Distinct Murine Pancreatic Transcriptomic Signatures during Chronic Pancreatitis Recovery

We have previously demonstrated that the pancreas can recover from chronic pancreatitis (CP) lesions in the cerulein-induced mouse model. To explore how pancreatic recovery is achieved at the molecular level, we used RNA-sequencing (seq) and profiled transcriptomes during CP transition to recovery. CP was induced by intraperitoneally injecting cerulein in C57BL/6 mice. Time-matched controls (CON) were given normal saline. Pancreata were harvested from mice 4 days after the final injections (designated as CP and CON) or 4 weeks after the final injections (designated as CP recovery (CPR) and control recovery (CONR)). Pancreatic RNAs were extracted for RNA-seq and quantitative (q) PCR validation. Using RNA-seq, we identified a total of 3,600 differentially expressed genes (DEGs) in CP versus CON and 166 DEGs in CPR versus CONR. There are 132 DEGs overlapped between CP and CPR and 34 DEGs unique to CPR. A number of selected pancreatic fibrosis-relevant DEGs were validated by qPCR. The top 20 gene sets enriched from DEGs shared between CP and CPR are relevant to extracellular matrix and cancer biology, whereas the top 10 gene sets enriched from DEGs specific to CPR are pertinent to DNA methylation and specific signaling pathways. In conclusion, we identified a distinct set of DEGs in association with extracellular matrix and cancer cell activities to contrast CP and CPR. Once during ongoing CP recovery, DEGs relevant to DNA methylation and specific signaling pathways were induced to express. The DEGs shared between CP and CPR and the DEGs specific to CPR may serve as the unique transcriptomic signatures and biomarkers for determining CP recovery and monitoring potential therapeutic responses at the molecular level to reflect pancreatic histological resolution.

Pancreatic stromal Gremlin 1 expression during pancreatic tumorigenesis

Chronic pancreatitis (CP) is a major risk factor of pancreatic ductal adenocarcinoma (PDAC). How CP promotes pancreatic oncogenesis remains unclear. A characteristic feature of PDAC is its prominent desmoplasia in the tumor microenvironment, composed of activated fibroblasts and macrophages. Macrophages can be characterized as M1 or M2, with tumor-inhibiting or -promoting functions, respectively. We reported that Gremlin 1 (GREM1), a key pro-fibrogenic factor, is upregulated in the stroma of CP. The current study aimed to investigate the expression of GREM1 and correlation between GREM1 and macrophages within the pancreas during chronic inflammation and the development of PDAC. By mRNA in situ hybridization, we detected GREM1 mRNA expression within α-smooth muscle actin (SMA)-positive fibroblasts of the pancreatic stroma. These designated Fibroblasts^Grem1+ marginally increased from CP to pancreatic intraepithelial neoplasia (PanIN) and PDAC. Within PDAC, Fibroblasts^Grem1+ increased with higher pathological tumor stages and in a majority of PDAC subtypes screened. Additionally, Fibroblasts^Grem1+ positively correlated with total macrophages (Mac^CD68+) and M2 macrophages (M2^CD163+) in PDAC. To begin exploring potential molecular links between Fibroblasts^Grem1+ and macrophages in PDAC, we examined the expression of macrophage migration inhibitory factor (MIF), an endogenous counteracting molecule of GREM1 and an M1 macrophage promoting factor. By IHC staining of MIF, we found MIF to be expressed by tumor cells, positively correlated with GREM1; by IHC co-staining, we found MIF to be negatively correlated with M2^CD163+ expression. Our findings suggest that GREM1 expression by activated fibroblasts may promote PDAC development, and GREM1/MIF may play an important role in macrophage phenotype.

Efficacy and safety of lodoxamide 0.1% vs cromolyn sodium 4% in patients with vernal keratoconjunctivitis

A multicenter, double-masked, parallel-group clinical study compared the efficacy and safety of lodoxamide 0.1% ophthalmic solution and cromolyn sodium 4% ophthalmic solution in 120 patients with vernal keratoconjunctivitis. On various follow-up visits, the clinical efficacy of lodoxamide 0.1% was statistically superior to cromolyn sodium 4% in alleviating four of the primary symptoms (itching, tearing, foreign-body sensation, and discomfort) and five of the primary signs (Trantas' dots, palpebral conjunctival changes, bulbar conjunctival hyperemia, erythema/swelling of the eyelids and periorbital tissues, and epithelial disease). At no time during the study was cromolyn sodium 4% statistically superior to lodoxamide 0.1% in demonstrating improvements in clinical signs and symptoms of vernal keratoconjunctivitis. The physician's clinical judgment of patients' response to treatment showed lodoxamide 0.1% effected a greater and earlier improvement than cromolyn sodium 4%. Both drugs were safe for topical ophthalmic use when used four times daily for up to 28 days.

Long-term betaxolol therapy in glaucoma patients with pulmonary disease

We evaluated the use of topically administered betaxolol 0.5% in 101 glaucoma patients (47 men and 54 women) who had chronic obstructive pulmonary disease, asthma, or timolol-induced bronchoconstriction. Betaxolol 0.5% was administered twice daily and patients were reexamined at three-month intervals for up to two years. In addition to measurement of intraocular pressure, pulmonary function tests were obtained before therapy (baseline), two or three weeks after initiating betaxolol therapy, and at yearly intervals. Before treatment with betaxolol, the mean ratio of forced expiratory volumes in one second (FEV1) to forced vital capacity (FVC) was 66.3% (n = 101). After two weeks of betaxolol treatment, mean FEV1/FVC ratio was 66.2% (n = 101). After one year of betaxolol therapy, mean FEV1/FVC ratio was 60.1% (n = 24), and after two years it was 54.4% (n = 5). Nine patients developed symptoms that may have been associated with betaxolol treatment and were withdrawn from the study. Five of these patients developed symptomatic pulmonary obstruction between one and 554 days after initiating betaxolol treatment. Topically administered betaxolol was well tolerated by most glaucoma patients with concomitant pulmonary disease.

Topical beta-blocker therapy and central nervous system side effects. A preliminary study comparing betaxolol and timolol

Topical beta-blocking agents have been associated with adverse central nervous system (CNS) effects, including depression, emotional lability, and sexual dysfunction. Two studies were done to determine if patients who develop CNS effects while using timolol maleate would improve with betaxolol hydrochloride. In one study, 18 patients with CNS symptoms during timolol therapy were switched to betaxolol. Sixteen of the 18 patients noted symptomatic improvement with betaxolol. The second study involved seven patients with CNS symptoms during timolol therapy who were entered into a double-masked cross-over study. In two patients CNS symptoms resolved with betaxolol; in three patients symptoms improved; and in one patient symptoms worsened with betaxolol. Although factors influencing beta-blocker activity in the CNS are not well understood, there may be some advantage to a selective agent.

Betaxolol in patients with glaucoma and asthma

We evaluated the use of topically administered betaxolol, a cardioselective beta-adrenergic blocking agent, in 11 patients (eight women and three men, 40 to 81 years old) who had asthma and severe glaucoma with increased intraocular pressure despite maximally tolerated medical therapy. In each of these patients, timolol was either contraindicated or had previously led to development of pulmonary symptoms or complications. Before betaxolol, mean forced expiratory volumes in one second were 66% in the men and 80% in the women of reported normal values in age- and height-matched groups. Betaxolol was then topically administered twice daily. All patients continued to administer betaxolol without exacerbation of pulmonary symptoms and without deterioration in measured pulmonary function tests. Betaxolol further reduced intraocular pressure by a mean of 18% (4 mm Hg) when added to the patients' otherwise maximal regimen.