Scaffolds for drug delivery and tissue engineering: The role of genetics

Scaffolds are implants commonly used to deliver cells, drugs, and genes into the body. Their regular porous structure ensures the proper support for cell attachment, proliferation, differentiated function, and migration. Techniques to fabricate a scaffold include leaching, freeze-drying, supercritical fluid technology, thermally induced phase separation, rapid prototyping, powder compaction, sol-gel, and melt molding. Gene delivery from the scaffold represents a versatile approach to influence the environment for managing cell function. Scaffolds can be used for various tissue engineering purposes, e.g. bone formation, periodontal regeneration, cartilage development, artificial corneas, heart valves, tendon repair, or ligament replacement. Moreover, they are also instrumental in cancer therapy, inflammation, diabetes, heart disease, and wound dressings. Scaffolds provide a platform to extend the delivery of drugs and genetic materials at a controlled timeframe, besides potentially being used to prevent infection upon surgery and other chronic diseases, provided that they can be formulated with specific medicines. This review discusses the need to design advanced functional scaffolds with the potential for modified drug delivery and tissue engineering in a synergistic approach. Special attention is given to works published in 2023 to generate the bibliometric map.

Phytocannabinoids: Chromatographic Screening of Cannabinoids and Loading into Lipid Nanoparticles

Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC) are receiving increasing interest as an approach to encapsulate natural extracts to increase the physicochemical stability of bioactives. Cannabis extract-derived cannabidiol (CBD) has potent therapeutic properties, including anti-inflammatory, antioxidant, and neuroprotective properties. In this work, physicochemical characterization was carried out after producing Compritol-based nanoparticles (cSLN or cNLC) loaded with CBD. Then, the determination of the encapsulation efficiency (EE), loading capacity (LC), particle size (Z-Ave), polydispersity index (PDI), and zeta potential were performed. Additionally, the viscoelastic profiles and differential scanning calorimetry (DSC) patterns were recorded. As a result, CBD-loaded SLN showed a mean particle size of 217.2 ± 6.5 nm, PDI of 0.273 ± 0.023, and EE of about 74%, while CBD-loaded NLC showed Z-Ave of 158.3 ± 6.6 nm, PDI of 0.325 ± 0.016, and EE of about 70%. The rheological analysis showed that the loss modulus for both lipid nanoparticle formulations was higher than the storage modulus over the applied frequency range of 10 Hz, demonstrating that they are more elastic than viscous. The crystallinity profiles of both CBD-cSLN (90.41%) and CBD-cNLC (40.18%) were determined. It may justify the obtained encapsulation parameters while corroborating the liquid-like character demonstrated in the rheological analysis. Scanning electron microscopy (SEM) study confirmed the morphology and shape of the developed nanoparticles. The work has proven that the solid nature and morphology of cSLN/cNLC strengthen these particles' potential to modify the CBD delivery profile for several biomedical applications.

Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier’s disease with an underlying lipoma: A case report

BACKGROUND

Ménétrier’s disease is a rare condition characterized by enlarged gastric folds, usually located in the whole body and fundus of the stomach. This report presents an unusual case of localized Ménétrier’s disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding. The mass was successfully removed with endoscopic submucosal dissection.

CASE SUMMARY

Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding, manifesting as fatigue and melena. A large polypoid mass (4 cm × 1 cm) with enlarged mucosal folds was found in the body of the stomach, between the lesser curvature and posterior wall. A small ulcer at the distal end of the mass was identified as the source of the bleeding. Biopsy was negative for neoplasia. Computed tomography showed a submucosal lesion beneath the affected mucosa, most likely a lipoma. The mass was removed en bloc with tunneling endoscopic submucosal dissection. Final pathology determined that the mass included Ménétrier’s disease and a submucosal lipoma. The patient was scheduled for follow-up esophagogastroduodenoscopy.

CONCLUSION

Localized Ménétrier’s disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.

Tocilizumab-coated solid lipid nanoparticles loaded with cannabidiol as a novel drug delivery strategy for treating COVID-19: A review

Commonly used clinical strategies against coronavirus disease 19 (COVID-19), including the potential role of monoclonal antibodies for site-specific targeted drug delivery, are discussed here. Solid lipid nanoparticles (SLN) tailored with tocilizumab (TCZ) and loading cannabidiol (CBD) are proposed for the treatment of COVID-19 by oral route. TCZ, as a humanized IgG1 monoclonal antibody and an interleukin-6 (IL-6) receptor agonist, can attenuate cytokine storm in patients infected with SARS-CoV-2. CBD (an anti-inflammatory cannabinoid and TCZ agonist) alleviates anxiety, schizophrenia, and depression. CBD, obtained from Cannabis sativa L., is known to modulate gene expression and inflammation and also shows anti-cancer and anti-inflammatory properties. It has also been recognized to modulate angiotensin-converting enzyme II (ACE2) expression in SARS-CoV-2 target tissues. It has already been proven that immunosuppressive drugs targeting the IL-6 receptor may ameliorate lethal inflammatory responses in COVID-19 patients. TCZ, as an immunosuppressive drug, is mainly used to treat rheumatoid arthritis, although several attempts have been made to use it in the active hyperinflammatory phase of COVID-19, with promising outcomes. TCZ is currently administered intravenously. It this review, we discuss the potential advances on the use of SLN for oral administration of TCZ-tailored CBD-loaded SLN, as an innovative platform for managing SARS-CoV-2 and related infections.

Lipid-Based Nanoparticulate Systems for the Ocular Delivery of Bioactives with Anti-Inflammatory Properties

The complexity of the eye structure and its physiology turned ocular drug administration into one of the most challenging topics in the pharmaceutical field. Ocular inflammation is one of the most common ophthalmic disorders. Topical administration of anti-inflammatory drugs is also commonly used as a side treatment in tissue repair and regeneration. The difficulty in overcoming the eye barriers, which are both physical and chemical, reduces drug bioavailability, and the frequency of administration must be increased to reach the therapeutic effect. However, this can cause serious side effects. Lipid nanoparticles seem to be a great alternative to ocular drug delivery as they are composed from natural excipients and can encapsulate both hydrophilic and lipophilic drugs of different sources, and their unique properties, as their excellent biocompatibility, safety and adhesion allow to increase the bioavailability, compliance and achieve a sustained drug release. They are also very stable, easy to produce and scale up, and can be lyophilized or sterilized with no significant alterations to the release profile and stability. Because of this, lipid nanoparticles show a great potential to be an essential part of the new therapeutic technologies in ophthalmology to deliver synthetic and natural anti-inflammatory drugs. In fact, there is an increasing interest in natural bioactives with anti-inflammatory activities, and the use of nanoparticles for their site-specific delivery. It is therefore expected that, in the near future, many more studies will promote the development of new nanomedicines resulting in clinical studies of new drugs formulations.

Non-melanoma skin cancers: physio-pathology and role of lipid delivery systems in new chemotherapeutic treatments

Non-melanoma carcinoma has high incidence rates and has two most common subtypes: basal cell carcinoma and squamous cell carcinoma. This type of carcinoma is usually not fatal; however, it can destroy sensory organs such as the nose, ears, and lips. The treatment of these injuries using non-invasive methods is thus strongly recommended. Some treatments for non-melanoma carcinoma are already well defined, such as surgery, cryosurgery, curettage and electrode section, and radiotherapy; however, these conventional treatments cause inflammation and scarring. In the non-surgical treatment of non-melanoma carcinoma, the topical administration of chemotherapeutic drugs contributes for an effective treatment with reduced side effects. However, the penetration of anticancer drugs in the deeper layers of the skin is required. Lipid delivery systems (liposomes, solid lipid nanoparticles, nanostructured lipid carriers) have been developed to overcome epidermal barrier of the skin and to allow the drugs to reach tumor cells. These lipid nanoparticles contribute to control the release profile of the loaded chemotherapeutic drugs, maintaining their stability and increasing death of tumor cells. In this review, the characteristics of non-melanoma carcinoma will be discussed, describing the main existing treatments, together with the contribution of lipid delivery systems as an innovative approach to increase the effectiveness of topical therapies for non-melanoma carcinomas.

Is there a relation between vitamin D, interleukin-17, and bone mineral density in patients with inflammatory bowel disease?

INTRODUCTION

In inflammatory bowel diseases (IBD), osteopenia and osteoporosis constitute a significant medical problem. Cytokines, especially IL-17, play an important role in the pathogenesis of IBD and osteoporosis. Vitamin D is a regulator of bone metabolism, and helps maintain immune system homeostasis.

MATERIAL AND METHODS

The research sample consisted of 208 persons: 83 patients (age 35 ±11.99 years) with Crohn's disease (CD); 86 patients (age 39.58 ±14.74 years) with ulcerative colitis (UC); and 39 persons (age 30.74 ±8.63 years) in the control group (CG). Clinical data on bone mineral density of the lumbar spine (L2-L4), bone mineral density of the femoral neck (FN), and body mass index (BMI) were collected. 25OHD and IL-17 serum concentrations were also measured.

RESULTS

Body mass index (kg/m²) results: in CD, 21.51 ±3.68; in UC, 23.31 ±4.38; and in CG, 24.57 ±3.45 (p < 0.01). Densitometry results for L2-L4 T-score SD: in CD -0.83 ±1.45; in UC -0.47 ±1.15; in CG 0.09 ±0.70. Densitometry results for FN T-score SD: in CD -0.62 ±1.26; in UC -0.29±1.17; in CG 0.41 ±1.03 25OHD (ng/ml) serum concentrations: in CD, 21.33±12.50; in UC, 22.04±9.56; in CG, 21.56±9.11 (ns). IL-17 (pg/ml) serum concentrations: in CD, 8.55±10.99; in UC, 11.67±12.97; in CG, 5.16±9.11 (ns).

CONCLUSIONS

Inflammatory bowel diseases patients and persons from the CG did not differ in vitamin D or IL-17 levels. Patients with a mild course of the disease had a higher vitamin D concentration and bone mineral density. In UC, higher vitamin D concentrations were associated with lower IL-17 concentrations. The IBD patients with a severe course of the disease had a lower body mass than those in the CG and the patients with a mild course of the disease.

Erythrocyte transketolase deficiency in patients suffering from Crohn's disease

OBJECTIVE

Aim of the study was to assess the possible vitamin B1 deficiency in relation to the exacerbation of Crohn's disease (CD) in adult patients.

PATIENTS AND METHODS

Forty-nine Crohn's disease (CD) patients with different disease activity (The Crohn's Disease Activity Index-CDAI) were included in the study. Anthropometrical and biochemical parameters, i.e., high sensitive C-reactive protein, were assessed. The spectrophotometric method was used to measure the transketolase activity (TK) in erythrocytes. The normalized transketolase activity ratio (NTKZ) and the percentage of activation with thiamine pyrophosphate (%TPP) were also evaluated.

RESULTS

The mean values of BMI were close to cut-off: 18.5 kg/m2, indicating a poor nutritional status in CD patients. The patients with moderate-to-severe active CD had a statistically significant higher value of CDAI and hsCRP concentrations compared to those being in the asymptomatic remission or at the mildly active stage of the disease. The level of NTKZ and %TPP were statistically different between the analyzed groups, showing the deficit of vitamin B1 in the group of moderate-to-severe active CD patients (Mean ± SD; NTKZ: 1.99 ± 0.87 vs. 1.54 ± 0.62 U/g Hb; % of TPP: 0.15 ± 0.78 vs. 54.90 ± 38.80).

CONCLUSIONS

Vitamin B1 deficiency is part of the Crohn's disease manifestation in moderate-to-severe active patients.

The Clinical Importance of 21-Day Combined Parenteral and Enteral Nutrition in Active Inflammatory Bowel Disease Patients

The aim of the study was to show the clinical magnitude of short-term feeding: enteral nutrition (EN) combined with parenteral nutrition (PN) in active Crohn’s disease and ulcerative colitis patients. Among 122 eligible inflammatory bowel disease (IBD) patients, 65 met the inclusion criteria. Combined EN and PN was administered for 21 days, wherein over the first 3–5 days of treatment, trophic enteral nutrition (300 kcal/day) was used with an energy increase of up to 1500 kcal. An EN was administered using a nasogastric tube or, in case of intolerance, using a naso-jejunal tube. For PN, the “All in One” system was used according to individually prepared admixtures (ESPEN Guidelines). In addition to routine blood measurement (i.e., ALAT, ASPAT, GGTP, creatinine, lipid profile), the following parameters were assessed: adiponectin, leptin, (hs)TNF-α, hsIL-6 and hsIL-10, TSH, NT-proBNP, serum vitamin B12 concentration, and tHcy. The results showed a considerable improvement in all clinically significant parameters (p < 0.05), showing the benefits and importance of short-term well-balanced EN combined with PN for nutritional and clinical status in IBD patients with active disease. The daily work at hospitals with active IBD patients demonstrates the potential of continued administration of home-based nutrition by patients.

Correction: Titania nanotubes infiltrated with the conducting polymer PEDOT modified by Prussian blue – a novel type of organic–inorganic heterojunction characterised with enhanced photoactivity

Correction for ‘Titania nanotubes infiltrated with the conducting polymer PEDOT modified by Prussian blue – a novel type of organic–inorganic heterojunction characterised with enhanced photoactivity’ by K. Siuzdak et al., RSC Adv., 2016, 6, 76246–76250.

C-reactive protein as a diagnostic and prognostic factor in inflammatory bowel diseases

AIM

The study aimed to evaluate high-sensitivity CRP (hsCRP) as a diagnostic and predictive marker in patients with inflammatory bowel disease (IBD).

MATERIAL/METHODS

Medical history of 106 patients with IBD revealed hsCRP concentrations at diagnosis and during the follow-up period.

RESULTS

The study showed that the majority of investigated patients had elevated hsCRP concentrations at diagnosis, although the mean concentration was much higher in the group of patients with Crohn's disease (CD) than the group with ulcerative colitis (UC) (P<0.001). The overall decrease in mean hsCRP concentration observed during the follow-up period was larger in the group of CD patients. The analysis showed a correlation between hsCRP concentrations at diagnosis and risk of surgery in the group of CD patients (r=0.408, P=0.002), but not in the group of UC patients. In a logistic regression analysis, surgery in CD patients was associated with age (OR: 0.89, 95% CI: 0.8-1.0, P=0.05) and hsCRP concentration (OR: 1.02, 95% CI: 1.0-1.04, P=0.03) at diagnosis.

DISCUSSION

HsCRP might be a useful diagnostic marker in differentiating active IBD from other diseases. Particularly important however seems to be the predictive value of hsCRP at diagnosis in prognosing the clinical outcome of the disease in CD patients.

A modified weighted mixture model for the interpretation of spatial and temporal changes in the microbial communities in drinking water reservoirs using compositional phospholipid fatty acid data

The aim of this work was to check whether a methodology based on the analysis of data that contain the entire phospholipid fatty acid, PLFA, compositions of water samples can be successfully used to interpret spatial and temporal changes in the microbial communities in water reservoirs. The proposed methodology consists of the construction of a modified weighted multivariate mixture model for the PLFA profiles of the water samples collected in a given monitoring campaign and the identification of latent PLFA components through a comparison with the known PLFA profiles of some cultivated or non-cultivated microbial communities. A 16S rDNA analysis of some of the selected water samples in the monitoring campaign was performed in order to verify the results of the PLFA analysis. The results showed that the proposed methodology can be useful for a dynamic and sensitive evaluation of changes in the microbial quality of water before and after flash flooding and can help in taking a decision regarding further risk assessment.

Titania nanotubes infiltrated with the conducting polymer PEDOT modified by Prussian blue – a novel type of organic–inorganic heterojunction characterised with enhanced photoactivity

A highly ordered p–n heterojunction was formed based on titania nanotubes containing a conducting polymer with Prussian blue matrix.

The influence of nanostructure size on V2O5electrochemical properties as cathode materials for lithium ion batteries

The influence of the V₂O₅nanostructure size on the aggregation process and their electrochemical properties.

Assessment of nutritional status and feeding methods in patients with inflammatory bowel disease

Aim. The aim of this study was to evaluate diet of patients with IBD, their nutritional status and potential differences as compared to diet of healthy persons.Material and methods. The examination included the patients of Internal, Metabolic Diseases and Dietetics Ward and Gastroenterology, Internal Diseases and Human Nutrition Ward of Heliodor Święcicki Clinic in the Poznan University of Medical Sciences in Poznan. The criterion allowing participation into the study involved a diagnosed ulcerative or Crohn’s disease, basing on histopathology and radiological examination. The study was conducted on 50 patients, 25 women and 25 men. The control of group included 50 persons, 30 women and 20 men, potentially healthy and occupationally active. In the study the authors' own questionnaire was used, which contained questions related to diet and evaluating conditions of nutrition, based on the results of anthropometric measurements and selected biochemical parameters.Results. The study documented that IBD affected diet, which proved to be distinct from that of potentially healthy person. Course of the disease reduced some laboratory parameters in serum: decreased levels of total protein were detected in 40% patients, reduced levels of albumin in 28% patients and of haemoglobin in 72% patients with IBD. Most of patients introduced some modifications and dietary restrictions to reduce the symptoms and prolong remission. Presentation of such attitudes, indicates a need for an effective multidirectional education, which should affect a conscious decision making about the diet. The Body Mass Index and evaluation of nutrition demonstrated that IBD predisposed development of malnutrition: as compared to the control group, 28% of the patients manifested underweight.

The microbiome and dermatological diseases

The human skin harbours hundreds of species of commensal organisms, collectively known as the skin microbiota. The composition of the microbiota can be modified by various factors, such as host genotype, diet, antibiotics, hygiene, and pathogen infections, among others. Changes in these factors can cause microbiome disruption known as dysbiosis, leading to the outgrowth of potential pathogenic bacteria or a decrease in the number of beneficial bacteria. Dysbiosis has been implicated in some dermatological diseases. This mini-review aims to discuss the topic of the skin microbiota and its potential effects on various skin diseases.

The role of the enzymatic antioxidant system in cylindrospermopsin-induced toxicity in human lymphocytes

Cylindrospermopsin (CYN) is known to induce cytotoxic effects in eukaryotic cells although the exact mechanism underlying these alterations is not fully explained. Given that CYN was previously found to decrease the proliferation of human lymphocytes through DNA damage and cell cycle arrest followed by an increase in the apoptotic rate, the present study evaluated the possible involvement of reactive oxygen species (ROS) and oxidative stress in these cytopathic responses. The status of enzymatic antioxidants: superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) as well as level of lipid peroxidation (LO) under CYN influence in human lymphocytes were also studied. It was found that CYN exposure (0.01-1.0 μg/ml) induces a concentration-dependent increase in H2O2 content within a time as short as 0.5h, reaching its maximum level after 3 and 6h. The highest H2O2 content was accompanied by a significant decrease of SOD and CAT activity and an elevated level of GPx. Moreover, CYN treatment resulted in a detectable increase in LO. We conclude that ROS and the products of LO play an essential role in CYN-induced toxicity in human lymphocytes. Our study helps to elucidate the sequence of events caused by CYN in eukaryotic cells and explain the background for previously observed cytopathic responses.

Different effect of smoking on genders in Crohn's disease

BACKGROUND/AIMS

Smoking is a well-established environmental risk factor in Crohn's disease (CD). The study was aimed to investigate possible gender differences in the effect of smoking on the course of CD, with a special focus on selected immune parameters such as Th1/Th2/Th17 cytokines and regulatory T cells (Tregs).

MATERIALS AND METHODS

A group of 55 adults with CD was enrolled to the study. The analysis of clinical, demographic and immunological characteristics of patients was performed according to their smoking status and gender. Values were considered significant when p≤0.05.

RESULTS

Patients who smoked, particularly females, more frequently suffered from a moderate-to-severe form of the disease, requiring glucocorticoid and immunosuppressive therapies. Smokers, particularly females, were also hospitalized and underwent surgeries more frequently than non-smokers. Cytometric analysis showed higher levels of serum proinflammatory cytokines and lower levels of peripheral Tregs in female smokers and former smokers, comparing to males from these subgroups.

CONCLUSION

Presented results demonstrate that in all investigated subgroups, particularly however among current smokers and former smokers, female patients seemed to be more affected by CD. Females developed more severe form of the disease and experienced the onset earlier than men. The imbalance between pro- and anti-inflammatory factors observed in CD patients was also more distinct in female smokers and former smokers, comparing to males, and could substantially contribute to the severity of the disease. Exposure to smoking seems to be one of the environmental factors contributing to the gender differences in CD.

Selected biologic markers of inflammation and activity of Crohn's disease

The study aimed to compare the accuracy of selected biologic markers in assessing the disease activity in patients with Crohn's disease (CD). The analysis included serum IL-2, IL-6, IL-17, TNF-α, IFN-γ, hsCRP, peripheral CD4 + CD25 + FOXP3 + regulatory T cells, as well as fecal calprotectin and lactoferrin. A group of 55 adults with CD was enrolled to the study. Disease activity was assessed using Crohn's Disease Endoscopic Index of Severity (CDEIS), which currently represents the gold standard for the evaluation of endoscopic activity. For clinical activity scoring, the Crohn's Disease Activity Index (CDAI) was used. Concentrations of investigated markers were estimated by means of flow cytometry and enzyme-linked immunosorbent assays, and the results were correlated with both indices. The study demonstrated that both fecal markers, i.e. calprotectin (r = 0.827, p < 0.001) and lactoferrin (r = 0.704, p < 0.001), correlate closely with CDEIS score, and might be used to evaluate the severity of CD in clinical setting. The correlation of those markers with CDAI was also significant, with r = 0.742 for calprotectin (p < 0.001) and r = 0.675 for lactoferrin (p < 0.05). As for the other investigated markers, only hsCRP (r = 0.672, p < 0.001) and IL-17 (r = 0.296, p < 0.005) correlated closely with CDEIS. The correlation of the markers with CDAI was also significant, though weaker, with r = 0.518 for hsCRP (p < 0.001) and r = 0.296 for IL-17 (p < 0.05). The study showed that IL-17, despite its vague role in the pathogenesis of CD, might be a useful marker, comparable with hsCRP, in assessing the activity of the disease.

Toxic potencies of metabolite(s) of non-cylindrospermopsin producing Cylindrospermopsis raciborskii isolated from temperate zone in human white cells

Cylindrospermopsis raciborskii (Nostocales, Cyanobacteria) has worldwide distribution and is well known for producing the toxic alkaloid, cylindrospermopsin (CYN). Strains unable to synthesize this compound but potentially toxic were recently identified in Europe. Here, for the first time the effect of cell-free extracts of a non-CYN-producing strain of C. raciborskii was studied in human cells (neutrophils and lymphocytes) isolated from healthy donors. The observed effects were compared to those induced by CYN (1.0-0.01 μg mL(-1)). Short-term (1h) extract treatments resulted in altered viability of cells demonstrated by increased necrosis and apoptosis in neutrophils and elevated apoptosis in lymphocytes. CYN did not induce similar effects, regardless of the toxin concentration. Exposure of T-lymphocytes to 100% C. raciborskii extract in isolated and whole-blood 72 h cultures resulted in decrease of proliferation by 20.6% and 32.5%, respectively. In comparison, exposure to 1.0 μg mL(-1) of CYN caused lymphocytes proliferation to be inhibited by 91.0% in isolated cultures and 56.5% in whole-blood assay. Significant antiproliferative properties were also found for 0.1 μg mL(-1) of CYN in whole-blood culture. From the results we conclude that strains occurring in temperate zones may pose a threat to human health through the production of hitherto unknown metabolites that reveal a toxic pattern different to that of CYN. At the same time our study demonstrates that CYN is a powerful but slowly-acting toxin in human immune cells.

Tin oxide nanoparticles from laser ablation encapsulated in a carbonaceous matrix – a negative electrode in lithium-ion battery applications

This report concerns carbonaceous electrodes doped with tin(ii) oxide nanoparticles.

Do we need to improve breast cancer education? Attitude towards breast self-examination and screening programmes among Polish women

Introduction. Breast cancer is a global health threat which requires systematic basic health education and increasing the public attention and awareness. Therefore, breast self-examination (BSE), however controversial, was largely promoted in many countries including Poland. Moreover, the national breast screening programmes (BSP) were made available to general public. Aim. The study investigated the attitude towards BSE, BSP and breast cancer as a health threat among Polish women in relation to age, education, place of living and economical status. Material and methods. An anonymous questionnaire was completed by 751 Polish women. The results were statistically elaborated.Results. The majority of women declared to know how to perform BSE but only a small part (older females) practiced it regularly (once a month). National BSP were acknowledged by most of surveyed. The higher awareness of BSP was found for women with higher education and economical status whereas the lowest – for women inhabiting small villages and performing BSE rarely or never. Medical doctors and other medical staff were an insignificant source of BSP. Most of responders recognized breast cancer as a serious health threat in Poland. Conclusion. The general awareness of BSP and BSE among Polish women is satisfactory, yet the percentage of females performing BSE on regular basis remains too low. There is a need to increase the contribution of medical staff in breast cancer education and control activities.

Inhibitors of phosphodiesterase 4 (PDE 4): A new therapeutic option in the treatment of psoriasis vulgaris and psoriatic arthritis

Psoriasis vulgaris and psoriatic arthritis are inflammatory diseases in which inflammation and sustained inducing lesions result from immune disorders associated with overactivity of T cells that produce multiple proinflammatory cytokines, including tumor necrosis factor alpha (TNF-α) and interleukin (IL): IL-2, IL-12, IL-17, IL-22 or IL-23. Modern treatment of these diseases is focused on reducing the inflammatory process responsible for the development of the disease. In recent years, the treatment of psoriasis is developing at a dynamic rate. Such therapeutic advances are contributed to the possibility of patient therapy through the use of some registered biologic agents, such as TNF-α inhibitors (infliximab, etanercept and adalimumab), and an inhibitor of the p40 subunit common to IL-12 and IL-23 (ustekinumab). In addition to the already registered medications for the indications mentioned above, there is a large group of preparations that are currently undergoing clinical trials in Europe, Canada and the United States, which provides hopes of therapy efficacy and safety.

Factors affecting response to biologic treatment in psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease, affecting approximately 2-4% of the population in western countries. Patients with a more severe form of the disease are typically considered for systemic therapy, including biologics. In spite of the overall superiority of biologic agents, the treatment response may differ substantially among individual patients. As with other medical conditions, a range of factors contribute to response heterogeneity observed in psoriasis. Proper identification of these factors can significantly improve the therapeutic decisions. This review focuses on potential genetic and nongenetic factors that may affect the treatment response and outcomes in patients with psoriasis.

The effects of the microbiota on the host immune system

The human gastrointestinal track harbors hundreds of species of commensal organisms, collectively known as microbiota. The composition of the intestinal microbiota is changeable by various factors, such as host genotype, diet, antibiotics, pathogen infections, among others. Changes in these factors can cause microbiome disruption known as dysbiosis, leading to the outgrowth of potential pathogenic bacteria or decrease in the number of beneficial bacteria. Dysbiosis has been implicated in numerous inflammatory and autoimmune diseases. This review is focused on host-microbiota interactions, specifically on influence of bacterial-derived signals on immune cell function and the mechanisms by which these signals modulate the development and progression of inflammatory and autoimmune diseases.

Increased apoptosis of regulatory T cells in Crohn's disease

BACKGROUND/AIMS

Crohn's disease (CD) is characterized by a transmural often granulomatous Th1-driven inflammatory process hallmarked by an increased production of IL-12, TNF-alpha and IFN-gamma. Accumulating evidence suggests that the numerical defect within the regulatory T cell (Tregs) compartment might contribute to this imbalance between pro- and antiinflammatory factors. This study was aimed to investigate whether the numerical defect of Tregs observed in CD resulted from an increased apoptosis of these cells.

METHODOLOGY

The cytometric analysis was performed to evaluate the percentage of CD4 + FOXP3 + Tregs in peripheral blood of 55 investigated subjects, as well as to estimate the rate of Treg apoptosis.

RESULTS

The cytometric analysis showed a significantly lower percentage of Tregs in peripheral blood of CD patients compared with the healthy control group (P = 0.03) as well as an increased rate of apoptosis within this cell subpopulation (P = 0.000001). Interestingly, a significantly higher rate of Treg apoptosis was observed in female than male CD patients (P = 0.03).

DISCUSSION

Current data suggest that CD is associated with a numerical deficiency of the Treg compartment. Presented study indicates that an increased apoptosis might contribute to this numerical deficiency. A higher rate of Tregs apoptosis found in female patients might suggest the involvement of hormonal factors and possibly contribute to the female predominance observed in CD as well as to the tendency of female patients to develop a more severe form of the disease.

[Role of Th17 lymphocytes in pathogenesis of colorectal cancer]

Colorectal cancer (CRC) is estimated to be the first leading cause of death from cancer among men and women in the EU. Every year in Poland, 15,254 cases of CRC are diagnosed, and 10,501 patients die of the disease, making it the second leading cause of death from cancer. In more than 90% of cases, the disease begins as adenomatous polyps with epithelial dysplasia as a common feature. Inflammatory bowel diseases (IBD), a group of chronic inflammatory diseases of the gastrointestinal tract characterized by remissions and relapses, constitute an independent risk factor of CRC development. CRC developing in IBD patients, however, has features distinct from sporadic cancer, suggesting the influence of unique factors. The high risk of CRC in IBD patients probably results from chronic inflammation. In most cases, neoplastic lesions arise within the inflamed gastrointestinal mucosa during the process of re-epithelization, which is a healing response to ulceration. The recently discovered Th17 lymphocytes, which demonstrate strong pro-inflammatory capabilities, might link the two diseases. Th17 lymphocytes produce a number of pro-inflammatory cytokines, such as interleukin (IL)-17A, IL-17F, IL-21, IL-22 and tumor necrosis factor (TNF)-a, and play a key role in mucosal defense against various pathogens. Numerous observations suggest that Th17 lymphocytes are involved in pathogenesis of different autoimmune diseases and pathologic inflammatory states. Mounting evidence suggests that Th17 cells contribute to the pathogenesis of IBD and CRC. However, their precise role in both diseases is unknown.

Reactive oxygen species (ROS) production in human peripheral blood neutrophils exposed in vitro to static magnetic field

The aim of this study was to determine the effect of gradient static magnetic field (SMF) on reactive oxygen species (ROS) production in human neutrophils in peripheral blood in vitro. Blood samples collected from healthy individuals were incubated in an inhomogeneous SMF (in a south or north pole of the field) for 15, 30 or 45 minutes. The maximum value of induction (B max) amounted to ≈ 60 mT. To determine the strength of the ROS production, dihydrorhodamine (123DHR) as fluorophore and phorbol 12-myristate 13-acetate (PMA) as respiratory burst stimulator were used. 123DHR oxidation by ROS was measured by flow cytometry. The exposure of blood samples to SMF induced statistically significant changes in ROS production in unstimulated and PMA-stimulated neutrophils. The observed effects were highly correlated with the exposure time and depended on the orientation of the field. Although intracellular mechanisms underlying such interactions are not thoroughly understood, it could be presumed that SMF affects ROS metabolic oscillations and their formation and inactivation. This study emphasizes the importance of proper adjustment of exposure time to SMF for any potential therapeutic applications.

Selected cytokine profiles during remission in bipolar patients

OBJECTIVES

The aim of the study was to examine the cytokine status in bipolar patients during immediate remission after acute episodes of mania or depression and in patients with sustained (≥6 months) remission, compared with healthy controls.

METHODS

The study was performed on 121 bipolar patients, of whom 35 were in immediate remission after mania, 41 were in immediate remission after depression, and 45 were in >6-month remission on lithium monotherapy or lithium combined with other drugs. The control group consisted of 78 healthy individuals without any history of psychiatric or immunological illnesses. Serum concentrations of IL-1β, IL-2, IL-6, IL-10, TNF-α and IFN-γ were determined using the Human Th1/Th2 Cytometric Bead Array method.

RESULTS

The concentration of IL-10 was higher in patients in remission after mania and the concentration of IFN-γ was higher in those in remission after depression than in healthy controls. On the other hand, cytokine concentrations in patients with sustained remission were not different from those of healthy subjects.

CONCLUSIONS

The results obtained in this study show that sustained remission in bipolar patients achieved mostly by lithium maintenance brings the cytokine status to a level similar to healthy control subjects.

Secukinumab, a human anti-IL-17A monoclonal antibody, for moderate to severe Crohn's disease: unexpected results of a randomised, double-blind placebo-controlled trial

OBJECTIVE

The authors tested whether the anti-interleukin (IL)-17A monoclonal antibody secukinumab was safe and effective for the treatment of active Crohn's disease.

DESIGN

In a double-blind, randomised, placebo-controlled proof-of-concept study, 59 patients with moderate to severe Crohn's disease (Crohn's Disease Activity Index (CDAI) ≥220 to ≤450) were assigned in a 2:1 ratio to 2×10 mg/kg intravenous secukinumab or placebo. The primary end point, addressed by bayesian statistics augmented with historical placebo information, was the probability that secukinumab reduces the CDAI by ≥50 points more than placebo at week 6. Ancillary analyses explored associations of 35 candidate genetic polymorphisms and faecal calprotectin response.

RESULTS

59 patients (39 secukinumab, 20 placebo, mean baseline CDAI 307 and 301, respectively) were recruited. 18/59 (31%) patients discontinued prematurely (12/39 (31%) secukinumab, 6/20 (30%) placebo), 10/59 (17%) due to insufficient therapeutic effect (8/39 (21%) secukinumab, 2/20 (10%) placebo). Fourteen serious adverse events occurred in 10 patients (seven secukinumab, three placebo); 20 infections, including four local fungal infections, were seen on secukinumab versus none on placebo. Primary end point analysis estimated <0.1% probability (CDAI (SD) =33.9 (19.7), 95% credible interval -4.9 to 72.9) that secukinumab reduces CDAI by ≥50 points more than placebo. Secondary area under the curve analysis (weeks 4-10) showed a significant difference (mean ΔCDAI=49; 95% CI (2 to 96), p=0.043) in favour of placebo. Post hoc subgroup analysis showed that unfavourable responses on secukinumab were driven by patients with elevated inflammatory markers (CRP≥10 mg/l and/or faecal calprotectin≥200 ng/ml; mean ΔCDAI=62; 95% CI (-1 to 125), p=0.054 in favour of placebo). Absence of the minor allele of tumour necrosis factor-like ligand 1A was strongly associated with lack of response measured by baseline-adjusted changes in calprotectin at week 6 (p=0.00035 Bonferroni-corrected).

CONCLUSIONS

Blockade of IL-17A was ineffective and higher rates of adverse events were noted compared with placebo.

CLINICAL TRIAL REGISTRATION

This trial was registered at ClinicalTrial.gov with the number NCT01009281.

De novo renal cell carcinoma of native kidneys in renal transplant recipients: a single-center experience

OBJECTIVES

Our study aimed to determine the incidence of de novo renal cell carcinoma in the native kidneys of patients transplanted at our center and to identify possible risk factors.

MATERIALS AND METHODS

We performed a retrospective, single-center cohort study, which included patients transplanted at the District Hospital in Poznan, Poland, during 1994-2011, among whom 836 were selected. Sixty-three patients with confirmed de novo cancer were found. Of those, 11 had renal cell carcinoma in the native kidney (1.3%) and 2 in the transplanted kidney (0.2%).

RESULTS

Mean follow-up was 10 ± 3.2 years. Mean age at renal cell carcinoma diagnosis was 52 ± 9.4 years, and mean time from transplant was 3 ± 2.6 years. A statistical analysis showed no significant differences in demographic or clinical characteristics between renal cell carcinoma and noncancer group, except for the prevalence of male sex and smoking in the cancer group (P < .05).

CONCLUSIONS

Renal cell carcinoma development in the native kidney seems to be an early event, frequently observed within 4 to 5 years after transplant. We believe that kidneys in renal transplant recipients should be routinely screened by ultrasound for early diagnosis.

Skin cancer following kidney transplantation: a single-center experience

One of the major problems associated with prolonged immunosuppression is a high occurrence of skin malignancies among kidney recipients. Studies have shown that nonmelanoma skin cancer is the most frequently occurring tumor after organ transplantation. The aim of this study was to determine the incidence of and identify possible risk factors for skin malignancies among a population of kidney recipients. This retrospective, single-center cohort comprised 1672 patients transplanted from 1994 to 2011. Only patients with a confirmed diagnosis of skin cancer were selected for medical records review. Among 836 kidney transplant recipients remaining under our care since 1994, skin malignancies were diagnosed in 16 patients (1.9%). The histological diagnoses included squamous cell carcinoma (n=8; 50.0%); basal cell carcinoma (n=6; 37.5%) or malignant melanoma (n=2; 12.5%). The slightly lower incidence of skin malignancies noted in our study compared with other reports might result from differences in the length of follow-up. Some patients diagnosed with skin cancer were treated in local dermatology clinics. Also, a lower exposure to the sun characteristic for the latitude and differences in immunosuppressive therapies could be partially responsible for the lower skin cancer incidence. We also did not observe any association between other reported risk factors, such as age, human leukocyte antigen mismatch, duration of pretransplant hemodialysis, particular immunosuppressive therapies and the skin cancer occurrence among our kidney recipients.

Flow cytometry as an estimation tool for honey bee sperm viability

Flow cytometry is a method to conduct a multiparameter analysis of cells suspended in liquid and passing through a laser beam. Analyses of human and other mammal sperm using this method have already been performed but its application for insect semen is still the subject of investigation. Semen isolated from honey bee Apis mellifera seminal vesicles was dyed using SYBR-14 and propidium iodide (PI). The fluorescence of the SYBR-14 stained cells was analyzed in a green fluorescence channel (FL-1), while the PI fluorescence was analyzed in a red fluorescence channel (FL-3). Living and dead cell populations were separated using a density dot plot and the percentage of each in the sample was calculated. Flow cytometry seems to be an effective tool for assessing the viability of honey bee semen, solving the problems of distinguishing and counting the double-stained cells.

Possible defect of T suppressor cell subpopulation in patients with kidney acute rejection

CD8(+)CD28(-) forkhead box P3 (Foxp3(+)) T suppressor (Ts) lymphocytes are antigen-specific cells capable of inducing tolerogenic antigen-presenting cells by up-regulation of inhibitory receptors immunoglobulin-like-transcripts -3 and -4 and down-regulation of costimulatory molecules. Our study sought to investigate the relation between the level of peripheral CD8(+)CD28(-)Foxp3(+) Ts cells and kidney allograft outcomes. The project included 44 kidney transplantation patients. During the 6-month period following transplantation an acute rejection episode (ARE) was diagnosed in 11 patients based on biopsy results using the Banff criteria. Peripheral blood samples collected at 1 day before as well as 14 and 30 days after transplantation were tested for CD8(+)CD28(-)Foxp3(+) T cells by means of flow cytometry. Values were considered significant when P < .05. Cytometric analysis did not show significant differences between the groups in pretransplant levels of peripheral CD8(+)CD28(-)Foxp3(+) Ts cells (P > .05); however, the posttransplantation analysis showed a higher mean level of Ts cells in nonrejection (NONARE) versus acute rejection (ARE) patients (P < .0001). This observation suggested that dysfunction of CD8(+)CD28(-)Foxp3(+) Ts cells observed in ARE patients may contribute to these episodes. Interestingly, we observed similar results with respect to peripheral CD4(+)CD25(+)Foxp3(+) T regulatory cells in ARE patients, suggesting impairment of immunoregulatory mechanisms (especially within the inducible Foxp3 system) in this group, leading to acute renal allograft rejection episodes.

Pretransplant urine cytokine pattern predicts acute kidney rejection

Acute rejection (AR) remains a major problem after kidney transplantation and crucial determinant of long-term graft function. Potent mediators of alloimmune response leading to AR are cytokines. To further explore the relation between cytokine pattern and frequency of AR episodes we analyzed Th1/Th2 cytokine concentrations in the urine of 44 patients prior to the kidney transplantation. During the 6-month period following the transplantation AR was diagnosed in 11 patients. Urine samples were collected 1day before the transplantation. Samples were cytometrically tested for concentrations of IL-2, IL-4, IL-5, IL-10, IFN-gamma and TNF-alpha. Analysis showed significantly higher pretransplant concentrations of IFN-gamma (P > .001), TNF-alpha (P < .05) and IL-10 (P < .001) in the urine of patients with diagnosed AR. No significant differences in the concentrations of IL-2, IL-4, IL-5 between the two groups were observed. Elevated pretransplant concentrations of urine IFN-gamma and TNF-alpha in AR patients, not accompanied by higher concentrations of IL-2, may suggest an ongoing undetected and local, non-specific Th1 immune response, capable of amplifying the alloimmune response in the early phase postsurgery. While higher concentrations of IL-10 can partially result from activation of monocytes/macrophages, and partially from peripheral regulatory mechanisms controlling the ongoing immune reaction.

Cytometric analysis of TH1/TH2 cytokines in the urine of patients undergoing kidney transplantation

BACKGROUND

Crucial inflammatory mediators involved in development of alloimmune response leading to AR are cytokines. Our project was aimed to investigate the relation between the urine cytokine profile and the development of acute rejection (AR) episodes in patients after kidney transplantation.

MATERIAL/METHODS

The project included 44 patients undergoing kidney transplantation. During the six-month period following the transplantation AR was diagnosed in 11 patients. Urine samples were collected 2, 4, 14 and 30 days posttransplantation and cytometrically tested for concentrations of IL-2, IL-4, IL-5, IL-10, IFN-gamma and TNF-alpha.

RESULTS

We found the elevated posttransplant concentrations of IFN-gamma, IL-10 and TNF-alpha in the urine of patients with diagnosed AR vs. NONAR (P<.05). No significant differences in the urine concentrations of IL-2, IL-4, IL-5 between the two groups were observed (P>.05). Elevated concentrations of urine IFN-gamma and TNF-alpha in AR patients, not accompanied by higher concentrations of IL-2, may suggest an ongoing undetected nonspecific Th1 immune response, capable of amplifying the alloimmune response in the early phase postsurgery, leading to AR. Higher concentrations of IL-10 found in the urine of AR patients, in turn, can partially result from peripheral regulatory mechanisms controlling the ongoing immune reaction, and partially from activation of monocytes/macrophages.

CONCLUSIONS

The results of our study suggest that higher concentrations of IFN-gamma, TNF-alpha and IL-10 in the urine of patients shortly after the kidney transplantation can be considered as risk factors increasing the probability of AR episodes.