Direct Stimulator Research Articles

Magnetoelectrics for Implantable Bioelectronics: Progress to Date.

ConspectusThe coupling of magnetic and electric properties manifested in magnetoelectric (ME) materials has unlocked numerous possibilities for advancing technologies like energy harvesting, memory devices, and medical technologies. Due to this unique coupling, the magnetic properties of these materials can be tuned by an electric field; conversely, their electric polarization can be manipulated through a magnetic field.Over the past seven years, our lab work has focused on leveraging these materials to engineer implantable bioelectronics for various neuromodulation applications. One of the main challenges for bioelectronics is to design miniaturized solutions that can be delivered with minimally invasive procedures and yet can receive sufficient power to directly stimulate tissue or power electronics to perform functions like communication and sensing.Magnetoelectric coupling in ME materials is strongest when the driving field matches a mechanical resonant mode. However, miniaturized ME transducers typically have resonance frequencies >100 kHz, which is too high for direct neuromodulation as neurons only respond to low frequencies (typically <1 kHz). We discuss two approaches that have been proposed to overcome this frequency mismatch: operating off-resonance and rectification. The off-resonance approach is most common for magnetoelectric nanoparticles (MENPs) that typically have resonance frequencies in the gigahertz range. In vivo experiments on rat models have shown that MENPs could induce changes in neural activity upon excitation with <200 Hz magnetic fields. However, the neural response has latencies of several seconds due to the weak coupling in the off-resonance regime.To stimulate neural responses with millisecond precision, we developed methods to rectify the ME response so that we could drive the materials at their resonant frequency but still produce the slowly varying voltages needed for direct neural stimulation. The first version of the stimulator combined a ME transducer and analog electronics for rectification. To create even smaller solutions, we introduced the first magnetoelectric metamaterial (MNM) that exhibits self-rectification. Both designs have effectively induced neural modulation in rat models with less than 5 ms latency.Based on our experience with in vivo testing of the rectified ME stimulators, we found it challenging to deliver the precisely controlled therapy required for clinical applications, given the ME transducer's sensitivity to the external transmitter alignment. To overcome this challenge, we developed the ME-BIT (MagnetoElectric BioImplanT), a digitally programmable stimulator that receives wireless power and data through the ME link.We further expanded the utility of this technology to neuromodulation applications that require high stimulation thresholds by introducing the DOT (Digitally programmable Overbrain Therapeutic). The DOT has voltage compliance up to 14.5 V. We have demonstrated the efficacy of these designs through various in vivo studies for applications like peripheral nerve stimulation and epidural cortical stimulation.To further improve these systems to be adaptive and enable a network of coordinated devices, we developed a bidirectional communication system to transmit data to and from the implant. To enable even greater miniaturization, we developed a way to use the same ME transducer for wireless power and data communication by developing the first ME backscatter communication protocol.

New Therapeutics for Heart Failure Worsening: Focus on Vericiguat.

Heart failure (HF) is a syndrome characterized by signs and symptoms resulting from structural or functional cardiac abnormalities, confirmed by elevated natriuretic peptides or evidence of congestion. HF patients are classified according to left ventricular ejection fraction (LVEF). Worsening HF (WHF) is associated with increased short- and long-term mortality, re-hospitalization, and healthcare costs. The standard treatment of HF includes angiotensin-converting enzyme inhibitors, angiotensin receptor-neprilysin inhibitors, mineralocorticoid-receptor antagonists, beta-blockers, and sodium-glucose-co-transporter 2 inhibitors. To manage systolic HF by reducing mortality and hospitalizations in patients experiencing WHF, treatment with vericiguat, a direct stimulator of soluble guanylate cyclase (sGC), is indicated. This drug acts by stimulating sGC enzymes, part of the nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) signaling pathway, regulating the cardiovascular system by catalyzing cGMP synthesis in response to NO. cGMP acts as a second messenger, triggering various cellular effects. Deficiencies in cGMP production, often due to low NO availability, are implicated in cardiovascular diseases. Vericiguat stimulates sGC directly, bypassing the need for a functional NO-sGC-cGMP axis, thus preventing myocardial and vascular dysfunction associated with decreased sGC activity in heart failure. Approved by the FDA in 2021, vericiguat administration should be considered, in addition to the four pillars of reduced EF (HFrEF) therapy, in symptomatic patients with LVEF < 45% following a worsening event. Cardiac rehabilitation represents an ideal setting where there is more time to implement therapy with vericiguat and incorporate a greater number of medications for the management of these patients. This review covers vericiguat's metabolism, molecular mechanisms, and drug-drug interactions.

AVPV Kiss1 neuron-specific knockdown of purinergic P2X2 receptor suppresses LH surge and ovulation in Kiss1-Cre rats.

Ovulation disorders are a major cause of low pregnancy rates and infertility in humans and livestock. Kisspeptin neurons located in the anteroventral periventricular nucleus (AVPV) are responsible for the generation of the gonadotropin-releasing hormone (GnRH)/luteinizing hormone (LH) surge and the consequent ovulation in female rodents. The present study aimed to examine whether purinergic neurons are direct upstream stimulators of AVPV kisspeptin neurons that trigger the GnRH/LH surge and consequent ovulation in Kiss1-Cre rats. We specifically knocked down the mRNA expression of the P2rx2 purinergic receptor in AVPV kisspeptin neurons by administering an adeno-associated virus (AAV) vector containing Cre-dependent P2rx2 short hairpin RNA (shRNA) into the AVPV region of ovariectomized (OVX) Kiss1-Cre rats treated with a proestrus level of estradiol-17β (OVX + high E2) or ovary-intact Kiss1-Cre rats. The E2-induced afternoon LH surge was significantly suppressed by AVPV kisspeptin neuron-specific knockdown of P2rx2 in OVX + high E2 Kiss1-Cre rats compared with scrambled shRNA-treated control OVX + high E2 Kiss1-Cre rats. Furthermore, the specific knockdown of P2rx2 in AVPV kisspeptin neurons largely disrupted the estrous cycle, spontaneous LH surge, and ovulation in ovary-intact Kiss1-Cre rats. These findings suggest that purinergic neurons directly stimulate AVPV kisspeptin neurons via P2X2 receptors (P2RX2) to induce the GnRH/LH surge and consequent ovulation in female rats.

The effect of leptin on trained innate immunity and on systemic inflammation in subjects with obesity.

Leptin is associated with cardiometabolic complications of obesity, such as metabolic syndrome and atherosclerosis. In obese men, the presence of metabolic syndrome is associated with higher circulating leptin and interleukin (IL)-6 concentrations and increased monocyte cytokine production capacity. Here, we investigated the effects of leptin on monocyte function and systemic inflammatory markers in obese individuals. We specifically explored whether leptin can induce long-term changes in innate immune function by inducing innate immune memory (also called trained immunity). We exposed human primary monocytes for 24 h to relevant leptin concentrations in vitro and measured cytokine production. In addition, after removing leptin, we incubated monocytes for 5 d in culture medium, and we restimulated them on day 6 to assess cytokine production capacity, phagocytosis, and foam cell formation. Direct stimulation with leptin did not induce cytokine production, but exposure to 50 ng/mL leptin augmented lipopolysaccharide- and R848-induced tumor necrosis factor α (TNF-α) production after 1 wk. In a separate in vivo study in a cohort of 302 obese subjects (body mass index [BMI] >27 kg/m2, 55 to 81 yr), we measured circulating leptin, inflammatory markers, and cytokine production upon ex vivo stimulation of isolated peripheral blood mononuclear cells. Circulating leptin concentrations positively correlated with circulating IL-1β and IL-6, which was more pronounced in men than in women. Four single nucleotide polymorphisms in the leptin gene influenced circulating IL-6 concentrations in men, suggesting a direct effect of leptin on IL-6. In conclusion, in vitro, leptin does not directly stimulate monocytes to produce cytokines, yet induces long-term monocyte hyperresponsiveness, i.e. trained immunity. In obese subjects, leptin is associated with circulating IL-6 in a sex-dependent manner. The underlying mechanisms of the sex-specific effect of leptin on innate immune cells remain to be further investigated.

Three-dimensional growth sensitizes breast cancer cells to treatment with ferroptosis-promoting drugs

Drugs causing ferroptosis, iron-mediated cell death, represent promising tools for cancer treatment. While exploring the effect of these drugs on breast cancer (BC), we found that a ferroptosis-inducing drug erastin dramatically inhibits tumorigenicity of human BC cells in mice but when used at a concentration known to effectively kill other cell types only modestly reduces such growth in 2D monolayer culture. BCs grow in vivo as 3D masses, and we found that ferroptosis inducers erastin and sulfasalazine inhibit growth of multiple human BC cell lines in 3D culture significantly stronger than in 2D culture. To understand the mechanism of this differential effect, we found that ferroptosis inducers upregulate mRNAs encoding multiple direct and indirect autophagy stimulators, such as ATG16L2, ATG9A, ATG4D, GABARAP, SQSTM/p62, SEC23A and BAX, in tumor cells growing in 2D but not in 3D culture. Furthermore, these drugs promoted autophagy of tumor cells growing in a 2D but not in a 3D manner. We observed that pharmacological inhibition of autophagy-stimulating protein kinase ULK1 or RNA interference-mediated knockdown of autophagy mediator ATG12 significantly sensitized tumor cells to erastin treatment in 2D culture. We also found that ferroptosis-promoting treatments upregulate heme oxygenase-1 (HO-1) in BC cells. HO-1 increases cellular free iron pool and can potentially promote ferroptosis. Indeed, we observed that HO-1 knockdown by RNA interference reversed the effect of ferroptosis inducers on BC cell 3D growth. Hence, the effect of these drugs on such growth is mediated by HO-1. In summary, autophagy triggered by ferroptosis-promoting drugs reduces their ability to kill BC growing in a 2D manner. This protection mechanism is inhibited in BC cells growing as a 3D mass, and ferroptosis-promoting drugs kill such cells more effectively. Moreover, this death is mediated by HO-1. Thus, ferroptosis induction represents a promising strategy for blocking 3D BC growth.

Benchtop and bedside validation of a low-cost programmable cortical stimulator in a testbed for bi-directional brain-computer-interface research.

Bi-directional brain-computer interfaces (BD-BCI) to restore movement and sensation must achieve concurrent operation of recording and decoding of motor commands from the brain and stimulating the brain with somatosensory feedback. A custom programmable direct cortical stimulator (DCS) capable of eliciting artificial sensorimotor response was integrated into an embedded BCI system to form a safe, independent, wireless, and battery powered testbed to explore BD-BCI concepts at a low cost. The BD-BCI stimulator output was tested in phantom brain tissue by assessing its ability to deliver electrical stimulation equivalent to an FDA-approved commercial electrical cortical stimulator. Subsequently, the stimulator was tested in an epilepsy patient with subcortical electrocorticographic (ECoG) implants covering the sensorimotor cortex to assess its ability to elicit equivalent responses as the FDA-approved counterpart. Additional safety features (impedance monitoring, artifact mitigation, and passive and active charge balancing mechanisms) were also implemeneted and tested in phantom brain tissue. Finally, concurrent operation with interleaved stimulation and BCI decoding was tested in a phantom brain as a proof-of-concept operation of BD-BCI system. The benchtop prototype BD-BCI stimulator's basic output features (current amplitude, pulse frequency, pulse width, train duration) were validated by demonstrating the output-equivalency to an FDA-approved commercial cortical electrical stimulator (R 2 > 0.99). Charge-neutral stimulation was demonstrated with pulse-width modulation-based correction algorithm preventing steady state voltage deviation. Artifact mitigation achieved a 64.5% peak voltage reduction. Highly accurate impedance monitoring was achieved with R 2 > 0.99 between measured and actual impedance, which in-turn enabled accurate charge density monitoring. An online BCI decoding accuracy of 93.2% between instructional cues and decoded states was achieved while delivering interleaved stimulation. The brain stimulation mapping via ECoG grids in an epilepsy patient showed that the two stimulators elicit equivalent responses. This study demonstrates clinical validation of a fully-programmable electrical stimulator, integrated into an embedded BCI system. This low-cost BD-BCI system is safe and readily applicable as a testbed for BD-BCI research. In particular, it provides an all-inclusive hardware platform that approximates the limitations in a near-future implantable BD-BCI. This successful benchtop/human validation of the programmable electrical stimulator in a BD-BCI system is a critical milestone toward fully-implantable BD-BCI systems.

Emerging concepts in heart failure management and treatment: focus on vericiguat.

The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway is dysregulated in patients with heart failure (HF) resulting in myocardial and vascular dysfunction that contributes to its progression. Vericiguat is a novel direct sGC stimulator that targets in at least two ways the NO-sGC-cGMP pathway with the subsequent restoration of cGMP activity. The VICTORIA trial assessed the effects of vericiguat (versus placebo) in 5050 patients with chronic HF (NYHA class II-IV), left ventricular ejection fraction (LVEF) <45%, elevated natriuretic peptide levels and a recent HF decompensation (hospitalized or outpatient intravenous diuretics). After a median follow-up of 10.8 months, a lower risk (10% reduction) of the primary combined outcome (cardiovascular death or HF hospitalization) was achieved (HR 0.90, 95% CI 0.83-0.98; p=0.02). The composite endpoint was driven by HF hospitalizations (HR 0.9, 95% CI 0.81-1.00; p=0.048) whilst CV death reduction was not statistically significant on its own. The target dose was achieved in 89% of patients treated with vericiguat, and no significant differences were observed in the rates of syncope or hypotension. The VICTORIA trial showed that vericiguat was safe, well tolerated and without need of laboratory testing. The aim of this review is to provide comprehensive information about vericiguat in terms of its differential mechanism of action and clinical data particularly focused on the VICTORIA trial. A comparison is also made with DAPA-HF and EMPEROR-Reduced considering that, in all these contemporary trials, a new study medication was added to the standard triple HF therapy. This is a relevant issue because the VICTORIA trial had a significant but less powerful effect than DAPA-HF and EMPEROR-Reduced on HF outcomes in a setting of more severe disease, higher event rate and shorter follow-up. In addition, relevant data on other previous studies are also provided in both HF with reduced LVEF (SOCRATES-Reduced) and HF with preserved LVEF (SOCRATES-Preserved and VITALITY-Preserved). This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

Vericiguat: A New Hope for Heart Failure Patients.

Heart failure with reduced ejection fraction (HFrEF) is the inability of the heart to adequately contract or eject blood. This heart is unable to produce adequate cardiac output to perfuse vital tissues. At a fundamental level, it is known that the cardioprotective pathway of nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate is impaired in heart failure patients. Vericiguat is a novel, orally used, small molecule, and direct stimulator of the soluble guanylate cyclase, and thus, it enhances the production of cyclic guanosine monophosphate. Vericiguat was approved by the FDA in January of 2021 to reduce the risk of cardiovascular death and heart failure hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics, in adults with symptomatic chronic heart failure and ejection fraction less than 45%. In this review, we describe the chemical and mechanistic aspects, pharmacokinetics, adverse effects, and contraindications of vericiguat so as to facilitate its optimal therapeutic use.

Serum galectin-3 and aldosterone: potential biomarkers of cardiac complications in patients with COVID-19.

Despite severe acute respiratory syndrome (SARS)-Coronavirus (CoV-2) primarily targeting the lungs, the heart represents another critical virus target. Thus, the identification of SARS-CoV-2 disease of 2019 (COVID-19)-associated biomarkers would be beneficial to stratify prognosis and the risk of developing cardiac complications. Aldosterone and galectin-3 promote fibrosis and inflammation and are considered a prognostic biomarker of lung and adverse cardiac remodeling. Here, we tested whether galectin-3 and aldosterone levels can predict adverse cardiac outcomes in COVID-19 patients. To this aim, we assessed galectin-3 and aldosterone serum levels in 51 patients diagnosed with COVID-19, using a population of 19 healthy subjects as controls. In in-vitro studies, we employed 3T3 fibroblasts to assess the potential roles of aldosterone and galectin-3 in fibroblast activation. Serum galectin-3 levels were more elevated in COVID-19 patients than healthy controls and correlated with COVID-19 severity classification and cardiac troponin-I (cTnI) serum levels. Furthermore, we observed an augmented secretion of aldosterone in COVID-19 patients. This adrenal hormone is a direct stimulator of galectin-3 secretion; therefore, we surmised that this axis could perpetrate fibrosis and adverse remodeling in these subjects. Thus, we stimulated fibroblasts with 10% of serum from COVID-19 patients. This challenge markedly rose the expression of smooth muscle alpha (α)-2 actin (ACTA2), a myofibroblast marker. Our study suggests that COVID-19 can affect cardiac structure and function by triggering aldosterone and galectin-3 release that may serve as prognostic and therapeutic biomarkers while monitoring the course of cardiac complications in patients suffering from COVID-19.

Trabecular Bone Microarchitecture Improvement Is Associated With Skeletal Nerve Increase Following Aerobic Exercise Training in Middle-Aged Mice.

Advancing age is associated with bone loss and an increased risk of osteoporosis. Exercise training improves bone metabolism and peripheral nerve regeneration, and may play a critical role in osteogenesis and increase in skeletal nerve fiber density. In this study, the potential positive role of aerobic exercise training in bone metabolism and skeletal nerve regeneration was comprehensively evaluated in 14-month-old male C57BL/6 mice. The mice were divided into two groups: no exercise (non-exercise group) and 8-weeks of aerobic exercise training (exercise group), with six mice in each group. Dual-energy X-ray absorptiometry and micro-computed tomography showed that femoral and tibial bone parameters improved after aerobic exercise training. Greater skeletal nerve fiber density was also observed in the distal femoral and proximal tibial periostea, measured and analyzed by immunofluorescence staining and confocal microscopy. Pearson correlation analysis revealed a significant association between skeletal nerve densities and trabecular bone volume/total volume ratios (distal femur; R2 = 0.82, p < 0.05, proximal tibia; R2 = 0.59, p = 0.07) in the exercise group; while in the non-exercise group no significant correlation was found (distal femur; R2 = 0.10, p = 0.54, proximal tibia; R2 = 0.12, p = 0.51). Analysis of archival microarray database confirmed that aerobic exercise training changed the microRNA profiles in the mice femora. The differentially expressed microRNAs reinforce the role of aerobic exercise training in the osteogenic and neurogenic potential of femora and tibiae. In conclusion, 8-weeks of aerobic exercise training positively regulate bone metabolism, an effect that paralleled a significant increase in skeletal nerve fiber density. These findings suggest that aerobic exercise training may have dual utility, both as a direct stimulator of bone remodeling and a positive regulator of skeletal nerve regeneration.

Follicle-stimulating hormone promotes growth of human prostate cancer cell line-derived tumor xenografts.

Chemical castration in prostate cancer can be achieved with gonadotropin-releasing hormone (GnRH) agonists or antagonists. Their effects differ by the initial flare of gonadotropin and testosterone secretion with agonists and the immediate pituitary-testicular suppression by antagonists. While both suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) initially, a rebound in FSH levels occurs during agonist treatment. This rebound is potentially harmful, taken the expression of FSH receptors (R) in prostate cancer tissue. We herein assessed the role of FSH in promoting the growth of androgen-independent (PC-3, DU145) and androgen-dependent (VCaP) human prostate cancer cell line xenografts in nude mice. Gonadotropins were suppressed with the GnRH antagonist degarelix, and effects of add-back human recombinant FSH were assessed on tumor growth. All tumors expressed GnRHR and FSHR, and degarelix treatment suppressed their growth. FSH supplementation reversed the degarelix-evoked suppression of PC-3 tumors, both in preventive (degarelix and FSH treatment started upon cell inoculation) and therapeutic (treatments initiated 3weeks after cell inoculation) setting. A less marked, though significant FSH effect occurred in DU145, but not in VCaP xenografts. FSHR expression in the xenografts supports direct FSH stimulation of tumor growth. Testosterone supplementation, to maintain the VCaP xenografts, apparently masked the FSH effect on their growth. Treatment with the LH analogue hCG did not affect PC-3 tumor growth despite their expression of luteinizing hormone/choriongonadotropin receptor. In conclusion, FSH, but not LH, may directly stimulate the growth of androgen-independent prostate cancer, suggesting that persistent FSH suppression upon GnRH antagonist treatment offers a therapeutic advantage over agonist.

PKG oxidation at Cys42 amplifies mTORC1 activation to worsen hypertrophic heart disease

Abstract Rationale Protein kinase G-1a (PKG1a) phosphorylation of tuberous sclerosis complex 2 (TSC2, or tuberin) at serine 1365 (S1365) potently suppresses mTORC1 activation. This results in greater autophagy and limits pathological hypertrophy myocytes and the heart. Cardiac stress also induce oxidation of PKG1a between cysteine 42 residues in homo-monomers, which reduces cardioprotection. Objective We tested the hypothesis that pathological mTORC1 activation is potently amplified by concomitant PKG1a C42-oxidation, and that this is countered by stimulating soluble guanylyl cyclase-1 (GC-1). Methods and results In mice expressing only C42-redox inhibited PKG1a (PKG1aCS), pressure-overload (PO) induces markedly less mTORC1 activation, increasing autophagic flux and reducing protein aggregation, hypertrophy, and dysfunction compared to PO in PKG1aWT mice. Similar results were obtained in cardiomyocytes exposed to endothelin-1. Protection against PO in PKG1aCS mice was similar to PKG1aWT co-treated with the mTORC1-inhibitor everolimus. TSC2 S1365 phosphorylation increased more in PKG1aCS than PKG1aWT myocardium after PO. Knock-in mice with TSC2 S1365A and PKG1aCS mutations, to prevent TSC2 phosphorylation by PKG1a displayed amplified mTORC1, cardiodepression, and mortality after PO as compared to PKG1aCS. Lastly, the marked disparity between PKG1aWT and PKG1aCS PO phenotype for TSC2 S1365 phosphorylation, mTORC1 activation, and cardiac dysfunction is overcome by BAY-602770, a direct stimulator of GC-1. Conclusion Oxidant-induced PKG1a C42 dimerization blunts its attenuation of mTORC1 activity by reducing TSC2 S1365 phosphorylation, thereby contributing to inadequate autophagy and worsened hypertrophic dysfunction. This is ameliorated by direct GC-1 stimulation. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): DFG

Detailed Analysis of the Space between the Semicircular Canals for the Purpose of Direct Bone Conduction Stimulation of the Inner Ear

Introduction: Until recently, all locations for bone conduction (BC) stimulator described in the literature were situated outside of the real otic capsule. In recent studies 2 new sites for the BC titanium implant were proposed to directly stimulate the cochlea from the closest possible distance, which was the bone forming the ampulla of the lateral semicircular canal (SC) and the bone between the superior and lateral SC. They proved to be the most efficient in terms of transmission of vibratory energy into the inner ear and could be introduced in the field of BC hearing rehabilitation. To the best of our knowledge the anatomy of the space between SC has not been studied so far. However, screwing the BC implant into the proposed new locations directly at the otic capsule and drilling the bone near the SC cast doubt on the safety of this procedure. In this study we aimed to present a detailed analysis of the anatomy of the otic capsule, especially as regards the space between the SC that seems to be safer. Methods: Sixteen fresh frozen cadaveric temporal bones scanned with micro-computed tomography and analyzed using the multiplanar reconstruction option. The anatomy of the space between the SC was analyzed in detail for the purpose of direct BC stimulation of the inner ear. Results: At least 3 mm of bony tissue is available above the bony space between the crura of the superior SC above the lateral SC, where the new location for the titanium BC implant is proposed. As regards the limitations of the length of screw the BC implant to be screwed, the smallest distance is at least 4 mm of bone thickness. Conclusions: The bone between the crura of the superior SC is the best placement to screw the BC implant directly to the otic capsule. The implant direction should be parallel to the plane of the lateral SC. This location, the direction, and the limitation of the screw length of the BC implant to a maximum of 7 mm present the lowest potential risk of damage to the inner ear.

SUN-638 Perinatal DDE Exposure Disrupts Thermogenesis Early in Development

Numerous epidemiological studies have identified a positive association of exposure to the endocrine-disrupting pesticide dichlorodiphenyltrichloroethane (DDT) and its primary metabolite dichlorodiphenyldichloroethylene (DDE) with the risk of obesity. Of particular concern is the persistent metabolic dysfunction resulting from early life DDT and DDE exposures, evidenced as obesity, glucose intolerance, dyslipidemia, and impaired thermogenesis in adult rodents. However, little is known about the developmental timing and etiopathogenesis of this long-term DDT-related metabolic phenotype. This study aimed to address these knowledge gaps by evaluating endocrine phenotypes and thermogenic parameters at two postnatal (P) time points, P0 and P12, in C57BL/6J mice. Dams were orally gavaged with p,p’-DDT (1.7 mg/kg body weight [BW]), p,p’-DDE (1.31 mg/kg BW), or organic olive oil (vehicle) daily from gestational day (GD) 11.5-P0 or P5. Infrared analysis was then performed during a cold challenge. We further attempted to rescue the cold-challenged P12 mice by administering the β3-adrenergic receptor (AR)-agonist CL316,243 (CL), a direct stimulator of brown adipose (BAT) thermogenesis. At P0, area under the curve analysis revealed higher body temperatures in both males and females exposed to DDE compared to controls during the 9 min cold challenge. In addition, DDE-exposed females lost body heat at a significantly faster rate than sex-matched controls over the 9 min cold challenge. This occurred without any treatment-related differences in resting glucose, suprascapular BAT weight, or body weight for either sex at P0. To assess BAT-autonomous response to β3-AR stimulation during a cold challenge, P12 mice were exposed to the pharmacological β3-AR agonist, or PBS control in a 2x2 exposure design and suprascapular BAT temperature was evaluated via infrared analysis of the suprascapular surface at 10 min intervals. Blood glucose, BAT weight, and BW remained equivocal across all P12 treatment groups. However, BAT temperature was significantly decreased 10 min after cold- challenge in female P12 mice with perinatal DDE-exposure when compared to sex- and perinatal treatment-matched controls. This DDE effect among P12 female mice was rescued by CL. These data suggest that thermogenic dysfunction consequent to perinatal DDE exposure is detectable during postnatal development, well before the emergence of endocrine phenotypes. The CL rescue of the BAT thermogenic impairments observed after perinatal DDE exposure are consistent with DDE toxicities upstream in the β3-AR nerve circuitry. Additionally, the data highlight the emergence of an early postnatal sex divergence in DDE-related thermogenic dysfunction. We speculate that the effects of DDE on suprascapular BAT heat production result from prenatal alterations in sympathetic circuitry.

A Novel Method of Health Services Website for Myocardial Infarction Prediction in Online Health

The current study aims at presenting a model to investigate the feature selection of health services website and its effect on increasing the role of Myocardial Infarction prediction and online health marketing through the case study of the Shahid Rajaee Heart Specialized Hospital, Iran. Considering research objectives, this study is a practical research and regarding the data collection method, it is a descriptive-survey one. The statistical population of this study included all clients of Shahid Rajaee Heart Specialized Hospital. Due to the unlimited and unavailability of the sample, the Cochran formula was used to determine the sample size and 384 people were selected. A questionnaire was distributed among them in a convenient way. Finally, all research hypotheses were confirmed; results showed that visual aesthetics has the most and user friendliness least effect on participation of heart diseases, respectively. In addition, visual aesthetics is an effective and direct stimulator for health marketing on the health services website. Finally, there are some suggestions and solutions to improve and enhance the role of Myocardial Infarction prediction and health marketing in the mentioned hospital.

2-Cl-C.OXT-A stimulates contraction through the suppression of phosphodiesterase activity in human induced pluripotent stem cell-derived cardiac organoids.

Background2-Cl-C.OXT-A (COA-Cl) is a novel synthesized adenosine analog that activates Sphingosine-1-phosphate 1 receptor (S1P1R) and combines with the adenosine A1 receptor (A1R) in G proteins and was shown to enhance angiogenesis and improve the brain function in rat stroke models. However, the role of COA-Cl in hearts remains unclear. COA-Cl, which has a similar structure to xanthine derivatives, has the potential to suppress phosphodiesterase (PDE), which is an important factor involved in the beating of heart muscle.Methods and resultsCardiac organoids with fibroblasts, human induced pluripotent stem cell-derived cardiac myocytes (hiPSC-CMs), and hiPSC-derived endothelial cells (hiPSC-ECs) were cultured until they started beating. The beating and contraction of organoids were observed before and after the application of COA-Cl. COA-Cl significantly increased the beating rate and fractional area change in organoids. To elucidate the mechanism underlying these effects of COA-Cl on cardiac myocytes, pure hiPSC-CM spheroids were evaluated in the presence/absence of Suramin (antagonist of A1R). The effects of COA-Cl, SEW2871 (direct stimulator of S1P1R), two positive inotropes (Isoproterenol [ISO] and Forskolin [FSK]), and negative inotrope (Propranolol [PRP]) on spheroids were assessed based on the beating rates and cAMP levels. COA-Cl stimulated the beating rates about 1.5-fold compared with ISO and FSK, while PRP suppressed the beating rate. However, no marked changes were observed with SEW2871. COA-Cl, ISO, and FSK increased the cAMP level. In contrast, the level of cAMP did not change with PRP or SEW2871 treatment. The results were the same in the presence of Suramin as absence. Furthermore, an enzyme analysis showed that COA-Cl suppressed the PDE activity by half.ConclusionsCOA-Cl, which has neovascularization effects, suppressed PDE and increased the contraction of cardiac organoids, independent of S1P1R and A1R. These findings suggest that COA-Cl may be useful as an inotropic agent for promoting angiogenesis in the future.

Effects of Bone Morphogenetic Protein-2 on Neovascularization During Large Bone Defect Regeneration.

Insufficient blood vessel supply is a primary limiting factor for regenerative approaches to large bone defect repair. Recombinant bone morphogenetic protein-2 (BMP-2) delivery induces robust bone formation and has been observed to enhance neovascularization, but whether the angiogenic effects of BMP-2 are due to direct endothelial cell stimulation or due to indirect paracrine signaling remain unclear. In this study, we evaluated the effects of BMP-2 delivery on vascularized bone regeneration and tested whether BMP-2 induces neovascularization directly or indirectly. We found that delivery of BMP-2 (5 μg) enhanced both bone formation and neovascularization in critically sized (8 mm) rat femoral bone defects; however, BMP-2 did not directly stimulate angiogenesis in vitro. In contrast, conditioned medium from both mesenchymal progenitor cells and osteoblasts induced endothelial cell migration in vitro, suggesting a paracrine mechanism of BMP-2 action. Consistent with this inference, codelivery of BMP-2 with endothelial colony forming cells to a heterotopic site, distant from the skeletal stem cell-rich bone marrow niche, induced ossification but had no effect on neovascularization. Taken together, these data suggest that paracrine activation of osteoprogenitor cells is an important contributor to neovascularization during BMP-2-mediated bone regeneration. Impact Statement In this study, we show that bone morphogenetic protein-2 (BMP-2) robustly induces neovascularization during tissue-engineered large bone defect regeneration, and we found that BMP-2 induced angiogenesis, in part, through paracrine signaling from osteoprogenitor cells.

Investigation of Low-Current Direct Stimulation for Rehabilitation Treatment Related to Muscle Function Loss Using Self-Powered TENG System.

Muscle function loss is characterized as abnormal or completely lost muscle capabilities, and it can result from neurological disorders or nerve injuries. The currently available clinical treatment is to electrically stimulate the diseased muscles. Here, a self‐powered system of a stacked‐layer triboelectric nanogenerator (TENG) and a multiple‐channel epimysial electrode to directly stimulate muscles is demonstrated. Then, the two challenges regarding direct TENG muscle stimulation are further investigated. For the first challenge of improving low‐current TENG stimulation efficiency, it is found that the optimum stimulation efficiency can be achieved by conducting a systematic mapping with a multiple‐channel epimysial electrode. The second challenge is TENG stimulation stability. It is found that the force output generated by TENGs is more stable than using the conventional square wave stimulation and enveloped high frequency stimulation. With modelling and in vivo measurements, it is confirmed that the two factors that account for the stable stimulation using TENGs are the long pulse duration and low current amplitude. The current waveform of TENGs can effectively avoid synchronous motoneuron recruitment at the two stimulation electrodes to reduce force fluctuation. Here, after investigating these two challenges, it is believed that TENG direct muscle stimulation could be used for rehabilitative and therapeutic purpose of muscle function loss treatment.

The Impact of Proinflammatory Cytokynes of Rheumatoid Polyarthritis on the Generalized Loss of Bone Mass

There is a bidirectional interaction between most immune cells and osteoblasts, osteoclasts and their precursor cells. The receptor activator of nuclear factor-kB ligand (RANKL)/RANK/osteoprotegerin (OPG) system plays an essential role in the formation of osteoblasts, but it also has implications in osteoclast biology and implicitly on the diseases characterized by bone loss. Proinflammatory cytokines existing at synovial level function as direct or indirect stimulators of osteoclast differentiation, but also of its survival or activity, although some cytokines may also play an antiosteocastogenic role. The fate of bone destruction is determined by the balance between osteoclastogenic and antiosteoclastogenic mediators. Our study has shown that the early initiation of the therapy with anti-TNF and anti-IL6 biological agents, in patients with rheumatoid arthritis, inhibits bone destruction, regardless of the anti-inflammatory activity in patients with rheumatoid arthritis.

One-Pot Transformation of Technical Lignins into Humic-Like Plant Stimulants through Fenton-Based Advanced Oxidation: Accelerating Natural Fungus-Driven Humification.

Commercial humic acids mainly obtained from leonardite are in increasing demand in agronomy, and their market size is growing rapidly because these materials act as soil conditioners and direct stimulators of plant growth and development. In nature, fungus-driven nonspecific oxidations are believed to be a key to catabolizing recalcitrant plant lignins, resulting in lignin humification. Here we demonstrated the effective transformation of technical lignins derived from the Kraft processing of woody biomass into humic-like plant fertilizers through one-pot Fenton oxidations (i.e., artificially accelerated fungus reactions). The lignin variants resulting from the Fenton reaction, and manufactured using a few different ratios of FeSO4 to H2O2, successfully accelerated the germination of Arabidopsis thaliana seeds and increased the tolerance of this plant to NaCl-induced abiotic stress; moreover, the extent of the stimulation of the growth of this plant by these manufactured lignin variants was comparable or superior to that induced by commercial humic acids. The results of high-resolution (15 T) Fourier transform-ion cyclotron resonance mass spectrometry, electrostatic force microscopy, Fourier transform-infrared spectroscopy, and elemental analyses strongly indicated that oxygen-based functional groups were incorporated into the lignins. Moreover, analyses of the total phenolic contents of the lignins and their sedimentation kinetics in water media together with scanning electron microscopy- and Brunauer–Emmett–Teller-based surface characterizations further suggested that polymer fragmentation followed by modification of the phenolic groups on the lignin surfaces was crucial for the humic-like activity of the lignins. A high similarity between the lignin variants and commercial humic acids also resulted from autonomous deposition of iron species into lignin particles during the Fenton oxidation, although their short-term effects of plant stimulations were maintained whether the iron species were present or absent. Finally, we showed that lignins produced from an industrial-scale acid-induced hydrolysis of wood chips were transformed with the similar enhancements of the plant effects, indicating that our fungus-mimicking processes could be a universal way for achieving effective lignin humification.