Development of nintedanib nanosuspension for inhaled treatment of experimental silicosis

Silicosis is an irreversible and progressive fibrotic lung disease caused by massive inhalation of crystalline silica dust at workplaces, affecting millions of industrial workers worldwide. A tyrosine kinase inhibitor, nintedanib (NTB), has emerged as a potential silicosis treatment due to its inhibitory effects on key signaling pathways that promote silica-induced pulmonary fibrosis. However, chronic and frequent use of the oral NTB formulation clinically approved for treating other fibrotic lung diseases often results in significant side effects. To this end, we engineered a nanocrystal-based suspension formulation of NTB (NTB-NS) possessing specific physicochemical properties to enhance drug retention in the lung for localized treatment of silicosis via inhalation. Our NTB-NS formulation was prepared using a wet-milling procedure in presence of Pluronic F127 to endow the formulation with nonadhesive surface coatings to minimize interactions with therapy-inactivating delivery barriers in the lung. We found that NTB-NS, following intratracheal administration, provided robust anti-fibrotic effects and mechanical lung function recovery in a mouse model of silicosis, whereas a 100-fold greater oral NTB dose given with a triple dosing frequency failed to do so. Importantly, several key pathological phenotypes were fully normalized by NTB-NS without displaying notable local or systemic adverse effects. Overall, NTB-NS may open a new avenue for localized treatment of silicosis and potentially other fibrotic lung diseases.

Mitochondria-Rich Fraction Isolated From Mesenchymal Stromal Cells Reduces Lung and Distal Organ Injury in Experimental Sepsis

OBJECTIVES

To ascertain whether systemic administration of mitochondria-rich fraction isolated from mesenchymal stromal cells would reduce lung, kidney, and liver injury in experimental sepsis.

DESIGN

Animal study.

SETTING

Laboratory investigation.

SUBJECTS

Sixty C57BL/6 male mice.

INTERVENTIONS

Sepsis was induced by cecal ligation and puncture; sham-operated animals were used as control. At 24 hours after surgery, cecal ligation and puncture and Sham animals were further randomized to receive saline or mitochondria-rich fraction isolated from mesenchymal stromal cells (3 × 106) IV. At 48 hours, survival, peritoneal bacterial load, lung, kidney, and liver injury were analyzed. Furthermore, the effects of mitochondria on oxygen consumption rate and reactive oxygen species production of lung epithelial and endothelial cells were evaluated in vitro.

MEASUREMENTS AND MAIN RESULTS

In vitro exposure of lung epithelial and endothelial cells from cecal ligation and puncture animals to mitochondria-rich fraction isolated from mesenchymal stromal cells restored oxygen consumption rate and reduced total reactive oxygen species production. Infusion of exogenous mitochondria-rich fraction from mesenchymal stromal cells (mitotherapy) reduced peritoneal bacterial load, improved lung mechanics and histology, and decreased the expression of interleukin-1β, keratinocyte chemoattractant, indoleamine 2,3-dioxygenase-2, and programmed cell death protein 1 in lung tissue, while increasing keratinocyte growth factor expression and survival rate in cecal ligation and puncture-induced sepsis. Mitotherapy also reduced kidney and liver injury, plasma creatinine levels, and messenger RNA expressions of interleukin-18 in kidney, interleukin-6, indoleamine 2,3-dioxygenase-2, and programmed cell death protein 1 in liver, while increasing nuclear factor erythroid 2-related factor-2 and superoxide dismutase-2 in kidney and interleukin-10 in liver.

CONCLUSIONS

Mitotherapy decreased lung, liver, and kidney injury and increased survival rate in cecal ligation and puncture-induced sepsis.

Niclosamide attenuates lung vascular remodeling in experimental pulmonary arterial hypertension

Despite advances in medical therapy, pulmonary arterial hypertension (PAH) remains an inexorably progressive and highly lethal disease. Signal transducer and activator of transcription (STAT)-3 is one of the main intracellular transcription factors implicated in PAH vascular remodeling. We hypothesized that niclosamide, a STAT3 inhibitor, would reduce vascular remodeling in an established pulmonary arterial hypertension model, thus enhancing cardiac function. Male Wistar rats were treated either with monocrotaline (60 mg/kg), to induce PAH, or saline (C group) by intraperitoneal injection. On day 14, PAH animals were randomly assigned to receive oral (1) saline (PAH-SAL); (2) niclosamide (75 mg/kg/day) (PAH-NICLO); (3) sildenafil (20 mg/kg/day) (PAH-SIL); or (4) niclosamide + sildenafil (PAH-NICLO + SIL), once daily for 14 days. On day 28, right ventricular systolic pressure was lower in all treated groups compared to PAH-SAL. Pulmonary vascular collagen content was lower in PAH-NICLO (37 ± 3%) and PAH-NICLO + SIL (37 ± 6%) compared to PAH-SAL (68 ± 4%), but not in PAH-SIL (52 ± 1%). CD-34, an endothelial cell marker, was higher, while vimentin, a mesenchymal cell marker, was lower in PAH-NICLO and PAH-NICLO + SIL compared to PAH-SAL, suggesting attenuation of endothelial-mesenchymal transition. Expression of STAT3 downstream targets such as transforming growth factor (TGF)-β, hypoxia-inducible factor (HIF)-1, and provirus integration site for Moloney murine leukemia virus (PIM-1) in lung tissue was reduced in PAH-NICLO and PAH-NICLO + SIL compared to PAH-SAL. In conclusion, niclosamide, with or without sildenafil, mitigated vascular remodeling and improved right ventricle systolic pressure. This new role for a well-established drug may represent a promising therapy for PAH.

Effects of the FGF receptor-1 inhibitor, infigratinib, with or without sildenafil, in experimental pulmonary arterial hypertension

BACKGROUND AND PURPOSE

Pulmonary arterial hypertension (PAH) is a progressive disease associated with high morbidity and mortality, despite advances in medical therapy. We compared the effects of infigratinib (NVP-BGJ398), a new FGF receptor-1 inhibitor, with or without the PDE-5 inhibitor sildenafil, on vascular function and remodelling as well as on gene expression of signal transducers for receptors of TGF-β (Smads-1/2/4) and transcription factor of endothelial-mesenchymal transition (Twist-1) in established experimental PAH. Types I and III pro-collagen and TGF-β expressions in lung fibroblasts were analysed in vitro after the different treatments.

EXPERIMENTAL APPROACH

PAH was induced in male Wistar rats with monocrotaline. 14 days later, treatments [sildenafil (SIL), infigratinib (INF) or their combination (SIL+INF)] were given for another 14 days. On Day 28, echocardiography and haemodynamic assays were performed, and lungs and pulmonary vessels were removed for analysis by histology, immunohistochemistry and RT-PCR. Fibroblasts prepared from PAH lungs were also analysed for TGF-β and pro-collagen.

KEY RESULTS

Only the combination of infigratinib and sildenafil significantly improved right ventricular systolic pressure and vascular remodelling parameters (right ventricular hypertrophy, smooth muscle α-actin, vessel wall thickness, and vascular collagen content). Infigratinib may act by reducing gene expression of Smads-1/4 and Twist-1 in lung tissue, as well as TGF-β and types I and III pro-collagen in lung fibroblasts.

CONCLUSIONS AND IMPLICATIONS

In this model of monocrotaline-induced PAH, the combination of the new inhibitor of FGF receptor-1, infigratinib, and sildenafil effectively improved haemodynamics and decreased vascular remodelling.

RESULTADOS DE TESTES DE CULTURA E ANTIBIOGRAMA EM SEIS CASOS DE ÚLCERA CORNEANA EM EQUINOS

A ulceração corneana é uma desordemimportante nos olhos eqüinos, podendo levará cegueira se não tratada adequadamente. Esteestudo retrospectivo tem por objetivo mostrar a importânciado conhecimento da microbiota comensalde olhos eqüinos, para que, em caso de ulceraçãocorneana, o tratamento seja empregado de formarápida, enquanto aguardam-se resultados dos testesde cultura e antibiograma para possível ajuste na terapia.

Cervical neoplasia after diagnosis and follow-up of women with atypical squamous cells of undetermined significance

BACKGROUND

Although the cytological finding of atypical squamous cells of undetermined significance (ASCUS) occurs in around 5% of women undergoing cytological screening, the clinical evolution is unknown. The objective of this study was to evaluate women with a diagnosis of ASCUS and compare the histological findings and clinical evolution over six and 12 months.

METHODS

1244 patients with ASCUS (two diagnostic cytologists) were evaluated in this study with Pap Smears and colposcopy (biopsy if necessary) at the first visit, and thereafter at second and third visits (6 and 12 months after the first visit). Comparisons were made between cytological findings and histological diagnoses at every visit during the study and during evolution.

RESULTS

At the first visit, 60.3% of the biopsied patients presented histological findings of CIN I, 17.46% CIN II/III and 6.3% invasive neoplasia. At the second visit, 48.3% of the biopsied patients presented CIN I, 24.1% CIN II/III and none invasive neoplasia. At the third visit, 68.9% of the biopsied patients presented CIN I, 13.8% CIN II/III and none invasive carcinoma. If we consider all visits, a total of 213 colposcopy-guided biopsies were performed, representing 17.1% of all the patients included. Of these, 164 (13.2%) presented a histological diagnosis of cervical intraepithelial neoplasia (CIN) and eight (0.6%) presented with invasive carcinoma.

CONCLUSION

We conclude that CIN or invasive lesions frequently occur in women with a diagnosis of ASCUS. Immediate review of the thin sections, new cytological tests or colposcopy and rigorous follow-up should be considered when making a diagnosis of ASCUS.

Unusual micelle and surface adsorption behavior in mixtures of surfactants with an ethylene oxide-propylene oxide triblock copolymer

Micellization and adsorption at the air-solution interface of binary mixtures of the triblock copolymer of ethylene oxide and propylene oxide, EO23PO52EO23 (EPE), and the surfactants sodium dodecyl sulfate (SDS), dodecyl trimethylammonium chloride (DTAC), and tetraethylene glycol monooctyl ether (C8EO4) have been studied by neutron reflectivity and surface tension. The synergistic attractive interaction between the polymer and the ionic surfactants has been analyzed in the framework of the pseudo phase approximation and gives rise to a stronger interaction for EPE/SDS than EPE/DTAC. In contrast, the interaction of the nonionic surfactant C8EO4 with the copolymer EPE shows an unexpected and rather different behavior, resulting in a strongly repulsive interaction, characterized by a positive interaction parameter. The neutron reflectivity measurements of the surface excess, where the predicted and measured surface excesses are directly compared, provide evidence that challenges the applicability of the pseudo phase approximation for describing the surface mixing behavior. Structural information on the mixed adsorbed layer provides evidence which in part explains the observed discrepancies between the measured surface excesses and the behavior predicted from the pseudo phase approximation. Furthermore the structural evidence can be use to rationalize the differences in behavior observed between the ionic and nonionic surfactants.

[Peridomiciliary changes and implications for Triatoma brasiliensis control]

A total of 9,906 annexes from 1,541 rural dwellings of Boa Viagem County, Ceará, Brazil, infested by Triatoma brasiliensis and Triatoma pseudomaculata were investigated and immediately sprayed with pyrethroid insecticide, followed by revisions at 6, 12, and 18 months. The initial infestation rate of annexes was 4.0%, with predominant infestation in animal shelters (7.0%). Mean insect density was low, regardless of triatomine species or type of annex. A progressive decrease in the number of initial annexes was observed (66% of remaining annexes), mainly those classified as "piles of materials". Only 3% of the annexes were modified by the population. New constructed annexes were important as new foci of infestation. Some 25% were infested at the end of observation period, significantly more than the "old" annexes (4.0%), a difference attributed to insecticide spraying at the beginning of the intervention. Reinfestation occurred slowly and was more frequent in animal shelters No differences were observed between traditional pyrethroid and slow-release organophosphate formulations. Selective spraying of "new" annexes is recommended.

[Focal and total residual insecticide spraying to control Triatoma brasiliensis and Triatoma pseudomaculata in Northeast Brazil]

To efficiently control the triatomines Triatoma brasiliensis and Triatoma pseudomaculata, a field trial was performed to compare conventional versus focal spraying of deltamethrin 5% SC at 25 mg a. i./m2 and the slow-release organophosphate malathion 8.3% SR at 2g a. i./m2. The assay took place in the county of Boa Viagem, Ceará State, with 1541 households, randomly separated into 4 groups. Two of them received focal spraying: PT, treated with deltamethrin indoors and in the peridomicile, and PL, which received slow-release malathion in the same circumstances. The other groups received conventional, i.e., total application: PT with deltamethrin in the intra- and peridomicile, and PL, which was treated with deltamethrin indoors and slow-release malathion in the peridomicile. Entomological surveys at 6 and 12 months post-treatment showed better results for mixed treatment, the PL group, probably due to good indoor performance for the pyrethroid and better performance of the slow-release formulation under the hostile peridomiciliary conditions. Domestic animal shelters underwent numerous modifications over the course of the year, fostering reduced insecticide performance in the peridomicile.

[Identifying areas of epidemiological stratification in an onchocerciasis focus in Yanomami territory, Roraima, Brazil]

In this paper, aimed at suitable planning, analysis, and follow-up of treatment, control, and eradication in a human onchocerciasis program, were studied 27 geographic areas and examined 3,974 inhabitants. Four epidemiological areas with different prevalences were identified and stratified.

[Preliminary activities of the program for the control and treatment of onchocerciasis in the Yanomâmi territory, Roraima, Brazil]

After to characterize the clinic and epidemiological picture of the onchocerciasis in Yanomâmi region, RR, Brazil, begun in 1993, the National Health Foundation (FNS) implemented a Control and Treatment Pilot Project in Tootobi and Balawaú. Here, it was studied skin biopsies from 426 inhabitants. In the nodules of 86.7% from patients was encountered Onchocerca volvulus. The over-all prevalence in the examined population was 66.2%. The treatment with ivermectin covered 80.1% of total population. Adverse reactions, light and moderate, of the medicament were reported in 12.3% of the patients. These results agreeing with the medical literature and suggesting the viability of to increase of the programme for all Yanomâmi area in the next phase.

National reporting of leishmaniasis: The Brazilian experience

Leishmaniasis is one of Brazil's major disease problems. Notifications of cutaneous and visceral leishmaniasis given to the Ministry of Health over the past few years show that the problem is increasing.

Controlled field trials of a vaccine against New World cutaneous leishmaniasis

Two controlled, double blind field trials of a non-living promastigote vaccine against New World Cutaneous Leishmaniasis (NWCL) were conducted in 1981 and 1983 in Brazil. Brazilian Army conscripts were randomly assigned to the vaccine or placebo groups and tested during their training in the Amazon jungle, a high risk area for NWCL. The results obtained showed: no significant differences between the vaccine and the placebo groups with respect to a number of characteristics (age, race, previous contact with the jungle, etc.); no significant differences between the participants who got and who did not get NWCL during the trial, with respect to length of exposure, contact with the jungle, etc. and a reduction of 67.3 and 85.7% in the annual incidence rate of NWCL, in 1981 and 1983 respectively (although the difference between incidence rates of the disease in vaccinated and control groups in the 1983 trial was not statistically significant), among those vaccinated who had converted to a positive leishmanin skin test as compared with the placebo groups.

[Brucella meningitis: a case report]

The authors report a case of genuine brucellar meningitis etiology. Emphasis was given on endemic and epidemiologic factors in our country as well as on contradictory clinical and complementary immunological tests in lower age groups. The CT scan ruled out possibilities of tissue damage. The case had good clinical evolution. The treatment was based on dimethyl-chlortetracycline associated with trimetropin-sulfametoxazol.

[Polymioclonia-opsoclonus: Kinsbourne's syndrome. Report of a case]

Case report of a 9 years old boy with Kinsbourne's syndrome. This condition was characterized by the subacute onset of polymyoclonia, cerebellar ataxia and opsoclonus that set later, following an herpes zoster infection. Steroid therapy resulted in rapid dramatic improvement of neurological symptoms.

[Dejerine-Roussy syndrome: report of a case]

The Déjérine-Roussy syndrome was not revised for several years by neurologists, although it has been known since 1906. The authors describe a typical case involving thalamic ischemic and calcarine other side cortex lesions emphasizing its study by computed axial tomography and by using new drugs on a vasodilatation, inhibition of platelet aggregation and tiapride base.

Plague in Brazil during two years of bacteriological and serological surveillance

In north-east Brazil, where plague infection is endemic, bacteriological and serological methods were employed during a two-year period to determine accurately the occurrence of human infection and to define certain epidemiological features of both human and rodent infection. There were 67 confirmed cases of plague, predominantly among males and children. Most of these cases occurred in two inland rural plateaux of Ceara State. Clustering of cases in place and time was common, as was a history of contact with rats. Peak occurrence was in November 1978, during the warm, harvest time of year. Rodent surveillance resulted in isolation of Yersinia pestis from 33 animals, most of them from the field rodent, Zygodontomys pixuna, in the States of Pernambuco and Ceara. Our results indicate a decline in the number of human cases from previous years but show that several foci remain active and that serological testing, in addition to routine bacteriological testing, can assist workers in maintaining the surveillance of both human and rodent plague in Brazil.