Inhibition Of Angiotensin Research Articles

Proteinuria and Progression of Renal Damage: The Main Pathogenetic Mechanisms and Pharmacological Approach

The integrity of the glomerular filtration barrier maintains protein excretion below 150 mg/day. When urinary proteins increase, this indicates damage to the filtration barrier. However, proteinuria is not only a marker of kidney damage but also exacerbates it through various mechanisms involving the glomerular and tubulointerstitial compartments. Therefore, it is essential to intervene with renoprotective action that reduces the proteinuria. In this context, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are cornerstone treatments. Recent advancements include sodium–glucose cotransporter 2 inhibitors, initially used for glycemic control, now recognized for their renoprotective properties in both diabetic and non-diabetic populations. Another drug, Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has emerged as a promising agent, offering anti-inflammatory and antifibrotic benefits with fewer side effects than traditional steroidal options. Finally, dual inhibition of angiotensin II and endothelin-1 receptors through agents like Sparsentan presents a novel approach with significant antiproteinuric effects in IgA nephropathy and focal segmental glomerulosclerosis. This brief review summarizes the mechanisms by which proteinuria promotes kidney damage and the renoprotective therapeutic approaches available, which can be combined with lifestyle modifications and specific treatments for underlying diseases to mitigate the progression of chronic kidney disease.

The Management and Prevention of Delirium in Elderly Patients Hospitalised in Intensive Care Units: A Systematic Review.

Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment. This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications. For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews. The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia. Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation.

Role of renin angiotensin system inhibitors and metformin in Glioblastoma Therapy: a review.

Glioblastoma multiforme (GBM) is a highly aggressive and incurable disease accounting for about 10,000 deaths in the USA each year. Despite the current treatment approach which includes surgery with chemotherapy and radiation therapy, there remains a high prevalence of recurrence. Notable improvements have been observed in persons receiving concurrent antihypertensive drugs such as renin angiotensin inhibitors (RAS) or the antidiabetic drug metformin with standard therapy. Anti-tumoral effects of RAS inhibitors and metformin have been observed in in vitro and in vivo studies. Although clinical trials have shown mixed results, the potential for the use of RAS inhibitors and metformin as adjuvant GBM therapy remains promising. Nevertheless, evidence suggest that these drugs exert multimodal antitumor actions; by particularly targeting several cancer hallmarks. In this review, we highlight the results of clinical studies using multidrug cocktails containing RAS inhibitors and or metformin added to standard therapy for GBM. In addition, we highlight the possible molecular mechanisms by which these repurposed drugs with an excellent safety profile might elicit their anti-tumoral effects. RAS inhibition elicits anti-inflammatory, anti-angiogenic, and immune sensitivity effects in GBM. However, metformin promotes anti-migratory, anti-proliferative and pro-apoptotic effects mainly through the activation of AMP-activated protein kinase. Also, we discussed metformin's potential in targeting both GBM cells as well as GBM associated-stem cells. Finally, we summarize a few drug interactions that may cause an additive or antagonistic effect that may lead to adverse effects and influence treatment outcome.

COMPOSITION OF VOLATILE BIOACTIVE COMPOUNDS OF SEA CUCUMBER (HOLOTHURIA ATRA) EXTRACT AND THEIR BIOACTIVITY AS ANTIVIRALS FOR SARS-COV-2 COVID-19

COVID-19 is a pandemic that has an impact on all aspects of life. This pandemic is caused by the SARS-CoV-2 virus, which has a fast pathogenesis cycle, so alternatives are needed, such as incredibly natural and marine ingredients that can be used as drug candidates. Holothuria atra is an animal candidate that has great potential. This study aims to describe the potential of H. atra as an antiviral candidate for COVID-19 through in silico analysis. The research began with extracts and GC-MS tests to identify the compound content in H. atra. Molecular docking analysis, Lipinski druglikeness, and toxicity predictions were carried out to determine the potential of the compound as an antiviral candidate for COVID-19 through inhibition of RNA-dependent RNA-polymerase protein (RdRp) and human Angiotensin Converting Enzym-2 (hACE2). The research results showed that there were five volatile compounds in the methanol extract of H. atra with one potential compound as a COVID-19 antiviral, namely Cyclohexanone, 2,6-bis((4-methoxyphenyl)methylene)-. Lipinskis druglikeness analysis and toxicity prediction provide support as a COVID-19 antiviral. Further research, such as in vitro and in vivo testing, can be carried out to give an overview of living cells and its activity as an antiviral for COVID-19.

Relationship of angiotensin II receptor blocker (ARB) to the effectiveness of immune checkpoint blockade (ICB) in non-small-cell lung cancer (NSCLC) and inhibition of angiotensin II/AGTR1 signaling in fibroblasts to reduce collagen deposition in the tumor microenvironment (TME).

e14618 Background: Immune checkpoint blockade (ICB) has achieved remarkable success. However, not all patients with advanced tumors respond to ICB. Remodeling of the tumor microenvironment (TME) has emerged as a strategy to facilitate the development of cancer therapies. As the most notable features of TME, immune cells and collagens play a significant role in influencing anti-tumor immunity, with collagen deposition is the most significant physical barrier that hinders immune cell infiltration. Cancer patients are often prescribed multiple medications to address pre-existing comorbidities or side effects from anti-tumor therapy. Given the high prevalence of concurrent medications and the potential for interactions between them and ICB, we identified that the angiotensin II receptor 1 (AGTR1) was positively expressed in CAFs and AGTR1 inhibitor angiotensin receptor blocker (ARB) suppressed the expression of type I collagen and promote immune infiltration. Methods: Retrospective clinical study: An in-house cohort was a multi-center cohort and included 270 patients with non-small-cell lung cancer (NSCLC) receiving ICB therapy from 2020 to 2021 from The Affiliated Wuxi People's Hospital of Nanjing Medical University and The First Affiliated Hospital of Nanjing Medical University. Meta-analysis: 4 studies involving 1,268 participants in total and an in-house cohort with 270 participants were included. We performed an additional meta-analysis on the association between the use of ARBs in cancer patients receiving ICB therapy. Animal models: Xenograft tumor models were randomly divided into two groups, including control and Losartan-treated groups, and mouse cancer models were randomly divided into three groups at the first round and four groups at the second round. Three groups included control, Losartan-treated, and Losartan-treated & CD8-deleted groups, and four groups included control, Losartan-treated, anti-PD-1-treated, and Losartan & anti-PD-1-treated groups. Results: Patients with NSCLC who received ARBs showed improved overall survival and response to immunotherapy compared to those who did not receive ARBs. Losartan, a representative drug of the ARB class, significantly increased collagen deposition in mice tumors, elevated levels of immune cell infiltration, and sensitized anti-PD-1 therapy. Conclusions: We reported that Losartan shaped an inflamed TME by inhibiting collagen I expression of CAFs and enhanced anti-PD-1 immunotherapy in the mouse tumor model. We recommend that ARB should be selected as much as possible for patients receiving ICB therapy and requiring antihypertensive treatment.

Mechanism of protective actions of sparsentan in the kidney: lessons from studies in models of chronic kidney disease.

Simultaneous inhibition of angiotensin II AT1 and endothelin ETA receptors has emerged as a promising approach for treatment of chronic progressive kidney disease. This therapeutic approach has been advanced by the introduction of sparsentan, the first dual AT1 and ETA receptor antagonist. Sparsentan is a single molecule with high affinity for both receptors. It is US Food and Drug Administration approved for immunoglobulin A nephropathy (IgAN) and is currently being developed as a treatment for rare kidney diseases, such as focal segmental glomerulosclerosis. Clinical studies have demonstrated the efficacy and safety of sparsentan in these conditions. In parallel with clinical development, studies have been conducted to elucidate the mechanisms of action of sparsentan and its position in the context of published evidence characterizing the nephroprotective effects of dual ETA and AT1 receptor inhibition. This review summarizes this evidence, documenting beneficial anti-inflammatory, antifibrotic, and hemodynamic actions of sparsentan in the kidney and protective actions in glomerular endothelial cells, mesangial cells, the tubulointerstitium, and podocytes, thus providing the rationale for the use of sparsentan as therapy for focal segmental glomerulosclerosis and IgAN and suggesting potential benefits in other renal diseases, such as Alport syndrome.

#145 Subgroup and secondary endpoint evaluation of a phase 2 randomized placebo-controlled trial of ravulizumab in IgA nephropathy

Abstract Background and Aims The pathogenesis of IgA nephropathy (IgAN) involves immune complex deposition and activation of the complement system, causing formation of the terminal pathway components C5a and C5b-9, leading to inflammation and glomerular damage. Elevated levels of activated C3 in plasma are associated with proteinuria and renal function decline in patients with IgAN [1]; mesangial C3 deposition is also associated with progression of disease [2]. Ravulizumab is a humanized monoclonal antibody that immediately and completely inhibits complement component C5. Primary endpoint (week 26) data from the phase 2 randomized controlled trial (RCT) (NCT04564339) were previously reported and demonstrated a 30% and 33% treatment effect of ravulizumab compared to placebo on 24-hour urine protein and 24-hour urine protein-to-creatinine ratio (UPCR) reduction, respectively [3]. This analysis reports prespecified subgroup and secondary endpoints as well as post hoc exploration of treatment response by baseline serum C3 and C4 quartiles through week 26. Method The SANCTUARY RCT evaluated ravulizumab (IV; weight-based dosing Q8W) vs placebo in adults with primary IgA nephropathy. Randomized patients (2:1) were stratified by mean proteinuria (1–2 vs >2 g/day). Patients (18–75 years) with biopsy-confirmed IgA nephropathy, proteinuria ≥1g/day, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, and on stable maximally tolerated renin angiotensin inhibition were enrolled. The primary endpoint was proteinuria reduction at week 26 based on 24-hour urine collection. Secondary endpoints at week 26 included the proportion of patients with >50% reduction in proteinuria (absolute urine protein) and the percentage with <1g/day proteinuria. The percentage change in proteinuria (absolute urine protein) among subgroups of sex, race, duration of disease, baseline proteinuria and eGFR, and baseline serum C3 and C4 levels were also evaluated, as were safety data. Results 66 patients entered the 26-week initial evaluation period (n = 43, ravulizumab arm; n = 23, placebo arm); 71.2% were White and 21.2% were Asian. Overall, 41.5% and 18.2% of ravulizumab- and placebo-treated patients, respectively, achieved >50% proteinuria reduction (Fig. 1). Proteinuria reduction to <1g/day was achieved in 26.8% and 18.2% in the ravulizumab and placebo arms, respectively. Subgroup analysis indicated a treatment effect across subgroups of sex, race, disease duration, and baseline proteinuria and eGFR (Fig. 2). With ravulizumab, there were reductions of 41.9% and 41.0% in proteinuria for those with the lowest quartile of baseline serum C3 and C4, respectively. Similarly, reductions of 40.4% and 40.8% were observed in those with baseline serum C3 and C4 levels above the lowest quartile. In the ravulizumab arm, two patients had low serum C3 at baseline and there were no patients with low serum C4 at baseline; there was no change in mean serum C3 and C4 levels over time. Treatment with ravulizumab was well-tolerated. Conclusion In this phase 2 trial of ravulizumab in IgAN, proteinuria was significantly reduced with ravulizumab vs placebo through week 26. A reduction in proteinuria was also observed across subgroups of patients. As is typical in IgAN, serum C3 and C4 levels at baseline were normal, and there was no difference in proteinuria reduction by baseline serum C3 and C4 levels with ravulizumab through 6 months.

Elucidating nonlinear pharmacokinetics of telmisartan: Integration of target-mediated drug disposition and OATP1B3-mediated hepatic uptake in a physiologically based model.

Telmisartan, a selective inhibitor of angiotensin II receptor type 1 (AT1), demonstrates nonlinear pharmacokinetics (PK) when orally administered in ascending doses to healthy volunteers, but the underlying mechanisms remain unclear. This study presents a physiologically based pharmacokinetic model integrated with target-mediated drug disposition (TMDD-PBPK model) to explore the mechanism of its nonlinear PK. We employed the Cluster-Gauss Newton method for top-down analysis, estimating the invivo Km,OATP1B3 (Michaelis-Menten constant for telmisartan hepatic uptake via Organic Anion Transporting Polypeptide 1B3) to be 2.0-5.7 nM. This range is significantly lower than the reported invitro value of 810 nM, obtained in 0.3% human serum albumin (HSA) conditions. Further validation was achieved through invitro assessment in plated human hepatocytes with 4.5% HSA, showing a Km of 4.5 nM. These results underscore the importance of albumin-mediated uptake effect for the hepatic uptake of telmisartan. Our TMDD-PBPK model, developed through a "middle-out" approach, underwent sensitivity analysis to identify key factors in the nonlinear PK of telmisartan. We found that the nonlinearity in the area under the concentration-time curve (AUC) and/or maximum concentration (Cmax) of telmisartan is sensitive to Km,OATP1B3 across all dosages. Additionally, the dissociation constant (Kd) for telmisartan binding to the AT1 receptor, along with its receptor abundance, notably influences PK at lower doses (below 20 mg). In conclusion, the nonlinear PK of telmisartan appears primarily driven by hepatic uptake saturation across all dose ranges and by AT1-receptor binding saturation, notably at lower doses.

Fibulin-1 promotes intimal hyperplasia after venous stent implantation through ACE mediated angiotensin II signaling

ObjectiveStent intimal hyperplasia leads to in stent restenosis and thrombosis. This study determined whether Fibulin-1 activity in smooth muscle cells (SMCs) contributes to stent restenosis or thrombosis. MethodsStent implantation was conducted in a pig model. Target vessel samples were stained and analyzed by protein mass spectrometry. Cell experiments and Fibulin-1 SMC specific knockout mice (Fbln1SMKO) were used to investigate the mechanism of Fibulin-1 induced SMC proliferation and thrombosis. ResultsSMC proliferation and phenotypic transition are the main pathological changes of intimal hyperplasia in venous stents. Protein mass spectrometry analysis revealed a total of 67 upregulated proteins and 39 downregulated proteins in intimal hyperplasia after stent implantation compared with normal iliac vein tissues. Among them, Fibulin-1 ranked among the top proteins altered. Fibulin-1 overexpressing human SMCs (Fibulin-1-hSMCs) showed increased migration and phenotypic switching from contractile to secretory type and Fibulin-1 inhibition decreased the activity of SMCs. Mechanistically, Fibulin-1-hSMCs displayed increased levels of angiotensin converting enzyme (ACE) expression and angiotensin II signaling. Inhibition of ACE or angiotensin II signaling alleviated the migration of Fibulin-1-hSMCs. Using Fibulin-1 SMC specific knockout mice (Fbln1SMKO) and venous thrombosis model, we demonstrated that Fibulin-1 deletion attenuated intimal SMCs proliferation and thrombosis. Further, Fibulin-1 concentration was high in iliac vein compression syndrome (IVCS) patients treated with stent and was an independent predictor of venous insufficiency. ConclusionsFibulin-1 promotes SMC proliferation partially through ACE secretion and angiotensin II signaling after stent implantation. Fibulin-1 plays a role in venous insufficiency syndrome, implicating the protein in the detection and treatment of IVCS.

Effect of freeze drying on alpha glucosidase, angiotensin (ACE) inhibition, and nutritional properties of Lactococcus lactis-fermented guava fruit powder

Effect of freeze drying on alpha glucosidase, angiotensin (ACE) inhibition, and nutritional properties of Lactococcus lactis-fermented guava fruit powder

Content analysis, nanoparticle forming potential and acaricidal effects on Tick (Hyalomma marginatum) of essential oils from two common Thymbra species

In this study, the fatty acid, essential oil and aroma composition of Thymbra sintenisii Bornm. & Aznav. subsp. sintenisii Bornm. & Aznav (TSS) and Thymbra sintenisii Bornm. & Azn. subsp. isaurica P.H.Davis (TSI) were determined by GC-MS. The cytotoxic activity was determined with MTT assay and antioxidant activities were determined with DPPH, ABTS, CUPRAC methods. Urease, acetyl, butyryl, angiotensin, α-amylase, tyrosinase, elastase, and collagenase enzyme inhibition activities of these species were also determined. The acaricidal effects of essential oils from aerial parts of TSS and TSI on ticks and the nanoparticle formation potential of their essential oils with AgNO3 were determined and compared. The main components of TSS essential oil and aroma were determined as carvacrol and o-cemen (66.78 and 35.44%, respectively), the major components of TSI essential oil and aroma were carvacrol and γ-terpinene (63.78 and 31.44%, respectively). The species exhibited remarkably high antioxidant activity, particularly in the ABTS and CUPRAC methods. It was also determined that the butyrylcholinesterase and acetylcholinesterase enzyme inhibition activities (Inhibition%: 76.12±0.83 and 74.13±0.33, respectively) of the species were quite high. Moderate antimicrobial activity against the bacteria was observed for both essential oils, with MIC values ranging from 312 to 1250 μg/mL. Moreover, essential oils of these species showed good acaricidal activity on Hyalomma marginatum (LC50: 11.82 μg/mL for TSS; LC50: 57.64 μg/mL for TSI). The high antioxidant, anticholinesterase, and acaracidal activities observed in both species are attributed to the presence of carvacrol in their essential oils. The species have potential to be used in food supplements-preservatives, pharmaceutical industry.

(159) Characteristics and Hypertension Management Trends in Hypertensive Men With and Without Erectile Dysfunction

Abstract Introduction Hypertension, defined as a blood pressure (BP) ≥ 130/80 mmHg and/or use of BP lowering medications, affects 47% of the U.S. population and is the most important modifiable risk factor for cardiovascular disease (CVD) prevention. Prevalence of BP control appears to be decreasing in the U.S. and currently only 1 in 4 adults with hypertension have controlled BP. Erectile dysfunction (ED), an early marker of subclinical CVD, often accompanies hypertension. Most BP lowering medications have been shown to not affect sexual function, but the drug class of angiotensin receptor blockers (ARBs) have generally been found to have favorable effects on erectile function through their inhibition of angiotensin II. Therefore, exploring the relationship between hypertension management and ED is advantageous for the ultimate control and treatment of these two common and highly prevalent diseases. Objective Assess the demographics of hypertensive men with and without ED and examine associations of ED with hypertension management and BP control outcomes Methods All men presenting for an initial visit for hypertension (ICD-10 codes I10, I11.0, and I11.9) between January 2017-December 2022 at an academic medical center were included for analysis. The electronic health record was queried for patient demographics, the diagnosis of ED, cardiovascular comorbidities, major drug classes of antihypertensives, and major PDE5-inhibitors. Descriptive statistics was used to describe patient characteristics by ED status. Chi-squared, t-test, and Mann-Whitney U tests was used to compare characteristics of patients by presence of ED. Results Of 24,723 hypertensive men in our health system during the study period, only 1,119 men (4.5%) were noted to have ED (Table 1). Hypertensive men with ED were younger (56 ± 11), than those without ED (61±15). There was no statistically significant difference in the use of ARBs amongst hypertensive men with and without ED. Initial systolic and diastolic BP was significantly higher amongst men with ED. After pooling all outpatient clinic visits prior to and after the diagnosis of ED, BP control did improve mildly over the study period, but this was coupled with a decrease in BP medication use across all drug classes. Finally, there was a significant increase in hypertensive males who were on a either sildenafil or tadalafil after their ED diagnosis (Table 2). Conclusions This study elucidates several key points in conceptualizing the ED and hypertension problem and lays a foundation for the next phase in addressing critical gaps in care. This research further validates the underdiagnoses and thus undertreatment of ED overall, with a significantly lower than expected number of men with ED. Despite the well-established benefits of ARBs in hypertensive men with ED, we observed a trend of underutilization of this beneficial BP medication option. Improvements in BP control over time for hypertensive men with ED emphasize the role ED could play in hypertension management. Leveraging ARBs and education on the interplay of ED and hypertension could lead to improved rates and control of both diseases. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals, ForHims.

Natural Product-derived Phytochemicals as Potential Inhibitors of Angiotensin Converting Enzyme 2 (ACE2): Promising Drug Candidates for COVID-19

Abstract: COVID-19 was deemed a global pandemic by the World Health Organization in February 2020. The prevalence of viral diseases worldwide has increased the importance of receiving immediate medical attention. There is currently no specific medication or vaccine under consideration to treat coronavirus infection. For reducing or preventing COVID-19 infections, a number of alternative therapies are anticipated, including the use of synthetic drugs, vaccines, interferon therapy etc. Due to the serious side effects of the utilized drug therapies, it is crucial to comprehend the pathogenesis of the coronavirus and explore safe and efficient treatment. : Considering the contribution of plants and herbs in the management of viruses like HIV, Herpes Simplex, MERS-CoV, and influenza, they can be further utilised for COVID-19 treatment. According to reports, SARS-CoV2 infects host cells through Angiotensin-converting enzyme 2 receptors, causing pneumonia linked to COVID-19 as well as acute myocardial injury and long-term cardiovascular damage. A cure for SARS-CoV2 may lie in understanding the receptor, its targets, and the mechanism of viral replication. This review article highlights several plants that have the potential to inhibit ACE2, including Punica granatum, Citrus aurantium, Allium sativum, Piper longum, Curcuma longa, and Coriandrum sativum as well as their extracts and phytoconstituents, such as flavonoids, alkaloids, anthraquinone glycosides, phenolic acids, and others. This review will provide opportunities for researchers to explore the possibility of developing promising dosage forms that will increase the bioavailability and in vivo effectiveness of the lead candidates.

ImmunoglobulinA nephropathy-New treatment possibilities

ImmunoglobulinA (IgA) nephropathy is the most frequent glomerulonephritis in adults in Central Europe. It is characterized by microhematuria and occasionally macrohematuria, proteinuria and a chronic loss of kidney function. The diagnosis is made based on a kidney biopsy. The progressive kidney damage must always be slowed down by normalizing blood pressure, using angiotensin inhibitors and consistently avoiding additional toxic substances. In many cases this is not sufficient and then sodium-glucose transporter 2 (SGLT-2)inhibitors and immunomodulators are used. In particular, the SGLT-2inhibitors show avery significant reduction in proteinuria and slow down the deterioration of the estimated glomerular filtration rate (eGFR). While systemic corticosteroids are now only indicated in rare cases, aspecial budesonide formulation shows good effects. Further pathophysiologically based pharmacotherapies are currently being tested in clinical studies. These include, among others, the dual endothelin type A receptor and angiotensin II receptor antagonist sparsentan, which has already been shown to reduce proteinuria as well as inhibitors of complement activation, which is important for kidney damage. Initial findings for these as well as for the B‑lymphocyte proliferation inhibitor sibeprenlimab, suggest that they could enrich the armamentarium for the treatment of IgA nephropathy in the future.

Correlation between Angiotensin Inhibitor Administration and Longer Survival in Patients Who Underwent Curative Resection for Pancreatic Cancer.

The microenvironment of pancreatic ductal adenocarcinoma (PDAC) with extensive desmoplastic stroma contributes to aggressive cancer behavior. Angiotensin system inhibitors (ASIs) reduce stromal fibrosis and are a promising therapeutic strategy. The purpose of this study was to examine how ASIs affected the oncological results of patients who had their PDAC removed. A retrospective assessment was conducted on the clinicopathological and survival data of patients who received curative resection for PDAC at Severance Hospital between January 2012 and December 2019. A total of 410 participants (228 male and 182 female), with a median follow-up period of 12.8 months, were included in this study. Patients were divided into three groups, based on ASI use and history of hypertension: group 1, normotensive and never used ASI (n=210, 51.2%); group 2, ASI non-users with hypertension (n=50, 12.2%); and group 3, ASI users with hypertension (n=150, 36.6%). The three groups did not differ significantly in terms of age, sex, kind of operation, T and N stages, or adjuvant and neoadjuvant therapy. Moreover, there was no discernible difference in disease-free survival between those who used ASI and those who did not (p=0.636). The 5-year overall survival (OS) rates in groups 1, 2, and 3 were 52.6%, 32.3%, and 38.0%, respectively. However, the OS rate of ASI users was remarkably higher than that of non-users (p=0.016). In patients with resected PDAC, ASI is linked to longer survival rates. Furthermore, for individuals with hypertension, ASI in conjunction with conventional chemotherapy may be an easy and successful treatment option.

A Comprehensive Study on Chemical and Biological Investigation of Thymus Brachychilus Jalas: A Rich Source of Ursolic and Oleanolic Acids

The significance of Thymus species in the scientific community is growing steadily due to their extensive utilization in traditional medicine, food industry, and pharmaceutical sector, owing to their abundance in essential oil and phytochemical content, rendering them commercially significant species. The current work focuses on conducting a comprehensive analysis of the ethanol extract and essential oil derived from the root and aerial portions of Thymus brachychilus Jalas, an endemic species that has not been previously investigated. Additionally, a novel GC-MS (gas chromatography–mass spectrometry) technique was developed to quantify the levels of triterpenoids, which are frequently found in many plants, particularly those belonging to the Lamiaceae family. The approach was then used to assess the triterpenoid content of the species. While the phenolic content of the species was determined by LC-MS/MS (liquid chromatography–tandem mass spectrometry), the chemical composition of triterpenoid, essential oil and flavor (aroma) of the plant was determined by GC-MS. Eucalyptol was the primary ingredient in both the essential oil and the flavor, accounting for 11.05% and 12.35%, respectively. In the DPPH and ABTS radical scavenging techniques, the root ethanol extract exhibited the greatest antioxidant activity with IC50 values of 26.70 ± 0.23 and 19.16 ± 0.11 µg/mL, respectively. There was a high level of urease (59.54 ± 1.67% at 100 µg/mL) inhibitory activity observed in the root ethanol extract in enzyme inhibition assays, as well as angiotensin (94.80 ± 0.56%), elastase (40.19 ± 0.39%), and collagenase (48.26 ± 0.12%) inhibition in the aerial ethanol extract. Moreover, the MCF-7 cell line for breast cancer had a strong cytotoxic impact when exposed to the essential oil of the species (vitality%: 1.45 ± 0.01 at 200 µg/mL. The LC-MS/MS and GC-MS studies revealed that the roots had a significant concentration of rosmarinic acid (15,801 µg analyte/g extract), but the aerial portions had a substantial quantity of ursolic acid (152,374 µg analyte/g extract). The plant exhibits potential in the food, cosmetic, and pharmaceutical sectors on account of its elevated levels of rosmarinic and ursolic acid, superior antioxidant capacity, and angiotensin and urease inhibitory effect.

Expanding options of supportive care in IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, with a potentially serious prognosis. At present, management of IgAN is primarily based on therapeutic lifestyle changes, and excellent blood pressure control and maximized supportive treatment with the combination of inhibition of the renin-angiotensin-aldosterone system with either inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers and inhibitors of sodium-glucose cotransporter-2, and possibly in the future also with endothelin antagonists. Supportive care currently represents the cornerstone of treatment of IgAN. Targeted-release formulation of budesonide should replace systemic corticosteroids in patients with higher proteinuria and active histological lesions. New treatment options are aimed at immunopathogenesis of IgAN including depletion or modulation of Galactose-deficient-Immunoglobulin A1-producing B cells, plasma cells, and the alternate and/or lectin pathway of complement. The exact place of monoclonal antibodies and complement inhibitors will need to be determined. This article reviews potential supportive therapies currently available for patients with IgAN.

Effects of renin–angiotensin inhibitors on renal function and the clinical course in patients with decompensated cirrhosis

Patients with decompensated cirrhosis are at risk of developing acute kidney injury (AKI). Studies have suggested that inhibition of the Renin-Angiotensin System (RAS) has certain nephro- and hepatoprotective effects in patients with compensated liver disease. This study aimed to investigate the clinical impact of RAS-Inhibitors in individuals with decompensated liver cirrhosis. Overall, 1181 consecutive hospitalized patients with ascites that underwent paracentesis were considered for this retrospective study. In total, 667 patients with decompensated cirrhosis fulfilled the inclusion criteria and were finally analyzed. RAS-Inhibitor intake was documented in 41 patients (7%). First, 28-day incidences of AKI and grade III AKI of all patients with RAS-Inhibitors were compared to those without intake. Afterwards, propensity score matching was conducted in a 3:1 manner. Here, incidence of further renal endpoints such as need of hemodialysis were analyzed in detail. In the unmatched setting, intake of RAS-Inhibitors was not associated with an increased 28 day-incidence of AKI (P = 0.76) or LTx-free survival (P = 0.60). However, 28 day-incidence of grade III AKI was significantly lower in patients with RAS-Inhibitor intake (P < 0.001). In the matched setting, 28 day-incidence of AKI did not differ (P = 0.81), while grade III AKI was significantly less frequent in the RAS-Inhibitor group (P < 0.001). Need for hemodialysis was also significantly lower in patients with RAS-Inhibitors (P = 0.03) and LTx-free survival was comparable between both groups (P = 0.52). Thus, this study suggests that intake of RAS-Inhibitors is associated with decreased incidences of grade III AKI and need of hemodialysis in patients with decompensated liver disease.

Factores asociados al tratamiento crónico no justificado con digoxina en pacientes con insuficiencia cardiaca aguda y relación con el pronóstico a corto plazo

ObjectivesTo analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome. MethodPatients diagnosed with AHF who were in chronic treatment with digoxin were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge. ResultsWe analyzed 2366 patients on chronic digoxin treatment (median age=83 years, women=61%), which was considered adequate in 1373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin–angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% vs. 7.6%, p=0.05; and 12.6% vs. 9.1%, p<0.001, respectively). No differences were recorded in prolonged stay (35.7% vs. 33.8%) or post-discharge adverse events (32.9% vs. 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95% CI=0.85-2.03) for in-hospital mortality; 1.29 (0.74-2.25) for 30-day mortality; 1.07 (0.82-1.40) for prolonged stay; and 0.88 (0.65-1.19) for post-discharge adverse event. ConclusionThere is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.

Bioactive Peptides in Meat and Meat Products

A number of bioactive peptides with health benefits have been reported to be generated in meat through the proteolysis phenomena taking place during postmortem aging or further processing. Bioactive peptides consist of short sequences, less than 20 amino acid residues, that are inactive while in the parent protein. These sequences may be activated when they are released from the parent protein by peptidases. Such peptides are released through the hydrolysis of major muscle proteins by muscle endopeptidases, like calpains and cathepsins, and resulting protein fragments and polypeptides are further hydrolyzed by muscle exopeptidases, mainly, tri- and di-peptidylpeptidases, aminopeptidases, and carboxypeptidases. As a result, a variety of peptides with different sequences and lengths and large amounts of free amino acids are generated. The highest amounts of bioactive peptides, and their major health benefits, have been reported in dry-cured ham as a result of the intense proteolysis experienced during the long processing time under mild conditions that favor the action of muscle peptidases. The generated peptides must be bioaccesible and bioavailable to exert their physiological benefit.This means that they must be resistant to gastrointestinal digestion and be absorbed through the intestinal barrier. Some bioactive peptides may be generated through hydrolysis during gastrointestinal digestion. This review is focused on the generation of bioactive peptides in meat and processed meats, on the most relevant bioactivities exerted by such peptides(such as inhibition of angiotensin I–converting enzyme and dipeptidyl peptidase IV as well as antioxidant and anti-inflammatory activity), and on their reported benefits to consumers’health.