Mast Cell Stabilizer Research Articles

Chitosan nanoparticles facilitate improved intestinal permeation and oral pharmacokinetics of the mast cell stabiliser cromoglycate

Cromoglycate is a mast cell stabiliser typically administered via inhalation or intranasally for the treatment of allergy-based respiratory issues. Oral dosing of cromoglycate remains challenging due to its high solubility but low permeability across epithelial membranes in the gastrointestinal tract: effective formulation strategies are clearly needed. Here, we investigate and preclinically develop chitosan-cromoglycate complexes and associated nano/microparticle formulations with muco-adhesive and permeation enhancing capabilities to overcome the biopharmaceutical challenges for oral dosing.The synthesized complexes were optimized with respect to chitosan grade, particle size, and drug loading and demonstrated up to a 9.3-fold enhancement in permeability across a Caco-2 monolayer for chitosan-cromoglycate particles, compared to the pure drug. This increased intestinal permeability led to improved pharmacokinetic performance of cromoglycate, e.g. up to 1.82-fold increase in relative oral bioavailability when dosed to Sprague-Dawley rats in a fasted state. These findings confirm the potential for chitosan particles to serve as an effective oral delivery vehicle for cromoglycate, with additional formulation optimization presenting the opportunity to reduce dosing frequency for treatment of allergy-based respiratory ailments.

Protocol for the Metformin Aneurysm Trial (MAT): a placebo-controlled randomised trial testing whether metformin reduces the risk of serious complications of abdominal aortic aneurysm

BackgroundMultiple observational studies have associated metformin prescription with reduced progression of abdominal aortic aneurysm (AAA). The Metformin Aneurysm Trial (MAT) will test whether metformin reduces the risk of AAA rupture-related mortality or requirement for AAA surgery (AAA events) in people with asymptomatic aneurysms.MethodsMAT is an international, multi-centre, prospective, parallel-group, randomised, placebo-controlled trial. Participants must have an asymptomatic AAA measuring at least 35 mm in maximum diameter, no diabetes, no contraindication to metformin and no current plans for surgical repair. The double-blind period is preceded by a 6-week, single-blind, active run-in phase in which all potential participants receive metformin. Only patients tolerating metformin by taking at least 80% of allocated medication will enter the trial and be randomised to 1500 mg of metformin XR or an identical placebo. The primary outcome is the proportion of AAA events defined as rupture-related mortality or need for surgical repair. Secondary outcomes include AAA growth, major adverse cardiovascular events and health-related quality of life. In order to test if metformin reduced the risk of AAA events by at least 25%, 616 primary outcome events will be required (power 90%, alpha 0.05).DiscussionCurrently, there is no drug therapy for AAA. Past trials have found no convincing evidence of the benefit of multiple blood pressure lowering, antibiotics, a mast cell inhibitor, an anti-platelet drug and a lipid-lowering medication on AAA growth. MAT is one of a number of trials now ongoing testing metformin for AAA. MAT, unlike these other trials, is designed to test the effect of metformin on AAA events. The international collaboration needed for MAT will be challenging to achieve given the current COVID-19 pandemic. If this challenge can be overcome, MAT will represent a trial unique within the AAA field in its large size and design.Trial registrationAustralian Clinical Trials ACTRN12618001707257. Registered on 16 October 2018

SARS-CoV-2-triggered mast cell rapid degranulation induces alveolar epithelial inflammation and lung injury

SARS-CoV-2 infection-induced hyper-inflammation links to the acute lung injury and COVID-19 severity. Identifying the primary mediators that initiate the uncontrolled hypercytokinemia is essential for treatments. Mast cells (MCs) are strategically located at the mucosa and beneficially or detrimentally regulate immune inflammations. In this study, we showed that SARS-CoV-2-triggered MC degranulation initiated alveolar epithelial inflammation and lung injury. SARS-CoV-2 challenge induced MC degranulation in ACE-2 humanized mice and rhesus macaques, and a rapid MC degranulation could be recapitulated with Spike-RBD binding to ACE2 in cells; MC degranulation altered various signaling pathways in alveolar epithelial cells, particularly, the induction of pro-inflammatory factors and consequential disruption of tight junctions. Importantly, the administration of clinical MC stabilizers for blocking degranulation dampened SARS-CoV-2-induced production of pro-inflammatory factors and prevented lung injury. These findings uncover a novel mechanism for SARS-CoV-2 initiating lung inflammation, and suggest an off-label use of MC stabilizer as immunomodulators for COVID-19 treatments.

Mitochondria-targeted triphenylphosphonium-based compounds inhibit FcεRI-dependent degranulation of mast cells by preventing mitochondrial dysfunction through Erk1/2

AimsFcεRI-dependent activation and degranulation of mast cells (MC) play an important role in allergic diseases. We have previously demonstrated that triphenylphosphonium (TPP)-based antioxidant SkQ1 inhibits mast cell degranulation, but the exact mechanism of this inhibition is still unknown. This study focused on investigating the influence of TPP-based compounds SkQ1 and C12TPP on FcεRI-dependent mitochondrial dysfunction and signaling during MC degranulation. Main methodsMC were sensitized by anti-dinitrophenyl IgE and stimulated by BSA-conjugated dinitrophenyl. The degranulation of MC was estimated by β-hexosaminidase release. The effect of TPP-based compounds on FcεRI-dependent signaling was determined by Western blot analysis for adapter molecule LAT, kinases Syk, PI3K, Erk1/2, and p38. Fluorescent microscopy was used to evaluate mitochondrial parameters such as morphology, membrane potential, reactive oxygen species and ATP level. Key findingsPretreatment with TPP-based compounds significantly decreased FcεRI-dependent degranulation of MC. TPP-based compounds also prevented mitochondrial dysfunction (drop in mitochondrial ATP level and mitochondrial fission), and decreased Erk1/2 kinase phosphorylation. Selective Erk1/2 inhibition by U0126 also reduced β-hexosaminidase release and prevented mitochondrial fragmentation during FcεRI-dependent degranulation of MC. SignificanceThese findings expand the fundamental understanding of the role of mitochondria in the activation of MC. It also contributes to the rationale for the development of mitochondrial-targeted drugs for the treatment of allergic diseases.

Guiding Chemically Synthesized Peptide Drug Lead Optimization by Derisking Mast Cell Degranulation-Related Toxicities of a NaV1.7 Peptide Inhibitor.

Studies have shown that some peptides and small molecules can induce non IgE-mediated anaphylactoid reactions through mast cell activation. Upon activation, mast cells degranulate and release vasoactive and proinflammatory mediators, from cytoplasmic granules into the extracellular environment which can induce a cascade of severe adverse reactions. This study describes a lead optimization strategy to select NaV1.7 inhibitor peptides that minimize acute mast cell degranulation (MCD) toxicities. Various in vitro, in vivo, and PKPD models were used to screen candidates and guide peptide chemical modifications to mitigate this risk. Anesthetized rats dosed with peptides demonstrated treatment-related decreases in blood pressure and increases in plasma histamine concentrations which were reversible with a mast cell stabilizer, supporting the MCD mechanism. In vitro testing in rat mast cells with NaV1.7 peptides demonstrated a concentration-dependent increase in histamine. Pharmacodynamic modeling facilitated establishing an in vitro to in vivo correlation for histamine as a biomarker for blood pressure decline via the MCD mechanism. These models enabled assessment of structure-activity relationship (SAR) to identify substructures that contribute to peptide-mediated MCD. Peptides with hydrophobic and cationic characteristics were determined to have an elevated risk for MCD, which could be reduced or avoided by incorporating anionic residues into the protoxin II scaffold. Our analyses support that in vitro MCD assessment in combination with PKPD modeling can guide SAR to improve peptide lead optimization and ensure an acceptable early in vivo tolerability profile with reduced resources, cycle time, and animal use.

Cromolyn platform suppresses fibrosis and inflammation, promotes microglial phagocytosis and neurite outgrowth

Neurodegenerative diseases are characterized by chronic neuroinflammation and may perpetuate ongoing fibrotic reactions within the central nervous system. Unfortunately, there is no therapeutic available that treats neurodegenerative inflammation and its sequelae. Here we utilize cromolyn, a mast cell inhibitor with anti-inflammatory capabilities, and its fluorinated analogue F-cromolyn to study fibrosis-related protein regulation and secretion downstream of neuroinflammation and their ability to promote microglial phagocytosis and neurite outgrowth. In this report, RNA-seq analysis shows that administration of the pro-inflammatory cytokine TNF-α to HMC3 human microglia results in a robust upregulation of fibrosis-associated genes. Subsequent treatment with cromolyn and F-cromolyn resulted in reduced secretion of collagen XVIII, fibronectin, and tenascin-c. Additionally, we show that cromolyn and F-cromolyn reduce pro-inflammatory proteins PLP1, PELP1, HSP90, IL-2, GRO-α, Eotaxin, and VEGF-Α, while promoting secretion of anti-inflammatory IL-4 in HMC3 microglia. Furthermore, cromolyn and F-cromolyn augment neurite outgrowth in PC12 neuronal cells in concert with nerve growth factor. Treatment also differentially altered secretion of neurogenesis-related proteins TTL, PROX1, Rab35, and CSDE1 in HMC3 microglia. Finally, iPSC-derived human microglia more readily phagocytose Aβ42 with cromolyn and F-cromolyn relative to controls. We propose the cromolyn platform targets multiple proteins upstream of PI3K/Akt/mTOR, NF-κB, and GSK-3β signaling pathways to affect cytokine, chemokine, and fibrosis-related protein expression.

Sphingoid base in pineapple glucosylceramide suppresses experimental allergy by binding leukocyte mono-immunoglobulin-like receptor 3.

BACKGROUNDThe increase in patients suffering from type I hypersensitivity, including hay fever and food allergy, is a serious public health issue around the world. Recent studies have focused on allergy prevention by food factors with fewer side effects. The purpose of this study was to evaluate the effect of dietary glucosylceramide from pineapples (P‐GlcCer) on type I hypersensitivity and elucidate mechanisms.RESULTSOral administration of P‐GlcCer inhibited ear edema in passive cutaneous anaphylaxis reaction. In a Caco‐2/RBL‐2H3 co‐culture system, P‐GlcCer inhibited β‐hexosaminidase release from RBL‐2H3 cells. The direct treatment of P‐GlcCer on RBL‐2H3 did not affect β‐hexosaminidase release, but sphingoid base moiety of P‐GlcCer did. These results predicted that sphingoid base, a metabolite of P‐GlcCer, through the intestine inhibited type I hypersensitivity by inhibiting mast cell degranulation. In addition, the inhibitory effects of P‐GlcCer on ear edema and degranulation of RBL‐2H3 cells were canceled by pretreatment of leukocyte mono‐immunoglobulin‐like receptor 3 (LMIR3)‐Fc, which can block LMIR3‐mediated inhibitory signals.CONCLUSIONIt was demonstrated that a sphingoid base, one of the metabolites of P‐GlcCer, may inhibit mast cell degranulation by binding to LMIR3. The oral administration of P‐GlcCer is a novel and attractive food factor that acts directly on mast cells to suppress allergy. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Effect of mast cell stabilization on angiogenesis in primary and secondary experimental Trichinella spiralis infection

BackgroundMast cells are known to affect the primary and secondary immune responses against parasites, and this effect is partially mediated through the release of pro-angiogenic mediators. The aim of this study was to explore the effect of the mast cell stabilizer (MCS), ketotifen, with and without albendazole, an anti-parasitic prescription medicine, on the inflammatory response against Trichinella spiralis, with the overall aim to investigate its effect on angiogenesis accompanying nurse cell formation.MethodsThe effect of ketotifen and albendazole was explored in eight groups of female BALB/c mice. Four groups were sensitized with a small dose of T. spiralis larvae. The drug regimen was then applied to both sensitized (challenged) and non-sensitized mice. The parasite load was assessed by histopathological examination of the small intestine and muscle tissue, and angiogenesis was assessed by immunohistochemistry to determine the expression of vascular endothelial growth factor (VEGF).ResultsSensitized mice showed a significantly lower parasite load and a more pronounced inflammatory response than mice receiving a single infective dose of T. spiralis larvae. All treated groups showed a significant reduction in parasite count compared to the control groups (groups IAa and IBa), reaching approximately an 98.8% reduction in adult parasite count in the sensitized group treated with albendazole (groups IIAb and IIBb). MCS significantly decreased the parasite count during both the intestinal or muscular phases, reduced tissue inflammation, and decreased local VEGF expression, both in the non-sensitized and sensitized groups.ConclusionSensitization with a low dose of T. spiralis larvae was found to confer a partial protective immunity against re-infection and to positively affect the study outcomes, thus underlining the importance of vaccination, but after extensive studies. The anti-angiogenic effect of MCS protects against larval encystation during the muscle phase. The anti-angiogenic potential of albendazole suggests that the action of this anti-helminthic during trichinellosis is not confined to structural damage to the parasite cuticle but includes an effect on host immunopathological response.Graphical

Mast Cell Stabilizing, Antianaphylactic and Bronchodilatory activity of Methanolic extract of Averrhoa carambola Fruit

This work was mainly aimed to study the mast cell stabilizing, anti-anaphylactic and bronchodilatory activities of methanolic extract of Averrhoa carambola (ACME). Mast cell stabilization activity was investigated by Compound 48/80 induced mast cell degranulation in rats and antianaphylactic activity was performed by determining the mortality rate of mice upon exposure to compound 48/80. The bronchodilatory effect of ACME was studied on histamine aerosol-induced bronchospasm using guinea pigs, in which occurrence of preconvulsive dyspnea (PCD) was noted as end point. Treatment with ACME (100, 200 and 400mg/kg) showed significant (p<0.05) protection of rat peritoneal mast cells and significantly (p<0.05) reduced the mortality of mice in a dose dependent manner. ACME significantly (p<0.05) increased the time of preconvulsive dyspnea (PCD) in a dose dependent manner that suggestive of bronchodilating activity. Phytochemical studies observed presence of saponins, tannins, steroids, alkaloids, flavonoids and glycosides. From these finding, we concluded that ACME possesses mast cell stabilizing; anti anaphylactic and bronchodilatory activity which might be used in treatment of asthma.

Enzymatic crosslinking and food allergenicity: A comprehensive review.

Food allergy has become a major global public health concern. In the past decades, enzymatic crosslinking technique has been employed to mitigate the immunoreactivity of food allergens. It is an emerging non-thermal technique that can serve as a great alternative to conventional food processing approaches in developing hypoallergenic food products, owing to their benefits of high specificity and selectivity. Enzymatic crosslinking via tyrosinase (TYR), laccase (LAC), peroxidase (PO), and transglutaminase (TG) modifies the structural and biochemical properties of food allergens that subsequently cause denaturation and masking of the antigenic epitopes. LAC, TYR, and PO catalyze the oxidation of tyrosine side chains to initiate protein crosslinking, while TG initiates isopeptide bonding between lysine and glutamine residues. Enzymatic treatment produces a high molecular weight crosslinked polymer with reduced immunoreactivity and IgE-binding potential. Crosslinked allergens further inhibit mast cell degranulation due to the lower immunostimulatory potential that assists in the equilibration of T-helper (Th)1/Th2 immunobalance. This review provides an updated overview of the studies carried out in the last decade on the potential application of enzymatic crosslinking for mitigating food allergenicity that can be of importance in the context of developing hypoallergenic/non-allergenic food products.

Understanding human mast cells: lesson from therapies for allergic and non-allergic diseases.

Mast cells have crucial roles in allergic and other inflammatory diseases. Preclinical approaches provide circumstantial evidence for mast cell involvement in many diseases, but these studies have major limitations - for example, there is still a lack of suitable mouse models for some mast cell-driven diseases such as urticaria. Some approaches for studying mast cells are invasive or can induce severe reactions, and very few mediators or receptors are specific for mast cells. Recently, several drugs that target human mast cells have been developed. These include monoclonal antibodies and small molecules that can specifically inhibit mast cell degranulation via key receptors (such as FcεRI), that block specific signal transduction pathways involved in mast cell activation (for example, BTK), that silence mast cells via inhibitory receptors (such as Siglec-8) or that reduce mast cell numbers and prevent their differentiation by acting on the mast/stem cell growth factor receptor KIT. In this Review, we discuss the existing and emerging therapies that target mast cells, and we consider how these treatments can help us to understand mast cell functions in disease.

A MAST KNOWN CAUSE OF SHOCK

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: The main types of shock include cardiogenic, hypovolemic, distributive, and neurogenic shock. Management of shock requires identifying and correcting the underlying cause, and supporting end-organ perfusion with fluid resuscitation and vasoactive medications. Here we present a rare cause of distributive shock. CASE PRESENTATION: A 65-year-old man presented with 2-month history of progressive weakness. Laboratory studies reviewed new thrombocytopenia to 25 x10(9)/L and acute renal failure with creatinine of 3.24 mg/dL. His bone marrow biopsy was concerning for acute mast cell leukemia, and he was started on treatment with 1 gram of methylprednisolone. About 1 hour after receiving this infusion, he developed chest pain, tachycardia and tachypnea. He was urgently transferred to the ICU. In the ICU, his condition progressed into ventricular fibrillation requiring CPR, defibrillation, and intubation. He was in refractory circulatory shock requiring high doses of norepinephrine, epinephrine, vasopressin, and stress dose steroids. Given his underlying mast cell leukemia, empirical treatment for mast cell activation syndrome was started. He received scheduled diphenhydramine, famotidine, montelukast and cromolyn. Patient was quickly weaned off vasoactive medications in the next 24 hours. Tryptase obtained at time of his hypotensive event was markedly elevated at greater than 2000 ng/mL. He had worsening renal failure requiring renal replacement therapy, and given his underlying diagnosis of mast cell leukemia, a rare hematological malignancy with limited treatment options and high mortality, the focus of his care was transitioned to concentrate solely on his comfort. DISCUSSION: Mast cell disorders include cutaneous and systemic mastocytosis, allergic diseases, and idiopathic disorders. Acute mast cell leukemia is a rare form of systemic mastocytosis characterized by at least 20% immature mast cells in bone marrow. Sudden mast cell activation leads to degranulation of mast cell and release of pre-formed mediators including histamine. It also stimulates de novo synthesis of other cytokines and chemokines. Typical symptoms include flushing, lightheadedness and abdominal cramping, but can progress to syncope and distributive shock, as seen in our patient. Treatment includes identification and avoidance of triggers, and supportive care with antihistamines (both H1 and H2 blockers) and cromolyn (mast cell stabilizer). CONCLUSIONS: It is essential for critical care clinicians to recognize mast cell activation syndrome as a potential cause of refractory shock, especially in at risk patients with systemic mastocytosis. Prompt treatment with antihistamines and cromolyn can facilitate resolution of shock. REFERENCE #1: Akin C, Valent P, Metcalfe DD. Mast cell activation syndrome: Proposed diagnostic criteria. J Allergy Clin Immunol. 2010;126(6):1099-104.e4. doi:10.1016/j.jaci.2010.08.035 REFERENCE #2: Molderings GJ, Haenisch B, Brettner S, et al. Pharmacological treatment options for mast cell activation disease. Naunyn Schmiedebergs Arch Pharmacol. 2016;389(7):671-694. doi:10.1007/s00210-016-1247-1 DISCLOSURES: No relevant relationships by Alice Gallo De Moraes, source=Web Response No relevant relationships by Zhenmei Zhang, source=Web Response

Nutraceutical Aid for Allergies - Strategies for Down-Regulating Mast Cell Degranulation.

Interactions of antigens with the mast cell FcεRI-IgE receptor complex induce degranulation and boost synthesis of pro-inflammatory lipid mediators and cytokines. Activation of spleen tyrosine kinase (Syk) functions as a central hub in this signaling. The tyrosine phosphatase SHP-1 opposes Syk activity; stimulation of NADPH oxidase by FcεRI activation results in the production of oxidants that reversibly inhibit SHP-1, up-regulating the signal from Syk. Activated AMPK can suppress Syk activation by the FcεRI receptor, possibly reflecting its ability to phosphorylate the FcεRI beta subunit. Cyclic GMP, via protein kinase G II, enhances the activity of SHP-1 by phosphorylating its C-terminal region; this may explain its inhibitory impact on mast cell activation. Hydrogen sulfide (H2S) likewise opposes mast cell activation; H2S can boost AMPK activity, up-regulate cGMP production, and trigger Nrf2-mediated induction of Phase 2 enzymes – including heme oxygenase-1, whose generation of bilirubin suppresses NADPH oxidase activity. Phycocyanobilin (PCB), a chemical relative of bilirubin, shares its inhibitory impact on NADPH oxidase, rationalizing reported anti-allergic effects of PCB-rich spirulina ingestion. Phase 2 inducer nutraceuticals can likewise oppose the up-regulatory impact of NADPH oxidase on FcεRI signaling. AMPK can be activated with the nutraceutical berberine. High-dose biotin can boost cGMP levels in mast cells via direct stimulation of soluble guanylate cyclase. Endogenous generation of H2S in mast cells can be promoted by administering N-acetylcysteine and likely by taurine, which increases the expression of H2S-producing enzymes in the vascular system. Mast cell stabilization by benifuuki green tea catechins may reflect the decreased surface expression of FcεRI.

S3178 Eosinophilic Gastroenteritis Presenting as Hypoalbuminemia

Introduction: Eosinophilic gastritis and gastroenteritis (EG/EGE) are inflammatory disorders characterized by eosinophilic infiltration of the stomach and/or duodenum, rarely also impacting the distal small bowel and colon. Case Description/Methods: We present a challenging case of eosinophilic gastroenteritis in a 64-year-old male with history of IgG Kappa monoclonal smoldering multiple myeloma who developed hypoalbunemia and lower and upper extremity edema. He was referred for concern for protein losing enteropathy. Lab work up was significant for an albumin level of 2.6 g/dl, and peripheral eosinophils were elevated to 9.5 %. Workup showed no cardiac etiology or deep venous thrombosis. Urine analysis was negative for protein loss. Computed tomography abdomen pelvis was normal. Infectious workup including stool testing for ova and parasites, HIV screening, and strongyloides IgG were negative. Stool tryptase was negative. Endoscopy was notable for impressively enlarged gastric folds with diffuse, patchy erythema (Fig. 1 right side). Mucosa was otherwise unremarkable on upper and lower endoscopy. Pathology of gastric biopsies showed >30 eosinophils per high-power field in the lamina propria, and biopsies of the ileum and colon were also notable for an increased eosinophilic infiltrate (Fig.1 left side). The patient was started on oral prednisone 40 mg daily, with improvement in peripheral eosinophil counts and albumin, though lab values were suggestive of recurrence with completion of steroid taper. The patient is currently planned for additional workup including bone marrow biopsy, as well as referral to a dietician for food elimination diet trial and allergist for environmental allergy evaluation. Discussion: The natural history and disease course of EG/EGE is not well defined. Dietary therapy and treatment with prednisone have been described as possible interventions, largely extrapolated from studies on eosinophilic esophagitis. Patients are often followed for response to treatments based upon their symptoms and the changes in peripheral eosinophilia. Other therapies like anti-Immunoglobulin E (IgE) monoclonal antibody, Leukotriene antagonist, H1-antihistamine and mast cell stabilizer and anti-Siglec-8 antibody that depletes eosinophils and inhibits mast cells, have bSeen looked into some case series but not routinely used.Figure 1.: Endoscopy with Narrow Band Imaging: (a) gastric body, (b) pre-pyloric stomach. Surgical pathology: (c) Active gastritis. Insert: H pylori (arrows), (d) Single focus of signet-ring adenocarcinoma (arrows).

S1421 Safety and Efficacy of Long-Term Treatment With Lirentelimab, A Monoclonal Antibody Against Siglec-8, in Patients With Eosinophilic Gastritis and/or Duodenitis

Introduction: Eosinophilic gastritis (EG) and/or duodenitis (EoD) are characterized by chronic gastrointestinal symptoms and accumulation and activation of eosinophils and mast cells in the stomach and/or duodenum. Lirentelimab (AK002), an antibody against siglec-8, depletes eosinophils and inhibits mast cells. In a 16-week randomized, double-blind phase 2 study of patients with moderate–severe EG and/or EoD (ENIGMA), lirentelimab significantly reduced gastrointestinal eosinophils and patient-reported total symptom scores (TSS) compared with placebo. To evaluate the long-term safety and efficacy of lirentelimab, we conducted an open-label extension (OLE) study, and present data by disease type (EG±EoD vs EoD without EG) through week 94. Methods: Fifty-eight of 59 eligible patients, who received 4 monthly infusions of lirentelimab or placebo during the ENIGMA study, entered the OLE study and received up to 26 monthly doses of lirentelimab (0.3 or 1 mg/kg escalating to 3 mg/kg). Abdominal pain, nausea, vomiting, early satiety, loss of appetite, abdominal cramping, bloating, and diarrhea were assessed using a daily electronic patient-reported outcome questionnaire to generate weekly TSS. Patients underwent upper endoscopy with biopsy at screening, week 14 of ENIGMA, and 2 timepoints during the OLE study. Histopathologic analyses were performed by a blinded central pathologist; EG and EoD were defined as ≥30 eos/hpf in ≥5 gastric hpfs and ≥30 eos/hpf in ≥3 duodenal hpfs, respectively. Results: As of March 2021, 13 patients with EG±EoD and 12 patients with EoD without EG received 94 weeks of lirentelimab (ENIGMA+OLE). At week 94, mean TSS was reduced by 70% in patients with EG±EoD and 81% in patients EoD without EG compared with baseline (Table 1). TSS decreased significantly from baseline through week 94 regardless of EG±EoD or EoD without EG (Figure 1). Gastro-duodenal eosinophil counts were significantly reduced. There were no drug-related serious adverse events. The most common adverse events were mild–moderate infusion-related reactions, mostly during the first infusion. Conclusion: In an OLE study, patients with EG±EoD or EoD without EG receiving lirentelimab for up to 94 weeks had sustained and similar reductions in TSS and eosinophil counts in gastric and duodenal biopsies—patients benefited regardless of whether the stomach was involved. Long-term treatment with lirentelimab (AK002) was well tolerated and holds promise for patients with EG and/or EoD.Table 1.: Continued Reduction in Symptoms in Patients Receiving Lirentelimab up to 94 Weeks aTotal lirentelimab exposure, inclusive of the ENIGMA study bUnpaired 2-tailed t test performed on means.Figure 1.: Similar Symptom Responses to Lirentelimab in Patients With EG ± EoD vs EoD Without EG a Total lirentelimab exposure, inclusive of the ENIGMA study b EG ± EoD n = 13, baseline TSS = 34; EoD without EG n = 12, baseline TSS=36 c Fisher exact test performed on proportion of responders ns = not significant.

Mast cell function in prostate inflammation, fibrosis, and smooth muscle cell dysfunction.

Intraurethral inoculation of mice with uropathogenic Escherichia coli (CP1) results in prostate inflammation, fibrosis, and urinary dysfunction, recapitulating some but not all of the pathognomonic clinical features associated with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). In both patients with LUTS and CP1-infected mice, we observed increased numbers and activation of mast cells and elevated levels of prostate fibrosis. Therapeutic inhibition of mast cells using a combination of a mast cell stabilizer, cromolyn sodium, and the histamine 1 receptor antagonist cetirizine di-hydrochloride in the mouse model resulted in reduced mast cell activation in the prostate and significant alleviation of urinary dysfunction. Treated mice showed reduced prostate fibrosis, less infiltration of immune cells, and decreased inflammation. In addition, as opposed to symptomatic CP1-infected mice, treated mice showed reduced myosin light chain-2 phosphorylation, a marker of prostate smooth muscle contraction. These results show that mast cells play a critical role in the pathophysiology of urinary dysfunction and may be an important therapeutic target for men with BPH/LUTS.NEW & NOTEWORTHY LUTS-associated benign prostatic hyperplasia is derived from a combination of immune activation, extracellular matrix remodeling, hyperplasia, and smooth muscle cell contraction in prostates of men. Using a mouse model, we describe the importance of mast cells in regulating these multiple facets involved in the pathophysiology of LUTS. Mast cell inhibition alleviates both pathology and urinary dysfunction in this model, suggesting the potential for mast cell inhibition as a therapeutic that prevents and reverses pathology and associated symptomology.

Insights on the inhibitors of dipeptidyl peptidase 1 as mast-cell stabilizer

Insights on the inhibitors of dipeptidyl peptidase 1 as mast-cell stabilizer

Evaluating the Protective Properties of a Xyloglucan-Based Nasal Spray in a Mouse Model of Allergic Rhinitis.

A breached nasal epithelial barrier plays an important role in driving allergic rhinitis (AR). Corticosteroids remain the standard of care (SoC) but come with side effects, thus alternative safe and effective treatments able to avoid inflammation and restore barrier integrity are needed. The aim of the present study is to evaluate the barrier-forming capacity of a xyloglucan-based nasal spray (XG) and compare its efficacy to several SoC treatments (corticosteroid spray, oral mast-cell stabilizer and oral antihistamine) in reducing allergic responses in addition to its effect when concomitantly administered with an antihistamine. An ovalbumin (OVA)-induced mouse AR model was used. XG shows a significant efficacy in reducing histological damage in AR mice; improves nasal rubbing and histamine-induced hyper-responsiveness. Total and OVA-specific IgE as well as pro-inflammatory cytokines are significantly reduced compared to OVA challenged-mice, with im-proved efficacy when used as an add-on treatment. However, XG reduces mucous secreting cells (PAS-positive) and mucin mRNA expression similar to the corticosteroid-treated mice. XG-spray maintains tight junction protein expression (ZO-1) and conversely decreases HDAC1 significantly; the latter being highly expressed in AR patients. Moreover, the concomitant treatment showed in all of the endpoints a similar efficacy to the corticosteroids. This innovative approach may represent a novel therapeutic strategy for nasal respiratory diseases like AR, reducing undesirable side effects and improving the quality of life in patients.

Mast Cells Mediate Inflammatory Injury and Aggravate Neurological Impairment in Experimental Subarachnoid Hemorrhage Through Microglial PAR-2 Pathway

Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular disease with high mortality and disability. Aberrant neuroinflammation has been identified as a critical factor accounting for the poor prognosis of SAH patients. Mast cells (MCs), the sentinel cells of the immune system, play a critical in the early immune reactions and participate in multiple pathophysiological process. However, the exact role of MCs on the pathophysiological process after SAH has not been fully understood. The current study was conducted to determine the role of MCs and MC stabilization in the context of SAH. Mouse SAH model was established by endovascular perforation process. Mice received saline or cromolyn (MC stabilizer) or compound 48/80 (MCs degranulator). Post-SAH evaluation included neurobehavioral test, western blot, immunofluorescence, and toluidine blue staining. We demonstrated that SAH induced MCs activation/degranulation. Administration of MC stabilizer cromolyn conferred a better neurologic outcome and decreased brain edema when compared with SAH+vehicle group. Furthermore, cromolyn significantly inhibited neuroinflammatory response and alleviated neuronal damage after SAH. However, pharmacological activation of MCs with compound 48/80 dramatically aggravated SAH-induced brain injury and exacerbated neurologic outcomes. Notably, pharmacological inhibition of microglial PAR-2 significantly reversed MCs-induced inflammatory response and neurological impairment. Additionally, the effect of MCs-derived tryptase in mediating neuroinflammation was also abolished by the microglial PAR-2 blockage in vitro. Taken together, MCs yielded inflammatory injury through activating microglia-related neuroinflammation after SAH. These data shed light on the notion that MCs might be a novel and promising therapeutic target for SAH.

Tuo-Min-Ding-Chuan Decoction Alleviate Ovalbumin-Induced Allergic Asthma by Inhibiting Mast Cell Degranulation and Down-Regulating the Differential Expression Proteins.

Allergic asthma is a stubborn chronic inflammatory disease, and is considered a co-result of various immune cells, especially mast cells, eosinophils and T lymphocytes. At present, the treatment methods of allergic asthma are limited and the side effects are obvious. Traditional Chinese medicine has been used to treat diseases for thousands of years in China. One such example is the treatment of allergic asthma, which take the characteristics of less adverse reactions and obvious curative effect. Tuo-Min-Ding-Chuan Decoction (TMDCD) is a traditional Chinese medicine compound for the treatment of allergic asthma optimized from Ma-Xing-Gan-Shi Decoction (MXGSD), which was put forward in Treatise on Febrile Diseases by Zhang Zhongjing in the Eastern Han Dynasty. The compound shows a significant clinical effect, but the mechanism of its influence on the immune system is still unclear. The purpose of this study was to observe whether TMDCD could alleviate the symptoms of ovalbumin (OVA) challenged allergic asthma mice, and to explore its immune regulatory mechanism, especially on mast cell (MC) degranulation. The results showed TMDCD could not only reduce the airway hyperresponsiveness (AHR), inflammatory cell infiltration and mucus secretion in the lung tissue of OVA challenged mice, but also decrease the levels of total IgE, OVA-specific IgE, histamine and LTC4 in serum. We found that TMDCD can downregulate the expression of Fractalkine, Tryptase ε, IL-25, CCL19, MCP-1, OX40L, Axl, CCL22, CD30, G-CSF, E-selectin, OPN, CCL5, P-selectin, Gas6, TSLP in OVA challenged mice serum by using mouse cytokines antibody array. It has been reported in some literatures that these differentially expressed proteins are related to the occurrence of allergic asthma, such as tryptase ε, MCP-1, CCL5, etc. can be released by MC. And the results of in vitro experiments showed that TMDCD inhibited the degranulation of RBL-2H3 cells stimulated by DNP-IgE/BSA. Taken together, we made the conclusion that TMDCD could reduce the infiltration of inflammatory cells in lung tissue and alleviate airway remodeling in mice with allergic asthma, showed the effects of anti-inflammatory and antiasthmatic. TMDCD could also reduce the levels of IgE, histamine, LTC4, Tryptase ε, and other MC related proteins in the serum of allergic asthma mice, and the in vitro experiments showed that TMDCD could inhibit IgE mediated degranulation and histamine release of RBL-2H3 cells, proved its anti allergic effect.