Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings

Background

The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning.

Methods

This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase.

Results

We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the “generation of evidence” (push side), 41 on the “use of evidence” (pull side) and 21 on the “interaction between these two” (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions).

Conclusion

The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country’s EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability.

Ochratoxin A challenges the intestinal epithelial cell integrity: results obtained in model experiments with Caco-2 cells

Contamination of human and animal diets with different mycotoxins have gained significant attention over the past decade. The intestinal barrier is the first site of exposure and a primary target for nutritional contaminants and hazardous substances including mycotoxins. In this study, the potential impact of ochratoxin A (OTA) on intestinal barrier integrity was highlighted using a human intestinal Caco-2 cell line. Cell viability following OTA exposure was determined by lactate dehydrogenase release and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Moreover, markers of barrier integrity, such as transepithelial electrical resistance (TEER) as well as the permeability of Lucifer Yellow (LY) and fluorescein isothiocyanate (FITC)-dextran, were assessed. Furthermore, the protein expression of different tight junction (TJ) proteins, as main constituents of barrier integrity, was evaluated by Western blot. Results show that OTA reduces TEER values in a concentration- and time-dependent manner and increase the permeability of LY through the intestinal epithelial layer, while the cell viability did not change significantly. However, the damage was not severe enough to change the permeability to larger molecules, such as FITC-dextran. OTA exposure down-regulated the expression of TJ proteins claudin-1, -3 and -4 and up-regulated the expression of zona occludens 1. The observation that OTA can disrupt the epithelial barrier is of clinical importance as it may lead to an increased passage of luminal antigens into the systemic circulation.

Breast Cancer Cell Apoptosis is Synergistically Induced by Curcumin, Trastuzumab, and Glutathione Peroxidase-1 but Robustly Inhibited by Glial Cell Line-Derived Neurotrophic Factor

We hypothesized that synergy between curcumin (CURC), trastuzumab (TZMB), and glutathione peroxidase-1 (GPX-1) accelerates breast cancer (BC) cell apoptosis which is inhibited by glial cell line-derived neurotrophic factor (GDNF). We measured survival of BC cell lines treated or cotreated with CURC and TZMB, and then with GDNF, before measuring expression levels of growth and apoptosis genes. These experiments were also repeated on SKBR3 cells transiently expressing GPX-1. CURC+TZMB cotreatment induced BC cell apoptosis more significantly than single treatment. GDNF highly inhibited CURC+TZMB toxicity and restored survival. Ectopic overexpression of GPX-1 per se induced SKBR3 cell death that was accelerated upon CURC+TZMB cotreatment. This substantial death induction was inhibited by GDNF more robustly than in single-treated cells. All these changes correlated with changes in expression levels of key molecules and were further confirmed by flow cytometry and correlation analysis. Our data indicate apoptotic induction is jointly shaped in BC cells by CURC, TZMB, and GPX-1 which correlates directly with their tripartite synergism and inversely with GDNF progrowth effects. In light of the active presence of GDNF in tumor microenvironment and necessity to overcome drug resistance, our findings can help in designing combined therapeutic strategies with implications for challenging TZMB resistance in BC.

The mycotoxin deoxynivalenol facilitates allergic sensitization to whey in mice

Intestinal epithelial stress or damage may contribute to allergic sensitization against certain food antigens. Hence, the present study investigated whether impairment of intestinal barrier integrity by the mycotoxin deoxynivalenol (DON) contributes to the development of whey-induced food allergy in a murine model. C3H/HeOuJ mice, orally exposed to DON plus whey once a week for 5 consecutive weeks, showed whey-specific IgG1 and IgE in serum and an acute allergic skin response upon intradermal whey challenge, although early initiating mechanisms of sensitization in the intestine appeared to be different compared with the widely used mucosal adjuvant cholera toxin (CT). Notably, DON exposure modulated tight-junction mRNA and protein levels, and caused an early increase in IL-33, whereas CT exposure affected intestinal γδ T cells. On the other hand, both DON- and CT-sensitized mice induced a time-dependent increase in the soluble IL-33 receptor ST2 (IL-1R1) in serum, and enhanced local innate lymphoid cells type 2 cell numbers. Together, these results demonstrate that DON facilitates allergic sensitization to food proteins and that development of sensitization can be induced by different molecular mechanisms and local immune responses. Our data illustrate the possible contribution of food contaminants in allergic sensitization in humans.

Cyclopiazonic acid attenuates the divalent cations and augments the mRNA level of iNOS in the liver and kidneys of chickens

An investigation was carried out into the occurrence of cyclopiazonic acid (CPA) producing fungi, the level of CPA contamination in chickens' diet, CPA effects on serum levels of divalent cations, on nitric oxide (NO) content and mRNA level of inducible nitric oxide synthase (iNOS) in the liver and kidney of chickens, as well as the cellular and molecular pathways of CPA toxicity. Mycological and HPLC analyses were used to determine the mycobiota and CPA level, respectively. The mycological studies revealed that 34.46 and 23.07% of the isolated fungi were Aspergillus flavus and Penicillium cyclopium, respectively. HPLC analyses showed the highest (0.95±0.35 μg/g) and lowest (0.08±0.03 μg/g) levels of CPA in maize and mix diet, respectively. For toxicological studies, male chickens (Ross 308) were assigned to the control and test groups (n=8), which received normal saline and 10, 25 and/or 50 μg/kg CPA for 28 days. The effects of CPA on NO content of the liver and kidneys were determined using the Griess reaction, and the effects on the serum level of divalent cations were established using commercially available kits. The effects of CPA on the mRNA level of iNOS were investigated using RT-PCR. CPA lowered the serum level of divalent cations, while NO contents were enhanced significantly (P<0.05). The mRNA level of iNOS in birds of the CPA test groups showed a reverse relationship with NO increase. These data suggest that CPA producing fungi along with CPA contamination in chickens' diet result in hepatic and renal disorders. Moreover, CPA induced disorders might contribute to the biochemical alterations such as NO increase that is reversely associated with mRNA level of iNOS.

Biochemical characterization of a novel high-affinity and specific plasma kallikrein inhibitor

BACKGROUND AND PURPOSE

Kallikrein acts on high molecular weight kininogen (HK) to generate HKa (cleaved HK) and bradykinin (BK). BK exerts its effects by binding to B(2) receptors. The activation of B(2) receptors leads to the formation of tissue plasminogen activator, nitric oxide (NO) and prostacyclin (PGI(2) ). An elevated kallikrein-dependent pathway has been linked to cardiovascular disease risk. The aim of this study was to investigate whether our novel plasma kallikrein inhibitor abolishes kallikrein-mediated generation of BK from HK and subsequent BK-induced NO and PGI(2) formation, thereby influencing endothelial pathophysiology during chronic inflammatory diseases.

EXPERIMENTAL APPROACH

Kinetic analysis was initially used to determine the potency of PF-04886847. Biochemical ligand binding assays, immunological methods and calcium flux studies were used to determine the selectivity of the kallikrein inhibitor. In addition, the effect of PF-04886847 on BK-induced relaxation of the rat aortic ring was determined in a model of lipopolysaccharide-induced tissue inflammation.

KEY RESULTS

Evidence was obtained in vitro and in situ, indicating that PF-04886847 is a potent and specific inhibitor of plasma kallikrein. PF-04886847 efficiently blocked calcium influx as well as NO and PGI(2) formation mediated through the BK-stimulated B(2) receptor signalling pathway. PF-04886847 blocked kallikrein-induced endothelial-dependent relaxation of isolated rat aortic rings pre-contracted with phenylephrine.

CONCLUSIONS AND IMPLICATIONS

PF-04886847 was shown to be the most potent small molecule inhibitor of plasma kallikrein yet described; it inhibited kallikrein in isolated aortic rings and cultured endothelial cells. Overall, our results indicate that PF-04886847 would be useful for the treatment of kallikrein-mediated inflammatory disorders.

Cyclopiazonic acid augments the hepatic and renal oxidative stress in broiler chicks

Generation of reactive oxygen species (ROS) leads to serious tissue injuries. The effect of cyclopiazonic acid (CPA) on oxidative stress markers in the liver and kidneys of broiler chicks was studied. Ten-day-old male broiler chicks (Ross 308) were assigned into the control and test groups, which received normal saline and 10, 25, and 50 μg/kg CPA, respectively, for 28 days. Body weight gain, serum level of alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), uric acid, creatinine, and blood urea nitrogen (BUN) were measured after 2 and 4 weeks exposure. Moreover, the total thiol molecules (TTM) and malondialdehyde (MDA) content of the liver and kidneys were assessed. No significant differences (p > 0.05) were found in body weight gain between the control and test groups. Whereas, the hepatic weight increased significantly (p < 0.05) in animals that received 25 and 50 μg/kg CPA. Both ALP and GGT level in serum were elevated in comparison to the control group. CPA also resulted in uric acid, creatinine, and BUN enhancement in broilers. The MDA content of the liver and kidneys showed remarkable increase. By contrast, the TTM levels in the liver and kidneys were significantly (p < 0.05) attenuated. Histopathological findings confirmed the biochemical changes in either organ characterized by inflammatory cells infiltration along with severe congestion and cell swelling, suggesting an inflammatory response. These data suggest that exposure to CPA resulted in hepatic and renal disorders, which were reflected as biochemical markers alteration and pathological injuries in either organ. The biochemical alteration and pathological abnormalities may be attributed to CPA-induced oxidative stress.