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Warner II ER, Satapathy SK. Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions. J Clin Exp Hepatol 2023; 13:162-177. [PMID: 36647414 PMCID: PMC9840086 DOI: 10.1016/j.jceh.2022.06.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Cirrhosis predisposes to abnormalities in energy, hormonal, and immunological homeostasis. Disturbances in these metabolic processes create susceptibility to sarcopenia or pathological muscle wasting. Sarcopenia is prevalent in cirrhosis and its presence portends significant adverse outcomes including the length of hospital stay, infectious complications, and mortality. This highlights the importance of identification of at-risk individuals with early nutritional, therapeutic and physical therapy intervention. This manuscript summarizes literature relevant to sarcopenia in cirrhosis, describes current knowledge, and elucidates possible future directions.
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Key Words
- ACE, angiotensin-converting enzyme
- ACE-I, angiotensin-converting enzyme inhibitor
- AKI, acute kidney injury
- ALM, appendicular lean mass
- ARB, angiotensin receptor blocker
- ASM, appendicular skeletal mass
- AT1R, angiotensin type 1 receptor
- AT2R, angiotensin type 2 receptor
- ATP, adenosine-5′-triphosphate
- AWGS, Asian Working Group for Sarcopenia
- BCAA, branched chained amino acids
- BIA, bioelectrical impedance analysis
- BMI, body mass index
- CART, classification and regression tree
- CKD, chronic kidney disease
- CRP, C-reactive protein
- DEXA, dual energy X-ray absorptiometry
- EAA, essential amino acids
- ESPEN-SIG, European Society for Clinical Nutrition and Metabolism Special Interests Groups
- ESRD, end-stage renal disease
- EWGSOP, European Working Group on Sarcopenia in Older People
- FAD, flavin adenine dinucleotide
- FADH2, flavin adenine dinucleotide +2 hydrogen
- FNIH, Foundation for the National Institutes of Health
- GTP, guanosine-5′-triphosphate
- GnRH, gonadotrophin-releasing hormone
- HCC, hepatocellular carcinoma
- HPT, hypothalamic-pituitary-testicular
- IFN-γ, interferon γ
- IGF-1, insulin-like growth factor 1
- IL-1, interleukin-1
- IL-6, interleukin-6
- IWGS, International Working Group on Sarcopenia
- LH, luteinizing hormone
- MELD, Model for End-Stage Liver Disease
- MuRF1, muscle RING-finger-1
- NAD, nicotinamide adenine dinucleotide
- NADH, nicotinamide adenine dinucleotide + hydrogen
- NADPH, nicotinamide adenine dinucleotide phosphate
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NF-κβ, nuclear factor κβ
- NHANES, National Health and Nutritional Examination Survey
- PMI, psoas muscle index
- PMTH, psoas muscle thickness
- RAAS, renin-angiotensin-aldosterone system
- ROS, reactive oxygen species
- SARC-F, Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls
- SHBG, sex hormone binding globulin
- SMI, skeletal muscle index
- SNS, sympathetic nervous system
- SPPB, Short Performance Physical Battery
- TNF-α, tumor necrosis factor α
- UCSF, University of California, San Francisco
- UNOS, United Network of Organ Sharing
- cirrhosis
- energy
- mTOR, mammalian target of rapamycin
- metabolism
- muscle
- sarcopenia
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Affiliation(s)
- Edgewood R. Warner II
- Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Sanjaya K. Satapathy
- Division of Hepatology and Northwell Health Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
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Li X, Zhu R, Jiang H, Yin Q, Gu J, Chen J, Ji X, Wu X, Fu H, Wang H, Tang X, Gao Y, Wang B, Ji Y, Chen H. Autophagy enhanced by curcumin ameliorates inflammation in atherogenesis via the TFEB-P300-BRD4 axis. Acta Pharm Sin B 2022; 12:2280-99. [PMID: 35646539 DOI: 10.1016/j.apsb.2021.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)–P300–bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid–liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.
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Key Words
- ATG5, autophagy-related 5
- Acetyl-H3, acetyl-histone 3
- Atherosclerosis
- Autophagy
- BET, bromodomain and extra-terminal
- BRD4
- BRD4, bromodomain protein 4
- CQ, chloroquine
- CVDs, cardiovascular diseases
- ChIP, chromatin immunoprecipitation
- Cur, curcumin
- Curcumin
- Dil-ox-LDL, 1,1′-dioctadecyl-3,3,3′,3′-tetramethy-lindocarbocyanine perchlorate labeled oxidized low-density lipoprotein
- FCs, foam cells
- HFD, high-fat diet
- IL-1β, interleukin 1β
- Inflammation
- LIR, LC3-interacting region
- MCP-1, monocyte chemotactic protein 1
- Macrophage
- NAC, N-acetyl-l-cysteine
- ORO, Oil red O
- P300
- ROS, reactive oxygen species
- Re-ChIP, re-chromatin immunoprecipitation
- SE, super-enhancer
- TFEB
- TFEB, transcription factor EB
- TNF-α, tumor necrosis factor α
- mTORC1, mammalian target of rapamycin complex 1
- ox-LDL, oxidized low-density lipoprotein
- qRT-PCR, quantitative real-time polymerase chain reaction
- siRNAs, small interference RNAs
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Dong S, Guo X, Han F, He Z, Wang Y. Emerging role of natural products in cancer immunotherapy. Acta Pharm Sin B 2022; 12:1163-1185. [PMID: 35530162 PMCID: PMC9069318 DOI: 10.1016/j.apsb.2021.08.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/05/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer immunotherapy has become a new generation of anti-tumor treatment, but its indications still focus on several types of tumors that are sensitive to the immune system. Therefore, effective strategies that can expand its indications and enhance its efficiency become the key element for the further development of cancer immunotherapy. Natural products are reported to have this effect on cancer immunotherapy, including cancer vaccines, immune-check points inhibitors, and adoptive immune-cells therapy. And the mechanism of that is mainly attributed to the remodeling of the tumor-immunosuppressive microenvironment, which is the key factor that assists tumor to avoid the recognition and attack from immune system and cancer immunotherapy. Therefore, this review summarizes and concludes the natural products that reportedly improve cancer immunotherapy and investigates the mechanism. And we found that saponins, polysaccharides, and flavonoids are mainly three categories of natural products, which reflected significant effects combined with cancer immunotherapy through reversing the tumor-immunosuppressive microenvironment. Besides, this review also collected the studies about nano-technology used to improve the disadvantages of natural products. All of these studies showed the great potential of natural products in cancer immunotherapy.
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Key Words
- AKT, alpha-serine/threonine-specific protein kinase
- Adoptive immune-cells transfer immunotherapy
- B2M, beta-2-microglobulin
- BMDCs, bone marrow dendritic cells
- BPS, basil polysaccharide
- BTLA, B- and T-lymphocyte attenuator
- CAFs, cancer-associated fibroblasts
- CCL22, C–C motif chemokine 22
- CIKs, cytokine-induced killer cells
- COX-2, cyclooxygenase-2
- CRC, colorectal cancer
- CTL, cytotoxic T cell
- CTLA-4, cytotoxic T lymphocyte antigen-4
- Cancer immunotherapy
- Cancer vaccines
- DAMPs, damage-associated molecular patterns
- DCs, dendritic cells
- FDA, US Food and Drug Administration
- HCC, hepatocellular carcinoma
- HER-2, human epidermal growth factor receptor-2
- HIF-1α, hypoxia-inducible factor-1α
- HMGB1, high-mobility group box 1
- HSPs, heat shock proteins
- ICD, Immunogenic cell death
- ICTs, immunological checkpoints
- IFN-γ, interferon γ
- IL-10, interleukin-10
- Immuno-check points
- Immunosuppressive microenvironment
- LLC, Lewis lung cancer
- MDSCs, myeloid-derived suppressor cells
- MHC, major histocompatibility complex class
- MITF, melanogenesis associated transcription factor
- MMP-9, matrix metalloprotein-9
- Mcl-1, myeloid leukemia cell differentiation protein 1
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NKTs, natural killer T cells
- NSCLC, non-small cell lung cancer
- Natural products
- OVA, ovalbumin
- PD-1, programmed death-1
- PD-L1, programmed death receptor ligand 1
- PGE-2, prostaglandin E2
- PI3K, phosphoinositide 3-kinase
- ROS, reactive oxygen species
- STAT3, signal transducer and activator of transcription 3
- TAMs, tumor-associated macrophages
- TAP, transporters related with antigen processing
- TGF-β, transforming growth factor-β
- TILs, tumor infiltration lymphocytes
- TLR, Toll-like receptor
- TNF-α, tumor necrosis factor α
- TSA, tumor specific antigens
- Teffs, effective T cells
- Th1, T helper type 1
- Tregs, regulatory T cells
- VEGF, vascular endothelial growth factor
- bFGF, basic fibroblast growth factor
- mTOR, mechanistic target of rapamycin
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Affiliation(s)
- Songtao Dong
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Xiangnan Guo
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Fei Han
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Zhonggui He
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yongjun Wang
- Department of Pharmaceutics, Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
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Tang G, Li S, Zhang C, Chen H, Wang N, Feng Y. Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management. Acta Pharm Sin B 2021; 11:2749-67. [PMID: 34589395 DOI: 10.1016/j.apsb.2020.12.020] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/17/2020] [Accepted: 12/25/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic nephropathy (DN) has been recognized as a severe complication of diabetes mellitus and a dominant pathogeny of end-stage kidney disease, which causes serious health problems and great financial burden to human society worldwide. Conventional strategies, such as renin-angiotensin-aldosterone system blockade, blood glucose level control, and bodyweight reduction, may not achieve satisfactory outcomes in many clinical practices for DN management. Notably, due to the multi-target function, Chinese medicine possesses promising clinical benefits as primary or alternative therapies for DN treatment. Increasing studies have emphasized identifying bioactive compounds and molecular mechanisms of reno-protective effects of Chinese medicines. Signaling pathways involved in glucose/lipid metabolism regulation, antioxidation, anti-inflammation, anti-fibrosis, and podocyte protection have been identified as crucial mechanisms of action. Herein, we summarize the clinical efficacies of Chinese medicines and their bioactive components in treating and managing DN after reviewing the results demonstrated in clinical trials, systematic reviews, and meta-analyses, with a thorough discussion on the relative underlying mechanisms and molecular targets reported in animal and cellular experiments. We aim to provide comprehensive insights into the protective effects of Chinese medicines against DN.
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Key Words
- ACEI, angiotensin-converting enzyme inhibitor
- ADE, adverse event
- AGEs, advanced glycation end-products
- AM, mesangial area
- AMPKα, adenosine monophosphate-activated protein kinase α
- ARB, angiotensin receptor blocker
- AREs, antioxidant response elements
- ATK, protein kinase B
- BAX, BCL-2-associated X protein
- BCL-2, B-cell lymphoma 2
- BCL-XL, B-cell lymphoma-extra large
- BMP-7, bone morphogenetic protein-7
- BUN, blood urea nitrogen
- BW, body weight
- C, control group
- CCR, creatinine clearance rate
- CD2AP, CD2-associated protein
- CHOP, C/EBP homologous protein
- CI, confidence interval
- COL-I/IV, collagen I/IV
- CRP, C-reactive protein
- CTGF, connective tissue growth factor
- Chinese medicine
- D, duration
- DAG, diacylglycerol
- DG, glomerular diameter
- DKD, diabetic kidney disease
- DM, diabetes mellitus
- DN, diabetic nephropathy
- Diabetic kidney disease
- Diabetic nephropathy
- EMT, epithelial-to-mesenchymal transition
- EP, E-prostanoid receptor
- ER, endoplasmic reticulum
- ESRD, end-stage renal disease
- ET-1, endothelin-1
- ETAR, endothelium A receptor
- FBG, fasting blood glucose
- FN, fibronectin
- GCK, glucokinase
- GCLC, glutamate-cysteine ligase catalytic subunit
- GFR, glomerular filtration rate
- GLUT4, glucose transporter type 4
- GPX, glutathione peroxidase
- GRB 10, growth factor receptor-bound protein 10
- GRP78, glucose-regulated protein 78
- GSK-3, glycogen synthase kinase 3
- Gαq, Gq protein alpha subunit
- HDL-C, high density lipoprotein-cholesterol
- HO-1, heme oxygenase-1
- HbA1c, glycosylated hemoglobin
- Herbal medicine
- ICAM-1, intercellular adhesion molecule-1
- IGF-1, insulin-like growth factor 1
- IGF-1R, insulin-like growth factor 1 receptor
- IKK-β, IκB kinase β
- IL-1β/6, interleukin 1β/6
- IR, insulin receptor
- IRE-1α, inositol-requiring enzyme-1α
- IRS, insulin receptor substrate
- IκB-α, inhibitory protein α
- JAK, Janus kinase
- JNK, c-Jun N-terminal kinase
- LC3, microtubule-associated protein light chain 3
- LDL, low-density lipoprotein
- LDL-C, low density lipoprotein-cholesterol
- LOX1, lectin-like oxidized LDL receptor 1
- MAPK, mitogen-activated protein kinase
- MCP-1, monocyte chemotactic protein-1
- MD, mean difference
- MDA, malondialdehyde
- MMP-2, matrix metallopeptidase 2
- MYD88, myeloid differentiation primary response 88
- Molecular target
- N/A, not applicable
- N/O, not observed
- N/R, not reported
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NOX-4, nicotinamide adenine dinucleotide phosphate-oxidase-4
- NQO1, NAD(P)H:quinone oxidoreductase 1
- NRF2, nuclear factor erythroid 2-related factor 2
- OCP, oxidative carbonyl protein
- ORP150, 150-kDa oxygen-regulated protein
- P70S6K, 70-kDa ribosomal protein S6 kinase
- PAI-1, plasminogen activator inhibitor-1
- PARP, poly(ADP-Ribose) polymerase
- PBG, postprandial blood glucose
- PERK, protein kinase RNA-like eukaryotic initiation factor 2A kinase
- PGC-1α, peroxisome proliferator-activated receptor gamma coactivator 1α
- PGE2, prostaglandin E2
- PI3K, phosphatidylinositol 3 kinases
- PINK1, PTEN-induced putative kinase 1
- PKC, protein kinase C
- PTEN, phosphatase and tensin homolog
- RAGE, receptors of AGE
- RASI, renin-angiotensin system inhibitor
- RCT, randomized clinical trial
- ROS, reactive oxygen species
- SCr, serum creatinine
- SD, standard deviation
- SD-rat, Sprague–Dawley rat
- SIRT1, sirtuin 1
- SMAD, small mothers against decapentaplegic
- SMD, standard mean difference
- SMURF-2, SMAD ubiquitination regulatory factor 2
- SOCS, suppressor of cytokine signaling proteins
- SOD, superoxide dismutase
- STAT, signal transducers and activators of transcription
- STZ, streptozotocin
- Signaling pathway
- T, treatment group
- TBARS, thiobarbituric acid-reactive substance
- TC, total cholesterol
- TCM, traditional Chinese medicine
- TFEB, transcription factor EB
- TG, triglyceride
- TGBM, thickness of glomerular basement membrane
- TGF-β, tumor growth factor β
- TGFβR-I/II, TGF-β receptor I/II
- TII, tubulointerstitial injury index
- TLR-2/4, toll-like receptor 2/4
- TNF-α, tumor necrosis factor α
- TRAF5, tumor-necrosis factor receptor-associated factor 5
- UACR, urinary albumin to creatinine ratio
- UAER, urinary albumin excretion rate
- UMA, urinary microalbumin
- UP, urinary protein
- VCAM-1, vascular cell adhesion molecule-1
- VEGF, vascular endothelial growth factor
- WMD, weight mean difference
- XBP-1, spliced X box-binding protein 1
- cAMP, cyclic adenosine monophosphate
- eGFR, estimated GFR
- eIF2α, eukaryotic initiation factor 2α
- mTOR, mammalian target of rapamycin
- p-IRS1, phospho-IRS1
- p62, sequestosome 1 protein
- α-SMA, α smooth muscle actin
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Raimondo A, Guglielmi G, Marino C, Ligrone L, Lembo S. Hair whitening in a patient with psoriasis on adalimumab reversed after switching to ixekizumab. JAAD Case Rep 2021; 11:51-53. [PMID: 33912637 PMCID: PMC8063687 DOI: 10.1016/j.jdcr.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Annunziata Raimondo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
| | - Giulia Guglielmi
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
| | - Carlo Marino
- Dermatology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
| | - Luigi Ligrone
- Dermatology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
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Qin X, Xu Y, Zhou X, Gong T, Zhang ZR, Fu Y. An injectable micelle-hydrogel hybrid for localized and prolonged drug delivery in the management of renal fibrosis. Acta Pharm Sin B 2021; 11:835-847. [PMID: 33777685 PMCID: PMC7982499 DOI: 10.1016/j.apsb.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
Localized delivery, comparing to systemic drug administration, offers a unique alternative to enhance efficacy, lower dosage, and minimize systemic tissue toxicity by releasing therapeutics locally and specifically to the site of interests. Herein, a localized drug delivery platform ("plum‒pudding" structure) with controlled release and long-acting features is developed through an injectable hydrogel ("pudding") crosslinked via self-assembled triblock polymeric micelles ("plum") to help reduce renal interstitial fibrosis. This strategy achieves controlled and prolonged release of model therapeutics in the kidney for up to three weeks in mice. Following a single injection, local treatments containing either anti-inflammatory small molecule celastrol or anti-TGFβ antibody effectively minimize inflammation while alleviating fibrosis via inhibiting NF-κB signaling pathway or neutralizing TGF-β1 locally. Importantly, the micelle-hydrogel hybrid based localized therapy shows enhanced efficacy without local or systemic toxicity, which may represent a clinically relevant delivery platform in the management of renal interstitial fibrosis.
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Key Words
- Anti-TGFβ antibody
- BSA, bovine serum albumin
- CLT, celastrol
- Celastrol
- Controlled release
- Cy5.5-NHS, cyanine 5.5-N-hydroxysuccinimide
- DAPI, 4′,6-diamidino-2-phenylindole
- DEX, dexamethasone
- DiD, 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindodicarbocyanineperchlorate
- ECM, extracellular matrix
- EDCI, carbodiimide hydrochloride
- ESR, equilibrium swelling ratio
- FITC, fluorescein isothiocyanate
- G", the loss modulus
- G', storage modulus
- HA, hyaluronic acid
- HASH, thiolated hyaluronic acid
- Hydrogel
- IL-1β, interleukin 1β
- IL-6, interleukin 6
- Inflammation
- Localized therapy
- MOD, mean optical density
- NHS, N-hydroxysuccinimide
- PDI, polydispersity index
- RIF, renal interstitial fibrosis
- RSR, real-time swelling ratio
- Renal fibrosis
- SD, standard deviation
- SEM, scanning electron microscopy
- TEM, transmission electron microscopy
- TGF-β1, transforming growth factor β1
- TNF-α, tumor necrosis factor α
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labelling
- UUO, unilateral ureteral obstruction
- bis-F127-MA, bis-F127-methacrylate
- iNOS, nitric oxide synthase
- α-SMA, α-smooth muscle actin
- “Plum‒pudding” structure
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Yu K, Yu X, Cao S, Wang Y, Zhai Y, Yang F, Yang X, Lu Y, Wu C, Xu Y. Layered dissolving microneedles as a need-based delivery system to simultaneously alleviate skin and joint lesions in psoriatic arthritis. Acta Pharm Sin B 2021; 11:505-519. [PMID: 33643827 PMCID: PMC7893142 DOI: 10.1016/j.apsb.2020.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a complicated psoriasis comorbidity with manifestations of psoriatic skin and arthritic joints, and tailoring specific treatment strategies for simultaneously delivering different drugs to different action sites in PsA remains challenging. We developed a need-based layered dissolving microneedle (MN) system loading immunosuppressant tacrolimus (TAC) and anti-inflammatory diclofenac (DIC) in different layers of MNs, i.e., TD-MN, which aims to specifically deliver TAC and DIC to skin and articular cavity, achieving simultaneous alleviation of psoriatic skin and arthritic joint lesions in PsA. In vitro and in vivo skin permeation demonstrated that the inter-layer retained TAC within the skin of ∼100 μm, while the tip-layer delivered DIC up to ∼300 μm into the articular cavity. TD-MN not only efficiently decreased the psoriasis area and severity index scores and recovered the thickened epidermis of imiquimod-induced psoriasis but also alleviated carrageenan/kaolin-induced arthritis even better than DIC injection through reducing joint swelling, muscle atrophy, and cartilage destruction. Importantly, TD-MN significantly inhibited the serum TNF-α and IL-17A in psoriatic and arthritic rats. The results support that this approach represents a promising alternative to multi-administration of different drugs for comorbidity, providing a convenient and effective strategy for meeting the requirements of PsA treatment.
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Key Words
- Blank-MN, blank layered MNs
- C6, coumarin 6
- CLSM, confocal laser scanning microscope
- DIC, diclofenac sodium
- DIC-MN, layered MNs loading DIC in the tip-layer of needles
- Diclofenac sodium
- HA, hyaluronic acid
- IL-17A, interleukin 17A
- IMQ, imiquimod
- IVISR, in vivo imaging system
- Layered microneedles
- MIX-MN, unlayered MNs loading the mixture of DIC and TAC in needles
- MN, microneedle
- NIC, nicotinamide
- NSAIDs, nonsteroidal anti-inflammatory drugs
- Need-based drug delivery
- OCT, optical coherence tomography
- PASI, psoriasis area and severity index
- PDMS, polydimethylsiloxane
- PVP, polyvinyl pyrrolidone
- PsA, psoriatic arthritis
- Psoriasis
- Psoriatic arthritis
- RhB, rhodamine B
- SC, stratum corneum
- SEM, scanning electron microscope
- TAC, tacrolimus
- TAC-MN, layered MNs loading TAC in the inter-layer of needles
- TD-MN, layered MNs co-loading TAC in the inter-layer of needles and DIC in the tip-layer
- TEWL, transepidermal water loss
- TNF-α, tumor necrosis factor α
- Tacrolimus
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yuehong Xu
- Corresponding author. Fax: +86 20 39943119.
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Waters ES, Kaiser EE, Yang X, Fagan MM, Scheulin KM, Jeon JH, Shin SK, Kinder HA, Kumar A, Platt SR, Duberstein KJ, Park HJ, Xie J, West FD. Intracisternal administration of tanshinone IIA-loaded nanoparticles leads to reduced tissue injury and functional deficits in a porcine model of ischemic stroke. IBRO Neurosci Rep 2021; 10:18-30. [PMID: 33842909 DOI: 10.1016/j.ibneur.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background The absolute number of new stroke patients is annually increasing and there still remains only a few Food and Drug Administration (FDA) approved treatments with significant limitations available to patients. Tanshinone IIA (Tan IIA) is a promising potential therapeutic for ischemic stroke that has shown success in pre-clinical rodent studies but lead to inconsistent efficacy results in human patients. The physical properties of Tan-IIA, including short half-life and low solubility, suggests that Poly (lactic-co-glycolic acid) (PLGA) nanoparticle-assisted delivery may lead to improve bioavailability and therapeutic efficacy. The objective of this study was to develop Tan IIA-loaded nanoparticles (Tan IIA-NPs) and to evaluate their therapeutic effects on cerebral pathological changes and consequent motor function deficits in a pig ischemic stroke model. Results Tan IIA-NP treated neural stem cells showed a reduction in SOD activity in in vitro assays demonstrating antioxidative effects. Ischemic stroke pigs treated with Tan IIA-NPs showed reduced hemispheric swelling when compared to vehicle only treated pigs (7.85 ± 1.41 vs. 16.83 ± 0.62%), consequent midline shift (MLS) (1.72 ± 0.07 vs. 2.91 ± 0.36 mm), and ischemic lesion volumes (9.54 ± 5.06 vs. 12.01 ± 0.17 cm3) when compared to vehicle-only treated pigs. Treatment also lead to lower reductions in diffusivity (-37.30 ± 3.67 vs. -46.33 ± 0.73%) and white matter integrity (-19.66 ± 5.58 vs. -30.11 ± 1.19%) as well as reduced hemorrhage (0.85 ± 0.15 vs 2.91 ± 0.84 cm3) 24 h post-ischemic stroke. In addition, Tan IIA-NPs led to a reduced percentage of circulating band neutrophils at 12 (7.75 ± 1.93 vs. 14.00 ± 1.73%) and 24 (4.25 ± 0.48 vs 5.75 ± 0.85%) hours post-stroke suggesting a mitigated inflammatory response. Moreover, spatiotemporal gait deficits including cadence, cycle time, step time, swing percent of cycle, stride length, and changes in relative mean pressure were less severe post-stroke in Tan IIA-NP treated pigs relative to control pigs. Conclusion The findings of this proof of concept study strongly suggest that administration of Tan IIA-NPs in the acute phase post-stroke mitigates neural injury likely through limiting free radical formation, thus leading to less severe gait deficits in a translational pig ischemic stroke model. With stroke as one of the leading causes of functional disability in the United States, and gait deficits being a major component, these promising results suggest that acute Tan IIA-NP administration may improve functional outcomes and the quality of life of many future stroke patients.
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Key Words
- ADC, Apparent Diffusion Coefficient
- ANOVA, analysis of variance
- AU, arbitrary units
- BBB, blood brain barrier
- Baic, Baicalin
- CNS, central nervous system
- CSF, cerebral spinal fluid
- DAMPS, damaged-associated molecular patterns
- DLS, dynamic light scattering
- DTI, Diffusion Tensor Imaging
- DWI, Diffusion-Weighted Imaging
- Edar, Edaravone
- FA, fractional anisotropy
- FDA, Food and Drug Administration
- GABA, γ-aminobutyric acid
- GM, gray matter
- IC, inhibitory concentration
- ICH, intracerebral hemorrhage
- IL-6, interleukin 6
- IM, intramuscular
- Ischemic stroke
- LPS, lipopolysaccharide
- MCA, middle cerebral artery
- MCAO, middle cerebral artery occlusion
- MLS, midline shift
- NP, nanoparticle
- NSCs, neural stem cells
- Nanomedicine
- PBS, phosphate buffered saline
- PEG–PLGA, polyethyleneglycol–polylactic-co-glycolic acid
- PLGA nanoparticle
- PLGA, Poly (lactic-co-glycolic acid)
- PLGA-b-PEG-OH, poly (lactide-co-glycolide)-b-poly (ethylene glycol)-maleimide
- Pig stroke model
- Piog, Pioglitazone
- Puer, Puerarin
- ROS, reactive oxygen species
- Resv, Resveratrol
- SOD, superoxide dismutase
- STAIR, Stroke Therapy Academic and Industry Roundtable
- T2*, T2Star
- T2FLAIR, T2 Fluid Attenuated Inversion Recovery
- T2W, T2Weighted
- TD, transdermal
- TEM, transmission electron microscopy
- TNF-α, tumor necrosis factor α
- Tan IIA, Tanshinone IIA
- Tan IIA-NPs, Tan IIA PLGA NPs
- Tan IIA-NPs, Tan IIA-loaded nanoparticles
- Tanshinone IIA
- UGA, University of Georgia
- WM, white matter
- ddH2O, double-distilled water
- tPA, Tissue plasminogen activator
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Liu EY, Xia Y, Kong X, Guo MS, Yu AX, Zheng BZ, Mak S, Xu ML, Tsim KW. Interacting with α 7 nAChR is a new mechanism for AChE to enhance the inflammatory response in macrophages. Acta Pharm Sin B 2020; 10:1926-1942. [PMID: 33163344 PMCID: PMC7606108 DOI: 10.1016/j.apsb.2020.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/16/2020] [Accepted: 04/22/2020] [Indexed: 01/01/2023] Open
Abstract
Acetylcholine (ACh) regulates inflammation via α7 nicotinic acetylcholine receptor (α7 nAChR). Acetylcholinesterase (AChE), an enzyme hydrolyzing ACh, is expressed in immune cells suggesting non-classical function in inflammatory responses. Here, the expression of PRiMA-linked G4 AChE was identified on the surface of macrophages. In lipopolysaccharide-induced inflammatory processes, AChE was upregulated by the binding of NF-κB onto the ACHE promotor. Conversely, the overexpression of G4 AChE inhibited ACh-suppressed cytokine release and cell migration, which was in contrast to that of applied AChE inhibitors. AChEmt, a DNA construct without enzymatic activity, was adopted to identify the protein role of AChE in immune system. Overexpression of G4 AChEmt induced cell migration and inhibited ACh-suppressed cell migration. The co-localization of α7 nAChR and AChE was found in macrophages, suggesting the potential interaction of α7 nAChR and AChE. Besides, immunoprecipitation showed a close association of α7 nAChR and AChE protein in cell membrane. Hence, the novel function of AChE in macrophage by interacting with α7 nAChR was determined. Together with hydrolysis of ACh, AChE plays a direct role in the regulation of inflammatory response. As such, AChE could serve as a novel target to treat age-related diseases by anti-inflammatory responses.
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Key Words
- ACh, acetylcholine
- AChE
- AChE, acetylcholinesterase
- BChE, butyrylcholinesterase
- CAP pathway, cholinergic anti-inflammatory pathway
- CDC42, cell division cycle
- ChAT, choline acetyltransferase
- Cholinergic anti-inflammatory pathway
- DPZ, donepezil
- GAL, galantamine hydrobromide
- IL, interleukin
- LPS, lipopolysaccharides
- MLA, methyllycaconitine citrate salt
- MMP, matrix metalloproteinase
- Macrophage
- NF-κB, nuclear factor-κB
- PHA, PHA-543613
- PRiMA, proline-rich membrane anchor
- TNF-α, tumor necrosis factor α
- nAChR, nicotinic AChR
- α7 nAChR
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Éva Sikura K, Combi Z, Potor L, Szerafin T, Hendrik Z, Méhes G, Gergely P, Whiteman M, Beke L, Fürtös I, Balla G, Balla J. Hydrogen sulfide inhibits aortic valve calcification in heart via regulating RUNX2 by NF-κB, a link between inflammation and mineralization. J Adv Res 2020; 27:165-176. [PMID: 33318875 PMCID: PMC7728582 DOI: 10.1016/j.jare.2020.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction Hydrogen sulfide (H2S) was revealed to inhibit aortic valve calcification and inflammation was implicated in the pathogenesis of calcific aortic valve disease (CAVD). Objectives We investigate whether H2S inhibits mineralization via abolishing inflammation. Methods and results Expression of pro-inflammatory cytokines, interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α) were increased in patients with CAVD and in calcified aortic valve of ApoE-/- mice. Administration of H2 2S releasing donor (4-methoxyphenyl piperidinylphosphinodithioc acid (AP72)) exhibited inhibition on both calcification and inflammation in aortic valve of apolipoprotein E knockout mice (ApoE-/-) mice is reflected by lowering IL-1β and TNF-α levels. Accordingly, AP72 prevented the accumulation of extracellular calcium deposition and decreased nuclear translocation of nuclear factor-κB (NF-κB) in human valvular interstitial cells (VIC). This was also accompanied by reduced cytokine response. Double-silencing of endogenous H2S producing enzymes, Cystathionine gamma-lyase (CSE) and Cystathionine beta-synthase (CBS) in VIC exerted enhanced mineralization and higher levels of IL-1β and TNF-α. Importantly, silencing NF-κB gene or its pharmacological inhibition prevented nuclear translocation of runt-related transcription factor 2 (Runx2) and subsequently the calcification of human VIC. Increased levels of NF-κB and Runx2 and their nuclear accumulation occurred in ApoE-/- mice with a high-fat diet. Administration of AP72 decreased the expression of NF-κB and prevented its nuclear translocation in VIC of ApoE-/- mice on a high-fat diet, and that was accompanied by a lowered pro-inflammatory cytokine level. Similarly, activation of Runx2 did not occur in VIC of ApoE-/- mice treated with H2S donor. Employing Stimulated Emission Depletion (STED) nanoscopy, a strong colocalization of NF-κB and Runx2 was detected during the progression of valvular calcification. Conclusions Hydrogen sulfide inhibits inflammation and calcification of aortic valve. Our study suggests that the regulation of Runx2 by hydrogen sulfide (CSE/CBS) occurs via NF-κB establishing a link between inflammation and mineralization in vascular calcification.
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Key Words
- AP72
- AP72, 4-methoxyphenyl piperidinylphosphinodithioc acid
- AS, stenotic aortic valve with calcification
- Aortic valve
- ApoE-/-, apolipoprotein E-deficient mice
- Apolipoprotein E knockout mice
- CAVD
- CAVD, calcific aortic valve disease
- CBS, Cystathionine beta-synthase
- CSE, Cystathionine gamma-lyase
- H2S
- HAV, healthy aortic valve from suicide patients
- IL-1β, interleukin-1β
- Inflammation
- NF-κB, nuclear factor-κB
- STED, Stimulated Emission Depletion Nanoscopy
- TNF-α, tumor necrosis factor α
- VIC, valvular interstitial cells
- cVIC, control healthy valve interstitial cells
- mHAV, healthy mouse aortic valve
- mVIC, mouse valvular interstitial cells
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Affiliation(s)
- Katalin Éva Sikura
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary.,HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
| | - Zsolt Combi
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary.,HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
| | - László Potor
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary.,HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
| | - Tamás Szerafin
- Department of Cardiac Surgery, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary
| | - Zoltán Hendrik
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary.,Department of Pathology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Gábor Méhes
- Department of Pathology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Péter Gergely
- Department of Forensic Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Matthew Whiteman
- University of Exeter Medical School, St. Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK
| | - Lívia Beke
- Department of Pathology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Ibolya Fürtös
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary
| | - György Balla
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, Debrecen, Hungary.,Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary
| | - József Balla
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, 4012 Debrecen, Hungary.,HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
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11
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Dai Q, Zheng Z, Xia F, Liu P, Li M. A one-step specific assay for continuous detection of sirtuin 2 activity. Acta Pharm Sin B 2019; 9:1183-1192. [PMID: 31867164 PMCID: PMC6900550 DOI: 10.1016/j.apsb.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022] Open
Abstract
Sirtuins (SIRTs) are nicotinamide adenine dinucleotide (NAD+)-dependent histone deacetylases with diverse physiological functions. A variety of small molecules have been developed to interrogate the physiological function of SIRTs. Therefore, it is desirable to establish efficient and convenient assays to screen SIRTs modulators. In this study, we designed a series of fluorescent nonapeptide probes derived from substrates of SIRT1–SIRT3. Fluorescence increment of these probes is based on SIRT-mediated removal of the acyl side chain with fluorophore, which makes this system free of lysine-recognizing protease. Comparing the reaction of these fluorescent nonapeptide substrates with SIRT1–SIRT3 and SIRT6, it was confirmed that this assessment system was the most suitable for SIRT2 activity detection. Thus, SIRT2 was used to modify substrates by truncating the amino acids or lysine side chain of nonapeptide. Finally, two specific and efficient fluorescent probes for SIRT2, ne-D9 and ne-K4a, were developed. Evaluation of the results revealed that ne-K4a based assay was more suitable for modulators screening in vitro, while the other specific substrate ne-D9 was stable in cell lysate and could detect the activity of SIRT2 in the same. In summary, this study presents a novel strategy for detecting SIRT2 activity in vitro and in cell lysate.
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12
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Ibrahim AB, Zaki HF, Ibrahim WW, Omran MM, Shouman SA. Evaluation of tamoxifen and simvastatin as the combination therapy for the treatment of hormonal dependent breast cancer cells. Toxicol Rep 2019; 6:1114-1126. [PMID: 31788433 PMCID: PMC6880098 DOI: 10.1016/j.toxrep.2019.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
Tamoxifen (TAM) is a nonsteroidal antiestrogen drug, used in the prevention and treatment of all stages of hormone-responsive breast cancer. Simvastatin (SIM), a lipid-lowering agent, has been shown to inhibit cancer cell growth. The study aimed at investigating the impact of using SIM with TAM in estrogen receptor-positive (ER+) breast cancer cell line, T47D, as well as in mice-bearing Ehrlich solid tumor. The cell line was treated with different concentrations of TAM or/and SIM for 72 h. The effects of treatment on cytotoxicity, oxidative stress markers, apoptosis, angiogenesis, and metastasis were investigated. Our results showed that the combination treatment decreased the oxidative stress markers, glucose uptake, VEGF, and MMP 2 &9 in the cell line compared to TAM- treated cells. Drug interaction of TAM and SIM was synergistic in T47D by increasing the apoptotic makers Bax/BCL-2 ratio and caspase 3 activity. Additionally, in vivo, the combination regimen resulted in a non-significant decrease in the tumor volume compared to TAM treated group. Moreover, the combined treatment decreased the protein expression of TNF-α, NF-kB compared to control. In conclusion, our results suggest that SIM may serve as a promising treatment with TAM for improving the efficacy against estrogen receptor-positive (ER+) breast cancer.
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Key Words
- Apoptosis
- Bax/Bcl-2, ratio Bcl-2-AssociatedXprotein/B-cell lymphoma 2 ratio
- Cytotoxicity
- EAC, ehrlich ascites carcinoma
- ER+, estrogen receptor-positive
- GSH, glutathione
- MDA, malondialdehyde
- MMP, 2&9 metalloproteinases-2and9
- NF-KB, nuclear factor kappa-B
- NOx, nitric oxide
- Oxidative stress
- SIM, simvastatin
- SOD, superoxide dismutase
- Simvastatin
- TAM, tamoxifen
- TNF-α, tumor necrosis factor α
- Tamoxifen
- VEGF, vascular endothelial growth factor
- Vascular endothelial growth factor
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Affiliation(s)
- Amel B. Ibrahim
- Department of Pharmacology, Faculty of Medicine, Zawia University, Libya
| | - Hala F. Zaki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Egypt
| | - Walaa W. Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Egypt
| | - Mervat M. Omran
- Department of Cancer Biology Department, Pharmacology Unit, National Cancer Institute, Cairo University, Egypt
- Corresponding author.
| | - Samia A. Shouman
- Department of Cancer Biology Department, Pharmacology Unit, National Cancer Institute, Cairo University, Egypt
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13
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Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019; 3:358-375. [PMID: 31485575 PMCID: PMC6713839 DOI: 10.1016/j.mayocpiqo.2019.04.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.
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Key Words
- ATS, American Thoracic Society
- AV, atrioventricular
- CMRI, cardiovascular magnetic resonance imaging
- DLCO, diffusing capacity of the lung for carbon monoxide
- DMARD, disease-modifying antirheumatic drugs
- ECG, electrocardiographic
- ERS, European Respiratory Society
- FDG-PET, 18F-fluorodeoxyglucose–positron emission tomography
- FVC, forced vital capacity
- GI, gastrointestinal tract
- LVEF, left ventricular ejection fraction
- NSAID, nonsteroidal anti-inflammatory drug
- PFT, pulmonary function test
- TBB, transbronchial lung biopsy
- TNF-α, tumor necrosis factor α
- WASOG, World Association of Sarcoidosis and other Granulomatous Disorders
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Affiliation(s)
- Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Address to Patompong Ungprasert, MD, MS, Clinical Epidemiology Unit, 3rd Floor, SIMR Bldg, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Eric L. Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Department of Health Sciences Research (E.L.M.), Mayo Clinic, Rochester, MN
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Manresa MC, Taylor CT. Hypoxia Inducible Factor (HIF) Hydroxylases as Regulators of Intestinal Epithelial Barrier Function. Cell Mol Gastroenterol Hepatol 2017; 3:303-315. [PMID: 28462372 PMCID: PMC5404106 DOI: 10.1016/j.jcmgh.2017.02.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/09/2017] [Indexed: 12/12/2022]
Abstract
Human health is dependent on the ability of the body to extract nutrients, fluids, and oxygen from the external environment while at the same time maintaining a state of internal sterility. Therefore, the cell layers that cover the surface areas of the body such as the lung, skin, and gastrointestinal mucosa provide vital semipermeable barriers that allow the transport of essential nutrients, fluid, and waste products, while at the same time keeping the internal compartments free of microbial organisms. These epithelial surfaces are highly specialized and differ in their anatomic structure depending on their location to provide appropriate and effective site-specific barrier function. Given this important role, it is not surprising that significant disease often is associated with alterations in epithelial barrier function. Examples of such diseases include inflammatory bowel disease, chronic obstructive pulmonary disease, and atopic dermatitis. These chronic inflammatory disorders often are characterized by diminished tissue oxygen levels (hypoxia). Hypoxia triggers an adaptive transcriptional response governed by hypoxia-inducible factors (HIFs), which are repressed by a family of oxygen-sensing HIF hydroxylases. Here, we review recent evidence suggesting that pharmacologic hydroxylase inhibition may be of therapeutic benefit in inflammatory bowel disease through the promotion of intestinal epithelial barrier function through both HIF-dependent and HIF-independent mechanisms.
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Key Words
- CD, Crohn’s disease
- DMOG, dimethyloxalylglycine
- DSS, dextran sodium sulfate
- Epithelial Barrier
- FIH, factor inhibiting hypoxia-inducible factor
- HIF, hypoxia-inducible factor
- Hypoxia
- Hypoxia-Inducible Factor (HIF) Hydroxylases
- IBD, inflammatory bowel disease
- IL, interleukin
- Inflammatory Bowel Disease
- NF-κB, nuclear factor-κB
- PHD, hypoxia-inducible factor–prolyl hydroxylases
- TFF, trefoil factor
- TJ, tight junction
- TLR, Toll-like receptor
- TNF-α, tumor necrosis factor α
- UC, ulcerative colitis
- ZO, zonula occludens
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Affiliation(s)
- Mario C. Manresa
- Conway Institute of Biomolecular and Biomedical Research, Belfield, Dublin, Ireland
- Charles Institute of Dermatology, Belfield, Dublin, Ireland
| | - Cormac T. Taylor
- Conway Institute of Biomolecular and Biomedical Research, Belfield, Dublin, Ireland
- Charles Institute of Dermatology, Belfield, Dublin, Ireland
- Systems Biology Ireland, School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
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15
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Ha D, Yang N, Nadithe V. Exosomes as therapeutic drug carriers and delivery vehicles across biological membranes: current perspectives and future challenges. Acta Pharm Sin B 2016; 6:287-96. [PMID: 27471669 PMCID: PMC4951582 DOI: 10.1016/j.apsb.2016.02.001] [Citation(s) in RCA: 826] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 02/07/2023] Open
Abstract
Exosomes are small intracellular membrane-based vesicles with different compositions that are involved in several biological and pathological processes. The exploitation of exosomes as drug delivery vehicles offers important advantages compared to other nanoparticulate drug delivery systems such as liposomes and polymeric nanoparticles; exosomes are non-immunogenic in nature due to similar composition as body׳s own cells. In this article, the origin and structure of exosomes as well as their biological functions are outlined. We will then focus on specific applications of exosomes as drug delivery systems in pharmaceutical drug development. An overview of the advantages and challenges faced when using exosomes as a pharmaceutical drug delivery vehicles will also be discussed.
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Key Words
- ALIX, ALG-2 interacting protein X
- ATPase, adenosine triphosphatase
- BBB, blood–brain barrier
- CCK-8, cell counting kit-8
- CD, cluster of differentiation
- DIL, 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate
- DNA, deoxyribonucleic acid
- Drug delivery systems
- EGF, epidermal growth factor
- EGFR, epidermal growth factor receptor
- ESCRT, endosomal sorting complexes required for transport
- EV, extracellular vesicle
- EpCAM, epithelial cell adhesion molecule
- Exosomes
- Extracellular vesicles
- HEK293, human embryonic kidney cell line 293
- HIV, human immunodeficiency virus
- HMGA2, high-mobility group AT-hook protein
- HeLa, Henrietta Lacks cells
- Hsp, heat shock proteins
- IL-6, interleukin-6
- ILVs, intraluminal vesicles
- LPS, lipopolysaccharides
- MAPK-1, mitogen-activated protein kinase 1
- MHC, major histocompatibility complex
- MPS, mononuclear phagocyte system
- MVB, multi-vesicular body biogenesis
- Nanocarrier
- PBMC, peripheral blood mononuclear cells
- PD, Parkinson’s disease
- PEG, polyethylene glycol
- RNA, ribonucleic acid
- ROS, reactive oxygen species
- RPE1, retinal pigment epithelial cells 1
- TNF-α, tumor necrosis factor α
- TSG101, tumor susceptibility gene 101
- VPS4, vacuolar protein sorting-associated protein 4
- kRAS, Kirsten rat sarcoma
- mRNA, messenger RNA
- miRNA, micro RNA
- siRNA, small interference RNA
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Affiliation(s)
| | | | - Venkatareddy Nadithe
- Manchester University, College of Pharmacy, Natural & Health Sciences, Fort Wayne, IN 46845, USA
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16
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Zhang Y, Feng L, Li L, Wang D, Li C, Sun C, Li P, Zheng X, Liu Y, Yang W, Niu X, Zhong N, Chen L. Effects of the fusion design and immunization route on the immunogenicity of Ag85A-Mtb32 in adenoviral vectored tuberculosis vaccine. Hum Vaccin Immunother 2016; 11:1803-13. [PMID: 26076321 DOI: 10.1080/21645515.2015.1042193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Vaccines containing multiple antigens may induce broader immune responses and provide better protection against Mycobacterium tuberculosis (Mtb) infection as compared to a single antigen. However, strategies for incorporating multiple antigens into a single vector and the immunization routes may affect their immunogenicity. In this study, we utilized recombinant adenovirus type 5 (rAd5) as a model vaccine vector, and Ag85A (Rv3804c) and Mtb32 (Rv0125) as model antigens, to comparatively evaluate the influence of codon usage optimization, signal sequence, fusion linkers, and immunization routes on the immunogenicity of tuberculosis (TB) vaccine containing multiple antigens in C57BL/6 mice. We showed that codon-optimized Ag85A and Mtb32 fused with a GSG linker induced the strongest systemic and pulmonary cell-mediated immune (CMI) responses. Strong CMI responses were characterized by the generation of a robust IFN-γ ELISPOT response as well as antigen-specific CD4(+) T and CD8(+) T cells, which secreted mono-, dual-, or multiple cytokines. We also found that subcutaneous (SC) and intranasal (IN)/oral immunization with this candidate vaccine exhibited the strongest boosting effects for Mycobacterium bovis bacille Calmette-Guérin (BCG)-primed systemic and pulmonary CMI responses, respectively. Our results supported that codon optimized Ag85A and Mtb32 fused with a proper linker and immunized through SC and IN/oral routes can generate the strongest systemic and pulmonary CMI responses in BCG-primed mice, which may be particularly important for the design of TB vaccines containing multiple antigens.
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Key Words
- APC, Allophycocyanin
- BCG, Mycobacterium bovis bacille Calmette-Guérin
- BSA, bovine serum album
- CMI, cell-mediated immune responses
- DAPI, 4′,6-diamidino-2-phenylindole
- DMSO, Dimethyl sulfoxide
- ELISPOT, Enzyme-linked immune-sorbent spot
- FACS, Fluorescence Activated Cell Sorter
- FBS, fetal bovine serum
- FITC, fluorescein isothiocyanate
- HA tag, hemagglutinin tag
- HEK, human embryo kidney
- ICS, Intracellular cytokine staining
- IFN-γ, interferon gamma
- IL-2, Interleukin 2
- IM, intramuscular
- IN, intranasal
- Mtb, Mycobacterium tuberculosis
- NBT/BCIP, Nitro blue tetrazolium/ 5-Bromo-4-chloro-3-indolyl phosphate
- PBS, Phosphate Buffered Saline
- PCR, polymerase chain reaction
- PE, Phycoerythrin
- PerCP, Peridinin-ChlorophylL-Protein Complex
- RPMI, Roswell Park Memorial Institute
- SC, subcutaneous
- SDS-PAGE, sodium dodecyl sulfate polyacrylamide gel electrophoresis
- SFC, spot-forming cells
- TB, tuberculosis
- TNF-α, tumor necrosis factor α
- fusion strategies
- immunization routes
- immunogenicity
- multiple antigens
- mycobacterium tuberculosis
- rAd5, recombinant adenovirus type 5
- tPA, tissue plasminogen activator
- vp, viral particles
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Affiliation(s)
- Yiling Zhang
- a State Key Laboratory of Respiratory Diseases; The First Affiliated Hospital of Guangzhou Medical University ; Guangzhou , China
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Abstract
The identification of tumor-associated antigens (TAA) has made possible the development of antigen-specific cancer immunotherapies such as tecemotide. One of those is mucin 1 (MUC1), a cell membrane glycoprotein expressed on some epithelial tissues such as breast and lung. In cancer, MUC1 becomes overexpressed and aberrantly glycosylated, exposing the immunogenic tandem repeat units in the extracellular domain of MUC1. Designed to target tumor associated MUC1, tecemotide is being evaluated in Phase III clinical trials for treatment of unresectable stage IIIA/IIIB non-small cell lung cancer (NSCLC) as maintenance therapy following chemoradiotherapy. Additional Phase II studies in other indications are ongoing. This review discusses the preclinical and clinical development of tecemotide, ongoing preclinical studies of tecemotide in human MUC1 transgenic mouse models of breast and lung cancer, and the potential application of these models for optimizing the timing of chemoradiotherapy and tecemotide immunotherapy to achieve the best treatment outcome for patients.
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Key Words
- ADT, androgen deprivation therapy
- APC, antigen presenting cell
- ASI, active specific immunotherapy
- BSC, best supportive care
- CEA, carcinoembryonic antigen
- CI, confidence interval
- CONSORT, consolidated standards of reporting trials
- CPA, cyclophosphamide
- CRT, chemoradiotherapy
- CTL, Cytotoxic T-lymphocyte
- Chemoradiotherapy
- DMPG, Dimyristoyl phosphatidylglycerol
- DPPC, Dipalmitoyl phosphatidylcholine
- DTH, delayed-type hypersensitivity
- ECOG, Eastern cooperative oncology group
- ELISpot, enzyme-linked immunosorbent spot
- FACT-L, functional assessment of cancer therapy-lung
- Gy, gray
- HLA, human lymphocyte antigen
- HR, hazard ratio
- IFN-γ, interferon gamma
- IL-2, Interleukin 2
- INSPIRE, stimuvax trial in Asian NSCLC patients: stimulating immune response
- ITT, intent to treat
- IgG, immunoglobulin G
- KLH, keyhole limpet hemocyanin
- LICC, L-BLP25 in colorectal cancer
- LR, locoregional
- MAP, multiple antigenic peptide
- MHC, major histocompatibility complex
- MMT, muc1-expressing mammary tumor
- MPLA, monophosphoryl lipid A
- MUC1
- MUC1, Mucin 1
- MUC1.Tg, MUC1 transgenic
- NSCLC, non-small cell lung cancer
- OH-BBN, N-butyl-N-(4-hydroxybutyl)nitrosamine
- OS, overall survival
- PBL, peripheral blood lymphocytes
- PCR, pathological complete remission
- PSA, prostate specific antigen
- PyV-mT, polyomavirus middle-T
- QOL, quality of life
- RCB, residual cancer burden
- RECIST, response evaluation criteria in solid tumors
- RTX, radiotherapy
- START, stimulating targeted antigenic responses to NSCLC
- TAA, tumor associated antigen
- TGF-β, transforming growth factor β
- TH1, T-helper type I
- TH2, T-helper type II
- TNF-α, tumor necrosis factor α
- TOI, trial outcome index
- VNTR, variable number of tandem repeats
- i.v., intravenous
- immunotherapy
- non-small cell lung cancer
- tecemotide
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Affiliation(s)
- Gregory T Wurz
- a University of California , Davis; Department of Internal Medicine; Division of Hematology and Oncology ; Sacramento , CA USA
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Møller LNO, Knudsen AR, Andersen KJ, Nyengaard JR, Hamilton-Dutoit S, Okholm Møller EM, Svendsen P, Møller HJ, Moestrup SK, Graversen JH, Mortensen FV. Anti-CD163-dexamethasone protects against apoptosis after ischemia/reperfusion injuries in the rat liver. Ann Med Surg (Lond) 2015; 4:331-7. [PMID: 26566435 PMCID: PMC4600939 DOI: 10.1016/j.amsu.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/12/2022] Open
Abstract
Aim The Pringle maneuver is a way to reduce blood loss during liver surgery. However, this may result in ischemia/reperfusion injury in the development of which Kupffer cells play a central role. Corticosteroids are known to have anti-inflammatory effects. Our aim was to investigate whether a conjugate of dexamethasone and antibody against the CD163 macrophage cell surface receptor could reduce ischemia/reperfusion injury in the rat liver. Methods Thirty-six male Wistar rats were used for the experiments. Animals were randomly divided into four groups of eight receiving anti-CD163-dexamethasone, high dose dexamethasone, low dose dexamethasone or placebo intravenously 18 h before laparotomy with subsequent 60 min of liver ischemia. After reperfusion for 24 h the animals had their liver removed. Bloods were drawn 30 min and 24 h post ischemia induction. Liver cell apoptosis and necrosis were analyzed by stereological quantification. Results After 24 h' reperfusion, the fraction of cell in non-necrotic tissues exhibiting apoptotic profiles was significantly lower in the high dose dexamethasone (p = 0.03) and anti-CD163-dex (p = 0.03) groups compared with the low dose dexamethasone and placebo groups. There was no difference in necrotic cell volume between groups. After 30 min of reperfusion, levels of haptoglobin were significantly higher in the anti-CD163-dex and high dose dexamethasone groups. Alanine aminotransferase and alkaline phosphatase were significantly higher in the high dose dexamethasone group compared to controls after 24 h' reperfusion. Conclusions We show that pharmacological preconditioning with anti-CD163-dex and high dose dexamethasone reduces the number of apoptotic cells following ischemia/reperfusion injury. We investigated the effect of pharmacologic preconditioning with HDD, LDD and anti-CD163-dex on ischemia/reperfusion injury. Liver cell apoptosis and necrosis were analyzed by stereological quantification. Anti-CD163-dex and high dose dexamethasone reduces the number of apoptotic cells following ischemia/reperfusion injury.
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Key Words
- ALT, alanine aminotransferase
- AP, alkaline phosphatase
- AST, aspartate transaminase
- Anti-CD163-dex, anti-CD163-dexamethasone
- BR, bilirubin
- CD-163
- Dexamethasone
- GGT, gamma-glutamyl transferase
- HDD, high-dose dexamethasone
- HE, hematoxylin & eosin
- Hp, haptoglobin
- IL-1, interleukin 1
- IL-6, interleukin 6
- IRI, ischemia/reperfusion injury
- Inflammatory response
- Ischemia/reperfusion injury
- LDD, low-dose dexamethasone
- Liver
- MP, methylprednisolone
- NVR, necrotic volume ratio
- PM, pringles maneuver
- ROS, reactive oxygen species
- SURS, systematic, uniform, random sampling
- TNF-α, tumor necrosis factor α
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Affiliation(s)
- Lin Nanna Okholm Møller
- Department of Surgical Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Anders Riegels Knudsen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Kasper Jarlhelt Andersen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Jens Randel Nyengaard
- Stereology & Electron Microscopy Laboratory, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | | | - Elise Marie Okholm Møller
- Department of Surgical Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Pia Svendsen
- Department of Biomedicine, Aarhus University, Ole Worms Allé 3, 8000 Aarhus C, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Søren Kragh Moestrup
- Department of Biomedicine, Aarhus University, Ole Worms Allé 3, 8000 Aarhus C, Denmark
| | - Jonas Heilskov Graversen
- Affinicon ApS, Aabogade 15, 8200 Aarhus N, Denmark ; Institute of Molecular Medicine, University of Southern Denmark, J. B. Winsløws vej 21-25, 5000 Odense C, Denmark
| | - Frank Viborg Mortensen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
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Abstract
Vascular permeability is a vital function of the circulatory system that is regulated in large part by the limited flux of solutes, water, and cells through the endothelial cell layer. One major pathway through this barrier is via the inter-endothelial junction, which is driven by the regulation of cadherin-based adhesions. The endothelium also forms attachments with surrounding proteins and cells via 2 classes of adhesion molecules, the integrins and IgCAMs. Integrins and IgCAMs propagate activation of multiple downstream signals that potentially impact cadherin adhesion. Here we discuss the known contributions of integrin and IgCAM signaling to the regulation of cadherin adhesion stability, endothelial barrier function, and vascular permeability. Emphasis is placed on known and prospective crosstalk signaling mechanisms between integrins, the IgCAMs- ICAM-1 and PECAM-1, and inter-endothelial cadherin adhesions, as potential strategic signaling nodes for multipartite regulation of cadherin adhesion.
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Key Words
- ICAM-1
- ICAM-1, intercellular adhesion molecule 1
- IgCAM, immunoglobulin superfamily cell adhesion molecule
- JAM, junctional adhesion molecule
- LPS, lipopolysaccharide
- PECAM-1
- PECAM-1, platelet endothelial cell adhesion molecule 1
- PKC, protein kinase C
- RDG, arginine-aspartic acid- glutamine
- S1P, sphingosine 1 phosphate
- SHP-2, Src homology region 2 domain-containing phosphatase
- TGF-β, transforming growth factor-β
- TNF-α, tumor necrosis factor α
- VCAM-1, vascular cell adhesion molecule 1
- VE-PTP, Receptor-type tyrosine-protein phosphatase β
- VE-cadherin
- VEGF, vascular endothelial growth factor
- adhesion
- eNOS, endothelial nitric oxide synthase
- endothelial barrier function
- fMLP, f-Met-Leu-Phe
- iNOS, inducible nitric oxide synthase
- integrins
- permeability
- transendothelial migration
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Affiliation(s)
- Ingrid H Sarelius
- University of Rochester; Department of Pharmacology and Physiology ; Rochester, NY USA
| | - Angela J Glading
- University of Rochester; Department of Pharmacology and Physiology ; Rochester, NY USA
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Serban K, Muzoora M, Hage CA, Lahm T. Distinct immunologic and radiographic patterns in etanercept-induced lung injury. Respir Med Case Rep 2013; 8:18-20. [PMID: 26029608 PMCID: PMC3920362 DOI: 10.1016/j.rmcr.2012.12.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/03/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022] Open
Abstract
Nonspecific clinical presentation of non-infectious, immune-mediated pulmonary complications of etanercept therapy makes the diagnosis difficult. While bronchoalveolar lavage fluid (BALF) cell analysis is frequently used in diagnosing drug-induced lung disease, BALF patterns in etanercept-induced lung injury (EILI) are not well established. Furthermore, previous reports of EILI diagnosis relied on transbronchial or surgical lung biopsies. Here, we report two patients who developed pulmonary toxicity after etanercept treatment. Both patients were diagnosed with EILI. While one patient presented with CD4(+)-predominant lymphocytic alveolitis (consistent with a sarcoid-like pattern), the other patient exhibited a CD8(+)-predominant pattern (consistent with hypersensitivity pneumonitis-like reaction). The different BAL patterns were accompanied by distinct radiographic findings. Both patients significantly improved after etanercept discontinuation and corticosteroid initiation. We propose that EILI can present with distinct immunologic and radiographic phenotypes. In addition, early BALF analysis with lymphocyte immunophenotyping can further define the underlying immunologic abnormalities, and thereby, avoid more invasive procedures.
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Key Words
- BAL, bronchoalveolar lavage
- Bronchoalveolar lavage
- COP, cryptogenic organizing pneumonia
- CT, computer tomography
- DLCO, diffusing capacity of the lung for carbon monoxide
- EILI, etanercept induced lung injury
- FEV1, forced expiratory volume in 1 second
- FVC, forced vital capacity
- GGO, ground glass opacities
- Hypersensitivity pneumonitis
- Lymphocytic alveolitis
- NSIP, non-specific interstitial pneumonia
- RA, rheumatoid arthritis
- Sarcoid-like reaction
- TNF-α antagonist
- TNF-α, tumor necrosis factor α
- UIP, usual interstitial pneumonia
- VATS, video assisted thoracic surgery
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Affiliation(s)
- Karina Serban
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, 1481 W. 10th Street, VA 111P-IU, Indianapolis, IN 46202, USA
| | - Michael Muzoora
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, 1481 W. 10th Street, VA 111P-IU, Indianapolis, IN 46202, USA
| | - Chadi A Hage
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, 1481 W. 10th Street, VA 111P-IU, Indianapolis, IN 46202, USA
| | - Tim Lahm
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University School of Medicine, 1481 W. 10th Street, VA 111P-IU, Indianapolis, IN 46202, USA ; Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
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