 6.8 nM) suppressed the Wnt/β-catenin signaling pathway and its target genes MYC, Fgf20, and Sall4 and exhibited the typical markers of apoptosis, cleaved poly(ADP-ribose)polymerase, and cleaved caspase-3. Compound 15 showed strong inhibition of viability in a panel of cancer cells, including colorectal cancer and triple-negative breast cancer cells, was effective against the NCI/ADR-RES DOX-resistant cell line, and restored the sensitivity to doxorubicin (DOX) in HT29/DX and MDCK/P-gp cells. Compound 15 is a novel dual-targeting compound with activity against hCA and Wnt/β-catenin. It thus has a broad targeting spectrum and is an anticancer agent with specific potential in P-glycoprotein overexpressing cell lines.

Pain in Pets: Beyond Physiology

Animals do not speak a language humans understand, making it easy to believe that they do not experience pain the way humans do. Despite data affirming that companion animals can and do experience pain much as do humans, there remains a gap between companion animal acute pain management knowledge and its execution. Companion animal pain is not simply a physiological issue. Veterinary clinicians can and should embrace the foundational principles of clinical bioethics-respect for autonomy, nonmaleficence, beneficence, and justice-translated from human medicine for the benefit of their patients. By reframing companion animal pain as a bioethical issue, as described in this paper, veterinarians affirm their commitment to closing the gap between what is known and what is done for painful companion animals. This takes pet pain beyond physiology.

Initial Psychometric Testing and Validation of the Italian Version of the Canine Brief Pain Inventory in Dogs With Pain Related to Osteoarthritis

The Canine Brief Pain Inventory (CBPI) is an owner-administered questionnaire, originally developed and validated in English, used to assess canine chronic pain in terms of severity and interference with daily life activities. The aim of the present study was to perform a preliminary validation of an Italian version of the CBPI. Translation was performed and the resulting questionnaire was administered to 45 native Italian speaking owners of dogs suffering from chronic pain due to radiographically confirmed osteoarthritis. Psychometric properties of the Italian CBPI including construct validity, convergent validity and reliability were evaluated. Construct validity was assessed by factor analysis and confirmed a two-factor model (i.e., pain severity and interference factors). The respective scores, that is, the pain severity score (PSS) and pain interference score (PIS), exhibited a substantial negative correlation with overall quality of life score. Pain severity and interference items showed a mean inter-item correlation of 0.90 and 0.80, respectively. For each question, communality ranged from 0.84 to 0.97, highlighting strong internal consistency and suggesting that PSS and PIS can be calculated by averaging the items contained within each factor. Cronbach's α was 0.97 and 0.96 for PSS and PIS, respectively. The present findings confirmed the main psychometric properties of the Italian version of the CBPI, providing clinicians and researchers with a useful metrology instrument to evaluate the severity of chronic pain and its interference with daily life activities in dogs with osteoarthritis owned by Italian speaking people. Further properties of the questionnaire need to be evaluated in future research and larger studies are warranted.

Intra-articular use of analgesic/antinflammatory drugs in dogs and horses

Joint pain is a major cause of lameness in animals such as horses and dogs, and it may affect their athletic performance and quality of life. The intra-articular administration of analgesic/antinflammatory drugs is a common practice in veterinary medicine, for both lameness diagnosis and joint pain management. It is used either perioperatively, such as in animals undergoing arthroscopy/arthrotomy, and in osteoarthritic animals. However, evidence regarding efficacy and safety of each drug is limited, and controversies persist in these areas. In particular, it is often uncertain whether a defined treatment is effective by simply relieving the symptomatic pain associated with the joint disease, or whether it has a positive effect on the joint environment. Moreover, there is still much hesitation about treatments for joint diseases, related to the time of their application for the best outcome, and to any possible deleterious side effects. This article includes a review of the literature concerning the main analgesic/antinflammatory drugs used intra-articularly for managing acute and chronic joint pain/inflammation in dogs and horses. Three main issues for each class of drugs are considered, including clinical efficacy, pharmacokinetics, and local cytotoxic effects.

Hemp in Veterinary Medicine: From Feed to Drug

Hemp (Cannabis sativa) is an angiosperm plant belonging to the Cannabaceae family. Its cultivation dates back to centuries. It has always been cultivated due to the possibility of exploiting almost all the parts of the plant: paper, fabrics, ropes, bio-compounds with excellent insulating capacity, fuel, biodegradable plastic, antibacterial detergents, and food products, such as flour, oils, seeds, herbal teas, and beer, are indeed obtained from hemp. Hemp flowers have also always been used for their curative effects, as well as for recreational purposes due to their psychotropic effects. Cannabis contains almost 500 chemical compounds, such as phytocannabinoids, terpenes, flavonoids, amino acids, fatty acids, vitamins, and macro-, and micro-elements, among others. When utilized as a food source, hemp shows excellent nutritional and health-promoting (nutraceutical) properties, mainly due to the high content in polyunsaturated fatty acids (especially those belonging to the ω-3 series), as well as in phenolic compounds, which seem effective in the prevention of common diseases such as gastrointestinal disorders, neurodegenerative diseases, cancer, and others. Moreover, hemp oil and other oils (i.e., olive oil and medium-chain triglyceride–MCT–oil) enriched in CBD, as well as extracts from hemp dried flowers (Cannabis extracts), are authorized in some countries for therapeutic purposes as a second-choice approach (when conventional therapies have failed) for a certain number of clinical conditions such as pain and inflammation, epilepsy, anxiety disorders, nausea, emesis, and anorexia, among others. The present review will synthetize the beneficial properties of hemp and hemp derivatives in animal nutrition and therapeutics.

Pharmacokinetics and analgesic efficacy of intranasal administration of tramadol in dogs after ovariohysterectomy

OBJECTIVE

To assess analgesic efficacy and the pharmacokinetics of intranasal (IN) tramadol in dogs following ovariohysterectomy.

STUDY DESIGN

Randomized, blinded clinical study.

ANIMALS

A total of 30 bitches undergoing elective ovariohysterectomy.

METHODS

Dogs were randomly assigned to one of three experimental groups (10 dogs per group): IN tramadol 4 mg kg^-1 (group T-IN), intravenous (IV) tramadol 4 mg kg^-1 (group T-IV) and IV methadone 0.2 mg kg^-1 (group M). Drugs were administered at extubation. At established time points (before surgery and up to 8 hours after drug administration) analgesia was assessed using the Italian version of the Glasgow Composite Measure Pain Scale Short Form and physiological variables were recorded. To determine the pharmacokinetics of IN tramadol, blood samples were collected at predetermined time points. Shapiro-Wilk test was used to assess whether data were normally distributed and consequently parametric or non parametric tests were applied. A p value < 0.05 was considered significant.

RESULTS

No significant intergroup differences were observed in the dogs that were administered rescue analgesia and time of its administration. Excluding dogs that were administered rescue analgesia, no significant intergroup differences emerged in pain scores and physiological variables, except for a lower rectal temperature in group M compared with the tramadol groups. After IN administration, tramadol was rapidly absorbed into the systemic circulation, reaching its maximum concentration (range 74.74-200.29 ng mL^-1) within 30-60 minutes, it then decreased rapidly and was detectable in plasma for up to 2 hours after treatment in all dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

IN tramadol administration appears to be as effective as IV tramadol and methadone treatments in pain management of dogs after elective ovariohysterectomy. Given its low concentrations and short detection time in plasma after the IN route, systemic tramadol action appears unlikely.

Development, Preliminary Validation, and Refinement of the Composite Oral and Maxillofacial Pain Scale-Canine/Feline (COPS-C/F)

Objectives: Oral pain is underrecognized and undertreated in small animal practice. This study aimed to develop and perform a preliminary validation of an instrument to evaluate oral and maxillofacial pain in dogs and cats. Methods: Indicators potentially associated with oral pain in dogs and cats were identified and selected. The Composite Oral Pain Scale-Canine/Feline (COPS-C/F) in the Italian language was developed using a two-part questionnaire (owner and veterinary specific questionnaires). The instrument was used to score the intensity of oral and maxillofacial pain in patients with oral disease. Content validity was performed and the COPS-C/F was applied to 20 dogs and 16 cats with oral disease at baseline and 15 days after dental treatment for construct validity. Criterion validity was assessed by comparing the COPS-C/F with a visual analog scale (VAS), a numeric rating scale (NRS), and a simple descriptive scale (SDS). Construct validity/responsiveness and criterion validity were assessed with Wilcoxon and Spearman Pearson tests, respectively (p ≤ 0.05). The Cronbach's alpha coefficient was used to calculate internal consistency. Thereafter, the instrument was refined and translated to English and back-translated for semantic equivalence. Results: Construct validity was confirmed with a significant reduction of pain scores after treatment (p < 0.05) for most items. Criterion validity was confirmed by a significant correlation among the COPS-C/F total pain scores and those from VAS, NRS, and SDS (p < 0.05). Cronbach's alpha coefficient was 0.876 and 0.860 for the owner and the veterinary specific questionnaires, respectively, indicating good internal consistency. The items that did not present significant differences between time-points and the VAS, NRS, and SDS were removed prior to translation to English (COPS-C/F ENG). Conclusions and Clinical Relevance: The study described the development and preliminary validation of the COPS-C/F as an instrument for pain assessment in dogs and cats. Refinement and back-translation of COPS-C/F with semantic equivalency resulted in the COPS-C/F ENG consisting of six and four items for the owner and veterinary specific questionnaires, respectively. The English version requires further validation and testing using a larger number of patients in the clinical setting.

Effects of a nutritional supplement in dogs affected by osteoarthritis

Osteoarthritis is a form of chronic joint inflammation caused by the deterioration of the joint cartilage, accompanied by chronic pain, lameness and stiffness, particularly after prolonged activity. Alternative treatments of canine osteoarthritis would be desirable and, recently nutraceuticals, have been proposed for this purpose. Twenty cross breed adult dogs affected by osteoarthritis were enrolled and equally divided into two groups (control vs. experimental). The nutritional supplement (Dynamopet srl, Verone, Italy) was administered for 90 days to the dogs of the experimental group in order to evaluate its metabolic and locomotor effects. All the clinical signs (lameness, pain on manipulation and palpation, range of motion and joint swelling) significantly (p < 0.01) improved during the trial as regards the experimental group. This group showed a significantly lower joint score than the control group (mean value 7.40 vs. 3.80). With regard to haematology, the mean corpuscular volume resulted significantly (p < 0.01) higher in the experimental group, i.e. alkaline phosphatase, cholesterol and triglycerides values decreased and were significantly (p < 0.01) lower than the control one, thus suggesting an improvement in bone remodelling and lipid metabolism. A decrease in the reactive oxygen metabolites and an increase in the biological antioxidant potential demonstrated an improvement in oxidative stress during the trial in the experimental group compare to the control group. Interleukins 6 decreased in the experimental group, while interleukins 10 resulted in the opposite trend. Moreover, the administration of up to 3 months of the studied supplement was well tolerated in the dogs and caused no adverse effects.

Efficacy, chondrotoxicity and plasma concentrations of tramadol following intra-articular administration in horses undergoing arthroscopy: preliminary findings

Intra-articular administration of analgesics is performed to ensure good perioperative pain management avoiding undesirable systemic effects. To evaluate the effect of intra-articular injection of tramadol on postoperative pain after arthroscopy in horses and to determine whether tramadol had a local effect. Before the in vivo study, an in vitro test was performed aiming to evaluate the viability of equine chondrocytes after exposure to various concentrations of tramadol. The concentration identified as most appropriate was used to treat the horses’ joints. Twelve horses affected by osteochondrosis were randomly assigned to two groups that were treated intra-articularly at the end of surgery with tramadol (4 mg/mL) and saline, respectively. At predetermined time-points a Composite Pain Scale was applied and blood samples were collected in order to define the extent of tramadol absorption into the systemic circulation. The Mann-Whitney test was used for statistical analysis. Serum of four out of six treated horses revealed traces of tramadol (range 10.6–19.3 ng/mL) sporadically between 0.5 and 4 hours post-treatment, while in the other two horses, no trace of drug was found. Findings suggested that any eventual effect was probably due to local action rather than systemic absorption. The pain scores obtained in tramadol-treated horses were lower between 1 and 6 hours post-administration, than those obtained in the control group, but the differences were not statistically significant. These preliminary results suggest that tramadol, at this concentration, is only mildly beneficial in the pain management of horses after arthroscopy.

Validation of the Italian version of the UNESP-Botucatu multidimensional composite pain scale for the assessment of postoperative pain in cats

The study described in this paper had the goal to validate the Italian version of the UNESP-Botucatu multidimensional composite pain scale (UNESP-Botucatu MCPS) to assess postoperative pain in cats using video analysis and psycometric testing. The English version of the scale was translated into Italian. Thirty videos of the perioperative period of ovariohysterectomy surgery were analysed by 5 Italian observers with the aim to determine the pain score using the Italian version of the scale and to verify the need for analgesic treatment for each cat. Obtained scores were submitted to psycometric validity, responsiveness, and reliability tests. Of the 3 domains identified by factor analysis, the internal consistency was excellent for 'Psychomotor changes' and 'Protection of the painful area and vocal expressions of pain', while 'Physiological variables' showed moderate internal consistency. Significant changes in pain scores in response to surgery and analgesics confirmed content and construct validity. The agreement between the 'gold standard' and the blinded observers supported the criterion validity. Inter- and intra-rater reliability ranged from good to very good for all scale items. The cut-off point for rescue analgesia was > 7. The study concluded that the Italian version of the UNESP-Botucatu MCPS is a valid and reliable instrument for assessing postoperative pain in cats. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

CREATION AND VALIDATION OF THE ITALIAN VERSION OF THE GLASGOW COMPOSITE MEASURE PAIN SCALE-SHORT FORM (ICMPS-SF)

Objective To validate the Italian translation of the Glasgow Composite Measure Pain Scale – Short Form (ICMPS-SF) in order to assess acute pain in dogs. The original English-version of the scale (the Glasgow Composite Measure Pain Scale – Short Form - CMPS-SF) was translated into Italian according to a standard protocol to ensure linguistic and cultural validity. Nine Italian veterinary surgeons then recorded pain scores in dogs undergoing orthopaedic or soft tissue surgery using the ICMPS-SF at 2, 6, and 24 hours post-extubation. Construct validity was demonstrated using hypothesis testing. A total of 95 dogs were recruited into the study. Thirty-seven dogs underwent orthopaedic procedures and 58 dogs underwent soft tissue procedures. Twenty-three, 45, and 27 procedures were classified as mild, moderate, and severe, respectively. Statistically significant differences in the median pain scores were demonstrated between orthopaedic and soft tissue cases as well as among mild, moderate, and severe cases. Median pain scores decreased with time and changes were statistically significant. The ICMPS-SF demonstrated construct validity similar to the original English-language scale, resulting in a valid and reliable instrument for the assessment of acute pain in dogs by Italian veterinarians.

Inhaled nitric oxide administration during one-lung ventilation in patients undergoing thoracic surgery

OBJECTIVE

To evaluate the effects of inhaled nitric oxide (iNO) on hemodynamics and oxygenation during one-lung ventilation (OLV) in the lateral decubitus position in patients undergoing elective thoracic surgery.

DESIGN

Prospective study.

SETTING

University hospital.

PARTICIPANTS

Thirty consecutive patients scheduled for thoracotomy.

INTERVENTIONS

Anesthesia consisted of thoracic epidural analgesia combined with general anesthesia (isoflurane, fentanyl, and vecuronium bromide). Systemic and pulmonary circulations were monitored with a radial artery catheter and a pulmonary artery catheter. Inhaled NO, 40 ppm, was administered during OLV, and the inhaled gas mixture was monitored for NO and nitrogen dioxide (NO2). Hemodynamic and oxygenation data were collected before and during inhaled NO administration.

MEASUREMENTS AND MAIN RESULTS

Inhaled NO caused a reduction of pulmonary vascular resistance index from 249 +/- 97.6 dyne. sec. cm(-5) to 199.3 +/- 68.9 dyne. sec. cm(-5) (p < 0.05), without effects on systemic hemodynamics or impairment of oxygenation. A stratification of the patients according to values of QS/QT (< 30%, 30% to 44%, > or = 45%), PaO(2)/fraction of inspired oxygen (> or = 200, 100 to 199, < 100), and pulmonary hypertension (mean pulmonary arterial pressure < 24 or > or = 24 mmHg) showed that inhaled NO causes a significant reduction of mean pulmonary artery pressure in patients with pulmonary hypertension, mainly as a result of a reduction of pulmonary vascular resistance index, and improves oxygenation by reducing intrapulmonary shunt in patients with severe hypoxemia during OLV.

CONCLUSIONS

Inhaled NO administration neither significantly decreased mean pulmonary arterial pressure in patients with normal pulmonary artery pressure nor improved oxygenation in nonhypoxic patients. Nevertheless, inhaled NO is effective in patients with pulmonary hypertension and hypoxemia during OLV.

Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin

OBJECTIVE

To evaluate hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IAP) during lung transplantation.

DESIGN

Prospective study.

SETTING

University hospital.

PARTICIPANTS

Ten patients scheduled for lung transplantation.

INTERVENTIONS

Ten patients, with a mean age of 38 years (range, 24 to 56 years), were scheduled for lung transplantation (2 single-lung transplantations and 8 double-lung transplantations). During first lung implantation with single-lung perfusion and ventilation, hemodynamic and oxygenation data were analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery clamping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (20 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combined administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% oxygen.

MEASUREMENTS AND MAIN RESULTS

During the inhaled NO phase, reductions of mean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0.05) were noted. After the start of prostacyclin inhalation, a further decrease in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/FIO2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonary shunt decreased (p < 0.05).

CONCLUSION

This study confirms the action of inhaled NO as a selective pulmonary vasodilator during lung transplantation. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygenation compared with inhaled NO administered alone without any systemic changes.

Pulmonary hemodynamics contribute to indicate priority for lung transplantation in patients with cystic fibrosis

OBJECTIVE

Lung transplantation is a viable option for patients with cystic fibrosis. The current strategy of selection, based on spirometry and deterioration of quality of life, results in a high mortality on the waiting list. We reviewed the case histories of patients with cystic fibrosis accepted for lung transplantation to ascertain whether pulmonary hemodynamics could contribute to predict life expectancy.

METHODS

Forty-five patients with cystic fibrosis were accepted: 11 died on the waiting list (group I), 24 underwent transplantation (group II), and 10 are still waiting (group III). During evaluation we recorded spirometry, oxygen requirement, ratio of arterial oxygen tension to inspired oxygen fraction (PaO (2)/FIO (2)), arterial carbon dioxide tension (PaCO (2)), 6-minute walk test results, right ventricular ejection fraction, echocardiography, and pulmonary hemodynamics. We compared data from group I, II, and III patients. A comparison was also made within group II between the data collected at the time of evaluation and at the time of transplantation to quantify the deterioration during the waiting time.

RESULTS

The waiting time, spirometry, 6-minute walk test results, and right ventricular ejection fraction did not differ among the three groups. A statistically significant difference was found for PaO (2)/FIO (2), PaCO (2), mean pulmonary artery pressure, cardiac index, pulmonary arterial wedge pressure, and intrapulmonary shunt between groups I and II. Groups I and III showed statistically significant differences for mean pulmonary artery pressure, PaO (2)/FIO (2), and systemic vascular resistance indexed. No differences were observed between groups II and III. The comparison within group II showed a significant deterioration of pulmonary hemodynamics during the waiting time.

CONCLUSIONS

Pulmonary hemodynamics are worst in patients dying on the waiting list and deteriorate significantly during the waiting time. They may thus contribute to establish priority for lung transplantation in patients with cystic fibrosis.