The Clinical Application of Established and Emerging Biomarkers for Chronic Respiratory Diseases

Biomarkers are indicators of a pathological or physiological state, and they are essential for facilitating the diagnosis of a subclinical condition, understanding the origin or progression of a disease, stratifying the risk, and assessing the response to a specific therapeutic approach [...].

Clinical Applications of Nasal Nitric Oxide in Allergic Rhinitis: A Review of the Literature

Allergic rhinitis, a common allergic disease affecting a significant number of individuals worldwide, is observed in 25% of children and 40% of adults, with its highest occurrence between the ages of 20 and 40. Its pathogenesis, like other allergic diseases, involves innate and adaptive immune responses, characterized by immunologic hypersensitivity to environmental substances. This response is mediated by type 2 immunity. Within type 2 allergic diseases, certain molecules have been identified as clinical biomarkers that contribute to diagnosis, prognosis, and therapy monitoring. Among these biomarkers, nitric oxide has shown to play a key role in various physiological and pathological processes, including neurotransmission, immunity, inflammation, regulation of mucus and cilia, inhibition of microorganisms, and tumor cell growth. Therefore, measurement of nasal nitric oxide has been proposed as an objective method for monitoring airway obstruction and inflammation in different settings (community, hospital, rehabilitation) and in various clinical conditions, including upper airways diseases of the nose and paranasal sinuses. The purpose of this review is to analyze the potential mechanisms contributing to the production of nasal nitric oxide in allergic rhinitis and other related health issues. Additionally, this review aims to identify potential implications for future research, treatment strategies, and long-term management of symptoms.

HDACs class II-selective inhibition alters nuclear receptor-dependent differentiation

Epigenetic deregulation contributes to diseases including cancer, neurodegeneration, osteodystrophy, cardiovascular defects, and obesity. For this reason, several inhibitors for histone deacetylases (HDACs) are being validated as novel anti-cancer drugs in clinical studies and display important anti-proliferative activities. While most inhibitors act on both class I, II, and IV HDACs, evidence is accumulating that class I is directly involved in regulation of cell growth and death, whereas class II members regulate differentiation processes, such as muscle and neuronal differentiation. Here, we show that the novel class II-selective inhibitor MC1568 interferes with the RAR- and peroxisome proliferator-activated receptor γ (PPARγ)-mediated differentiation-inducing signaling pathways. In F9 cells, this inhibitor specifically blocks endodermal differentiation despite not affecting retinoic acid-induced maturation of promyelocytic NB4 cells. In 3T3-L1 cells, MC1568 attenuates PPARγ-induced adipogenesis, while the class I-selective MS275 blocked adipogenesis completely thus revealing a different mode of action and/or target profile of the two classes of HDACs. Using in vivo reporting PPRE-Luc mice, we find that MC1568 impairs PPARγ signaling mostly in the heart and adipose tissues. These results illustrate how HDAC functions can be dissected by selective inhibitors.

Histone acetyltransferase inhibitors and preclinical studies

BACKGROUND

Drugs able to regulate the histone modifier enzymes are very promising tools for the treatment of several diseases, such as cancer. Histone acetyltransferase (HAT) inhibitors are compounds able to inhibit the catalytic activity of HATs reported to be active in cancer, or in several other diseases, such as Alzheimer (AD), diabetes and hyperlipidaemia.

OBJECTIVES

Here we review the status and the rationale for the use of HAT inhibitors in the treatment of various diseases.

METHODS

Patents have been found on the espacenet database; the clinical trials have been reported as in the clinicaltrial.gov website.

RESULTS AND CONCLUSION

Despite the fact that other drugs able to regulate the histone modifier enzymes (such as histone deacetylase inhibitors) have been already approved for the treatment of cancer, HAT inhibitors seem promising for the treatment of human diseases such as AD and diabetes, although side effects and toxicity need to be investigated.

Molecular analysis of the apoptotic effects of BPA in acute myeloid leukemia cells

Background:

BPA (bisphenol A or 2,2-bis(4-hydroxy-phenol)propane) is present in the manufacture of polycarbonate plastic and epoxy resins, which can be used in impact-resistant safety equipment and baby bottles, as protective coatings inside metal food containers, and as composites and sealants in dentistry. Recently, attention has focused on the estrogen-like and carcinogenic adverse effects of BPA. Thus, it is necessary to investigate the cytotoxicity and apoptosis-inducing activity of this compound.

Methods:

Cell cycle, apoptosis and differentiation analyses; western blots.

Results:

BPA is able to induce cell cycle arrest and apoptosis in three different acute myeloid leukemias. Although some granulocytic differentiation concomitantly occurred in NB4 cells upon BPA treatment, the major action was the induction of apoptosis. BPA mediated apoptosis was caspase dependent and occurred by activation of extrinsic and intrinsic cell death pathways modulating both FAS and TRAIL and by inducing BAD phosphorylation in NB4 cells. Finally, also non genomic actions such as the early decrease of both ERK and AKT phosphorylation were induced by BPA thus indicating that a complex intersection of regulations occur for the apoptotic action of BPA.

Conclusion:

BPA is able to induce apoptosis in leukemia cells via caspase activation and involvement of both intrinsic and extrinsic pathways of apoptosis.

New pyrrole-based histone deacetylase inhibitors: binding mode, enzyme- and cell-based investigations

Aroyl-pyrrolyl-hydroxy-amides (APHAs) are a class of synthetic HDAC inhibitors described by us since 2001. Through structure-based drug design, two isomers of the APHA lead compound 1, the 3-(2-benzoyl-1-methyl-1H-pyrrol-4-yl)-N-hydroxy-2-propenamide 2 and the 3-(2-benzoyl-1-methyl-1H-pyrrol-5-yl)-N-hydroxy-2-propenamide 3 (iso-APHAs) were designed, synthesized and tested in murine leukemia cells as antiproliferative and cytodifferentiating agents. To improve their HDAC activity and selectivity, chemical modifications at the benzoyl moieties were investigated and evaluated using three maize histone deacetylases: HD2, HD1-B (class I human HDAC homologue), and HD1-A (class II human HDAC homologue). Docking experiments on HD1-A and HD1-B homology models revealed that the different compounds selectivity profiles could be addressed to different binding modes as observed for the reference compound SAHA. Smaller hydrophobic cap groups improved class II HDAC selectivity through the interaction with HD1-A Asn89-Ser90-Ile91, while bulkier aromatic substituents increased class I HDAC selectivity. Taking into account the whole enzyme data and the functional test results, the described iso-APHAs showed a behaviour of class I/IIb HDACi, with 4b and 4i preferentially inhibiting class IIb and class I HDACs, respectively. When tested in the human leukaemia U937 cell line, 4i showed altered cell cycle (S phase arrest), joined to high (51%) apoptosis induction and significant (21%) differentiation activity.

HDAC-class II specific inhibition involves HDAC proteasome-dependent degradation mediated by RANBP2

Discovered for their ability to deacetylate histones and repress transcription, HDACs are a promising target for therapy of human diseases. The class II HDACs are mainly involved in developmental and differentiation processes, such as myogenesis. We report here that class I and class II HDAC inhibitors such as SAHA or the class II selective inhibitor MC1568 induce down-regulation of class II HDACs in human cells. In particular, both SAHA and MC1568 induce HDAC 4 down-regulation by increasing its specific sumoylation followed by activation of proteasomal pathways of degradation. Sumoylation that corresponds to HDAC 4 nuclear localization results in a transient increase of the HDAC 4 repressive action on target genes such as RARalpha and TNFalpha. The HDAC 4 degradation that follows to its sumoylation results in gene target activation. Silencing of the RANBP2 E3 ligase reverts HDAC 4 repression by blocking its own sumoylation. These findings identify a crosstalk occurring between acetylation, deacetylation and sumoylation pathways and suggest that class II specific HDAC inhibitors may affect different epigenetic pathways.

TNF-related apoptosis-inducing ligand: signalling of a 'smart' molecule

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the tumor necrosis factor super-family and signals via two death receptors, TRAIL-R1 and TRAIL-R2, and two decoy receptors, TRAIL-R3 and TRAIL-R4, differently expressed in normal and cancer cells. TRAIL is mainly studied for its capacity to induce apoptosis preferentially in cancer cells. TRAIL is expressed in a variety of human tissues, in particular in the lymphoid system, suggesting a strong physiological role in the innate immunity. This review will focus on TRAIL gene structure and regulation, protein folding, tissue expression and molecular signalling. Finally, the potential use of TRAIL as anticancer treatment alone or in combination therapy as well as the use of drugs which signal via TRAIL and its receptors will be analyzed.

Feijoa sellowiana derived natural Flavone exerts anti-cancer action displaying HDAC inhibitory activities

Curative properties of some medicinal plants such as the Feijoa sellowiana Bert. (Myrtaceae), have been often claimed, although the corresponding molecular mechanism(s) remain elusive. We report here that the Feijoa acetonic extract exerts anti-cancer activities on solid and hematological cancer cells. Feijoa extract did not show toxic effects on normal myeloid progenitors thus displaying a tumor-selective activity. In the Feijoa acetonic extract, fractionation and subsequent purification and analyses identified Flavone as the active component. Flavone induces apoptosis which is accompanied by caspase activation and p16, p21 and TRAIL over-expression in human myeloid leukemia cells. Use of ex vivo myeloid leukemia patients blasts confirms that both the full acetonic Feijoa extract and its derived Flavone are able to induce apoptosis. In both cell lines and myeloid leukemia patients blasts the apoptotic activity of Feijoa extract and Flavone is accompanied by increase of histone and non-histone acetylation levels and by HDAC inhibition. Our findings show for the first time that the Feijoa apoptotic active principle is the Flavone and that this activity correlates with the induction of HDAC inhibition, supporting the hypothesis of its epigenetic pro-apoptotic regulation in cancer systems.

HDAC inhibitors induce apoptosis in glucocorticoid-resistant acute lymphatic leukemia cells despite a switch from the extrinsic to the intrinsic death pathway

Inhibitors of histone deacetylases (HDACi's) are promising novel tools for cancer therapy. We have compared the growth inhibitory and apoptogenic potential of the pan-HDACi SAHA and the sub-class I selective HDAC inhibitor MS275, as well as valproic acid (VPA) on glucocorticoid sensitive and resistant B (B-ALL) and T (T-ALL) cell acute lymphoblastic leukemia cells and patients blasts. In contrast, to our previous results with U937 acute myeloid leukemia (AML) cells which showed a similar activity of MS275 and SAHA in growth inhibition and apoptosis induction, both B and T-ALL cells were much more efficiently killed by SAHA and VPA than by MS275. The same relative potency was observed with some patient ALL blasts treated ex vivo. SAHA displayed similar efficacy on glucocorticoid-sensitive and insensitive ALL cells but did not synergize with dexamethasone. In studying mediators of apoptosis we found that the TRAIL receptor DR5 is constitutively expressed in glucocorticoid-sensitive CEM-C7 cells which are also TRAIL sensitive. In contrast, glucocorticoid-insensitive CEM-C1 cells do not express DR5 and are insensitive to TRAIL. However, SAHA induces, in addition to p21(WAF1/CIP1) also re-expression of DR5. Importantly, SAHA-induced apoptosis of CEM-C7 cells operates through initiator caspase 10, while it induces apoptosis of CEM-C1 cells through the intrinsic, as well as through caspase-independent death pathways. Our data suggest that the generation of resistance to glucocorticoids has dramatically altered death signaling in these cells and that SAHA overcomes these restrictions by inducing alternative death pathways.

[Tension-free laparoscopic versus open inguinal hernia repair]

AIM

During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique, esthetic, and functional benefits of mini-invasive surgery. Anyway controversy persists regarding the most effective inguinal hernia repair. The aim of this study is to compare the open technique and the laparoscopic approach concerning: complications, recurrences, recovery time and return to usual activity.

METHODS

A randomized prospective analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period. Male well-informed patients with primary monolateral inguinal hernia (ASA I-II) were divided into 2 groups and consecutively treated; group A was treated with laparoscopic transabdominal preperitoneal approach (TAPP) (median age 47+/-7 years, 57 patients), group B with open mesh herniorrhaphy (45+/-6 years, 64 patients).

RESULTS

Complication rate was 5.26% for group A (none needed conversion) and 4.68% for group B. All complications were considered minor. No recurrences were observed over a 12-month follow-up in both groups. Post-operative hospital stay and return to activity show statistically significant differences. Median post-hospital stay was 1.7 days for group A while it was longer (2.9 days) for group B. Significant difference was observed in the duration of convalescence too (group A 9.3+/-7.2 days; group B 12.1+/-7. 1 days).

CONCLUSION

On the basis of our experience, even if a longer follow-up is needed, the validity of laparoscopic approach to inguinal hernia is confirmed. General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity.

[Functional results of colorectal and coloanal anastomosis with and without pouch]

In the last two decades one of the main targets of anorectocolonic surgery has been to develop sphincter saving procedure able to achieve good results with acceptable five-years survivals, optimal local control of the diseases and low rate of local cancer recurrence. Partially the development of new operative techniques such as low colorectal and coloanal anastomoses with or without pouch, the TME operation and the nerve sparing procedure have reach this target. In fact, often after these operations we can observe a functional syndrome called "Post Anterior Resection Syndrome". The basis of this syndrome have to researched in anatomical and physiological alterations that followed a reconstructive operation. It is characterized by frequency and fragmentation of the stool, feeling of incomplete evacuation, tenesmus and urgency. Fecal continence may be compromised to different levels: usually with alteration limited to soiling and impaired control of flatus, occasionally with loss of liquid stool, rarely with loss of solid stools. The anorectal function will be altered for long time following the surgical procedure and the stabilization of functional results may require 1-3 years. On the basis of these considerations, the authors examine the etiopathogenesis and clinical presentation of the "Post Anterior Resection Syndrome", suggesting some expedients to prevent the functional problems. Analysing our experience and a wide specific bibliography, they also underline the indispensable point to achieve a good functional results after a reconstructive procedure. The author conclude asserting that the absence of these points have to be carefully valued because, in these situations, a simply colostomy is able to guarantee a better quality of life that a colorectal/coloanal anastomoses with or without pouch but associated to functional problems.

[Fournier syndrome: multidisciplinary approach]

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and genito-perineal region, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of this mechanisms: local trauma, extension from a perineal, periurethral or ischiorectal infection. It is associated with a high mortality rate. Predisposing factors included diabetes mellitus, steroids or chemotherapy, alcohol abuse, malignancy and radiation therapy. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support, immediate extensive surgical debridement and hyperbaric oxygen therapy. The use of etherologue serum is a valuable adjunct in the therapy of Fournier's gangrene. We report a case of Fournier's syndrome treated with etherologue serum immuno-therapy, together with the conventional multidisciplinary approach. The postoperative course was uneventful and the patient was discharged on day 50 post intervention in good general conditions. The 3 years follow-up showed no recurrence of the disease. In conclusion we remark that the survival can be improved in patients with Fournier's gangrene by multidisciplinary approach.

[Complicated Spigelian hernia: our experience]

We present a case of complicated Spigelian hernia presented with symptoms of intestinal occlusion, in a 50 years old woman. Spigelian hernia represents 1-2% of all abdominal hernias and can occur anywhere along the semicircular line of Douglas. The patient underwent emergency surgery followed by polypropylene plastic repair. The postoperative course was uneventful and the patient was discharged on day 8 post intervention in good general conditions. The 2 years follow-up showed no recurrence of the disease. Clinical examination is the foundation of the diagnosis, whereas radiological findings (ultrasonography, TC) allow the exclusion of other pathologies in the differential diagnosis. The preoperative diagnosis is difficult, mainly because of the non-specificity of symptoms as well as the few cases reported in the literature. In conclusion, we remark that the surgery remains the most effective treatment of Spigelian Hernia.

[Morgagni-Larrey diaphragmatic hernia: report of a case]

The Authors presents a Morgagni-Larrey's diaphragmatic hernia case, observed during subocclusive manifestation. They emphasize the utility to perform always the surgical intervention, also in the asintomatic cases.

Urinary NMP22 in the management of superficial bladder tumours after transurethral resection

The aim of this study was to evaluate the clinical utility of the NMP22 test after transurethral resection of superficial transitional cell carcinoma of the bladder. The test was performed in 28 patients with histologically confirmed bladder tumours and in 41 patients who already had two consecutive negative cytological and cystoscopic results at least 3 months after TUR. In the first group the mean NMP22 value was 62.5 u/ml with a false negative rate of 18%. The specificity of the NMP22 test in 41 patients with a previous history of TCCB was 49%. No difference was detected between patients treated or not with intravesical chemotherapy. Despite its good sensitivity, the NMP22 test cannot be adopted as a routine tool in post-TUR surveillance of patients with superficial bladder cancer, due to its low specificity.