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Costantino A, Mezzetti E, De Matteis A, Volonnino G, De Simone S, Fazio V. Comparative study between conventional and new methods in defining the cause of death from anaphylactic shock. Clin Ter 2021; 172:369-371. [PMID: 34247221 DOI: 10.7417/ct.2021.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract Anaphylaxis is defined as a rapid systemic reaction that develops in individuals previously exposed to specific allergens. The new exposure causes systemic cellular degranulation, which in turn leads to cardiovascular and respiratory changes that are fatal if not treated immediately. One of the main problems of this scenario in the forensic field is the determination of a correct post-mortem diagnosis. Traditional methods, such as histopathological examination of the respiratory tract and the use of specific antibodies used in immunohistochemistry, are sensitive but not always specific and therefore do not guarantee a high degree of probability in the diagnosis of anaphylaxis. For this reason, a new and promising research frontier in this field of forensic pathology could be represented by the application of miRNAs as biomarkers, as has been done in other areas of medicine.
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Affiliation(s)
- A Costantino
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - E Mezzetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - A De Matteis
- Department of Human anatomy, Histology, Forensic medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - G Volonnino
- Department of Human anatomy, Histology, Forensic medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - S De Simone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - V Fazio
- Department of Human anatomy, Histology, Forensic medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
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Wei L, Zheng YY, Sun J, Wang P, Tao T, Li Y, Chen X, Sang Y, Chong D, Zhao W, Zhou Y, Wang Y, Jiang Z, Qiu T, Li CJ, Zhu MS, Zhang X. GGPP depletion initiates metaflammation through disequilibrating CYB5R3-dependent eicosanoid metabolism. J Biol Chem 2020; 295:15988-16001. [PMID: 32913122 DOI: 10.1074/jbc.ra120.015020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/20/2020] [Indexed: 12/30/2022] Open
Abstract
Metaflammation is a primary inflammatory complication of metabolic disorders characterized by altered production of many inflammatory cytokines, adipokines, and lipid mediators. Whereas multiple inflammation networks have been identified, the mechanisms by which metaflammation is initiated have long been controversial. As the mevalonate pathway (MVA) produces abundant bioactive isoprenoids and abnormal MVA has a phenotypic association with inflammation/immunity, we speculate that isoprenoids from the MVA may provide a causal link between metaflammation and metabolic disorders. Using a line with the MVA isoprenoid producer geranylgeranyl diphosphate synthase (GGPPS) deleted, we find that geranylgeranyl pyrophosphate (GGPP) depletion causes an apparent metaflammation as evidenced by abnormal accumulation of fatty acids, eicosanoid intermediates, and proinflammatory cytokines. We also find that GGPP prenylate cytochrome b 5 reductase 3 (CYB5R3) and the prenylated CYB5R3 then translocate from the mitochondrial to the endoplasmic reticulum (ER) pool. As CYB5R3 is a critical NADH-dependent reductase necessary for eicosanoid metabolism in ER, we thus suggest that GGPP-mediated CYB5R3 prenylation is necessary for metabolism. In addition, we observe that pharmacological inhibition of the MVA pathway by simvastatin is sufficient to inhibit CYB5R3 translocation and induces smooth muscle death. Therefore, we conclude that the dysregulation of MVA intermediates is an essential mechanism for metaflammation initiation, in which the imbalanced production of eicosanoid intermediates in the ER serve as an important pathogenic factor. Moreover, the interplay of MVA and eicosanoid metabolism as we reported here illustrates a model for the coordinating regulation among metabolite pathways.
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Affiliation(s)
- Lisha Wei
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Yan-Yan Zheng
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Jie Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Pei Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Tao Tao
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Yeqiong Li
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Xin Chen
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Yongjuan Sang
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Danyang Chong
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Wei Zhao
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Yuwei Zhou
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Ye Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Zhihui Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Tiantian Qiu
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Chao-Jun Li
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China.
| | - Min-Sheng Zhu
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China.
| | - Xuena Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, Model Animal Research Center and Medical School of Nanjing University and Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School, Nanjing University, Nanjing, China.
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Löfgren L, Forsberg GB, Davidsson P, Eketjäll S, Whatling C. Development of a highly sensitive liquid chromatography-mass spectrometry method to quantify plasma leukotriene E 4 and demonstrate pharmacological suppression of endogenous 5-LO pathway activity in man. Prostaglandins Other Lipid Mediat 2020; 150:106463. [PMID: 32450304 DOI: 10.1016/j.prostaglandins.2020.106463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
Low basal endogenous concentrations (<20 pg/mL) of the 5-lipoxygenase (5-LO) pathway biomarker leukotriene E4 (LTE4) in human plasma present a significant analytical challenge. Analytical methods including liquid chromatography-mass spectrometry and enzyme linked immunosorbent assays have been used to quantify plasma LTE4 in the past but have not provided consistent data in the lower pg/mL-range. With our new method, a detection limit (<1 pg/mL plasma) significantly below basal levels of LTE4 was achieved by combining large volume sample purification and enrichment by anion-exchange mixed mode solid phase extraction (SPE) with large volume injection followed by chromatographic separation by ultra performance liquid chromatography (UPLC) and quantification by highly sensitive negative-ion electrospray tandem mass spectrometry (MS/MS). The method was reproducible, accurate and linear between 1 and 120 pg/mL plasma LTE4. The method was used to perform an analysis of plasma samples collected from healthy volunteers in a Phase 1 study with the FLAP (5-lipoxygenase activating protein) inhibitor AZD5718. Basal endogenous LTE4 levels of 5.1 ± 2.7 pg/mL were observed in healthy volunteers (n = 34). In subjects that had been administered a single oral dose of AZD5718, significant suppression (>80%) of plasma LTE4 level was observed, providing pharmacological evidence that endogenous 5-LO pathway activity could be assessed.
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Affiliation(s)
- Lars Löfgren
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
| | - Gun-Britt Forsberg
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Pia Davidsson
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Susanna Eketjäll
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Carl Whatling
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Thalanayar Muthukrishnan P, Nouraie M, Parikh A, Holguin F. Zileuton use and phenotypic features in asthma. Pulm Pharmacol Ther 2019; 60:101872. [PMID: 31841698 DOI: 10.1016/j.pupt.2019.101872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/16/2019] [Accepted: 12/07/2019] [Indexed: 11/17/2022]
Abstract
Zileuton, a 5-lipoxygenase (5LPO) inhibitor exerts a broad influence in the arachidonic acid (AA) pathway by blocking upstream molecules that otherwise would lead to production of an array of inflammatory leukotrienes (LT) A4-E4. Hence, it has the potential to be a drug suitable to treat complicated asthmatics. Studies have shown modest response rates for zileuton in asthmatics. OBJECTIVE We sought to study our hypothesis that response to zileuton varies across specific asthmatic phenotypes. METHODS We retrospectively analyzed data from 129 patients with asthma that were prescribed zileuton at the University of Pittsburgh's Comprehensive Lung Clinic. A total of 75 patients from the above population had requisite lung function data and zileuton usage that would help assess a drug response effect. A zileuton responder was defined as having at least or greater than 5% annualized increase in post-bronchodilator FEV1% from baseline. Using a multivariate logistic regression analysis, we determined the association between responder status and the underlying phenotypic characteristics. RESULTS Using generalized estimating equations (GEE) analysis of 331 individual lung function test data-points as well as logistic regression analysis for predictors of 5% or more annualized increase in FEV1%, 21 of 75 patients (28%) met criteria for having a differential response to zileuton. Severe asthma was associated less often with responder status (OR 0.12; p 0.004). Obesity was less often associated with responder status, however did not reach significance (OR 0.46; p 0.15). CONCLUSION In this retrospective study, zileuton response varies across asthmatics, with poorer response rates being associated with those with severe asthma and possibly obesity. Although prescription trends for zileuton may predominate amongst severe asthmatics, this tendency does not seem to mirror the actual likelihood to respond. As against the trivial role for zileuton per current GINA algorithms, our study brings forward a notion that zileuton may well be considered along with LTRAs (like montelukast) for non-severe asthma.
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Affiliation(s)
| | - M Nouraie
- Departments of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Parikh
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - F Holguin
- Department of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center Pittsburgh, PA, USA
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Divekar R, Hagan J, Rank M, Park M, Volcheck G, O'Brien E, Meeusen J, Kita H, Butterfield J. Diagnostic Utility of Urinary LTE4 in Asthma, Allergic Rhinitis, Chronic Rhinosinusitis, Nasal Polyps, and Aspirin Sensitivity. J Allergy Clin Immunol Pract 2016; 4:665-70. [PMID: 27080204 DOI: 10.1016/j.jaip.2016.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/02/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Urinary leukotriene E4 (LTE4) is a well-validated marker of the cysteinyl leukotriene pathway, and LTE4 elevation has been described in conditions such as asthma, aspirin sensitivity, and chronic rhinosinusitis (CRS). There have been a number of reports investigating the role of spot urine LTE4 to predict aspirin sensitivity; however, variability in urinary LTE4 may affect the accuracy of this approach. OBJECTIVE Here, we explored the utility of 24-hour urinary LTE4 in 5 clinical diagnoses of allergic rhinitis, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), CRS without nasal polyps, and aspirin sensitivity. METHODS This was a retrospective review of patients who had 24-hour quantification of urinary LTE4 by a clinically validated liquid chromatography tandem mass spectrometry method and their assigned diagnoses after assessment and clinical care. RESULTS Twenty-four-hour urinary LTE4 elevations were seen in those with asthma and those with CRSwNP but influenced by underlying aspirin sensitivity. Elevation in LTE4 was significant in those with CRSwNP after adjusting for aspirin sensitivity. Allergic rhinitis was not associated with elevated LTE4 excretion. Receiver operator characteristic analysis of 24-hour urinary LTE4 showed that a cutoff value of 166 pg/mg Cr suggested the presence of history of aspirin sensitivity with 89% specificity, whereas a cutoff value of 241 pg/mg Cr discriminated "challenge-confirmed" aspirin-sensitive subjects with 92% specificity. CONCLUSIONS Elevated 24-hour excretion of urinary LTE4 is a reliable and simple test to identify aspirin sensitivity in patients with respiratory diagnoses.
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Affiliation(s)
- Rohit Divekar
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
| | - John Hagan
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Matthew Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz
| | - Miguel Park
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Gerald Volcheck
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Erin O'Brien
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn
| | - Jeffrey Meeusen
- Laboratory Medicine and pathology, Mayo Clinic, Rochester, Minn
| | - Hirohito Kita
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Joseph Butterfield
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
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Strand M, Sillau S, Grunwald GK, Rabinovitch N. Regression calibration with instrumental variables for longitudinal models with interaction terms, and application to air pollution studies. Environmetrics 2015; 26:393-405. [PMID: 26640396 PMCID: PMC4662860 DOI: 10.1002/env.2354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
In this paper, we derive forms of estimators and associated variances for regression calibration with instrumental variables in longitudinal models that include interaction terms between two unobservable predictors and interactions between these predictors and covariates not measured with error; the inclusion of the latter interactions generalize results we previously reported. The methods are applied to air pollution and health data collected on children with asthma. The new methods allow for the examination of how the relationship between health outcome leukotriene E4 (LTE4, a biomarker of inflammation) and two unobservable pollutant exposures and their interaction are modified by the presence or absence of upper respiratory infections. The pollutant variables include secondhand smoke and ambient (outdoor) fine particulate matter. Simulations verify the accuracy of the proposed methods under various conditions.
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Affiliation(s)
- M Strand
- Division of Biostatistics & Bioinformatics, National Jewish HealthDenver, CO, U.S.A.
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado DenverDenver, CO, U.S.A.
| | - S Sillau
- Department of Neurology, Colorado School of Medicine, University of Colorado DenverDenver, CO, U.S.A.
| | - G K Grunwald
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado DenverDenver, CO, U.S.A.
| | - N Rabinovitch
- Department of Pediatrics, National Jewish HealthDenver, CO, U.S.A.
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Marmarinos A, Saxoni-Papageorgiou P, Cassimos D, Manoussakis E, Tsentidis C, Doxara A, Paraskakis I, Gourgiotis D. Urinary leukotriene E4 levels in atopic and non-atopic preschool children with recurrent episodic (viral) wheezing: a potential marker? J Asthma 2015; 52:554-9. [PMID: 25415829 DOI: 10.3109/02770903.2014.990092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
UNLABELLED Backround: Reliable biological markers for the differentiation of asthma phenotypes in preschool children with wheezing are lacking. The purpose of the study is to assess the relationship of urinary Leukotriene E4 (U-LTE4) to particular asthma phenotypes in preschool children with recurrent episodic (viral) wheezing following upper respiratory tract infections with or without atopic predisposition. METHODS Ninety-six preschool patients with recurrent episodic wheezing participated, 52 atopic and 44 non-atopic, during exacerbation and in remission. Exacerbation was defined on clinical basis (wheeze in the presence of coryzal symptoms). Atopy was determined by specific serum IgE measurement and skin-prick testing. U-LTE4 was determined by enzyme immunoassay. Thirty-six age-matched, non-asthmatic, non-atopic children served as controls. RESULTS During exacerbation, U-LTE4 was significantly higher in all children with recurrent episodic wheezing in comparison to A: Remission: 642.20 ± 268 versus 399.45 ± 204, p value <0.001 and B: CONTROLS 642.20 ± 268 versus 271.39 ± 83, p value <0.001. Atopic patients demonstrated significantly higher levels of U-LTE4 compared to non-atopic, both during exacerbation 872.13 ± 246 versus 613.15 ± 150, p value = 0.0013 and during remission 507.59 ± 182 versus 283.59 ± 160, p value <0.001. During remission, a highly significant difference of U-LTE4 was found when controls were compared to atopic patients: 271.39 ± 83 versus 507.59 ± 182, p value = 0.002 but not when compared to non-atopic ones: 271.39 ± 83 versus 283.59 ± 160, p value = 0.432. CONCLUSION U-LTE4 is strongly associated with the acute wheeze episode in preschool children, more so in atopics. Increased basal levels of U-LTE4 occur only in atopics. This suggests a potential role of U-LTE4 as a marker of atopic, virus-induced asthma in preschool children.
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Affiliation(s)
- Antonios Marmarinos
- a Laboratory of Clinical Biochemistry - Molecular Diagnostics, Second Department of Pediatrics , Athens University Medical School, "P & A Kyriakou" Children's Hospital , Athens , Attica , Greece
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