Effective Adjunctive Therapy Research Articles

Antimicrobial photodynamic therapy minimizes the deleterious effect of nicotine in female rats with induced periodontitis

The aim of this study was to compare the use of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) in the treatment of experimentally induced periodontitis in female rats that were systemically treated with or without nicotine. Female rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were implanted in the rats 30days before the induction of experimental periodontitis (EP). EP was induced by placing a cotton ligature around the left mandibular first molar. After 7days, the ligature was removed, and the rats were randomly divided into three treatment subgroups: SRP (only SRP), DL (SRP plus diode laser), and aPDT (SRP plus aPDT). The aPDT consisted of phenothiazine photosensitizer deposition followed by diode laser irradiation. Ten rats from each subgroup were euthanized at 7, 15, and 30days after treatment. Alveolar bone loss (ABL) in the furcation region was evaluated using histological, histometric, and immunohistochemical analyses. The rats that were treated with nicotine showed more ABL compared to those treated with vehicle. In both the Veh and Nic groups, SRP plus aPDT treatment resulted in reduced ABL, smaller numbers of both TRAP- and RANKL-positive cells, and higher numbers of PCNA-positive cells compared to SRP treatment alone. aPDT was an effective adjunctive therapy for the treatment of periodontitis in female rats regardless of whether they received nicotine.

ATPS-61NEW SMALL MOLECULES THAT KILL HYPOXICALLY TRANSFORMED GLIOMA STEM-LIKE CELLS

High grade gliomas (HGGs) are lethal brain cancers, accounting for 78% of adult onset primary CNS malignancies. HGGs are resistant to current conventional therapies, including radiation therapy (RT), chemotherapy, and treatment with anti-angiogenic agents. Populations of cancer cells surviving these treatments regenerate leading to recurrence in more than 95% of patients. Spontaneous tumor necrosis within avascular tumor domains imparts poor clinical prognosis as glioma cells are reprogrammed by hypoxic transcription factors to adopt ‘stem-cell’ like properties; commonly referred to as glioma ‘stem-like’ cells (GSCs). GSCs possess several properties of normal stem cells, including self-aggregation, expression of stem cell markers, ability to survive in hypovascularized tumor regions, ability to survive detachment, and most importantly, the ability of tumor regrowth. GSCs can stop proliferating in hypoxic and acidic perinecrotic regions, which increases their resistance to RT and conventional anti-mitotic therapies. Hypoxically reprogrammed GSCs represent an important drug target to prevent the recurrence of HGGs. Drug targeting of hypovascularized GSCs is challenging as acidic and hypoxic tumor domains promote cell cycle arrest. Thus, therapeutic agents must be cytotoxic, not cytostatic, and need to kill independently of proliferative status. We developed novel small molecules that triggers ‘mis-trafficking’ of endosomes containing urokinase protein cargo in HGGs, and killing non-proliferating and proliferating glioma cells by an irreversible caspase-independent necrotic pathway. We identified that more than 90% of glioma cells within 22 patient derived xenografts (PDX) express intracellular PAI-1 and uPA and that 40-80% of these cells co-express the pluripotent stem cell transcription factors Oct4 and Nanog. Our lead small molecule crosses the intact rodent BBB and selectively kills glioma cells within intracerebral PDX glioma xenografts (PDX). The anti-glioma cytotoxicities of these small molecules is cell cycle independent, unaffected by hypoxia, and could represent an effective adjunctive therapy to be combined with radiotherapy, anti-mitotic, and/or anti-angiogenic therapies.

Retinal Detachment and Proliferative Vitreoretinopathy.

In normal eyes, retinal detachment (RD) occurs at a rate of approximately 5 per 100,000 people per year and the frequency of proliferative vitreoretinopathy (PVR) remains largely unchanged in primary RD, with the incidence ranging from 5.1 to 11.7%. PVR is the most common cause of failed repair of rhegmatogenous RD, and risk factors for PVR are related to several well-known pre-, intra-, and postoperative clinical situations. Current methods of surgical management of RD and PVR are pneumatic retinopexy, scleral buckling, and pars plana vitrectomy (PPV). Surgical success rates for PVR have improved as techniques and instruments of vitrectomy evolved. However, despite these advances, more than one fourth of initially successful cases results in redetachment due to recurrent vitreoretinal traction. Retinal pigment epithelial cells are the key factor in triggering PVR development. In addition, soluble mediators and the extracellular matrix components play a critical role in cellular events, including proliferation and tissue contraction which occur in PVR. Although PPV remains a critical component of the treatment in RD and PVR, ongoing efforts seek to identify adjuvant therapies that might inhibit PVR development. Recent studies have therefore been directed toward pharmacologic inhibition of cellular proliferation and membrane contraction with drugs such as daunorubicin, 5-fluorouracil, and heparin. More detailed understanding of the pathophysiology underlying PVR may lead to the development of effective prophylactic and/or adjunctive therapies. Further work is necessary to identify optimal adjunctive therapies for the management of RD and PVR.

Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report

Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

Targeting glutamine metabolism rescues mice from late-stage cerebral malaria

The most deadly complication of Plasmodium falciparum infection is cerebral malaria (CM) with a case fatality rate of 15-25% in African children despite effective antimalarial chemotherapy. There are no adjunctive treatments for CM, so there is an urgent need to identify new targets for therapy. Here we show that the glutamine analog 6-diazo-5-oxo-L-norleucine (DON) rescues mice from CM when administered late in the infection a time at which mice already are suffering blood-brain barrier dysfunction, brain swelling, and hemorrhaging accompanied by accumulation of parasite-specific CD8(+) effector T cells and infected red blood cells in the brain. Remarkably, within hours of DON treatment mice showed blood-brain barrier integrity, reduced brain swelling, decreased function of activated effector CD8(+) T cells in the brain, and levels of brain metabolites that resembled those in uninfected mice. These results suggest DON as a strong candidate for an effective adjunctive therapy for CM in African children.

HYPERNEPHROMA EXTENDING IN THE RETROHEPATIC VENA CAVA SUS-HEPATIC VEINS OR RIGHT ATRIUM: SURGICAL TECHNIQUES AND OUTCOMES IN 41 PATIENTS

The natural history of hypernephroma with tumoral thrombus extending within the retrohepatic vena cava is dismal. Classic operative treatment consists of cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest. We herein report our experience in terms of surgical techniques and outcomes in 41 consecutive patients presenting a hypernephroma extending in the retrohepatic vena cava at the level of the sus-hepatic veins or the right atrium. Retrospective review of 41 patients operated for hypernephroma extending in the retrohepatic vena cava sus-hepatic veins/right atrium between 2000 and 2015. Patients operated by a dedicated urology/cardiac surgical team. Mean age was 62.6±10.4; 39% female. Surgery was emergent in 7.3% of patients, 2.4% of patients had pre-op dialysis, 4.9% required redo sternotomy and 19.5% had CAD. Tumor thrombus extended to the right atrium in 23pts and to the level of sus-hepatic veins in 18pts. CPB was used in 38pts; mean CPB time 96,5 ± 42,9 min. Mean aortic cross clamp time was 21,1 ± 16,4min. Arterial cannulation was in the aorta or femoral artery in 14pts during the initial experience. In the current era, the axillary artery and the innominate artery were used in 12 pts respectively. Circulatory arrest was performed in 36pts; mean duration of 10,2 ±8,2min at a mean temp of 25.9oC. Cerebral perfusion was antegrade in 25pts, retrograde in 2 pts and hypothermia alone in 9pts. Non-CPB with hepatic exclusion was performed to excise the tumoral thrombus in 3pts. A right nephrectomy was performed in 25pts, a left in 15 pts and bilateral nephrectomy in 1 pt. Four patients had partial vena cava resection with reconstruction. Three patients had an IVC ligation and 5pts had a partial IVC resection. One patient suffered a CVA in the postoperative period. One in-hospital death occurred. Mean follow up time was 1.9±2.0 years. Twenty-two patients died during follow up; 21 were disease related. Three years survival rate was 37.1%. Hypernephroma with extension in the retrohepatic vena cava/right atrium is a rare clinical entity which treatment is complex thus requires dedicated operative teams. Operative technique should be tailored to the patient’s tumor extension and the extent of vena cava obstruction by the tumor. Perioperative results may be conducted with excellent results. Mid-term survival is limited supporting the necessity to pursue research efforts towards effective adjunct therapies.

006.3 Host-directed therapeutics as adjunctive therapy for antibiotic-resistantneisseria gonorrhoeae

Background Due to the emergence of antibiotic resistance, novel therapies such as host-directed therapeutics (HDT) are being explored as adjunctive therapies against Neisseria gonorrhoeae (Gc). Inhibitors of histone deacetylases (HDACi) are HDTs that restore the balance between host histone acetylases and HDAC, the latter of which are induced by pathogens to enhance infection. We recently reported that sulforaphane (SFN), a natural HDACi, induced effectors with anti-Gc activity in tissue culture cells and reduced colonisation of female mice. Here we tested SFN against the multidrug-resistant strain HO41 and its potential to increase the susceptibility of this strain to antibiotics. Methods ME180 cervical epithelial cells were treated with 40 or 80 µM SFN or no SFN for 24 h. Cell culture supernatants were then incubated with HO41; in some experiments, sub-lethal concentrations of ciprofloxacin (CIP) or cefixime (CFX) were added to the supernatants. The number of viable Gc recovered after a 4-hour incubation was determined by quantitative culture. Results Supernatants from cervical cells treated with 40 or 80 µM SFN reduced the survival of strain H041 to 53% and 20%, respectively, relative to recovery from supernatants from untreated cells. Addition of sub-inhibitory concentrations of CIP or CFX to supernatants from SFN-treated (40 µM) cells resulted in a dose-dependent reduction in survival, with 4 µg/ml CIP resulting in 27% survival. Two and 4 µg/ml doses of CFX resulted in 13% and 7% survival, respectively. Addition of 1, 2 and 4 µg/ml of CFX to supernatants from cells treated with 80 uM SFN reduced survival to 15%, 8% and 1%, respectively. Conclusion The susceptibility of strain HO41 to CIP or CFX is enhanced when tested in tissue culture media containing SFN-induced host effectors. These findings suggest that a combination of HDACi and antibiotics may be an effective adjunct therapy against antibiotic-resistant Gc. Disclosure of interest statement This project was funded by grant RO1 AI43053 from the US NIH. No pharmaceutical grants were received in the development of this study.

Simultaneously targeting inflammatory response and parasite sequestration in brain to treat Experimental Cerebral Malaria.

Malaria afflicts around 200 million people annually, with a mortality number close to 600,000. The mortality rate in Human Cerebral Malaria (HCM) is unacceptably high (15–20%), despite the availability of artemisinin-based therapy. An effective adjunct therapy is urgently needed. Experimental Cerebral Malaria (ECM) in mice manifests many of the neurological features of HCM. Migration of T cells and parasite-infected RBCs (pRBCs) into the brain are both necessary to precipitate the disease. We have been able to simultaneously target both these parameters of ECM. Curcumin alone was able to reverse all the parameters investigated in this study that govern inflammatory responses, CD8+ T cell and pRBC sequestration into the brain and blood brain barrier (BBB) breakdown. But the animals eventually died of anemia due to parasite build-up in blood. However, arteether-curcumin (AC) combination therapy even after the onset of symptoms provided complete cure. AC treatment is a promising therapeutic option for HCM.

Ameliorative effect of vanadyl(IV)–ascorbate complex on high-fat high-sucrose diet-induced hyperglycemia, insulin resistance, and oxidative stress in mice

There is mounting evidence demonstrating causative links between hyperglycemia, oxidative stress, and insulin resistance, the core pathophysiological features of type 2 diabetes mellitus. Using a combinational approach, we synthesized a vanadium–antioxidant (i.e., l-ascorbic acid) complex and examined its effect on insulin resistance and oxidative stress. This study was designed to examine whether vanadyl(IV)-ascorbate complex (VOAsc) would reduce oxidative stress, hyperglycemia, and insulin resistance in high-fat high-sucrose diet (HFSD)-induced type 2 diabetes in mice. Male C57BL/6J mice were fed a HFSD for 12 weeks to induce insulin resistance, rendering them diabetic. Diabetic mice were treated with rosiglitazone, sodium l-ascorbate, or VOAsc. At the end of treatment, fasting blood glucose, fasting serum insulin, homeostasis model assessment-insulin resistance index, and serum adipocytokine levels were measured. Serum levels of nitric oxide (NO) parameters were also determined. The liver was isolated and used for determination of malondialdehyde, reduced glutathione, and catalase levels, and superoxide dismutase and glutathione peroxidase activities. VOAsc groups exhibited significant reductions in serum adipocytokine and NO levels, and oxidative stress parameters compared to the corresponding values in the untreated diabetic mice. The results indicated that VOAsc is non-toxic. In conclusion, we identified VOAsc as a potentially effective adjunct therapy for the management of type 2 diabetes.

Phenylbutyrate Is Bacteriostatic against Mycobacterium tuberculosis and Regulates the Macrophage Response to Infection, Synergistically with 25-Hydroxy-Vitamin D3.

Adjunctive vitamin D treatment for pulmonary tuberculosis enhances resolution of inflammation but has modest effects on bacterial clearance. Sodium 4-phenylbutyrate (PBA) is in clinical use for a range of conditions and has been shown to synergise with vitamin D metabolites to upregulate cathelicidin antimicrobial peptide (CAMP) expression. We investigated whether clinically attainable plasma concentrations of PBA (0.4-4mM) directly affect Mycobacterium tuberculosis (Mtb) growth and human macrophage and PBMC response to infection. We also tested the ability of PBA to enhance the immunomodulatory actions of the vitamin D metabolite 25(OH)D3 during infection and synergistically inhibit intracellular Mtb growth. PBA inhibited Mtb growth in broth with an MIC99 of 1mM, which was reduced to 0.25mM by lowering pH. During human macrophage infection, PBA treatment restricted Mtb uptake, phagocytic receptor expression and intracellular growth in a dose-dependent manner. PBA independently regulated CCL chemokine secretion and induced expression of the antimicrobial LTF (lactoferrin), the anti-inflammatory PROC (protein C) and multiple genes within the NLRP3 inflammasome pathway. PBA co-treatment with 25(OH)D3 synergistically modulated expression of numerous vitamin D-response genes, including CAMP, CYP24A1, CXCL10 and IL-37. This synergistic effect was dependent on MAPK signalling, while the effect of PBA on LTF, PROC and NLRP3 was MAPK-independent. During PBA and 25(OH)D3 co-treatment of human macrophages, in the absence of exogenous proteinase 3 (PR3) to activate cathelicidin, Mtb growth restriction was dominated by the effect of PBA, while the addition of PR3 enhanced growth restriction by 25(OH)D3 and PBA co-treatment. This suggests that PBA augments vitamin D–mediated cathelicidin-dependent Mtb growth restriction by human macrophages and independently induces antimicrobial and anti-inflammatory action. Therefore through both host-directed and bacterial-directed mechanisms PBA and vitamin D may prove an effective combinatorial adjunct therapy for tuberculosis to both resolve immunopathology and enhance bacterial clearance.

Inhibiting the Mammalian target of rapamycin blocks the development of experimental cerebral malaria.

ABSTRACTMalaria is an infectious disease caused by parasites of several Plasmodium spp. Cerebral malaria (CM) is a common form of severe malaria resulting in nearly 700,000 deaths each year in Africa alone. At present, there is no adjunctive therapy for CM. Although the mechanisms underlying the pathogenesis of CM are incompletely understood, it is likely that both intrinsic features of the parasite and the human host’s immune response contribute to disease. The kinase mammalian target of rapamycin (mTOR) is a central regulator of immune responses, and drugs that inhibit the mTOR pathway have been shown to be antiparasitic. In a mouse model of CM, experimental CM (ECM), we show that the mTOR inhibitor rapamycin protects against ECM when administered within the first 4 days of infection. Treatment with rapamycin increased survival, blocked breakdown of the blood-brain barrier and brain hemorrhaging, decreased the influx of both CD4+ and CD8+ T cells into the brain and the accumulation of parasitized red blood cells in the brain. Rapamycin induced marked transcriptional changes in the brains of infected mice, and analysis of transcription profiles predicted that rapamycin blocked leukocyte trafficking to and proliferation in the brain. Remarkably, animals were protected against ECM even though rapamycin treatment significantly increased the inflammatory response induced by infection in both the brain and spleen. These results open a new avenue for the development of highly selective adjunctive therapies for CM by targeting pathways that regulate host and parasite metabolism.

Is Mental Practice an Effective Adjunct Therapeutic Strategy for Upper Limb Motor Restoration After Stroke? A Systematic Review and Meta- Analysis

Stroke is one of the most common conditions requiring rehabilitation, and its motor impairments are a major cause of permanent disability. Hemiparesis is observed by 80% of the patients after acute stroke. Neuroimaging studies showed that real and imagined movements have similarities regarding brain activation, supplying evidence that those similarities are based on the same process. Within this context, the combination of mental practice (MP) with physical and occupational therapy appears to be a natural complement based on neurorehabilitation concepts. Our study seeks to investigate if MP for stroke rehabilitation of upper limbs is an effective adjunct therapy. PubMed (Medline), ISI knowledge (Institute for Scientific Information) and SciELO (Scientific Electronic Library) were terminated on 20 February 2015. Data were collected on variables as follows: sample size, type of supervision, configuration of mental practice, setting the physical practice (intensity, number of sets and repetitions, duration of contractions, rest interval between sets, weekly and total duration), measures of sensorimotor deficits used in the main studies and significant results. Random effects models were used that take into account the variance within and between studies. Seven articles were selected. As there was no statistically significant difference between the two groups (MP vs control), showed a - 0.6 (95% CI: -1.27 to 0.04), for upper limb motor restoration after stroke. The present meta-analysis concluded that MP is not effective as adjunct therapeutic strategy for upper limb motor restoration after stroke.

Inhibiting the mammalian target of rapamycin as an adjunctive therapy for cerebral malaria (MPF7P.714)

Abstract Malaria is an infectious disease caused by parasites of the Plasmodium spp. In endemic areas, in approximately 1% of cases, almost exclusively in young children, malaria becomes severe resulting in nearly seven hundred thousand deaths each year in Africa alone. Cerebral malaria (CM) is a common form of severe malaria and one for which we have no effective adjunctive therapy. The kinase, mammalian target of rapamycin (mTOR), through its regulation of cellular metabolism, is a central regulator of immune responses and drugs that inhibit the mTOR pathway have been shown to be antiparasitic, raising the possibility that mTOR inhibitors could be effective adjunctive therapies for CM. Here we show in a mouse model of CM, experimental CM (ECM), that the mTOR inhibitor rapamycin protects against ECM when administered within the first four days of infection. Treatment with rapamycin increased survival, blocked breakdown of the blood brain barrier and brain hemorrhaging, decreased influx of both CD4+ and CD8+ T cells into the brain and the accumulation of parasitized red blood cells in the brain. Remarkably, animals were protected against ECM even though rapamycin treatment significantly increased the inflammatory response induced by infection in both the brain and spleen and elevated the levels of peripheral parasitemia. These results open a new avenue for the development of highly selective adjunctive therapies for CM, by targeting pathways that regulate host and parasite metabolism.

Fenofibrate is effective adjunctive therapy in the treatment of primary biliary cirrhosis: A meta-analysis

Fenofibrate is a potential novel therapy for primary biliary cirrhosis (PBC). We performed a systematic review and a meta-analysis of studies of fenofibrate in PBC. Electronic database search was performed for relevant studies. A search of abstracts presented in the main scientific meetings in the field and articles in press was also performed. Random effect model was used to pool the effect size across studies for changes in alkaline phosphatase, GGT, bilirubin and IgM levels before and after treatment and the overall rate of complete response to fenofibrate therapy. Six studies with 102 patients met the inclusion criteria. All studies were case series and in all, patients who had no or incomplete response to UDCA had fenofibrate added at a dose of 100-200mg daily. Treatment duration ranged from 8-100weeks. Treatment with fenofibrate was associated with a significant decrease in alkaline phosphatase (-114IU/L, 95% CI: -152 to -76, P<0.0001); a significant decrease in GGT level (-92IU/L, 95% CI: -149 to -43; P=0.0004); significant decrease in total bilirubin (-0.11mg/dL, 95% CI: -0.18 to -0.08; P=0.0008); and a significant decrease in IgM level (-88mg/dL, 95% CI: -119 to -58; P<0.0001). The complete response rate was 69% (95% CI: 53-82%) with an odds ratio of 82.8 (95% CI: 21.6-317.2; P=0.024) while on fenofibrate. Fenofibrate at doses of 100-200mg daily appears to be effective adjunctive therapy in PBC patients who had no or incomplete response to UDCA. There is a critical need for larger scale randomized trials to determine its effect on liver-related morbidity and mortality (or progression towards end-stage disease).

Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis on the effects of electrical stimulation therapy (EST) on healing pressure ulcers in individuals with spinal cord injury (SCI). CINAHL, The Cochrane Library, PubMed, SCOPUS, EMBASE, Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI. A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta-analysis with five studies demonstrated that EST significantly decreased the ulcer size by 1·32%/day [95% confidence interval (CI): 0·58-2·05, P < 0·001] compared to standard wound care (SWC) or sham EST. Another meta-analysis conducted with four studies showed that EST increased the risk of wound healing by 1·55 times compared with standard wound care or sham EST (95% CI: 1·12 to 2·15, P < 0·0001). Because of the wide array of outcome measures across studies, a single meta-analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI.

255 High Unsaturated Fat Diets and Unsaturated Visceral Fat Worsen Acute Pancreatitis (AP) Outcomes At Lower Body Mass Index (BMI)

Background & Aims: Environmental enteropathy (EE) is a subclinical intestinal condition highly prevalent in lowand middle-income countries characterized, in part, by malabsorption, intestinal villous atrophy, and crypt hypertrophy. The pathogenesis of EE remains unclear, however supplementation with folate (a key source of one carbon units for DNA methylation) is an effective adjunct therapy for tropical sprue, i.e., persistent diarrhea on a background of EE. To determine the extent to which methyl donor deficiency (MDD) provokes features of EE in mice, we evaluated mechanistic links between dietary methyl donor deficiency and intestinal crypt hypertrophy in mice and in mouse small intestinal crypt cultures (enteroids). Methods: We randomized dams to a standard diet or an isocaloric MDD diet lacking folate, choline, and betaine when pups were 10-days-old. We then randomized weanlings to their dams' diet on day of life 21. Mice were sacrificed and the jejunum was harvested at 6 weeks of age for both histology (n=6/group) and generation of enteroids. Results: Histological comparisons of the jejunum revealed longer crypts in MDD versus control mice, moreso in the distal (85.6 +/13.7 μm vs. 69.3 +/7.2 μm; P<0.0001), vs. proximal (88.8 +/17 μm vs 80.7 +/10.7 μm; P=0.04) portions of the small intestine. Enteroids from control and MDD mice were both viable in standard minigut media; however, all enteroids maintained in MDD media displayed alterations in crypt morphology and decreased epithelial proliferation. Enteroid crypt neck width was 1.3-fold greater in standard vs. MDD media (P<0.001). The number of crypt buds per enteroid was 1.6-fold higher in standard media vs. MDD media (p = 0.0007). The ratio of EdU-positive, or proliferating, cells to Hoechst-positive cells was 2.2-fold higher in standard media vs. MDD media (P<0.0001). Qualitatively, enteroids in MDD media displayed longer crypt domains vs. enteroids in standard media. Conclusions: Complementary in vivo and in vitro findings of altered small intestinal crypt in the setting of methyl donor deficiency suggest that methyl donor deficiency plays a role in the pathogenesis of environmental enteropathy. Further studies are needed to determine whether prolonged methyl donor deficiency promotes epigenetic changes of intestinal stem cells and whether methyl donor supplementation prevents or reverses these changes to promote intestinal epithelial homeostasis in global settings of poverty.

Estrogen receptor (ER) was regulated by RNPC1 stabilizing mRNA in ER positive breast cancer.

Estrogen receptors (ERs), including ERα and ERβ, mainly mediate the genotype effect of estrogen. ERα is highly expressed in most breast cancers. Endocrine therapy is the most effective and safety adjunctive therapy for ER positive breast cancers. RNPC1, an RNA binding protein (RBP), post-transcriptionally regulating gene expression, is emerging as a critical mechanism for gene regulation in mammalian cells. In this study, we revealed RNPC1's capability of regulating ERα expression. There was a significant correlation between RNPC1 and ERα expression in breast cancer tissues. Ectopic expression of RNPC1 could increase ERα transcript and expression in breast cancer cells, and vice versa. Consistent with this, RNPC1 was able to bind to ERα transcript to increase its stability. Furthermore, overexpression of ERα could decrease the level of RNPC1 transcript and protein. It suggested a novel mechanism by which ERα expression was regulated via stabilizing mRNA. A regulatory feedback loop between RNPC1 and ERα was proved. It indicated that RNPC1 played a crucial role in ERα regulation in ER-positive breast cancers via binding to ERα mRNA. These findings might provide new insights into breast cancer endocrine therapy and ERα research.

Normobaric hyperoxia slows blood-brain barrier damage and expands the therapeutic time window for tissue-type plasminogen activator treatment in cerebral ischemia.

Prolonged ischemia causes blood-brain barrier (BBB) damage and increases the incidence of neurovasculature complications secondary to reperfusion. Therefore, targeting ischemic BBB damage pathogenesis is critical to reducing neurovasculature complications and expanding the therapeutic time window of tissue-type plasminogen activator (tPA) thrombolysis. This study investigates whether increasing cerebral tissue PO2 through normobaric hyperoxia (NBO) treatment will slow the progression of BBB damage and, thus, improve the outcome of delayed tPA treatment after cerebral ischemia. Rats were exposed to NBO (100% O2) or normoxia (21% O2) during 3-, 5-, or, 7-hour middle cerebral artery occlusion. Fifteen minutes before reperfusion, tPA was continuously infused to rats for 30 minutes. Neurological score, mortality rate, and BBB permeability were determined. Matrix metalloproteinase-9 was measured by gelatin zymography and tight junction proteins (occludin and cluadin-5) by Western blot in the isolated cerebral microvessels. NBO slowed the progression of ischemic BBB damage pathogenesis, evidenced by reduced Evan blue leakage, smaller edema, and hemorrhagic volume in NBO-treated rats. NBO treatment reduced matrix metalloproteinase-9 induction and the loss of tight junction proteins in ischemic cerebral microvessels. NBO-afforded BBB protection was maintained during tPA reperfusion, resulting in improved neurological functions, significant reductions in brain edema, hemorrhagic volume, and mortality rate, even when tPA was given after prolonged ischemia (7 hours). Early NBO treatment slows ischemic BBB damage pathogenesis and significantly improves the outcome of delayed tPA treatment, providing new evidence supporting NBO as an effective adjunctive therapy to extend the time window of tPA thrombolysis for ischemic stroke.

Tuberculosis treatment and management—an update on treatment regimens, trials, new drugs, and adjunct therapies

WHO estimates that 9 million people developed active tuberculosis in 2013 and 1·5 million people died from it. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis continue to spread worldwide with an estimated 480,000 new cases in 2013. Treatment success rates of MDR and XDR tuberculosis are still low and development of new, more effective tuberculosis drugs and adjunct therapies to improve treatment outcomes are urgently needed. Although standard therapy for drug-sensitive tuberculosis is highly effective, shorter, more effective treatment regimens are needed to reduce the burden of infectious cases. We review the latest WHO guidelines and global recommendations for treatment and management of drug-sensitive and drug-resistant tuberculosis, and provide an update on new drug development, results of several phase 2 and phase 3 tuberculosis treatment trials, and other emerging adjunct therapeutic options for MDR and XDR tuberculosis. The use of fluoroquinolone-containing (moxifloxacin and gatifloxacin) regimens have failed to shorten duration of therapy, and the new tuberculosis drug pipeline is sparse. Scale-up of existing interventions with increased investments into tuberculosis health services, development of new antituberculosis drugs, adjunct therapies and vaccines, coupled with visionary political leadership, are still our best chance to change the unacceptable status quo of the tuberculosis situation worldwide and the growing problem of drug-resistant tuberculosis.

Clinical outcomes of intravenous immunoglobulin therapy in refractory uveitis.

Intravenous immunoglobulin (IVIg) therapy has multiple mechanisms of immunomodulatory action. We wished therefore to assess itsefficacy in a spectrum of patients with refractory uveitis. Retrospective review of clinical chartswas conducted to document response to IVIg treatment in consecutive patients with treatment-refractory uveitis. Main outcome measures were control of intraocular inflammation, visual acuity, progression of the disease, and complications. Four (two male) patients, with a mean age at the beginning of the treatment of 47years (range: 39-64), were included in the study. Indication fortreatment was patients with active non-infectious uveitis refractory to steroids and immunomodulatory therapy. All patients received a course of 0.5g/kg per day of IVIg for three consecutive days, repeating this course at a mean of 11week (range: 2-39weeks) intervals when indicated clinically. The median duration of the IVIg therapy was 7months (range: 3-14months). In three patients treatment resulted in stabilisation and prevention of progression of the disease, and additionally in two patients it facilitated a decrease in prednisolone dose. Treatment failed to induce long-term remission in one patient with recurrence of macular oedema. IVIg was well tolerated with neither immediate nor longer-term adverse events observed. In three out of four cases IVIg was an effective adjunctive therapy and well tolerated for the management of treatment-refractory uveitis.