POPULARITY
BUFFALO, NY- December 10, 2024 – A new #research paper was #published in Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science) Volume 16, Issue 21 on November 18, 2024, entitled, “Prostaglandin E2 regulates senescence and post-senescence neoplastic escape in primary human keratinocytes.” Researchers Elise Srour, Nathalie Martin, Claire Drullion, Clémentine De Schutter, Joëlle Giroud, Adrien Pioger, Julie Deslé, Laure Saas, Joe Nassour, Julien Théry, Gauthier Decanter, Nicolas Penel, Chantal Vercamer, Clara Salazar-Cardozo, Corinne Abbadie, and Olivier Pluquet from CNRS, University of Lille, the Oscar Lambret Center, and the University of Colorado School of Medicine have revealed how a molecule called Prostaglandin E2 (PGE2) influences skin aging and cancer risk. Their study shows that PGE2 not only drives skin cells to age but also enables some of these aging cells to bypass natural limits and develop into pre-cancerous cells. This process provides insights into why older skin is more susceptible to cancer. The study focused on keratinocytes, the primary cells in the outer layer of the skin. As these cells age, they enter a state called senescence, where they stop dividing to prevent damaged cells from turning cancerous. While this process typically serves as a protective mechanism, the researchers found that, in certain cases, some senescent cells can escape this state, re-enter the cell cycle, and acquire characteristics of early cancer. By examining keratinocytes from donors of different ethnicities and ages, the researchers identified the PTGS2/PGE2/EP4 pathway as a key driver of this escape process. The researchers show that blocking PGE2 or its associated pathway reduced the chances of aged cells becoming precancerous. This suggests that drugs targeting this pathway, including some anti-inflammatory medications already in use, might be repurposed to slow skin aging and prevent early-stage skin cancers. Additionally, the study also found that PGE2 levels increase in the skin as it ages, further supporting its role in skin health and disease. "These results indicate that the PTGS2/PGE2/EP4 pathway is required to induce and maintain the senescent phenotype of NHEKs, and that PGE2 level is a potential determinant of the initial steps of the age-related oncogenic process." The team also highlighted the broader implications of their work. The PTGS2/PGE2/EP4 pathway is not only linked to skin health but also to age-related inflammation, a condition that contributes to several diseases. By addressing this pathway, researchers hope to address not only skin aging but other health challenges linked to aging and chronic inflammation. In conclusion, this study reveals important molecular drivers of skin aging and early cancer, leading the way for new approaches that can promote healthier skin. DOI - https://doi.org/10.18632/aging.206149 Corresponding author - Olivier Pluquet - olivier.pluquet@ibl.cnrs.fr Video short - https://www.youtube.com/watch?v=4aNf3X2RJSw About Aging-US The mission of the journal is to understand the mechanisms surrounding aging and age-related diseases, including cancer as the main cause of death in the modern aged population. The journal aims to promote 1) treatment of age-related diseases by slowing down aging, 2) validation of anti-aging drugs by treating age-related diseases, and 3) prevention of cancer by inhibiting aging. (Cancer and COVID-19 are age-related diseases.) Please visit our website at https://www.Aging-US.com and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.06.23.546291v1?rss=1 Authors: Mellentine, S. Q., Ramsey, A. S., Li, J., Brown, H. N., Tootle, T. Abstract: A key regulator of collective cell migration is prostaglandin (PG) signaling. However, it remains largely unclear whether PGs act within the migratory cells or their microenvironment to promote migration. Here we use Drosophila border cell migration as a model to uncover the cell-specific roles of two PGs in collective migration. Prior work shows PG signaling is required for on-time migration and cluster cohesion. We find that the PGE2 synthase cPGES is required in the substrate, while the PGF2 synthase Akr1B is required in the border cells for on-time migration. Akr1B acts in both the border cells and their substrate to regulate cluster cohesion. One means by which Akr1B regulates border cell migration is by promoting integrin-based adhesions. Additionally, Akr1B limits myosin activity, and thereby cellular stiffness, in the border cells, whereas cPGES limits myosin activity in both the border cells and their substrate. Together these data reveal that two PGs, PGE2 and PGF2, produced in different locations, play key roles in promoting border cell migration. These PGs likely have similar migratory versus microenvironment roles in other collective cell migrations. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.04.16.537099v1?rss=1 Authors: Pei, X., Zheng, F., Li, Y., Lin, Z., Zhang, Y., Han, X., Feng, Y., Li, F., Yang, J., Li, T., Tian, Z., Cao, K., Ren, D., Li, C. Abstract: Idiopathic pulmonary fibrosis (IPF) is marked with the replacement of normal alveolar tissue by thicker and harder fibrous material, damaged exchange ability. Currently, nintedanib and pirfenidone, are the only FDA-approved drugs with limited efficacy for IPF, which indicated an urgent need to explore new therapies. Disulfiram (DSF), an acetaldehyde dehydrogenase inhibitor, used as anti-alcohol treatment. Despite reported with anti-hepatic fibrosis effect of DSF, the underlying mechanism remains unclear. In our study, DSF exhibited regulative impact on abnormal proliferation, EMT and ECM production in cell models of IPF including primary DHLF-IPF cells and TGF-{beta}1-stimulated A549 cells. The absence of COX-2 was restored by DSF treatment, together with elevated prostaglandin biosynthesis both in vitro and in vivo models of IPF. Furthermore, the anti-fibrotic effect of DSF was impeded with COX-2 knockdown or pharmacological inhibition in TGF-{beta}1-stimulated A549 cells, however, exogenous PGE2 reclaimed with anti-EMT function. In established animal model of IPF, DSF ameliorated declined lung function and histopathological changes, and restrained the lung hydroxyproline content. Together, these findings suggest that the anti-fibrotic effect of DSF was achieved through re-activation of COX-2 mediated PGE2 biosynthesis. The above results suggest that DSF can be applied therapeutically in fibrotic conditions. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.04.04.535590v1?rss=1 Authors: Liu, Y., Guo, J., Matoga, M., Korotkova, M., Jakobsson, P.-J., Aguzzi, A. Abstract: Oligodendrocyte-lineage cells of patients and animal models undergo prominent changes in various neurodegenerative disorders. This raises the question of how myelinating cells interact with neurodegenerative processes. Here, we investigated the role of oligodendrocyte precursor cells (NG2 glia) in prion infections. We found that NG2 glia were activated in prion-infected cerebellar organotypic cultured slices (COCS) and in brains of prion-inoculated mice. In both model systems, depletion of NG2 glia exacerbated prion-induced neurodegeneration and accelerated prion pathology, suggesting a protective effect for NG2 glia. Loss of NG2 glia unleashed a microglial reaction promoting the biosynthesis of prostaglandin E2 (PGE2), which augmented prion toxicity in HovS cells and COCS through binding to the EP1 and EP4 receptors. Pharmacological or genetic inhibition of PGE2 biosynthesis attenuated prion-induced neurodegeneration in COCS and mice, antagonized the enhanced neurodegeneration in NG2 glia-depleted COCS and brains after prion infection, and dampened the acceleration of prion disease in NG2 glia-depleted mice. These data unveil a non-cell-autonomous interaction involving NG2 glia and microglia in prion disease and suggest that PGE2 signaling may represent an actionable target against prion diseases. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.13.527949v1?rss=1 Authors: Ruan, J., Xie, H., Quan, X., Zhang, Y., Zhang, D., Wang, W., Hu, X., Tao, Y., Zhao, B., Lu, D., Jia, J.-M. Abstract: Proper brain function depends on intact neurovascular coupling (NVC). Through NVC, local cerebral blood flow (CBF) is rapidly increased in activated cerebral regions to meet the corresponding demands of neural activities. NVC has been believed to support advanced cerebral functions such as complex emotional homeostasis. However, few studies provide causal link evidence with specific molecular and cellular identities. Here, using RNAscope, cell-type specific conditional knockout (cKO) perturbation in BL6/C57 mice, laser speckle contrast imaging, and mouse behavior assays, we demonstrated that the N-methyl-D-aspartic acid (NMDA) receptor noncore subunit NR2D is only expressed in cerebral arteriole smooth muscle cells (aSMCs) but not in peripheral aSMCs. Both aSMC-NR2D cKO and aSMC-NR2D+NMDA receptor subunit 1 (NR1) double cKO mice displayed a severe decline in functional hyperemia induced by whisker stimulation. In addition, the NR2D pathway was independent of previously demonstrated COX-2-PGE2-dependent mechanism and high-fat diet (HFD)-induced impairments in NVC. Caldesmon is a potential downstream protein in the NR2D pathway for NVC regulation. Notably, we demonstrated that NVC deficits caused abnormalities in complex emotional behaviors, such as anxiety-like behaviors (exhibiting increased defecation and urine), reduced curiosity and decreased fear instinct (displaying less fear of aggressive CD1 mice). Furthermore, fear-response gene c-FOS expression in the amygdala neurons was attenuated in aSMC-NR2D knockout mice after response to acute stresses. In contrast, its expression level remained unchanged in the non-fear-related cerebral regions such as the piriform cortex and hippocampus. These findings demonstrated that inadequate functional hyperemia impaired cerebral complex emotional functions and suggested a co-existence of anxiety and fearlessness in single individuals. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter? Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails. For our full catalog of shows with complete show notes, visit our podcast page To wit… In vitro studies show azithromycin reduces rhinovirus replication and release. Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation. Kids with coronavirus (the pre-COVID, old-school coronavirus) had reduced viral load with azithromycin. In enterovirus-infected mice, azithromycin improved survival. Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients. This study, however, did not show improved clinical outcomes with azithromycin. Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group. A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization. Selective poison Every medication is a selective poison and azithromycin poisons a lot of stuff: interleukin beta production, PGE2 synthesis, tumor necrosis factor, cytokine expression, it slows membrane trafficking towards lysosomes, and inhibits the fluid phase of endocytosis of macromolecules. Suffice it to say, there's a lot going on here. When we see these changes in inflammatory markers or in vitro decreased viral loads, it isn't far-fetched. By extension, it frankly wouldn't be far-fetched if this drug improved resolution and severity of illness in viral upper respiratory infections. When it comes to the flu, an illness with cytokine dysregulation, a medication such as azithromycin, with its immunomodulatory and anti-inflammatory effects, looks very tasty. Bottom line: It's pretty clear that something happens when a patients take this drug. It's even possible that they may even have a sense of feeling better. I can't refute that. My assumption is that their cold or acute sinusitis improves despite their taking an antibiotic, but maybe there is something subtle afoot that is as yet unmeasured. Unfortunately, the data to date do not show observable clinical outcome benefits with azithromycin and viral infections.
When you have a patient who requests a Z-pack for what is almost certainly an acute viral respiratory infection, you probably respond internally or externally (possibly both) that antibiotics do not treat viruses. But could there be some effect on their symptoms, or the viral infection itself, that is not part of the common discussion when it comes to such things? We know that azithromycin is an antibiotic, but it turns out that azithromycin actually has some activity in the viral arena. This absolutely shocked me. The question is, does it matter? Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails. For our full catalog of shows with complete show notes, visit our podcast page To wit… In vitro studies show azithromycin reduces rhinovirus replication and release. Another in vitro study on respiratory cells from lung transplant patients found azithromycin reduces rhinovirus-associated cellular inflammation. Kids with coronavirus (the pre-COVID, old-school coronavirus) had reduced viral load with azithromycin. In enterovirus-infected mice, azithromycin improved survival. Patients infected with influenza a who were given azithromycin had reduced interleukins 6, 8, 17, tumor necrosis factor, and CRP, indicating anti-inflammatory properties in flu patients. This study, however, did not show improved clinical outcomes with azithromycin. Another study using a similar methodology did not see any change in inflammatory markers but had a slight improvement in sore throat and fever resolution in the azithromycin group. A 2009 paper found that azithromycin did not improve disease course in hospitalized infants with a respiratory synovial virus. There has been signal of clarithromycin decreasing hospitalization in patients with severe RSV, but the preponderance of data are fairly consistent that there is no benefit in hospital stay, length of illness, or oxygen utilization. Selective poison Every medication is a selective poison and azithromycin poisons a lot of stuff: interleukin beta production, PGE2 synthesis, tumor necrosis factor, cytokine expression, it slows membrane trafficking towards lysosomes, and inhibits the fluid phase of endocytosis of macromolecules. Suffice it to say, there's a lot going on here. When we see these changes in inflammatory markers or in vitro decreased viral loads, it isn't far-fetched. By extension, it frankly wouldn't be far-fetched if this drug improved resolution and severity of illness in viral upper respiratory infections. When it comes to the flu, an illness with cytokine dysregulation, a medication such as azithromycin, with its immunomodulatory and anti-inflammatory effects, looks very tasty. Bottom line: It's pretty clear that something happens when a patients take this drug. It's even possible that they may even have a sense of feeling better. I can't refute that. My assumption is that their cold or acute sinusitis improves despite their taking an antibiotic, but maybe there is something subtle afoot that is as yet unmeasured. Unfortunately, the data to date do not show observable clinical outcome benefits with azithromycin and viral infections.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.01.526734v1?rss=1 Authors: Watabe, T., Yamahira, S., Takakura, K., Thumkeo, D., Narumiya, S., Matsuda, M., Terai, K. Abstract: Prostaglandin E2 (PGE2) is a key player in a plethora of physiological and pathological events. Nevertheless, little is known about the dynamics of PGE2 secretion from a single cell and its effect on the neighboring cells. Here, by observing confluent Madin-Darby canine kidney (MDCK) epithelial cells expressing fluorescent biosensors we demonstrate that calcium transients in a single cell cause PGE2-mediated radial spread of PKA activation (RSPA) in neighboring cells. By in vivo imaging, RSPA was also observed in the basal layer of the mouse epidermis. Experiments with an optogenetic tool revealed a switch-like PGE2 discharge in response to the increasing cytoplasmic Ca2+ concentrations. The cell density of MDCK cells correlated with the frequencies of calcium transients and the following RSPA. The ERK MAP kinase activation also enhanced the frequency of RSPA in MDCK and in vivo. Thus, the PGE2 discharge is regulated temporally by calcium transients and ERK activity. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
References Dr. Guerra's lipid lectures JCI Insight. 2020 Sep 3;5(17):e138443 Proc Natl Acad Sci U S A. 1998 Mar 31; 95(7): 4061–4065. --- Send in a voice message: https://anchor.fm/dr-daniel-j-guerra/message
This month on Episode 44 of Discover CircRes, host Cynthia St. Hilaire highlights four original research articles featured in the January 6th and January 20th issue of Circulation Research. This episode also features an interview with Dr Timothy McKinsey and Dr Marcello Rubino about their study, Inhibition of Eicosanoid Degradation Mitigates Fibrosis of the Heart. Article highlights: Prasad, et al. ACE2 in Gut Integrity and Diabetic Retinopathy Cui, et al. Epsins Regulate Lipid Metabolism and Transport Li, et al. Endothelial H2S modulates EndoMT in HF Luo, et al. F. plautii Attenuates Arterial Stiffness Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's Journal Circulation Research. I'm your host, Dr Cindy St. Hilaire from the Vascular Medicine Institute at the University of Pittsburgh. And today I'm going to be highlighting articles from our January 6th and January 20th issues of Circulation Research. I'm also going to have a chat with Dr Timothy McKinsey and Dr Marcello Rubino about their study, Inhibition of Eicosanoid Degradation Mitigates Fibrosis of the Heart. But before the interview, I want to get to a few articles to highlight. Cindy St. Hilaire: The first article is titled, Maintenance of Enteral ACE2 Prevents Diabetic Retinopathy in Type 1 Diabetes. The first authors are Ram Prasad and Jason Floyd, and the corresponding author is Maria Grant, and they are from the University of Alabama. Type 1 Diabetes has a complex etiology and pathology that are not entirely understood. In addition to the destruction of insulin-producing cells, a recently discovered feature of the disease in both humans and in rodent models is that the levels of angiotensin converting enzyme 2 or ACE2 can be unusually low in certain tissues. ACE2 is a component of the renin angiotensin system controlling hemodynamics and interestingly, genetic deficiency of ACE2 in rodents exacerbates aspects of diabetes such as gut permeability, systemic inflammation and diabetic retinopathy, while boosting ACE2 has been shown to ameliorate diabetic retinopathy in mice. This study shows that ACE2 treatment also improves gut integrity and systemic inflammation as well as retinopathy. Six months after the onset of diabetes in a mouse model, oral doses of a bacteria engineered to express humanized ACE2 led to a reversal of the animal's gut barrier dysfunction and its retinopathy. Humans with diabetic retinopathy also displayed evidence of increased gut permeability in low levels of ACE2. This study suggests they may benefit from a similar probiotic treatment. Cindy St. Hilaire: The next article I want to highlight is titled, Epsin Nanotherapy Regulates Cholesterol Transport to Fortify Atheroma Regression. The first authors are Kui Cui, Xinlei Gao and Beibei Wang, and the corresponding authors are Hong Chen and Kaifu Chen and they're from Boston Children's Hospital. Epsins are a family of plasma membrane proteins that drive endocytosis. They're expressed at varying levels throughout the tissues of the body, and recent research shows that they are unusually abundant on macrophages within atherosclerotic lesions. In mice, macrophage specific Epsin loss results in a reduction in foam cell formation and atherosclerotic plaque development. This study now shows that this effect on foam cells is because Epsins normally promote the internalization of lipids into macrophages through their endosytic activity. But that's not all. The proteins also impede cholesterol efflux from macrophages to further exacerbate lipid retention. It turns out out Epsins regulate the endocytosis and the degradation of a cholesterol efflux factor called ABCG1. Importantly, these pro atrogenic activities of Epsins can be stopped. Using macrophage targeted nanoparticles carrying Epson specific silencing RNA, the team could suppress reduction of the protein in cultured macrophages and could reduce the size and number of plaques in atherosclerosis prone mice. Together these results suggest blocking Epsins via nanotherapy or other means could be a therapeutic approach to stopping or slowing atherosclerotic plaque progression. Cindy St. Hilaire: The third article I want to highlight is coming from our January 20th issue of Circ Res and is titled, Hydrogen Sulfide Modulates Endothelial-Mesenchymal Transition in Heart Failure. The first author is Zhen Li, and the corresponding author is David Lefer and they're from Cedars-Sinai. Hydrogen sulfide is a critical endogenous signaling molecule that exerts protective effects in the setting of heart failure. Cystathionine γ-lyase, or CSE, is one of the three hydrogen sulfide producing enzymes, and it's predominantly localized in the vascular endothelium. Genetic deletion of CSE, specifically in the endothelium, leads to reduced nitric oxide bioavailability, impaired vascular relaxation and impaired exercise capacity, while genetic over-expression of PSE in endothelial cells improves endothelial cell dysfunction, and attenuates myocardial infarction following myocardial ischemia-reperfusion injury. In this study, endothelial cell specific CSE knockout mice and endothelial cell specific CSE overexpressing transgenic mice were subjected to transverse aortic constriction to induce heart failure with reduced ejection fraction. And the goal was to investigate the contribution of the CSE hydrogen sulfide access in heart failure. Endothelial specific CSE knockout mice exhibited increased endothelial to mesenchymal transition and reduced nitric oxide bioavailability in the myocardium. And this was associated with increased cardiac fibrosis, impaired cardiac and vascular function, and it worsened the vascular performance of these animals. In contrast, genetic overexpression of CSE in endothelial cells led to increased myocardial nitric oxide, decreased EndoMT and decreased cardiac fibrosis. It also improved exercise capacity. These data demonstrate that endothelial CSE modulates endothelial mesenchymal transition and ameliorated the severity of pressure overload induced heart failure , in part through nitric oxide related mechanisms. This data further suggests that endothelium derived hydrogen sulfide is a potential therapeutic for the treatment of heart failure with reduced ejection fraction. Cindy St. Hilaire The last article I want to highlight is titled, Flavonifractor plautii Protects Against Elevated Arterial Stiffness. The first authors are Shiyun Luo and Yawen Zhao, and the corresponding author is Min Xia, and they are at Sun Yat-sen University. Dysbiosis of gut microbiota contributes to vascular dysfunction and gut microbial diversity has been reported to be inversely correlated with arterial stiffness. However, the causal role of gut microbiota in the progression of arterial stiffness and the specific species along with the molecular mechanisms underlying this change remain largely unknown. In this study, the microbial composition in metabolic capacities were compared in participants with elevated arterial stiffness and in normal controls free of medication. And these groups were age and sex match. Human fecal metagenomic sequencing identified a significant presence of Flavonifractor plautii or F. plautii in normal controls, which was absent in the subjects with elevated arterial stiffness. The microbiome of normal controls exhibited an enhanced capacity for glycolysis and polysaccharide degradation, whereas individuals with increased arterial stiffness exhibited increased biosynthesis of fatty acids and aromatic amino acids. Additionally, experiments in the angiotensin II induced and humanized mouse model show that replenishment with F. plautii or its main effector cis-aconitic acid or CCA improved elastic fiber network and reversed increased pulse wave velocity through the suppression of matrix metalloproteinase-2 and through the inhibition of monocyte chemoattractant protein-1. And this was seen in both the angiotensin II induced and humanized models of arterial stiffness. This study now identifies a novel link between F. plautii and arterial function and raises the possibility of sustaining vascular health by targeting the gut microbiota. Cindy St. Hilaire: Today with me I have Dr Tim McKinsey and Dr Marcello Rubino from the University of Colorado Anschutz Medical Campus, and we're here to talk about their paper Inhibition of Eicosanoid Degradati`on Mitigates Fibrosis of the Heart. And this article is in our January 6th issue of Circulation Research, so thank you both so much for joining me today. Timothy McKinsey: Thank you for inviting us. Marcello Rubino: Yeah, thank you for the opportunity. Cindy St. Hilaire: And so Dr McKinsey, you're a professor at the University of Colorado. How long have you been investigating cardiac fibrosis? Timothy McKinsey: Oh, a long time. Before I started the lab here in 2010, I was in industry working in biotech with Myogenic Gilead, and we were very interested in cardiac fibrosis all the way back then. Cindy St. Hilaire: Oh wow, so you actually made an industry to academia transfer. Timothy McKinsey: Yes. Cindy St. Hilaire: Good topic for another podcast. That is really great. Timothy McKinsey: Yeah, it's of interest to a lot of people, including trainees. Cindy St. Hilaire: Yeah, I bet. Dr Rubino, you were or are a postdoc in the McKinsey lab? Marcello Rubino: Yeah, I was a postdoc in Timothy McKinsey lab. I spent four years in Tim's lab. It was my first time studying cardio fibrosis, so it was a little bit difficult at the end, but I think I was right choosing Tim, so I'm really happy now. Cindy St. Hilaire: Nice and are you sticking with fibrosis or are you moving on? Marcello Rubino: Yeah, so now I'm back in Milan where I did my PhD student and postdoc. I am like an independent researcher, but it's still not a principal investigator, so I want to become one of the that, studying cardiac fibrosis. Yeah. And inflammation and epigenetics, so yeah, I'm going try to go to my way, thanks to Tim, I think that I find my own way. Cindy St. Hilaire: I'm sure you will. I mean, based on the great work in this study, right. Building upon that, I'm sure you'll be a success. Timothy McKinsey: No doubt about it. Cindy St. Hilaire: So your manuscript, this study, it's investigating whether eicosanoid availability can attenuate fibrosis in the heart. But before we kind of jump into this study, why is fibrosis in the heart a bad thing? Is it always detrimental? Is there some level of fibrosis that's necessary or even helpful? Timothy McKinsey: I mean, a certain level of extracellular matrix is deposited in your heart and that maintains the structure of the heart. Fibrosis can also be good after you have a myocardial infarction and a big piece of the muscle of your heart has died, it needs to be replaced with a fibrotic scar, essentially to prevent rupture of the ventricle. So fibrosis isn't always bad, but chronic fibrosis can be really deleterious to the heart and contribute to stiffening of the heart and cause diastolic dysfunction. It can create substrates for arrhythmias and sudden cardiac death. So we're really trying to block the maladaptive fibrosis that occurs in response to chronic stress. Cindy St. Hilaire: Yeah, yeah. And what about eicosanoids? What are they and what role do they play in cardiac fibrosis or what was known about their role in this process before your study? Timothy McKinsey: Eicosanoids are lipids, they're basically fatty acids, 20 carbon in length and a lot is known about them. It's a very complex system. There are many different eicosanoids, but they're produced from arachidonic acid through the action of cyclooxygenase enzymes like COX-2. And so you're probably familiar with the literature showing that non-steroidal anti-inflammatory drugs that target the COX enzymes can actually increase the risk of cardiac disease, so there was a lot known about what produces eicosanoids in the heart, but our study is really the first to address how they're degraded and how that controls cardiac fibrosis. Cindy St. Hilaire: What I thought you did really well in the introduction and what I guess I didn't really fully appreciate until I had read your study, was that your goal was to identify compounds that could attenuate fibrosis. And you spent some time emphasizing the differences between a targeted small molecule screen and a phenotype based screen. And I was wondering if you could just expand on this difference for the audience and maybe just explain why in your case you went with the latter. Timothy McKinsey: Well, we wanted to use an unbiased approach and some people call this a chemical biology approach where we took a targeted library, meaning we took compounds with known activities, meaning compounds that with known targets and we screened that library using a phenotypic assays that we developed in the lab. And the phenotypic assay is an unbiased assay, right? We're just screening for compounds that have the ability to block the activation of fibroblasts. And we monitor activation by looking at markers of fibroblast activation such as alpha smooth muscle Actin. And we can do this in a very quantitative and high throughput manner using this imaging system, high content imaging system that we have in the lab. It was an unbiased screen looking for inhibitors of fibroblasts activation across organ systems. We not only studied cardiac fibroblasts, but we also studied lung and renal fibroblasts looking for compounds with a common ability to block the activation state of each of those cell types. One of the things that I get asked frequently is how do we maintain the cardiac fibroblasts in a quiescent state? Because you may know this, but when fibroblasts are plated on cell culture plastic, which has a very high 10 cell strength, they tend to spontaneously activate, so we actually spent a couple of years working out the conditions to maintain the cells in quiescent state, and I think that will also be of great interest to the field. Cindy St. Hilaire: Probably even the smooth muscle cell biology field where I hang out and even valve interstitial cells that we study. All of those, I guess basic things related to cell culture, we have taken for granted that plastic is not physiological. Timothy McKinsey: Right. Cindy St. Hilaire: And so I think with this really nice phenotypic or chemical screen that you conducted, you first identified nine compounds, but what made you zero in on this one, SW033291? Timothy McKinsey: When we got the hits, we were intrigued by the SW compound SW033291 because there was only one paper describing its action and there was a paper published in Science showing that SW or inhibition of this enzyme 15-PGDH could enhance organ regeneration. Cindy St. Hilaire: Oh, okay. Timothy McKinsey: And there's a very interesting interplay between fibrosis and organ regeneration where fibrosis inhibits regeneration and if you can stimulate regenerative pathways, they can actually block fibrosis, so there's this back and forth. And so that's really the main reason we were interested in pursuing SW just because of the novelty and the potential. And also it was a compound that behaved beautifully in our cell culture models with beautiful dose-dependent inhibition of each of the fibroblast types. Cindy St. Hilaire: It's kind of like the cleanest thing to start with. Also, if there's nothing known, it's ripe for investigation, so that's great. You just said this SW compound acts on 15-PGDH, so what is the role of that protein in fibroblasts and what if any known effects are there on this protein's inhibition in other cell types or disease states? Marcello Rubino: In fibroblasts team, I would like to say that this was really the first article that was published. Maybe there was just one published in Pulmonary Fibrosis, but like last year, but I didn't really talk about 15-PGDH, so you need to consider that 15-PGDH is an inhibitor, an enzyme that degrades prostaglandin, so if you inhibit the inhibitor, the release increase production, a lot of prostaglandin. And so a lot of paper were talking about this effect, so they will see we are just using SW in order to increase Prostaglandin E2 level and that was why we had this like anti-inflammatory or whatever effect. I would like to say that until now, maybe this can be the first really paper talking about no more than not just prostaglandin but 15-PGDH. Its action total level, a global level at particularly on fibroblasts. To answer your question, I would like to say that this was also our question first and we checked by level other browser to try to find the answer to your question. We figured out that it was known that 15-PGDH was increasing a pathology condition in different organ, not just related by fibroblasts, not just related to cardiac disease, about the function with discover a function in macrophage that interested us because it can regulate maybe the polarization macrophage, so still involving the prostaglandin production inflammation, so that's why also we decide to take a look because it was still novel in fibrolbasts and we still know that it was doing something important and we were trying not to put the piece together and find something new in that we were lucky for this. Timothy McKinsey: 15-PGDH is actually expressed at very low levels in fibroblasts. It's much more highly expressed in macrophage, just as Marcello pointed out, so in the future we're very interested in knocking out or inhibiting 15-PGDH in different cell types to see how that contributes to inhibition of cardiac fibrosis. Cindy St. Hilaire: Really interesting. Related to that, you used a couple different animal models for fibrosis. They're all different or special in their own way. How well did these recapitulate what we observe in humans. Are there any limitations of benefits? Timothy McKinsey: They're always limitations to animal models. We started out with a very robust commonly used model of cardiac fibrosis, which relies on Angiotensin II infusion in mice. We like that model because it's robust and quick so we can get answers quickly. And then we transitioned into a model of diastolic dysfunction that we've been working with in a lab where we remove a kidney from a mouse and we implant something called DOCA, which is an aldosterone memetic. And so the animals develop hypertension that leads to a mild but significant diastolic dysfunction with preserved ejection fraction. And that's a model that we like a lot. It has something that we call hidden fibrosis, so if you just do standard histochemical staining of the hearts from the DOCA unit, nephrectomy model, that diastolic dysfunction model, you really can't see robust fibrosis. It's only when you dive more deeply with more sensitive assays like mass spectrometry or atomic force microscopy that you can detect this fibrosis and stiffening of the heart, so we usually lead with a robust model of fibrosis, cardiac fibrosis, and then transition into a slightly more complex model but more physiologically relevant model or disease relevant model. Cindy St. Hilaire: Obviously you showed some really nice robust results with this SW compound. So in the continuum of heart failure in human, what do you think or what would you speculate would be the ideal timeframe for administration of this compound? Timothy McKinsey: Wouldn't want to give it immediately after someone's had a heart attack. As we discussed earlier, you need that reparative scar to form so you don't want to block that fibrotic remodeling. We believe that there's kind of smoldering fibroblast activation in the heart, even in someone who's had heart disease for many, many years. And if we can dampen that, we can either prevent further progression of heart failure or perhaps reverse it. We don't really know if we can reverse really established fibrosis in the heart yet. But I would want to try to catch fibrosis fairly early on in the disease process in someone who has chronic hypertension or obesity or a variety of different comorbidities and then start delivering an antifibrotic therapy at that point. Marcello Rubino: I would like to add that, so it is really tricky when we talk about clinical trials because a lot of molecules that maybe they can work hopefully in a preclinical model don't work at the end in the clinical model. That's because can be some off target also like you just asked what is really important is when you do the administration of the molecule and talk about this in SW, like things say we don't want to prevent the fibrosis because there is something like called a kneeling at the beginning, so it is the good fibrosis we like to say, but the good thing of SW compound is that is affecting in a good way the proliferation of fibroblast that is different for all the other. I would like to say all the other inhibitor that we saw so far, because I remember the first time that I presented this work, there was an expert told me that he didn't believe that all my data because the compound was inhibiting fibrosis, it was inhibiting proliferation. And I show him, no, this is contrary, so oh okay, I like it. We need to consider this that the action seems to be not like the retire for the cell, so because the cells continue to proliferate, they can proliferate more. But the good thing and we need to investigate more is that SW action seems to increase when the cell are more fibrotic, because we show just few human fibroblasts isolating from a human patient and we saw a higher positive effect of SW compound when the cell were more fibrotic. That can be interesting. I think that it's worth to try to test in the future like in different preclinical models and maybe in patients at the end because if we really can find something like maybe SW that can be specific for the state of pathology, that will be wonderful. I don't really know if we can really do it, but we need some therapy like this, so that's why we were really excited about what we discovered for this compound. Timothy McKinsey: We have a lot more to learn about this pathway and about fibrosis in general. Cindy St. Hilaire: Yeah. Timothy McKinsey: It's a very exciting time to be doing science because of the amazing technologies that we have at our disposal to address detailed mechanisms of disease. Cindy St. Hilaire: What was the most challenging aspect of the study? Timothy McKinsey: This was an incredibly difficult study. I can't even stress to you how much work went into this. Spearheaded by Marcello's awesome leadership. There was huge input from a big team. Keith Cook and I worked together in industry and we were able to recruit him over here for a few years as part of our fibrosis center called the CFReT. It's an advertisement. And Keith was able to implement some of the drug discovery approaches that we used in biotech and create this imaging system that we initially employed for the screens. That was challenging. Maintaining the cells in a quiescent state was very challenging as I mentioned. That took a couple of years and then just following up on SW and trying to figure out its mechanism of action was really challenging as well because as Marcello mentioned, most people have attributed SW's effects to an increase in PGE2 levels, so PGE2 is an eicosanoid that is degraded by 15-PGDH. And definitely when you inhibit 15-PGDH with SW, you see increased PGE2. But surprisingly we couldn't find that PGE2 was doing anything in our cell culture systems, meaning when we added it exogenously it was not blocking fibroblast activation, so then Marcello set out to identify which eicosanoid that is regulated by 15-PGDH is actually the antifibrotic eicosanoid. And that led him to something called 12(S)-HETE. That was challenging. And then just determining at the molecular level what was going on was also challenging. And that led Marcello to this kind of paradoxical discovery that it activating ERK signaling was actually blocking fibroblast activation. Cindy St. Hilaire: And of course ERK does everything right? Marcello Rubino: It does. Everything. Timothy McKinsey: And sort of the dogma is that ERK is promoting fibrosis in the heart, but Marcello's data suggests otherwise. Timothy McKinsey: And then other shout outs, Josh Travers, who's the second author of the paper provided huge input, especially after Marcello left. Josh helped get this across the finish line. We have an amazing in vivo team conducting the animal model studies. Maria Cavasin and Elizabeth Hardy. I could go on and on. There are a lot of authors and if I didn't mention one of them, it doesn't mean that they weren't key contributors. I just wanted to throw that out there. We also had great collaborators. I think another component of this paper that is of great interest to us, and initially I was against doing any of this, is that Marcello and Josh created this biobank of human cardiac fibroblasts that we obtained from explanted hearts from individuals undergoing heart transplantation. And initially I thought it was going to be a waste of time and money for Marcello and Josh to do that, but they were persistent and they started isolating these cells. And the cells are really fascinating because even after you take them out of that failed human heart and culture them, they maintain this constituently active state, which is different than the cells we were using for screening where we kept them quiescent and then we stimulated them with TGF-β to activate them. These human cardiac fibroblasts from the failed human hearts are just on all the time. Cindy St. Hilaire: Wow. Timothy McKinsey: And SW does a really amazing job of reversing that activated state. Cindy St. Hilaire: Very cool and excellent resource I'm sure for future studies. So my last question is what's next? You know, you discovered a lot in this paper. What's the next thing you want to tackle? Timothy McKinsey: Cell type specific roles for 15-PGDH in the heart, in the control of cardiac homeostasis and disease. Basically we want to knock it out in fibroblasts. We want to knock it out in our macrophages and see what the consequences are. That's one thing. We want to really pursue the whole GPR31 12(S)-HETE pathway in the heart. That's something that has never been studied. And so GPR31 is a G protein coupled receptor that is bound by this eicosanoid called 12(S)-HETE. And that seems to be blocking fibroblast activation, so we're going to further pursue that pathway. And then we think that this paradoxical finding related to ERK signaling in the heart is also worthy of pursuit. Why is it that stimulating ERK in a cardiac fibroblast is actually blocking the activation state of that cell? Marcello Rubino: I'm interested in this like Tim says, but also interested in the role of the interaction of the cell because it's important to study like a specific gene inhibitor, whatever role in a specific cell, but what happened to the other cell, the interaction the other cell when you do knocking in some specific cell, so that's what I'm trying to do in general. Now I move back in Italy, like I told you, I'm like a kind of independent research and I'm studying a lot single cell sequencing right now. Try to do also try to see what happened to interaction, understand during pathology. The idea is to study like inhibitor treatment and to see what really happened because gene expression is important, but we need to consider also of course the protein shape, the protein interaction, the cell interaction, so I try to grow in this field and see what really happened because the problem of the cell, they're just cell in vitro. They can mimic what happened, but it's not what really happened in vivo, so can we use this novel technology to improve our knowledge, that's what I want to try to do. Cindy St. Hilaire: Well that's great. Dr McKinsey, Dr Rubino, thank you so much for taking the time to speak with me today. Title of their article was Inhibition of Eicosanoid Degradation Mitigates Fibrosis of the Heart. It's in our January 6th issue of Circ Res. And thank you both so much for joining me today and thank you to you and all of your colleagues who worked so hard on this for this amazing study. Timothy McKinsey: Thank you. We really enjoyed this visit and we're grateful to have our work published in Circulation Research. Cindy St. Hilaire: That's it for highlights from the January 6th and 20th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @CircRes or #DiscoverCircRes. Thank you to our guests, Dr Tim McKinsey and Dr Marcello Rubino. This podcast is produced by Ishara Rantayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy text for highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire, and this is Discover CircRes, your on-the-go source for the most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2022. The opinions expressed by the speakers of this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, please visit ahajournals.org.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.24.517788v1?rss=1 Authors: Lai, S.-f., Huang, W.-Y., Wang, W.-H., Hong, J.-B., Kuo, S.-H., Lin, S.-J. Abstract: Growing hair follicles (HFs) harbor actively dividing transit amplifying cells (TACs), rendering them highly sensitive to radiotherapy (RT). Clinically, there is still a lack of effective treatment for radiotherapy-induced alopecia (RIA). We aimed to dissect the effect and mechanism of local prostaglandin E2 (PGE2) pretreatment in RIA prevention. We found that PGE2 pretreatment reduced RIA by preventing premature termination of anagen through enhancing HF self-repair. Mechanistically, PGE2 did not activate HF stem cells, but preserved more TACs for regenerative attempts. Pretreatment of PGE2 lessened radiosensitivity of TACs by transiently arresting them in the G1 phase, thereby reducing TAC apoptosis and mitigating HF dystrophy. The preservation of more TACs accelerated HF self-repair and bypassed RT-induced premature catagen entry. Promoting G1 arrest by systemic administration of palbociclib isethionate (PD0332991), a CDK4/6 inhibitor, offered a similar protective effect against RT. Therefore, PGE2 protects HF TACs from RT by transiently inducing G1 arrest, and the regeneration of HF structures lost from RT is accelerated to resume anagen growth, thus bypassing the long downtime of hair loss. PGE2 has the potential to be repurposed as a preventive treatment for RIA. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Nonsteroid antienflamatuar ilaçlar (NSAID), antipiretik, antiinflamatuar ve analjezik ajanlar olarak kullanılan FDA onaylı bir ilaç sınıfıdır1. Bu etki mekanizmaları nsaidleri; dismenore, artritik durumlar, ateş, gut, migren tedavisinde faydalı kılar2 3,4 ve nsaidlerin dünyada en cok reçete edilen ilaçlar arasında yer almasını sağlar5. Narkotik ajanlara göre analjezik etkinlikleri daha düşük olsa da bağımlılık yapıcı yan etkileri olmamaları sayesinde acil servislerde de nsaidlerin parenteral ve oral formlarının sık kullanılması söz konusudur. NSAID etki mekanizması NSAID'lerin ana etki mekanizması, siklooksijenaz (COX) enziminin inhibisyonudur. Araşidonik asidi tromboksanlara, prostaglandinlere ve prostasiklinlere dönüştürmek için COX gereklidir. NSAID'lerin terapötik etkileri ve advers reaksiyonları, COX inhibisyonuyla bu eikosanoidlerin eksikliğine atfedilir6. COX-1 ve COX-2 olmak üzere iki siklooksijenaz izoenzimi vardır. COX-1 vücutta yapısal olarak eksprese edilir ve gastrointestinal mukoza zarının, böbrek fonksiyonunun ve trombosit agregasyonunun korunmasında rol oynar. COX-2 vücutta yapısal olarak yoktur; ve bunun yerine, inflamatuar yanıt ile indüklenerek eksprese olur. NSAID'lerin mide mukozası başta olmak üzere gastrointestinal sistemi, nefroloji sistemini, kardiyovasküler sistemi ve hematolojik sistemi etkileyen yan etkileri vardır. Acil hekimleri de dahil olmak üzere; nsaidleri hasta ile buluşturmada, hekimlerin en büyük endişelerinden biri nsaidlerin bu yan etki profilidir. Biz de bu yazımızda NSAIDlerin böbrek fonksiyonlarına etkisi ve akut böbrek hasarı riski ile ilgili literatürden derlediğimiz çalışmalardan bahsedeceğiz: NSAID ler ve Böbrek NSAID'ler, araşidonik asit kaskadını inhibe ederek, prostaglandinlerin oluşumunu inhibe eder. Prostaglandinler (esas olarak prostasiklinler, PGE2, PGD2 ) böbrekte renin anjiyotensin aldesteron sisteminin (RAAS) inhibisyonu ve afferent arteriyolde vazodilatörler etki ile böbrek perfüzyonunu artırır. NSAID'lerin özellikle COX-1 inhibisyonu ile bu mekanizmayı inhibe etmesi ile yan etki olarak akut böbrek hasarı riskini arttırdığı düşünülmektedir. COX-2 inflamatuar yanıt ile indüklenebilir bir reseptör olsa da son çalışmalarda normal fizyolojide de önemli bir rol oynadığı gösterilmiştir. Özellikle nefronlarda makula densada ve henle kulpunun çıkan kolunda su ve elektrolit dengesinin korunmasında rol oynar. Bu yüzden hem selektif hem nonselektif nsaidlerin akut böbrek hasarı gelişiminde rolü olduğu düşünülmektedir.89 Akut Böbrek Hasarı ve NSAID'ler Akut böbrek hasarı(AKI), akut böbrek yetmezliğini ifade etmek için kabul görmüş yeni bir terimdir. Kreatinin ve üre gibi nitrojen metabolizması ürünlerinin ve klinik olarak ölçülemeyen diğer atık ürünlerin birikmesiyle böbrek boşaltım fonksiyonunda saatler ile günler içinde hızlı azalma ile karakterize klinik bir sendromu ifade eder10.KDIGO rehberine göre; Akut böbrek hasarı (AKI): 48 saat içinde serum kreatininde ≥0,3 mg/dl artış , son 7 gün içinde serum kreatininde bazal değerinin ≥1.5 katına artış ya da 6 saat boyunca idrar hacmi ≤0.5 ml/kg/saat olarak tanımlanmaktadır. İnsidansı, popülasyonlar arasında değişiklik gösterse de diyaliz gerektirmeyen akut böbrek hasarı için yılda milyonda 5000 vakadan, diyaliz gerektiren AKI için ise yılda milyonda 295 vakaya kadar olduğu tahmin edilmektedir. Hastanede yatan hastalarda görülme sıklığı %1,9'dur ve özellikle sepsis varlığında yoğun bakım hastalarında prevalansının %40'tan fazla olduğu tahmin edilmektedir11. NSAID'ler ile tedavi edilen hastalarda nefrotoksisite prevalansı nispeten düşük olmasına rağmen, bu ajanların yaygın kullanım profili birçok kişinin risk altında olduğunu göstermektedir.12 Griffin ve arkadaşları 1987-1991 yılları arasında 65 ve üstündeki yaş grubunda toplum kökenli AKI tanısı ile hastaneye yatırılan hastaları dahil eden bir vaka kontrol çalışması gerçekleştirdiler. Akut böbrek yetmezliği olan 1.
Polyphenol pills counter inflammation in women on hormonal contraceptives: RCT Universidade Federal do Rio Grande do Sul (Brazil), April 7, 2022 Supplements containing a mixture of polyphenols may counter increases in pro-inflammatory markers in women of childbearing age using combined hormonal contraceptives, says a new study. The supplements, formulated with resveratrol, catechin, quercetin, chlorogenic acid and cyanidin, were also found to prevent the increases in markers of systemic oxidative stress like F2-isoprostane. “The increase in biomarkers of inflammation and oxidative stress observed in the present study were possibly caused by the use of hormonal contraceptives, as verified in the [control group], and this change was not observed in the group that used polyphenols,” wrote researchers from the Institute of Cardiology and the Universidade Federal do Rio Grande do Sul in Brazil. “Therefore, the results of this polyphenol supplementation showed that the antioxidant and anti-inflammatory effects observed in the studied population is due to the reduction in plasma levels of PGE2, supporting the conceptual hypothesis, by its action on the inflammatory cascade, probably by COX inhibition.” (NEXT) The power of kindness in improving brain health Center for BrainHealth at The University of Texas, April 11, 2022 Kindness is powerful and does not just affect the recipient's feelings—kindness can also impact an entire family's brain health. A cross-disciplinary team of researchers and clinicians from Center for BrainHealth at The University of Texas at Dallas sought to understand whether an online kindness training program improves preschooler's prosocial behaviors and their parents' resilience during the COVID-19 pandemic. (NEXT) Omega-3 supplementation could offer MCI benefits: Pilot study University of California-Los Angeles, April 10, 2022 Supplementation with a drink containing 2000 mg of omega-3 and mixed botanicals could have ‘significant' immune and biochemical effects in people that have minor cognitive impairment (MCI), new research suggests. The pilot study, published in The FASEB Journal, investigated the immune and pro- and anti-inflammatory effects of nutritional supplementation with a drink (Smartfish) that combines high levels of the omega-3 fatty acids DHA and EPA with a mixture of vitamins and botanicals including resveratrol vitamin D3, “thus targeting several facets of AD [Alzheimer's disease] pathogenesis.” (NEXT) Magic mushroom compound increases brain connectivity in people with depression after use by Imperial College London, April 11, 2022 Psilocybin, the psychedelic compound found in magic mushrooms, helps to "open up" depressed people's brains, even after use, enabling brain regions to talk more freely to one another. These are the findings of a new analysis of brain scans from close to 60 people receiving treatment for depression, led by Imperial College London's Centre for Psychedelic Research. The team behind the study believes it may have untangled how psilocybin exerts its therapeutic effects on the brain. (NEXT) Regular cycling helps patients with 'accelerated aging' disease McMaster University, April 11, 2022 A study led by McMaster University researchers has found that regular cycling can greatly improve mobility in patients with myotonic dystrophy (MD), a genetic disease that causes muscle degeneration. Senior author Mark Tarnopolsky said that cycling for 35 minutes three times a week for 12 weeks led to a 32 percent increase in overall fitness in people with MD. Patients who took part in the study also saw a 1.6-kilogram increase in their muscle massand a two percent reduction of body fat. They were also able to walk an extra 47 meters in six minutes, when tested by researchers at the end of the 12-week trial.
Dr Michael Lange host of "ask the dr" has been hosting live call-in talk show called "Ask The Dr" since April of 93 all over the world . Tune in each week while he discusses the latest in anti aging, eye care and nutrition. todays show both Dr Michael Lange and Dr Richard Hall discuss inflammation and how it can effect the eyes and entire body. They also discuss the muscle wasting age related disease called Sarcopenia and How Fortifeye Fit especially when combined with Fortifeye Super Protein or Fortifeye Grass fed whey isolate can bring nutritional support to sarcopenia. Dr Lange discusses how whey protein is not only great for building muscles but also amazing for building a powerful immune system. He says if you have negative reactions to milk you may still be able to take whey protein since the casein and lactose have been removed. Dr Michael Lange says when buying a whey protein make sure you look for 3 things on the label. 1. grass fed, 2. non denatured 3. where the cows come from ex: new Zealand , America etc... A grass fed non denatured whey protein is one of the best ways to stimulate glutathione production form the covalent bonded cystine in non denatured whey protein. Drinking a good grass fed whey protein that is non denatured can promote less inflammation and less body fat less enhance muscle production and improve immune system. They discuss the importance of reading labels of omega 3 fish oil and how important tg form omega 3 fish oil is. This is actually called rTG form omega3 fish oil or re esterified triglyceride form omega 3 fish oil. Most omega 3 fish oil is an ethyl ester or ee form that has ethanol attached to the backbone. This is an inferior cheaper way to make omega 3 fish oil that is very unstable and in efficient since it must go thru your liver to cleav off the ethanol and replace with a triglyceride (TG) backbone. Fortifeye Super Omega and Fortifeye Super Omega 3 Max are already in the TG form and are two of the purest and most potent tg omega 3 fish oils in the industry at 2 per day dosing. many competitors in the omega 3 fish oil market you have to take 3-6 capsules to be equivalent to 1-2 Fortifeye Super omega or Super Omega Max capsules. Fortifeye Super Omega is one of the nutrients in the dry eye vitamin Pak called Fortifeye Advanced Dry Eye Therapy. When combining this omega 3 with GLA form Black currant seed oil and Fortifeye Focus it helps to quell the inflammatory cascade in the eye and body. GLA form black current seed oil stimulates PGE1 and helps to reduce inflammation in the eyes and body. EPA form omega 3 fish oil helps to block D5D ( delta 5 desaturase enzyme) and lessen the inflammatory effects of arachidonic acid by decreasing the cox and lox inflammatory pathways and helping to stop this inflammatory cascade from leading to the endpoint pro inflammatory PGE2 and Leukotrienes. Omega 3 fish oil also helps to promote the ant inflammatory pathway of PGE3. Reduce inflammation in the eyes and body and also help to reduce associated pain with Fortifeye Advanced Dry Eye Therapy. For the best deals on all Fortifeye Supplements go to the Bundle section at www.fortifeye.com They both discussed natural treatments for rosacea especially when involving the eye and meibomian glands. Support the show: https://www.drmichaellange.com/category/ask-the-doctor/ See omnystudio.com/listener for privacy information.
Hi ladies, welcome back! Prostaglandins may be the culprit to your period issues such as cramps, nausea, vomiting, diarrhea, and headaches! This episode dives into the three types of prostaglandins : PgE1, PgE2, and PgE3 and their direct connection with our Omega-3:Omegas-6 ratios. Great news is we can do some simple dietary changes to help support this bodily process and see changes in our menstrual cycle. Tuen in to find out all the deets! Click to get on the email list for special offers and discounts! Click to download your free period journal! Click to get $10 off period panties! Click to connect on Instagram!
Study strengthens links between red meat and heart disease Queen Mary University (UK), 15 April 2021 An observational study in nearly 20,000 individuals has found that greater intake of red and processed meat is associated with worse heart function. The research is presented at ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).1 "Previous studies have shown links between greater red meat consumption and increased risk of heart attacks or dying from heart disease," said study author Dr. Zahra Raisi-Estabragh of Queen Mary University of London, UK.2,3 "For the first time, we examined the relationships between meat consumption and imaging measures of heart health. This may help us to understand the mechanisms underlying the previously observed connections with cardiovascular disease." The study included 19,408 participants of the UK Biobank.4 The researchers examined associations of self-reported intake of red and processed meat with heart anatomy and function. Three types of heart measures were analysed. First, cardiovascular magnetic resonance (CMR) assessments of heart function used in clinical practice such as volume of the ventricles and measures of the pumping function of the ventricles. Second, novel CMR radiomics used in research to extract detailed information from heart images such as shape and texture (which indicates health of the heart muscle). Third, elasticity of the blood vessels (stretchy arteries are healthier). The analysis was adjusted for other factors that might influence the relationship including age, sex, deprivation, education, smoking, alcohol, exercise, high blood pressure, high cholesterol, diabetes, and body mass index (BMI) as a measure of obesity. The researchers found that greater intake of red and processed meat was associated with worse imaging measures of heart health, across all measures studied. Specifically, individuals with higher meat intake had smaller ventricles, poorer heart function, and stiffer arteries - all markers of worse cardiovascular health. As a comparison, the researchers also tested the relationships between heart imaging measures and intake of oily fish, which has previously been linked with better heart health. They found that as the amount of oily fish consumption rose, heart function improved, and arteries were stretchier. Dr. Raisi-Estabragh said: "The findings support prior observations linking red and processed meat consumption with heart disease and provide unique insights into links with heart and vascular structure and function." The associations between imaging measures of heart health and meat intake were only partially explained by high blood pressure, high cholesterol, diabetes, and obesity. "It has been suggested that these factors could be the reason for the observed relationship between meat and heart disease," said Dr. Raisi-Estabragh. "For example, it is possible that greater red meat intake leads to raised blood cholesterol and this in turn causes heart disease. Our study suggests that these four factors do play a role in the links between meat intake and heart health, but they are not the full story." She noted that the study did not look into alternative mechanisms. But she said: "There is some evidence that red meat alters the gut microbiome, leading to higher levels of certain metabolites in the blood, which have in turn been linked to greater risk of heart disease." Dr. Raisi-Estabragh said: "This was an observational study and causation cannot be assumed. But in general, it seems sensible to limit intake of red and processed meat for heart health reasons." More Fruits and Veggies Improves Sleep for Young Adults University of Michigan, April 15, 2021 Eating more fruits and vegetables can help young adults, especially young women, sleep better, a new study shows Young adults who reported eating less than five servings of fruits and vegetables per day reported a high prevalence of chronic insomnia symptoms, with over one-third reporting difficulties with falling asleep or maintaining sleep at least three times per week for three months or longer. Women who increased their fruit and vegetable intake by three or more servings over a three-month period were more than twice as likely to experience an improvement in these insomnia symptoms, according to the study in the Sleep Health Journal. “We were very excited to see that a fairly simple dietary intervention, such as encouraging an increase in fruit and vegetable consumption, could make such an impact on sleep,” says lead author Erica Jansen, research assistant professor of nutritional sciences at the University of Michigan’s School of Public Health. “We know from other literature that improving sleep improves overall quality of life and many other health outcomes, so the benefits likely extend beyond the sleep changes.” Jansen and senior author Gwen Alexander, a researcher in the public health sciences department at Henry Ford Health System, and colleagues analyzed data of more than 1,400 participants compiled by Detroit-based Henry Ford and the more rural Geisinger Health System headquartered in Danville, Pennsylvania. “From my health educator perspective, our study shows a link between dietary choices and improved sleep for young people who wish to improve their overall health and well-being,” Alexander says. “Our study was unique in that it investigated an understudied population of generally healthy young adults. Future research designed for this population has great potential to lead to better health habits.” Eligible young adults included those ages 21-30, who received any medical care at the centers and who reported eating less than five servings of fruits and vegetables per day. Researchers randomized the participants into one of three groups: one had an untailored web-based program to encourage higher fruits and vegetables consumption; the second had an age-targeted tailored web-based program; and the third group also included personalized e-coaching support. Young adults who increased their fruit and vegetable consumption by at least three servings experienced modest improvements in sleep latency (time to fall asleep) and insomnia over a three-month period, compared to participants with no change or smaller increases in fruits and vegetable intake, although there were no differences in sleep duration. Women who increased their fruit and vegetable intake by three or more servings reported a four-minute shorter time, on average, to fall asleep at follow-up, and twofold higher odds of improvement in insomnia symptoms. “What is unique about our study is that we were able to see that as fruit and vegetable intake changed, insomnia-related sleep characteristics also changed,” Jansen says. “We still cannot rule out that sleep characteristics changed first, which in turn caused a change in fruit and vegetable intake, but since the participants were part of a trial to increase fruit and vegetable intake, it is more likely the other way around. The participants were not told to change anything about their sleep habits.” The researchers hope the findings will be incorporated into other sleep hygiene principles, which include things like maintaining a consistent bedtime and rise time, eliminating screens prior to going to bed, sleeping in a dark, cool environment, and not drinking caffeine or alcohol before bed. Additional coauthors are from the University of South Carolina School of Medicine and the Henry Ford Health System. Multivits, omega-3, probiotics, vitamin D may lessen risk of positive COVID-19 test British Medical Journal, April 20, 2021 Taking multivitamins, omega-3, probiotics or vitamin D supplements may lessen the risk of testing positive for SARS-CoV-2, the virus responsible for COVID-19 infection—at least among women—indicates a large population study, published online in the journal BMJ Nutrition Prevention & Health. But taking any of vitamin C, zinc, or garlic supplements wasn't associated with a lower risk of testing positive for the virus, the findings show. There has been plenty of celebrity endorsement of the use of dietary supplements to both ward off and treat COVID-19 infection since the start of the pandemic, note the researchers. In the UK alone, market share rose by 19.5% in the period leading up to the first national 'lockdown' on March 23 last year, with sales of vitamin C rising by 110% and those of multivits by 93%. Similarly, zinc supplement sales rose by 415% in the first week of March, at the height of COVID-19 fears in the U.S.. Dietary supplements can help to support a healthy immune system, but whether specific supplements might be associated with a lower risk of catching SARS-CoV-2 isn't known. In a bid to plug this knowledge gap, the researchers drew on adult users of the COVID-19 Symptom Study app to see if regular supplement users were less likely to test positive for SARS-CoV-2. The app was launched in the UK, the US, and Sweden in March 2020 to capture self-reported information on the evolution of the pandemic. Initially, it recorded the location, age and core health risk factors of its users. But as time went on, subscribers were asked to provide daily updates on a range of issues, including symptoms, coronavirus test results, and healthcare. People without obvious symptoms were also encouraged to use it. For the purposes of this study, the researchers analysed information supplied by 372,720 UK subscribers to the app about their regular use of dietary supplements throughout May, June, and July 2020 during the first wave of the pandemic as well as any coronavirus swab test results. Between May and July,175,652 UK subscribers regularly took dietary supplements;197,068 didn't. Around two thirds (67%) were women and over half were overweight (BMI of 27). In all, 23,521 people tested positive for SARS-CoV-2 and 349,199 tested negative between May and July. Taking probiotics, omega-3 fatty acids, multivits or vitamin D was associated with a lower risk of SARS-CoV-2 infection: by 14%, 12%, 13% and 9%, respectively, after accounting for potentially influential factors, including underlying conditions and usual diet. No such effects were observed among those taking vitamin C, zinc, or garlic supplements. And when the researchers looked specifically at sex, age and weight (BMI), the protective associations for probiotics, omega-3 fatty acids, multivits and vitamin D were observed only in women of all ages and weights. No such clear associations were seen in men. Despite some differences, the same overall patterns were mirrored in both the US (45,757) and Swedish (27,373) subscribers. The equivalent figures for the US and Sweden were a reduced risk of:18% and 37%, respectively for probiotics; 21% and 16%, respectively, for omega-3 fatty acids; 12% and 22%, respectively for multivits; and 24% and 19%, respectively, for vitamin D supplements. This is an observational study, and as such, can't establish cause. The researchers also acknowledge several limitations, including that the study relied on self reported data and a self selected group. No information was collected on supplement doses or ingredients either. But although the observed effects were modest, they were significant, note the researchers, who call for large clinical trials to inform evidence-based therapeutic recommendations. "We know that a range of micronutrients, including vitamin D, are essential for a healthy functioning immune system. This, in turn, is key to prevention of, and recovery from, infections. "But to date, there is little convincing evidence that taking nutritional supplements has any therapeutic value beyond maintaining the body's normal immune response," comments Professor Sumantra Ray, Executive Director, NNEdPro Global Centre for Nutrition and Health, which co-owns the journal. "What's more, this study wasn't primarily designed to answer questions about the role of nutritional supplements in COVID-19. This is still an emerging area of research that warrants further rigorous study before firm conclusions can be drawn about whether specific nutritional supplements might lessen the risk of COVID-19 infection," he cautions. Vitamin D deficiency may impair muscle function Garvan Institute of Medical Research (Australia), April 16, 2021 Vitamin D deficiency may impair muscle function due to a reduction in energy production in the muscles, according to a mouse study published in the Journal of Endocrinology. Vitamin D deficient mice were found to have impaired muscle mitochondrial function, which may have implications for muscle function, performance and recovery. This may suggest that preventing vitamin D deficiency in older adults could help maintain better muscle strength and function and reduce age related muscle deterioration, but further studies are needed to confirm this. Vitamin D is a hormone well known to be important for maintaining bone health and preventing rickets and osteoporosis. In recent years, vitamin D deficiency has been reported to be as prevalent as 40% in European populations and linked to increased risk for several conditions, including COVID-19, cancer and diabetes. Although these studies report association rather than causation, the benefits of vitamin D supplementation are now a major subject of health debate. Multiple studies have also linked low vitamin D levels to poor muscle strength, particularly in older people. Skeletal muscle enables us to move voluntarily and perform everyday activities. It is essential that they have enough energy to power these movements. Specialised organs in cells, called mitochondria, convert nutrients in to energy to meet this demand. Previous studies indicate that impaired muscle strength in people with vitamin D deficiency may be linked to impaired muscle mitochondrial function. Determining the role of vitamin D in muscle performance of older people is also difficult, as they may suffer from a number of pre-existing health conditions that can also affect their vitamin D status. Therefore, previous studies have been unable to determine how vitamin D may directly affect muscle performance. Dr Andrew Philp and his team at the Garvan Institute of Medical Research in Australia, and collaborating universities, used a mouse model to determine the effects of diet-induced vitamin D deficiency on skeletal muscle mitochondrial function in young, male mice. Mice were either fed a diet with normal quantities of vitamin D, or with no vitamin D to induce deficiency, for a period of 3 months. A typical vitamin D level for humans is 40-50 nmol.L-1, and acute vitamin D deficiency is diagnosed when levels drop below 12 nmol.L-1. On average, the mice in this study had vitamin D levels of 30 nmol.L1, with diet-induced vitamin D deficiency leading to levels of just 3 nmol.L-1. Although this level was more extreme than typically observed in people, it is still within the clinically-recognised range. Tissue and blood samples were collected monthly to quantify vitamin D and calcium concentrations and to assess markers of muscle mitochondrial function and number. After 3 months of diet-induced vitamin D deficiency skeletal muscle mitochondrial function was found to be impaired by up to 37%. This was not due to a reduced number of mitochondria or a reduction in muscle mass. "Our results show there is a clear link between vitamin D deficiency and oxidative capacity in skeletal muscle. They suggest that vitamin D deficiency decreases mitochondrial function, as opposed to reducing the number of mitochondria in skeletal muscle." Dr Philp comments. "We are particularly interested to examine whether this reduction in mitochondrial function may be a cause of age related loss in skeletal muscle mass and function." These findings suggest that vitamin D deficiency may impair mitochondrial function and reduce the amount of energy produced in the muscles, which may lead to poor muscle function. Therefore, preventing vitamin D deficiency in older people may help maintain muscle performance and reduce the risk of muscle related diseases, such as sarcopenia. However, further studies that investigate the direct effect of vitamin D deficiency on muscle function and strength are necessary to confirm this. Whilst this study indicates that vitamin D deficiency can alter mitochondrial function in skeletal muscle, Dr Philp and his team were unable to determine precisely how this process occurred. Therefore, their future work aims to establish how vitamin D deficiency alters mitochondrial control and function in skeletal muscle. Psychedelic experience may not be required for psilocybin's antidepressant-like benefits So-called 'magic mushroom' drug seems to work through multiple brain mechanisms for its different effects University of Maryland School of Medicine, April 16, 2021 University of Maryland School of Medicine (UMSOM) researchers have shown that psilocybin--the active chemical in "magic mushrooms"-- still works its antidepressant-like actions, at least in mice, even when the psychedelic experience is blocked. The new findings suggest that psychedelic drugs work in multiple ways in the brain and it may be possible to deliver the fast-acting antidepressant therapeutic benefit without requiring daylong guided therapy sessions. A version of the drug without, or with less of, the psychedelic effects could loosen restrictions on who could receive the therapy, and lower costs, making the benefits of psilocybin more available to more people in need. In all clinical trials performed to date, the person treated with psilocybin remains under the care of a guide, who keeps the person calm and reassures them during their daylong experience. This can include hallucinations, altered perception of time and space, and intense emotional and spiritual encounters. Researchers in the field have long attributed psilocybin's effectiveness to the intense psychedelic experience. "We do not understand the mechanisms that underlie the antidepressant actions of psilocybin and the role that the profound psychedelic experience during these sessions plays in the therapeutic benefits," says Scott Thompson, Ph.D., Professor and Chair, Department of Physiology at UMSOM and senior author of the study. "The psychedelic experience is incredibly powerful and can be life-changing, but that could be too much for some people or not appropriate." Several barriers prevent the wide-spread use of psychedelic compounds. For example, there is fear that the psychedelic experience may promote psychosis in people who are predisposed to severe mental disorders, like bipolar disorder and schizophrenia, so the clinical therapy sessions performed to-date have been limited to a highly selected screened group without a family history of these disorders. Dr. Thompson adds that there may also be an equity issue because not everyone can take several days off work to prepare and engage in the experience. The costs of staffing a facility with at least one trained guide per treated person per day and a private space may also be prohibitive to all but a few. He says it is conceivable that a depression treatment derived from psilocybin could be developed without the psychedelic effects so people can take it safely at home without requiring a full day in a care facility. For their study, led by UMSOM MD/PhD student Natalie Hesselgrave, the team used a mouse model of depression in which mice were stressed for several hours a day over 2-3 weeks. Because researchers cannot measure mouse moods, they measure their ability to work for rewards, such as choosing to drink sugar water over plain water. People suffering from depression lose the feeling of pleasure for rewarding events. Similarly, stressed mice no longer preferred sugar water over plain water. However, 24 hours after a dose of psilocybin, the stressed mice regained their preference for the sugar water, demonstrating that the drug restored the mice's pleasure response. Psilocybin exerts its effects in people by binding to and turning on receptors for the chemical messenger serotonin. One of these receptors, the serotonin 2A receptor, is known to be responsible for the psychedelic response. To see if the psychedelic effects of psilocybin were needed for the anti-depressive benefits, the researchers treated the stressed mice with psilocybin together with a drug, ketanserin, which binds to the serotonin 2A receptor and keeps it from being turned on. The researchers found that the stressed mice regained their preference for the sugar water in response to psilocybin, even without the activation of the psychedelic receptor. "These findings show that activation of the receptor causing the psychedelic effect isn't absolutely required for the antidepressant benefits, at least in mice," says Dr. Thompson, "but the same experiment needs to be performed in depressed human subjects." He says his team plans to investigate which of the 13 other serotonin receptors are the ones responsible for the antidepressant actions. "This new study has interesting implications, and shows that more basic research is needed in animals to reveal the mechanisms for how these drugs work, so that treatments for these devastating disorders can be developed" says Albert E. Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, University of Maryland Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. Tea compound promotes formation of osteoblasts under inflammatory environment and increases bone mass First Affiliated Hospital of Soochow University (China), April 7, 2021 According to news originating from Suzhou, People’s Republic of China, the research stated, “Postmenopausal osteoporosis is a disease of bone mass reduction and structural changes due to estrogen deficiency, which can eventually lead to increased pain and fracture risk.” Our news correspondents obtained a quote from the research from First Affiliated Hospital of Soochow University: “Chronic inflammatory microenvironment leading to the decreased activation of osteoblasts and inhibition of bone formation is an important pathological factor that leads to osteoporosis. Theaflavin-3,3’-digallate (TFDG) is an extract of black tea, which has potential anti-inflammatory and antiviral effects. In our study, we found that TFDG significantly increased the bone mass of ovariectomized (OVX) mice by micro-CT analysis. Compared with OVX mice, TFDG reduced the release of proinflammatory cytokines and increased the expression of osteogenic markers in vivo. In vitro experiments demonstrated that TFDG could promote the formation of osteoblasts in inflammatory environment and enhance their mineralization ability. In this process, TFDG activated MAPK, Wnt/b-Catenin and BMP/Smad signaling pathways inhibited by TNF-a, and then promoted the transcription of osteogenic related factors including Runx2 and Osterix, promoting the differentiation and maturation of osteoblasts eventually.” According to the news reporters, the research concluded: “In general, our study confirmed that TFDG was able to promote osteoblast differentiation under inflammatory environment, enhance its mineralization ability, and ultimately increase bone mass in ovariectomized mice. These results suggested that TFDG might have the potential to be a more effective treatment of postmenopausal osteoporosis.” Patients who are overweight or obese at risk of more severe COVID-19 Murdoch Children's Research Institute and University of Queensland, April 16, 2021 Patients who are overweight or obese have more severe COVID-19 and are highly likely to require invasive respiratory support, according to a new international study. The research, led by the Murdoch Children's Research Institute (MCRI) and The University of Queensland and published in Diabetes Care, found obese or overweight patients are at high risk for having worse COVID-19 outcomes. They are also more likely to require oxygen and invasive mechanical ventilation compared to those with a healthy weight. MCRI researcher Dr Danielle Longmore said the findings, which highlighted the relationship between obesity and increased COVID-19 disease burden, showed the need to urgently introduce strategies to address the complex socio-economic drivers of obesity, and public policy measures such as restrictions on junk food advertising. "Although taking steps to address obesity in the short-term is unlikely to have an immediate impact in the COVID-19 pandemic, it will likely reduce the disease burden in future viral pandemics and reduce risks of complications like heart disease and stroke," she said. The study looked at hospitalised SARS-CoV-2 patients from 18 hospitals in 11 countries including China, America, Italy, South Africa and The Netherlands. Among the 7244 patients aged 18 years and over, 34.8 per cent were overweight and 30.8 per cent were obese. COVID-19 patients with obesity were more likely to require oxygen and had a 73 per cent greater chance of needing invasive mechanical ventilation. Similar but more modest results were seen in overweight patients. No link was found between being overweight or obese and dying in hospital from COVID-19. Cardiovascular and pre-existing respiratory diseases were associated with increased odds of in-hospital deaths but not a greater risk for needing oxygen and mechanical ventilation. For patients with pre-existing diabetes, there was increased odds of needing invasive respiratory support, but no additionally increase in risk in those with obesity and diabetes. Men were at an increased risk of severe COVID-19 outcomes and needing invasive mechanical ventilation. In those aged over 65 years, there was an increased chance of requiring oxygen and higher rates of in-hospital deaths. The University of Queensland's Dr Kirsty Short, who co-led the research, said almost 40 per cent of the global population was overweight or obese. "Obesity is associated with numerous poor health outcomes, including increased risk of cardiometabolic and respiratory disease and more severe viral disease including influenza, dengue and SARS-CoV-1," she said. Dr Short said while previous reports indicated that obesity was an important risk factor in the severity of COVID-19, almost all this data had been collected from single sites and many regions were not represented. Moreover, there was a limited amount of evidence available about the effects of being overweight or obese on COVID-19 severity. "Given the large scale of this study we have conclusively shown that being overweight or obese are independent risk factors for worse outcomes in adults hospitalised with COVID-19," she said. MCRI Professor David Burgner, who co-led the research, said the data would help inform immunisation prioritisation for higher-risk groups. "At the moment, the World Health Organization has not had enough high-quality data to include being overweight or obese as a risk factor for severe COVID-19 disease. Our study should help inform decisions about which higher-risk groups should be vaccinated as a priority," he said. Neuroprotective Herbs for the Management of Alzheimer’s Disease University of Central Florida and University of California, Los Angeles Background—Alzheimer’s disease (AD) is a multifactorial, progressive, neurodegenerative disease that is characterized by memory loss, personality changes, and a decline in cognitive function. While the exact cause of AD is still unclear, recent studies point to lifestyle, diet, environmental, and genetic factors as contributors to disease progression. The pharmaceutical approaches developed to date do not alter disease progression. More than two hundred promising drug candidates have failed clinical trials in the past decade, suggesting that the disease and its causes may be highly complex. Medicinal plants and herbal remedies are now gaining more interest as complementary and alternative interventions and are a valuable source for developing drug candidates for AD. Indeed, several scientific studies have described the use of various medicinal plants and their principal phytochemicals for the treatment of AD. This article reviews a subset of herbs for their anti-inflammatory, antioxidant, and cognitive-enhancing effects. Methods—This article systematically reviews recent studies that have investigated the role of neuroprotective herbs and their bioactive compounds for dementia associated with Alzheimer’s disease and pre-Alzheimer’s disease. PubMed Central, Scopus, and Google Scholar databases of articles were collected, and abstracts were reviewed for relevance to the subject matter. Conclusions—Medicinal plants have great potential as part of an overall program in the prevention and treatment of cognitive decline associated with AD. It is hoped that these medicinal plants can be used in drug discovery programs for identifying safe and efficacious small molecules for AD. 1.1. Ashwagandha (Withania somnifera) Ashwagandha, commonly called Indian ginseng or winter cherry, is one of the most prominent herbs prescribed as a brain rejuvenator for AD. It is prescribed to increase energy, improve overall health and longevity, and as a nerve tonic [86]. Ashwagandha has been shown to possess antioxidant activity, free radical scavenging activity, as well as an ability to support a healthy immune system [87]. Ashwagandha contains several bioactive compounds of great interest, such as ergostane-type steroidal lactones, including withanolides A-Y, dehydrowithanolide-R, withasomniferin-A, withasomidienone, withasomniferols A-C, withaferin A, withanone, and others. Other constituents include the phytosterols sitoindosides VII-X and beta-sitosterol and alkaloids [86,88]. A subset of these components has been shown to scavenge free radicals generated during the initiation and progression of AD. Molecular modeling studies showed that withanamides A and C uniquely bind to the active motif of Aβ25-35 and prevent fibril formation. Furthermore, these compounds protected PC-12 cells and rat neuronal cells from β-amyloid-induced cell death [89,90,91]. Treatment with the methanol extract of ashwagandha triggered neurite outgrowth in a dose- and time-dependent manner in human neuroblastoma cells [29], and, in another study involving cultured rat cortical neurons, treatment with Aβ peptide induced axonal and dendritic atrophy and loss of pre-and postsynaptic stimuli [92]. Subsequent treatment with withanolide A induced significant regeneration of both axons and dendrites and restored the pre- and post-synapses in the cultured cortical neurons. In vivo, withanolide A inhibited Aβ(25–35)-induced degeneration of axons, dendrites, and synapses in the cerebral cortex and hippocampus and also restored Aβ-peptide-induced memory deficits in mice [93]. The in vivo ameliorative effects were maintained even after the discontinuation of the drug administration. Aqueous extracts of ashwagandha increased acetylcholine (ACh) content and choline acetyl transferase activity in rats, which might partly explain the cognition-enhancing and memory-improving effects [29,94,95]. Treatment with the root extract caused the upregulation of the low-density lipoprotein receptor-related protein, which enhanced the Aβ clearance and reversed the AD pathology in middle-aged and old APP/PS1 mice [96]. Oral administration of a semi-purified extract of ashwagandha reversed behavioral deficits and blocked the accumulation of Aβ peptides in an APP/PS1 mouse model of AD. This therapeutic effect of ashwagandha was mediated by the liver low-density lipoprotein receptor-related protein [96]. Using an AD model of Drosophila melanogaster, researchers noted that treatment with ashwagandha mitigated Aβ toxicity and also promoted longevity [97]. Despite the extensive literature on the therapeutic effects of ashwagandha, there are limited data on its clinical use for cognitive impairment [98]. In a prospective, randomized, double-blind, placebo-controlled pilot study involving 50 subjects with mild cognitive impairment, subjects were treated with either ashwagandha root extract (300 mg twice daily) or placebo for eight weeks. After eight weeks of study, the ashwagandha treatment group demonstrated significant improvements in both immediate and general memory tests compared to the placebo group. Furthermore, the treatment group showed significant improvement in executive function, sustained attention, and information-processing speed [99]. These studies lend credence to ashwagandha’s role in enhancing memory and improving executive function in people with SCI or MCI. 1.2. Brahmi (Bacopa monnieri) Brahmi, or Bacopa monnieri (Bm), is a perennial creeper medicinal plant found in the damp and marshy wetlands of Southern and Eastern India, Australia, Europe, Africa, Asia, and North and South America. In the Ayurvedic system of medicine, Bm is recommended for mental stress, memory loss, epilepsy, insomnia, and asthma [34,36]. The bioactive phytochemicals present in this plant include saponins, bacopasides III, IV, V, bacosides A and B, bacosaponins A, B, C, D, E, and F, alkaloids, sterols, betulic acid, polyphenols, and sulfhydryl compounds, which may be responsible for the neuroprotective roles of the plant. Both in vitro and in vivo studies show that these phytochemicals have an antioxidant and free radical scavenging action by blocking lipid peroxidation in several areas of the brain [36,100,101,102]. Bm acts by reducing divalent metals, scavenging reactive oxygen species, decreasing the formation of lipid peroxides, and inhibiting lipoxygenase activity [103]. Numerous studies have also shown Bm’s role in memory and intellect [33,56,100,104,105,106]. To determine the neuroprotective effect of Bm in a rat model of AD, researchers tested an alcoholic extract of Bm at doses of 20, 40, and 80 mg/kg for a period of 2 weeks before and 1 week after the intracerebroventricular (icv) administration of ethylcholine aziridinium ion (AF64A). Spatial memory was tested using the Morris water maze (MWM), and the cholinergic neuron density was determined using histological techniques. The researchers showed that Bm extract improved the escape latency time in the MWM test and blocked the reduction of cholinergic neuron densities [35]. Another group reported the reversal of colchicine-induced cognitive deficits by a standardized extract of Bm. In addition to reversing colchicine-triggered cognitive impairment, the Bm extract also attenuated colchicine-induced oxidative damage by decreasing the protein carbonyl levels and restoring the activities of the antioxidant enzymes [107]. Most of the studies exploring the cognitive-enhancing effects of Bm in humans focused on normal, aged individuals. In a double-blind, randomized, placebo-controlled trial on 35 individuals aged above 55 years, subjects received either 125 mg of Bm extract or a placebo twice a day for a period of 12 weeks, followed by a placebo period of another four weeks. Subjects underwent a battery of memory tests, including general information, orientation, mental control, logical memory, digit forward, digit backward, visual reproduction, and paired association learning. Subjects were scored on each sub-test, and total memory score was calculated by adding the score of all subtests. A significant improvement was observed in mental control, logical memory, and paired association learning in Bm-treated patients compared to the placebo group at 8 and 12 weeks after initiation of the trial [37]. The results suggested the use of Bm in the treatment of age-associated memory impairment. Ten subjects were given 500 mg of Sideritis extract, 320 mg Bm extract, or a combination using a crossover design. Sideritis extract is rich in a variety of flavonoids and has been shown to improve cognition in animal models of AD [108]. The Attention d2 Test is a neuropsychological measure of selective and sustained attention and visual scanning speed. Assessment tests revealed that Sideritis extract combined with a low-dose Bm extract resulted in improvement in the d2 concentration test score [109]. A similar effect of Bm alone was observed only after repetitive dosing, suggesting that the long-term memory effects seen with repetitive dosing of Bm may be a promising therapeutic option for subjects suffering from MCI [109]. In another prospective, non-comparative, multicenter trial involving 104 subjects who suffered from MCI, Bm extract in combination with astaxanthin, phosphatidylserine, and vitamin E was given for 60 days. The tested combination formula was well tolerated. Cognitive and mnemonic performance was assessed with validated instruments including Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) and Clock-Drawing Test (CDT) that can assess the risk of MCI progression to AD. Researchers noted significant improvements in ADAS-cog and CDT scores [110]. The observed sixty-day improvements in ADAS-cog and CDT were statistically significant as compared with baseline values. Memory is affected by several factors, including focus and attention, neurotransmitters, hormones, trophic factors, cyclic AMP, ion channels, protein transcription, synapse formation, and nutrients. Some of these processes can be modulated by Bm extract alone or in combination with other compounds. The abovementioned study design is similar to our therapeutic program for people with SCI and MCI, where Bm is administered in combination with other nutraceuticals and cogniceuticals [15,111]. 1.3. Cat’s Claw (Uncaria tomentosa) Cat’s claw (CC) is a tropical vine with hooked thorns that resemble the claws of a cat and is mainly recommended for its potential role in the treatment of AD and pre-AD. It is found mainly in the Amazon rainforest and other areas of South and Central America. This medicinal plant contains oxindole alkaloids, polyphenols (flavonoids, proanthocyanidins, and tannins), glycosides, pentacyclic alkaloids, and sterols [38,39]. CC is known for its immune-modulating and anti-inflammatory effects and for its role as a free radical scavenger. Based on in vitro studies, the anti-inflammatory effect of CC is attributed to its ability to inhibit iNOS gene expression, nitrate formation, cell death, PGE2 production, and the activation of NF-κB and TNF-α [45]. Using a transgenic mouse model of Alzheimer’s disease, a significant reduction in the Aβ load (by 59%) and plaque number (by 78%) in the hippocampus and cortex was observed after treating 8-month-old mice with the CC extract for 14 days [44]. CC extract also caused a significant reduction in astrocytosis and microgliosis, and it improved hippocampus-dependent memory. Some of the components in the CC extract crossed the blood–brain barrier (BBB) and entered the brain parenchyma following intravenous injection [44]. Pre-clinical studies suggest that CC extract inhibits the formation of plaques and tangles, reduces astrocytosis and microgliosis and improves memory in mouse models of AD [43,44]. CC extract not only prevented the formation and aggregation of Aβ fibrils and tau protein paired helical filaments, but it also facilitated the disaggregation of preformed fibrils and tau protein tangles [43,44]. While proanthocyanidin B2 was identified as the primary phytochemical with plaque-and tangle-dissolving activity, other polyphenols present in the CC extract also possess plaque-reducing activity [44]. Based on pre-clinical studies, Cat’s claw may be effective for memory loss and cognitive decline associated with AD, although no studies have been carried out in humans. 1.4. Ginkgo Biloba Ginkgo biloba (Gb) has been in the spotlight primarily for its potential role in treating AD. Gb also appears promising as a therapeutic agent for several other chronic and acute forms of diseases. The main pharmacologically active groups of compounds are flavonoids and terpenoids. Almost all clinical studies use Gb extract that contains a combination of flavonoid glycosides, terpene lactones, and ginkgolic acids [50]. Gb extract has shown beneficial effects in treating Alzheimer’s, cardiovascular diseases, cancer, tinnitus, and other age-associated conditions [49,50]. The suggested mechanisms of the Gb extract are its antioxidant effect, anti-platelet activating factor activity for vascular diseases, inhibition of β-amyloid peptide aggregation in AD, and decreased expression of peripheral benzodiazepine receptor for stress alleviation [48,49,50]. Gb is popular as a treatment for early-stage AD and vascular dementia. Gb extract reverses β-amyloid and NO-induced toxicity in vitro and reduces apoptosis both in vitro and in vivo [112,113,114]. Treatment with Gb extract enhanced memory retention in young and old rats and improved short-term memory in mice [49,115]. Several studies indicate that ginkgo delays the progression of AD and is as effective as the cholinesterase inhibitors for treating AD. A modest improvement in cognitive function was observed in AD subjects in various randomized, double-blind, placebo-controlled trials [116,117,118]. Gb extract also improves ADLs among AD individuals and is preferred over other AD medications because of its negligible adverse effects [119,120]. 1.5. Gotu Kola (Centella asiatica) Considered both a nutraceutical and cogniceutical, Gotu kola (Gk) is a staple in Chinese, Indonesian, and Ayurvedic medicine [57]. This medicinal plant is used to strengthen the brain, heal skin issues, and promote liver and kidney health. Gk is considered a rejuvenating herb for nerve and brain cells as it is believed to promote intelligence and improve memory [54,55,56,57]. In vitro studies using various Gk plant derivatives (asiaticosides, asiatic acid, madecassoside, and madasiatic acid) showed that these compounds were capable of blocking H2O
Sufficient vitamin D during gestation and early life can lower susceptibility to allergy in infants Wageningen University (Netherlands), April 5, 2021 According to news originating from Wageningen, Netherlands, the research stated, “Worldwide, the prevalence of allergies in young children, but also vitamin D deficiency during pregnancy and in newborns is rising. Vitamin D modulates the development and activity of the immune system and a low vitamin D status during pregnancy and in early life might be associated with an increased risk to develop an allergy during early childhood.” Our news editors obtained a quote from the research from Wageningen University and Research: “This review studies the effects of vitamin D during gestation and early life, on allergy susceptibility in infants. The bioactive form of vitamin D, 1,25(OH)2D, inhibits maturation and results in immature dendritic cells that cause a decreased differentiation of naive T cells into effector T cells. Nevertheless, the development of regulatory T cells and the production of interleukin-10 was increased. Consequently, a more tolerogenic immune response developed against antigens. Secondly, binding of 1,25(OH)2D to epithelial cells induces the expression of tight junction proteins resulting in enhanced epithelial barrier function. Thirdly, 1,25(OH)2D increased the expression of anti-microbial peptides by epithelial cells that also promoted the defense mechanism against pathogens, by preventing an invasive penetration of pathogens.” According to the news editors, the research concluded: “Immune intervention by vitamin D supplementation can mitigate the disease burden from asthma and allergy. In conclusion, our review indicates that a sufficient vitamin D status during gestation and early life can lower the susceptibility to develop an allergy in infants although there remains a need for more causal evidence.” Training in compassion improves the well-being of relatives to people with mental illness Aarhus University (Denmark), April 7, 2021 If relatives of people with mental illness become better at accepting the difficult emotions and life events they experience - which is what training in compassion is about - their anxiety, depression and stress is reduced. These are the results of a new study from the Danish Center for Mindfulness at Aarhus University. Being a relative of a person with a mental illness can be very burdensome. It can feel like a great responsibility, and many people struggle with feelings of fear, guilt, shame and anger. A new study from the Danish Center for Mindfulness shows that eight weeks of training in compassion can significantly improve the well-being of relatives. Compassion is a human quality that is anchored in the recognition of and desire to relieve suffering. In other words, compassion occurs when we come into contact with our own or others' suffering and feel motivated to relieve our own or others pain. "After completing the course, the relatives had increased their well-being on several parameters. They could deal with the illness in a new and more skillful way, and we saw that the training reduced their symptoms of depression, anxiety and stress," says psychologist and PhD student Nanja Holland Hansen, who is behind the study. And the positive results were maintained after a six month follow-up. Trying to fix what is difficult "The relatives learned that the more they turn towards what is difficult, the more skillful they may act. For example, relatives often try to 'fix' the problem or the challenge - so as to relieve their loved ones of what is difficult. That's a huge pressure to constantly deal with, and very few people can bear it," says Nanja Holland Hansen. Living with chronic fear She goes on to explain that training in compassion helps people to find the strength and courage to bear pain and suffering when life is difficult. It may seem both sensible and intuitive to guard yourself from the confrontation or avoid what is difficult and unpleasant. But this is the paradox of the training, explains the researcher. Because it is precisely actions and thoughts like these that shut down our compassion and thereby maintain the suffering. "Fear and grief are emotions that take up a lot space for relatives of people with mental illness. For example chronic fear, which is a real fear that parents of a child with schizophrenia have about whether their child is going to commit suicide, or whether a child with autism will ever enjoy a 'normal life'," explains Nanja Holland Hansen and continues: "Our suffering is maintained inside of us when we don't work with it. To avoid feeling pain, we may resort to behaviour such as working too much or buying things that we don't need. It's therefore in all these everyday actions that our compassion training becomes important and can be used to help alleviate what is difficult," she says. No one escapes The purpose of training in compassion is thus more than just feeling empathy or worrying about another person. "Not a single person can completely avoid experiencing painful things in their life. In this way we're all the same. But what isn't the same for everyone is our ability to deal with the pain and suffering we experience. Training programmes in compassion have been developed because the research shows that we can train and strengthen our mental health. With systematic training of compassion, we generate more attention - and understanding of - our own thoughts, feelings and behaviour. And this helps us to develop the tools and skills to engage in healthier relations with ourselves and others," she explains. A total of 161 relatives of people with mental illness participated in the study. This makes the study one of the largest of its kind in the world, and also the first scientific randomised clinical trial carried out with relatives in Denmark. The relatives were between 18 and 75 of age and were family members to people with various psychiatric disorders such as e.g. ADHD, schizophrenia and depression. Meditation as homework The relatives met once a week in groups of twenty participants over an eight-week period. Each session lasted two hours and was structured with small group exercises, large group discussions, instruction in the theme of the week and meditation. The homework consisted of twenty minutes of daily meditation. "There is definitely a shortage of offers for these relatives. They're often told that they should remember to take care of themselves, but they haven't learned how to. We found that those who were involved in the study received the tools for precisely this," says Nanja Holland Hansen. The results have just been published in the scientific journal JAMA. "My hope is that local authorities and regions can offer this type of intervention for relatives. It should be an option and could easily be incorporated into our healthcare system. Economically and socially, a healthy person going on sick leave solely because he or she is a relative is a huge loss," says the researcher. [Billedtekst:]: "Up to fifty percent of relatives of people with mental illness risk becoming ill themselves. That's why it's important that we also keep them and their well-being in mind," says Nanja Holland Hansen. Sesaminol prevents Parkinson's disease by activating the Nrf2-ARE signaling pathway Osaka City University (Japan), March 331, 2021 Parkinson's disease (PD) is a neurodegenerative disease caused by the degeneration of substantia nigra neurons due to oxidative stress. Sesaminol has strong antioxidant and anti-cancer effects. We investigated the preventive effect on PD as a new physiological action of sesaminol produced from sesaminol glycoside using in vitro and in vivo PD models. To prepare an in vitro PD model, 6-hydroxydopamine (6-OHDA) was added to human neuroblastoma (SH-SY5Y cells). The viability of SH-SY5Y cells decreased dose-dependently following 6-OHDA treatment, but the addition of sesaminol restored viability to the control level. 6-OHDA increased intracellular reactive oxygen species production, and the addition of sesaminol significantly suppressed this increase. No Nrf2 expression in the nucleus was observed in the control group, but a slight increase was observed in the 6-OHDA group. The sesaminol group showed strong expression of Nrf2 in the cytoplasm and nucleus. NAD(P)H: quinone oxidoreductase (NQO1) activity was enhanced in the 6-OHDA group and further enhanced in the sesaminol group. Furthermore, the neurotoxine rotenone was orally administrated to mice to prepare an in vivo PD model. The motor function of rotenone-treated mice was shorter than that of the control group, but a small amount of sesaminol restored it to the control level. The intestinal motility in the rotenone group was significantly lower than that in the control group, but it remained at the control level in the sesaminol group. The expression of α-synuclein in the substantia nigra increased in the rotenone group but decreased in the sesaminol group. The rotenone group exhibited shortening and damage to the colonic mucosa, but these abnormalities of the colonic mucosa were scarcely observed in the sesaminol group. These results suggest that sesaminol has a preventative effect on PD. Study finds connection between lifestyle choices, Alzheimer disease Brigham Young University, April 8, 2021 A recent study out of BYU has linked lifestyle choice to Alzheimer's disease, at least to some degree, through findings that show a possible energy gap between the amount of glucose and ketones being used to power the brain. BYU professor Ben Bikman, who studies diabetes and insulin resistance, thought of a fundamental question surrounding Alzheimer's disease and insulin resistance in the brain. Bikman said there has been growing evidence that the brains in humans with Alzheimer's disease are deficient in the use of glucose. "The brain has a certain energy demand, let's say that is 100%," Bikman said. "In most instances, glucose is providing virtually all of that energy, nearly 100% all of the time. There is a secondary fuel known as ketones, so the average brain is consuming almost all of its energy from glucose with a little bit of energy coming from ketones at any moment. In some individuals, the brain starts to become deficient in its ability to use glucose. So now glucose can only provide about 60% of that energy, and then ketones would be expected to fill up the rest of that energy. The tragedy is that the average individual has almost undetectable levels of ketones and that's entirely a matter of lifestyle." This lack of ketones as well as the brain's resistance to insulin is linked to lifestyle. Insulin is expected to stimulate tissues or cells to take in the glucose and use it for energy. As the brain becomes more insulin resistant, it can't take in glucose anymore and this is something Bikman said has been shown in other research. The BYU research expanded on some of those findings. "We found that indeed the expression of genes involved in glucose metabolism was significantly down, very broad across every cell type we looked at in the brain," Bikman said. "All of the cell types we looked at had significant reductions in glucose-related genes, but the ketone-related genes were almost totally normal." This is key because it shows that if the brain can receive more ketones, there is a possibility that one could overcome that energy gap. While it may not be able to be filled in with glucose, it can be with ketones but ketones need to be produced by one's body. With many people having diets that are high in refined sugars and starches, insulin is elevated all of the time, and ketones are only produced when insulin levels are low. These conditions include fasting or low-carb diets, also known as keto diets. Ph.D. student Erin Saito is another one of the lead authors of the study and is doing this project as her dissertation. Another collaborator included Washington University of Saint Louis, which gave the BYU research team access to various brain banks. "BYU is a wonderfully collaborative environment, not only encouraging collaborations within the university but also outside of the university," Bikman said. "Thus communicating with our internal and external collaborators was very easy and very natural. There was very much a common interest to work on this project together, a common enthusiasm for answering a question that had not been asked yet. It would not have been possible without that mutual collaboration and enthusiasm." He added that managing the project with enthusiastic students was a delight, making it easy because of the enthusiasm surrounding the project. Bikman said it is gratifying for him to be able to contribute to what little is known about Alzheimer's disease, because traditional strategies and approaches have continued to fail. "Looking at Alzheimer's disease as a metabolic problem, I would say, is the greatest breakthrough in our understanding of the disease in decades," Bikman said. Looking at it through the metabolic side of things allows people to possibly detect the problem years in advance, looking at changes in brain glucose metabolism long before Alzheimer's sets in. Bikman believes that someday the metabolic approach to Alzheimer's will be the standard of care. Moving forward, Bikman said he hopes that people feel empowered when it comes to Alzheimer's disease. He wants people to not look at it as a passive process where they are the victim, but rather acknowledging that their lifestyle choices can either act as the culprit or the cure. "For too long we have viewed Alzheimer's disease as a disease that is no respecter of person, no respecter of choices and that is simply not true," Bikman said. "We have long known that people with metabolic disorders, like type 2 diabetes and insulin resistance, are at significantly greater risk of developing Alzheimer's disease and we have more evidence suggesting that dietary choices and changes do make significant improvements in someone's cognition." Even someone in the midst of Alzheimer's disease can see improvements in memory and learning with a lifestyle change, according to Bikman, and he added that he hopes this evidence will help to strengthen that view and empower individuals to take matters into their own hands. New Study Shows Broad Benefits Of High-CBD Cannabis Health Canada Research Institute, April 6, 2021 With CBD exploding in popularity, new studies continue to reveal its potential benefits. A new study published in the journal Aging-US reported that high-CBD cannabis has anti-inflammatory and anti-cancer properties and may even help reduce COVID symptoms. Cannabidiol, or CBD, is a non-psychoactive compound in cannabis and is legal in all 50 states. “Cannabis sativa, especially those high in the anti-inflammatory cannabinoid cannabidiol, has been found to alter gene expression and inflammation and harbour anti-cancer and anti-inflammatory properties,” the researchers at Health Canada concluded. As such, they say specific CBD extracts “may become a useful and safe addition to the prevention/treatment of COVID-19 as an adjunct therapy.” Researchers hypothesized that high-CBD C. sativa extracts may be used to down-regulate ACE2 expression in target COVID-19 tissues. Using artificial 3D human models of oral, airway and intestinal tissues, they identified 13 high-CBD C. sativa extracts that decrease ACE2 protein levels. Some C. sativa extracts down-regulate serine protease TMPRSS2, another critical protein required for SARS-CoV-2 entry into host cells. This is not the first study to suggest that CBD could combat respiratory illnesses like COVID. In April 2020, researchers at the University of Nebraska and the Texas Biomedical Research Institute published a peer-reviewed article suggesting that CBD could be included in the treatment regimen for the COVID-19 coronavirus as THC and CBD both appeared to reduce the severe lung inflammation associated with the virus. In July 2020, researchers at the Dental College of Georgia and Medical College of Georgia found early evidence that Cannabidiol, or CBD, may help reduce the cytokine storm and excessive lung inflammation that killed many patients with COVID-19. “Our laboratory studies indicate pure CBD can help the lungs recover from the overwhelming inflammation, or cytokine storm, caused by the COVID-19 virus, and restore healthier oxygen levels in the body,” says co-author Dr. Jack Yu, physician-scientist and chief of pediatric plastic surgery at MCG. In October 2020, the same research group published a follow-up peer-reviewed study identifying the mechanism they believe was responsible for the encouraging results of using CBD to reduce lung inflammation. “One way CBD appears to reduce the “cytokine storm” that damages the lungs and kills many patients with COVID-19 is by enabling an increase in levels of a natural peptide called apelin, which is known to reduce inflammation and whose levels are dramatically reduced in the face of this storm,” they concluded. While this is incredibly encouraging news for relief from COVID, businesses that sell CBD edibles and oils are not allowed to mention these benefits in advertising because the FDA has not officially approved it for any specific treatment. Apparently, experimental vaccines are okay to advertise but natural plant extracts aren’t. The new study above is just another to suggest cannabis and CBD can help fight cancer. There have been many studies as well as countless confirmed anecdotal accounts. In 2018, a 44-year-old UK mom refused chemo for her aggressive triple-negative breast cancer. She opted for CBD oil instead and was declared cancer-free five months later. In 2019, an 81-year-old diagnosed with lung cancer shrunk his tumors in half by taking CBD oil. The case study was published in the peer-reviewed journal Sage. More recently, a Colorado State University study showed that CBD extract can slow growth and kill cancer cells in aggressive brain cancer. “Our experiments showed that CBD slows cancer cell growth and is toxic to both canine and human glioblastoma cell lines,” said Chase Gross, a doctoral student participating in the study. “Importantly, the differences in anti-cancer affects between CBD isolate and extract appear to be negligible.” That’s not all, CBD has shown potential for treating a variety of other ailments such as arthritis, seizures, chronic pain, high blood pressure, Alzheimer’s and more – with little to no severe side effects that are common with leading pharmaceuticals. Big Pharma hopes more people don’t discover natural treatments to common health issues, like CBD, because it could severely impact their profits and influence. Polyphenol pills counter inflammation in women on hormonal contraceptives: RCT Universidade Federal do Rio Grande do Sul (Brazil), April 7, 2021 Supplements containing a mixture of polyphenols may counter increases in pro-inflammatory markers in women of childbearing age using combined hormonal contraceptives, says a new study. The supplements, formulated with resveratrol, catechin, quercetin, chlorogenic acid and cyanidin, were also found to prevent the increases in markers of systemic oxidative stress like F2-isoprostane, according to findings published in Prostaglandins, Leukotrienes and Essential Fatty Acids . “The increase in biomarkers of inflammation and oxidative stress observed in the present study were possibly caused by the use of hormonal contraceptives, as verified in the [control group], and this change was not observed in the group that used polyphenols,” wrote researchers from the Institute of Cardiology and the Universidade Federal do Rio Grande do Sul in Brazil. “Therefore, the results of this polyphenol supplementation showed that the antioxidant and anti-inflammatory effects observed in the studied population is due to the reduction in plasma levels of PGE2, supporting the conceptual hypothesis, by its action on the inflammatory cascade, probably by COX inhibition.” Study details The Brazil-based researchers recruited 40 women aged between 25 and 35 using contraceptives, and randomly assigned them to receive either placebo or polyphenols (3,000 mg per day) for 15 days. “A higher dosage was chosen in order to reduce the risk of food ingestion of control group to overcome the dosage of polyphenol supplementation in the [polyphenol group],” they explained. Data from the 28 women who completed the study indicated that, as expected, markers of inflammation (PGE2 and C-reactive protein) and oxidative stress (F2-isoprostane) increased significantly in women in the placebo group. However, no such increases were observed in the polyphenol group. “Among participants of the polyphenols group, an inverse correlation was observed between the consumption of polyphenols estimated by the [food frequency questionnaire] with PGE2 levels at the end of the study. This finding had not yet been previously described in the literature and reinforces the hypothesis of the present study regarding the action of polyphenols in reducing PGE2 levels,” wrote the researchers. “The liver is the main organ involved in the metabolism of polyphenols, and metabolites are secreted in bile and urine. Excretion of polyphenols in participants of the [polyphenol group] was significantly higher than in the [control group], confirming the effective ingestion of capsules and absorption of compounds, which can vary depending on the amount ingested, the chemical structure of the substance and the intestinal flora of the subjects.” Childhood diet and exercise creates healthier, less anxious adults University of California Riverside, April 9, 2021 Exercise and a healthy diet in childhood leads to adults with bigger brains and lower levels of anxiety, according to new UC Riverside research in mice. Though diet and exercise are consistently recommended as ways to promote health, this study is the first to examine the long-lasting, combined effects of both factors when they are experienced early in life. "Any time you go to the doctor with concerns about your weight, almost without fail, they recommend you exercise and eat less," said study lead and UCR physiology doctoral student Marcell Cadney. "That's why it's surprising most studies only look at diet or exercise separately. In this study, we wanted to include both." The researchers determined that early-life exercise generally reduced anxious behaviors in adults. It also led to an increase in adult muscle and brain mass. When fed "Western" style diets high in fat and sugar, the mice not only became fatter, but also grew into adults that preferred unhealthy foods. These findings have recently been published in the journal Physiology and Behavior. To obtain them, the researchers divided the young mice into four groups -- those with access to exercise, those without access, those fed a standard, healthy diet and those who ate a Western diet. Mice started on their diets immediately after weaning, and continued on them for three weeks, until they reached sexual maturity. After an additional eight weeks of "washout," during which all mice were housed without wheels and on the healthy diet, the researchers did behavioral analysis, measured aerobic capacity, and levels of several different hormones. One of those they measured, leptin, is produced by fat cells. It helps control body weight by increasing energy expenditure and signaling that less food is required. Early-life exercise increased adult leptin levels as well as fat mass in adult mice, regardless of the diet they ate. Previously, the research team found that eating too much fat and sugar as a child can alter the microbiome for life, even if they later eat healthier. Going forward, the team plans to investigate whether fat or sugar is more responsible for the negative effects they measured in Western-diet-fed mice. Together, both studies offer critical opportunities for health interventions in childhood habits. "Our findings may be relevant for understanding the potential effects of activity reductions and dietary changes associated with obesity," said UCR evolutionary physiologist Theodore Garland. In other words, getting a jump start on health in the early years of life is extremely important, and interventions may be even more critical in the wake of the pandemic. "During the COVID-19 lockdowns, particularly in the early months, kids got very little exercise. For many without access to a park or a backyard, school was their only source of physical activity," Cadney said. "It is important we find solutions for these kids, possibly including extra attention as they grow into adults." Given that exercise was also shown to reduce adult anxiety, Cadney believes children who face these challenges may face unique physical and mental health issues as they become adults in the coming decade.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.02.279240v1?rss=1 Authors: Montalban, E., Giralt, A., Taing, L., Nakamura, Y., Martin, C., de Pins, B., Pelosi, A., Goutebroze, L., Castell, L., Wang, W., Daila Neiburga, K., Vestito, L., Nairn, A. C., Valjent, E., Herve, D., Heintz, N., Gambardella Le Novere, N., Greengard, P., Roussarie, J.-P., Girault, J.-A. Abstract: Forebrain dopaminoceptive neurons play a key role in movement, action selection, motivation, and working memory. Their activity is dysregulated in addiction, Parkinson's disease and other conditions. To characterize the diverse dopamine target neuronal populations, we compare translating mRNAs in neurons of dorsal striatum and nucleus accumbens expressing D1 or D2 dopamine receptor and prefrontal cortex expressing D1 receptor. We identify D1/D2 and striatal dorso-ventral differences in the translational and splicing landscapes, which establish the characteristics of dopaminoceptive neurons. Expression differences and network analyses identify novel transcription factors with presumptive roles in these differences. Prostaglandin E2 appears as a candidate upstream regulator in the dorsal striatum, a hypothesis supported by converging functional evidence indicating its role in enhancing D2 dopamine receptor action. Our study provides powerful resources for characterizing dopamine target neurons, new information about striatal gene expression patterns, and reveals the unforeseen role of prostaglandin E2 in the dorsal striatum. Copy rights belong to original authors. Visit the link for more info
You are what you eat. Maybe not literally, but to pretend that what you put into your body doesn't affect your health and performance is nonsense. Today we review a study from the University of Michigan seeking to establish an association between chronic spinal pain and diet. In some ways, we already know (there was a Nobel prize given in 1982 for the PGE2 and Omega-6 link) that a poor diet can lead to increased pain byways of inflammation. But this study wants to link chronic spinal pain to more certain types of diets and people who eat those diets. The purpose of this podcast is to review the data, give our opinions and let you know how we believe this applies to your life and what you can do to make your health better. What We Cover Spinal pain (pain in the back, neck, and hip) affects 54% to 80% of adults and is a leading cause of physical disability and associated problems, including decreased quality of life, unemployment, and mood disorders. How the costs add up! The impact of chronic spinal pain is approximately $253 billion annually. What are the mechanisms linking diet to chronic pain? How does sugar intake affect chronic pain?
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.07.31.231753v1?rss=1 Authors: Tavares-Ferreira, D., Ray, P., Sankaranarayanan, I., Mejia, G. L., Wangzhou, A., Shiers, S., Uttarkar, R. S., Megat, S., Barragan-Iglesias, P., Dussor, G., Akopian, A. N., Price, T. J. Abstract: Background: There are clinically relevant sex differences in acute and chronic pain mechanisms, but we are only beginning to understand their mechanistic basis. Transcriptome analyses of rodent whole dorsal root ganglion (DRG) have revealed sex differences, mostly in immune cells. We examined the transcriptome and translatome of the mouse DRG with the goal of identifying sex differences. Methods: We used Translating Ribosome Affinity Purification (TRAP) sequencing and behavioral pharmacology to test the hypothesis that nociceptor (Nav1.8 expressing neurons) translatomes would differ by sex. Results: We found 66 genes whose mRNA were sex-differentially bound to nociceptor ribosomes. Many of these genes have known neuronal functions but have not been explored in sex differences in pain. We focused on Ptgds, which was increased in female mice. The mRNA encodes the prostaglandin D2 (PGD2) synthesizing enzyme. We observed increased Ptgds protein and PGD2 in female mouse DRG. The Ptgds inhibitor AT-56 caused intense pain behaviors in male mice but was only effective at high doses in females. Conversely, female mice responded more robustly to another major prostaglandin, PGE2, than did male mice. Ptgds protein expression was also higher in female cortical neurons, suggesting DRG findings may be generalizable to other nervous system structures. Conclusions: Nociceptor TRAP sequencing (TRAP-seq) reveals unexpected sex differences in one of the oldest known nociceptive signaling molecule families, the prostaglandins. Our results demonstrate that translatome analysis reveals physiologically relevant sex differences important for fundamental protective behaviors driven by nociceptors. Copy rights belong to original authors. Visit the link for more info
On today's episode we discuss: — Climate: The Immunization Action Coalition and the Vanderbilt School of Medicine discuss the progress of developing a COVID-19 vaccine, detailing the 11 vaccines in phase 1/2 clinical trials and the inclusion of multiple countries in the development of a Target Product Profile, a tool for quantifying critical vaccine characteristics. The authors emphasize the need for well-established infrastructure and logistical planning in order to distribute a potential COVID-19 vaccine safely and effectively to the world in a timely manner. — Epidemiology: Researchers in the United States and United Kingdom used Twitter data to predict human mobility in and out of China and estimate global spread of COVID-19 and found a high correlation between country-level Twitter user visits and reported COVID-19 cases. These findings highlight the utility of geolocated platforms for public health authorities to develop response protocols and assess impending risks of COVID-19. — Transmission and Prevention: Based on literature of prostaglandins in SARS-CoV-1 and MERS-CoV, a group from the University of Edinburgh cite the potential roles of multiple prostaglandins (including PGD2, PGE2, PGI2) in the pathogenesis of COVID-19 and consider the possible benefits of NSAID usage in COVID-19 patients. — Management: A study found that among 59 patients with symptoms consistent with COVID-19, fibrinogen levels were markedly higher in patients who ultimately tested positive on RT-PCR compared to those who tested negative. Additionally, the neutrophil-to-lymphocyte ratio was increased in critically ill COVID-19 patients. These results suggest that fibrinogen may have value as a diagnostic marker in patients with suspected COVID-19 and that neutrophil to lymphocyte ratio may be useful as a prognostic marker indicative of COVID-19 disease severity. — Adjusting Practice: A cross sectional study of 26 heart failure patients found a 16.2% decrease in daily step count on wearable accelerometers during the first 3 weeks of quarantine compared to regular activity suggesting that widespread COVID-19 quarantine mandates were detrimental to physical activity habits in these patients. These findings highlight the importance of physical activity during the pandemic in reducing deterioration in cardiovascular health. — R&D Diagnosis and Treatment: Investigators in China measured SARS-CoV-2-specific antibodies among moderate and severe COVID-19 patients as well as non-COVID-19 patients and found that IgA and IgG were higher among severe patients compared to moderate patients whereas no difference was observed between the groups in IgM. Based on their findings, the authors suggest that IgA-IgG serological diagnosis of COVID-19 may be more effective than the traditional detection of IgM-IgG combined antibodies. --- Support this podcast: https://anchor.fm/covid19lst/support
Volume 11, Issue 26 of Oncotarget reported that Lung cancer is of particular importance, as it is the deadliest cancer worldwide. In this study, the authors show that high mi R-708 expression is associated with survival rates in lung squamous cell carcinoma patients. mi R-708 also represses PGE2 production by suppressing both COX-2 and mPGES-1 expression in lung cancer cells. Moreover, mi R-708 decreases proliferation, survival, and migration of lung cancer cells, which can be partially attributed to mi R-708's inhibition of PGE2 signaling. Lastly, they identify novel mi R-708 predicted targets and possible regulators of mi R-708 expression in lung cancer. Collectively, these data demonstrate that dysregulated mi R-708 expression contributes to exacerbated PGE2 production, leading to an enhanced pro-tumorigenic phenotype in lung cancer cells. Dr. Carol S. Lutz from The Department of Microbiology, Biochemistry, and Molecular Genetics at Rutgers Biomedical & Health Sciences, New Jersey Medical School, School of Graduate Studies in Newark New Jersey USA said, "Lung cancer is the most common cancer, with more than 2.09 million lung cancer cases worldwide in 2018." More importantly, lung cancer is the deadliest cancer in the world, with more than 1.79 million lung cancer-related deaths in 2018. Lung cancer is a collection of several distinct subtypes, with non-small cell lung cancer accounting for 85% of all lung tumors. mi R-708 also indirectly regulates the expression of genes involved in PI3K signaling, cell cycle progression, epithelial-mesenchymal transition, and cancer cell stemness. In this study, the authors aim to decipher novel mi R-708 targets and suggest a solution to the controversy on whether mi R-708 is an oncogenic or tumor-suppressive mi RNA in lung cancer. The Lutz Research Team concluded in their Oncotarget Research Paper that collectively, their findings suggest further study of mi R-708 in lung cancer. The data paired with previous studies highlight a potential value for mi R-708 as a diagnostic in differentiating lung tumors, as well as a potential therapeutic intervention, particularly in lung squamous cell carcinomas. Their work has identified novel tumor-suppressive mi R-708 functions by suppressing oncogenic PGE2 production through targeting of COX-2 and mPGES-1. These findings could be the foundation for identifying novel mi R-708 targets, as well as regulators of mi R-708 expression in cancer. Moreover, the study highlights the need to better understand lung cancer biology to improve the diagnosis and treatment of lung cancer, ultimately aiming to increase positive patient outcomes. Sign up for free Altmetric alerts about this article DOI - https://doi.org/10.18632/oncotarget.27614 Full text - https://www.oncotarget.com/article/27614/text/ Correspondence to - Carol S. Lutz - lutzcs@njms.rutgers.edu Keywords - miR-708-5p, miR-708, lung cancer, COX-2, mPGES-1 About Oncotarget Oncotarget is a weekly, peer-reviewed, open access biomedical journal covering research on all aspects of oncology. To learn more about Oncotarget, please visit https://www.oncotarget.com or connect with: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Oncotarget is published by Impact Journals, LLC please visit http://www.ImpactJournals.com or connect with @ImpactJrnls Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957x105
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.04.25.061663v1?rss=1 Authors: Paige, C., Barba-Escobedo, P. A., Mecklenburg, J., Patil, M., Goffin, V., Grattan, D., Dussor, G., Akopian, A. N., Price, T. J. Abstract: Many clinical and preclinical studies report higher prevalence and severity of chronic pain in females. We used hyperalgesic priming with interleukin 6 (IL6) priming and PGE2 as a second stimulus as a model for pain chronicity. Intraplantar IL6 induced hypersensitivity was similar in magnitude and duration in both males and females, while both paw and intrathecal PGE2 hypersensitivity was more persistent in females. This difference in PGE2 response was dependent on both circulating estrogen and translation regulation signaling in the spinal cord. In males, the duration of hypersensitivity was regulated by testosterone. Since the prolactin receptor (Prlr) is regulated by reproductive hormones and is female-selectively activated in sensory neurons, we evaluated whether Prlr signaling contributes to hyperalgesic priming. Using a competitive Prlr antagonist, and a mouse line with ablated Prlr in the Nav1.8 sensory neuronal population, we show that Prlr in sensory neurons is necessary for the development of hyperalgesic priming in female but not male mice. Overall, sex-specific mechanisms in the initiation and maintenance of chronic pain are regulated by the neuroendocrine system and, specifically, sensory neuronal Prlr signaling. SIGNIFICANCE STATEMENT: Females are more likely to experience chronic pain than males, but the mechanisms that underlie this sexual dimorphism are not completely understood. Here, we demonstrate that the duration of mechanical hypersensitivity is dependent on circulating sex hormones in mice, where estrogen caused an extension of sensitivity and testosterone was responsible for a decrease in the duration of the hyperalgesic priming model of chronic pain. Additionally, we demonstrated that Prolactin receptor expression in Nav1.8+ neurons was necessary for hyperalgesic priming in female, but not male mice. Our work demonstrates a female-specific mechanism for the promotion of chronic pain involving the neuroendrocrine system and mediated by sensory neuronal prolactin receptor. Copy rights belong to original authors. Visit the link for more info
Thanks for Merike for suggesting the gastric brooding frog and to Hally for suggesting newly-discovered frogs!! The Gastric brooding frog: Darwin's frog, round boi: The Surinam toad carries her eggs and tadpoles in the skin of her back: Kermit the frog and a newly discovered glass frog: Show transcript: Welcome to Strange Animals Podcast. I’m your host, Kate Shaw. This week we have another fantastic listener suggestion, about frogs! Merike is a herpetologist from Estonia, who suggested the gastric brooding frog, and another listener, Hally, also wanted to learn about some of the new frog species discovered recently. The gastric brooding frog is native to eastern Australia, specifically Queensland. There are two species, and both of them live in creeks in separate rainforests. The habitat is specific and small, and unfortunately both species went extinct less than forty years ago. Researchers aren’t sure why they went extinct, but it was probably due to pollution and habitat loss. The gastric brooding frog was a slender frog, with the northern gastric brooding frog being about three inches long, or about 8 cm, while the southern gastric brooding frog was about half that size. Females were larger than males. It was grey or brown-gray in color with some darker and lighter patches on the back with a lighter belly. During the day it spent most of its time at the water’s edge, hidden in leaf litter or among rocks, although it generally only fully came out of the water when it was raining. It ate insects and may have hibernated in winter. As you may have guessed from its name, the gastric brooding frog had a unique way of taking care of its eggs. After the eggs were fertilized, the female would actually swallow the eggs and keep them in her stomach while they developed. Even after the eggs hatched into tadpoles, they stayed in the mother’s stomach. As they grew larger, the stomach also grew larger, until it pretty much filled up the mother’s insides, to the point where she couldn’t even use her lungs to breathe. Fortunately many frogs, including the gastric brooding frog, can absorb a certain amount of oxygen through the skin. Finally the tadpoles metamorphosed into little frogs, at which point the mother regurgitated one or a few of them at a time, or sometimes all of them at once if she felt threatened. So how did the mother keep from digesting her own eggs or tadpoles? How did she eat when her stomach was full of babies? How did the babies eat? The jelly around the gastric brooding frog’s eggs contained prostaglandin E2, also called PGE2, which causes the stomach to stop producing hydrochloric acid. That’s a digestive acid, so once the eggs were inside the stomach, the stomach basically stopped stomaching. There is some speculation that the first eggs the mother frog swallowed actually got digested, but then the acid production stopped and the rest of the eggs remained. Once the eggs hatched, the tadpoles also produced PGE2 in the mucus in their gills. The tadpoles continued to live off the yolk sac from their eggs as they developed, and in fact their mouths weren’t even connected to their gut yet. As for the mother, she just didn’t eat until the babies were developed and released into the water on their own, which took about six weeks. The gastric brooding frog is the only frog known to raise its babies this way, but other frog species have interesting variations of the usual way frogs reproduce. Most female frogs lay their eggs, and then the male fertilizes them. But about a dozen species of frog have developed internal fertilization, where the female retains the eggs in her body until the male fertilizes them. The tailed frog from California in the United States, in North America, gets its name from a structure that looks like a tail, but is actually an extension of the cloaca. That’s the opening used for both excretion and reproduction. Only males have the tail,
After I made my first oral castor oil for hair loss post a couple of months ago, I received hundreds of DM's, private messages, YouTube comments, emails and tweets asking me to post an update. Well, here it is. After trying oral castor oil for hair loss for 2 months, I have concluded that it is an effective growth promoter, and is far more potent than topical castor oil.…
This episode is a continuation of the discussion on racial reconciliation. In this episode Dr. Michael Hawn discusses cross-cultural worship and especially the use of music a valence or combining and binding medium for facilitating racial reconciliation through cross-cultural worship. He establishes the practice of cross-cultural worship in the event of the first Christian disciples at Pentecost, which was a boundary-crossing experience. Michael discusses many of the concepts and practices developed in his book, One Bread, One Body: Exploring Cultural Diversity in Worship.
Oral castor oil is something not thoroughly explored in the hair loss community, despite a significant amount of promising data backing its potential efficacy. Typically, castor oil is topically applied. In practical application, its effect on hair loss prevention topically seems to be minimal when it comes to dealing with androgenic alopecia as opposed to a skin condition.…
This story is something I stumbled across by accident. It's really interesting as it backs up the theory of wounding, and also implies the importance of Prostaglandins and the recruitment of growth factors via a stimulus. In this story, a 78-year-old man with common male pattern baldness was dozing off in his armchair when he fell head first into a coal fire.…
Dr. McKenna has successfully treated an incredible array of diseases, inside and outside of orthopedics with stem cells. McKenna has been on the front line of stem cells and their clinical application for decades. If you have ever wanted to know the vast array of proven applications for stem cells, do not miss this episode. What stem cells are, how they work, where they are and are not taken from, why cord blood and PRP are NOT the same as stem cells technology used today, the issues of the FDA, his association with RMI (Riordan, McKenna Institute for stem cells with Neil Riordan), treating Mel Gibson and other celebs & lawmakers, the future of research in stem cells, why all SC healthcare providers are not practicing equally (or ethically), why Panama & the Bahamas are used for advanced stem cell therapy and more.https://TheCellSpa.comhttps://drwademckenna.comAtrantilhttps://lovemytummy.com/spoonyProlon Fastinghttps://prolonfmd.com/isreferral.html?p=KBMD&w=FMDhttps://kbmdhealthhttps://gutcheckproject.comHey hi Mandy if you don't know me it's probably because I'm not famous but I did start a men's grooming company called Harry's the idea for Harry's came out of a frustrating experience I had buying razor blades most brands were overpriced overdesigned and out of touch and here is our approach is simple here's our secret we make sharp durable blades and sell them at honest prices for as low as two dollars each we care about quality so much that we do some crazy things by world-class German blade factory obsessing over every detail means were confident in offering 100% quality guarantee millions of guys have already made the switch to Harry's so thank you if you're one of them and if you're not we hope you give us a try with the special offer get a Harry starter set with a five blade razor weighted handle shave gel and a travel cover all for just three bucks plus free shipping just go to Harry's.com and enter 5000 at checkout that's Harry's.com code 5000 enjoy all life we are here with a gadget project this is episode number seven on marriage for you here with your host Dr. Kendra I was going on today good morning good morning how you doing I am doing well how are you doing this more well than what I am on the day number four of the fasting mimicking diet how about you I am also on day four the fasting mimicking diet made by prolonged made by prolonged so I want do a shout out to Dr. Joseph onto the CEO prolonged and Dr. Walter Longo who wrote the longevity diet they sent us some prolonged kits and were given a shot the fasting mimicking diet they are it is the fasting mimicking diet so I am comparing it to a previous experience of doing a water fast it's very interesting and this is far more tolerable quite honestly and just this morning I did check key tone levels I was it 2.2.1 date date three you're supposed to start doing it so by as this day goes on you probably start kicking up a whole lot more yeah so I found that to be beneficial it's only falling in line with what you want I did comparing this to a water fast at this point I was big meal for being in three nap days I feel like I was really ready to start eating the by day four that was enough for me I did dad it four full days of the water fast but with Pro line I feel actually feel really really good it's not too bad it is nice the way they can portion out every days meals what were going to be eating so my wife's doing with this also the only hard part was it earlier this early this week I had to cook dinner for the boys because they still gotta eat and family had some nice juicy steaks to sit there and you can have any of it I couldn't do anything with it was not the box about yourself how was yours will I'm you I'm doing well this is my fourth five day fast I guess is a little over year trying to do them every few months I first want to prolong which is not a big deal all second one I did kind of my own little fasting and keep mimicking style I didn't have that what I'm in a call that burst of energy right or possibly it was stimulation of stem cells listed in that in a few minutes here and then I did a water fast only my ketones went through the roof but I was quite miserable sore back to the prolonged given this a shot and we'll talk about that in the second but I mention the stem cells today's guest while this is going to be if you know anybody to have autoimmune disease if you know anybody that has back pain anybody has joint pain to an end because we have a stem cell expert Dr. Wade McKenna orthopedic surgeon skies a bad ass in this field and we were sitting there talking just outside I'm like holy cow I'm just considering take notes like we brought in a professor of stem cells may ease size pretty amazing how he actually played football at Oklahoma State went to med school I perform indices with him several years ago whenever he was still heavily just as he is today doing orthopedics he's a fantastic surgeon all of this is led to somebody's actually can remind me you he never wants to stop learning and so it's it's led to areas where he is today and he is I would say quite the expert with stem cells and where the future is going with them so this is so exciting that we have to time to fast for this episode because you know people throw around the word stem cell a whole lot and much like the CBD industry people throw around there's lots of misinformation there's lots of quality differences the people that are actually giving stem cells there's lots of differences with that so we could clarify all of it I really feel like there's some parallels you and I have brought in several CBD experts right and there's some parallels here and so you know this is a super exciting for that anything going on with the family anything going on socially well this last week whenever Morreale moved into preparing to do this fast I would say that the boys have the have enjoyed teasing us and other than that they've they thought back into all season basketball quite busy and is kind of the every day as usual at the round Renner household self typical tennis weekend both the Lucas and Karla were playing tennis and they both did really well it was kind of a little curb although I'm really proud of my team because as working to be launching the D hat health box Dr. Lisa Alvarez actually did a little commercial for she did so yeah and so do I get a chance to pop into the set see it the move honestly try to see what that happens I appreciate her taking her time to do that so another chemical thing I just go phone with Dr. Chang Ron Houston yeah great guy fantastic functional medicine doctor he actually has ties with prolonged him and him and Joseph were friends okay to be having a huge conference coming up on April 27 were he to talk about brain got issues where you have them on the show because he's got some incredible stuff on brain waves and its affect pre-and post trauma and its effect pre-and post-diet change and using hemp dry products so super cool I just have a phone with him so to get a chance go to his Facebook page a lot of really cool information so awesome I think the work on the move and all these unique directions right but what's the big deal stenciled what we want to talk about I think that it's it's the newest new frontier it's no different than the way we've been spending time talking about CBD why why just a few years ago the revelation that you had into polyphenols and how I could do these are it's a lot of what nature is giving us to work with and it's kind of amazing that it's it's all coming to fruition nowadays and you hit on it a little bit earlier I know that the Dr. McCann is going to address it as well the FDA it many times when we want this government entity to be on our side in helping us out can really be stymieing a lot of the progress that many of the citizens could be enjoying that they could be taken party to have a better quality of life and in a really odd yet when you get down to money reason you find out that the FDA is is hard to budge out of the way in in terms of progress so interesting because what he was talking about is exactly what I've been doing so in in all fields of medicine it's very hard to change the direction of this large Titanic like shipper people doing things and we have either many ways as he said as he described it to skin a cat or really none of them really working very well sure and then when you find something it's hard to get people to pay attention to much like trying to write I mean when we sit there when we came in without her until we know that mojo and 5.0 guys are talking there really trying to tell everybody about the bloating effects with it but we know that our trenches made up of polyphenols and we know those polyphenols are really good for you they actually are the antiaging and anti-inflammatory molecules in the Mediterranean diet so we need to expand that message a little bit more rhino people hey you can take these polyphenols which are in trying to and they can actually do some of the things Duncan that stem cells do and we can talk about this in some science but if you're curious about that if you looking at upfront Hills or any place that you go where they should go to love my tummy.com Ford/spoony that's love my tummy.com/spoony and then use the code spinning Sabal cash while you pick up your own polyphenols to be delivered right to your home and then keep listen to this because you do realize that these there's lots of overlap chain runs you to be doing a brain gut thing where he shows that you need to protect your gut I'll try to help with that we got Wade McKenna here talked about stem cells the body wants to rejuvenate itself you need to give it the things that can this is going to be so excited working a really geek out today I am the earliest I want to definitely I want to hang in there because what you learn is literally some of those cutting edge stuff you meant Dearborn stem cells person to make a circuit in the news and it's really odd the way the people began to report new science and health sometimes it can be this is the greatest thing ever or it can be a lot of scare tactics in our member the first time I heard about stem cells it was the unfortunate been taken from unborn babies etc. but that's not what's happening in all when you begin to get past that layer will guess what it's just like anything else you get past the first layer and then you find that there's a whole new world to discover and in terms of what Dr. McCann is going to talk about we have lawmakers here in the US to prohibit certain strip certain lines of stem cells being used but they are still incredibly beneficial and some of the culturing over the growth of those stem cells and do what the US would state would determine to be tissues they couldn't do it here they could do in Panama and oddly enough who found his work in Panama always couple lawmakers really kind of the good kind of weird and ironic that the same people there are part of that institution it doesn't allow us to do certain things will go out of the country to get that kind help is such a small world and its fate in whatever it is I think a lot of things that have happened in both our lives have been opportunities that we take advantage of and I love you and I were working one day and I was like dude did you see that Joe Rogan we had Mel Gibson on and some other guys some PhD knew it yeah I know those guys and I was like laughing because no Gibson said the same thing a lot of people think is like you think about stem cells you have a mouth going up the side of your face and now not at all as it turns out he took his dad down to Panama and his nonmaterial dad and he got better and that's what I was like whoa and you started saying to me this is a long time you're over your half your menu go to meet my buddy Wade because he's doing a lot of the same thing same parallel paths and since it is really scientific and is just trying to get people better that's it a year of your right on and just think about that so that being at least 18 months ago I believe that Mel's dad was started going down there maybe five years ago think of the advances in the tank and the technologies that have come along with stem cell research and send that's exactly why Wade Dr. Wei McCann is here to tell us a little bit more about where it's going how you going to measure what is authentic stem cell injection what is there the right protocol what you be looking for who are the imposters there's a there's a lot of information out there it's no different than learning about CBD and where to go get the right kind of CBD of its harvest of the Rahway producer away I just think it's it stinks I went to a doctor friend of mine Dr. Marlon Padilla and we are in his office and he just are talking about I'll check this out I'm now doing stem cell know the quote you have stencil expert on this week you go take a listen easier is it Hillcrest medical and University Park area… Having super great guy very innovative himself trying new things yeah and you he started do that like that small world some sort to pay attention to all these things so one of these lectures get caught up on everything that sewer pursuer at night to geek out a little bit so how I Titus altogether how to retire fasting together how to get stem cells and how we come full circle to discuss what's out there in the literature about what were passionate about also write well it's kind interesting because what were doing with that with that diet selection are trying to heal CBD fasting and learning that stem cells you find I think for all of our listeners as well as us this is all synergistic there's a reason why we're Gerber took the mail here with this kind of message so using our graduate student that always helps us out we've got some really cool articles kinds altogether, and with what I consider really geeky stuff I want you to hang in there for me okay so the first question is your on day four of the prolonged fast why the world even doing that well it has been shown that in cellular metabolism in July 2015 summarize whatever you and will fast it promotes stress resistance so basically when you're put on a fasting mimicking diet or I should back up we've always known that the caloric restriction diet has been shown in yeast and other animals to prolong life Walter Longo in his book figure out a way that you can eat a little bit and trick your body to believe that it is completely fast that's the fasting mimicking diet is so this study in 2015 looked at putting mice on the fasting limiting diet and they demonstrated that these mice decrease the size of multiple organs improved glucose control decreased visceral fat lower blood pressure improved bone mineral density rejuvenated the immune system and reduce cancer risk always too good to be true and Academy just five days three times a year and can accomplish this but wait there's more we got more here they also showed after they re-fed the mice solicit what this is the coolest thing about this when you listen to vaulter give lectures he said it's not so much the fast it's the recovery from the fast because when they re-fed him they showed that in older mice areas of the brain like the hippocampus showed neurogenesis and improved cognitive performance while yeah so it's pretty wild with the re-feeding that super important which makes it fun because on Monday for I'm really looking to some refuted yeah can't wait for some re-creating but any that's all part of the process I will say going through at my second fast that this is becomes easier it's it's not as hard as the first run of some that's with prolonged but it is the expectation is they are know what to expect I know struggle for so what would be contributing to better neural thinking that is you a question so the question is what's going on there so then we dug up an article in the Journal of stem cell research in 2016 what they showed is that fasting protects against immune system damage and induces regeneration by waking up stem cells or by catalyzing dormant stencils so all those what they realize is what this article describing is what vulture was figuring out right there what he had figured out that all comes down to stem cells at the refuting stage basically not with her not stenciled several times which is to find what is real quick stem cells are the body's raw material their pre-sells for all other cells stem cells are the only cells that can generate new cell types and they can divide into form what are called daughter cells which become specialized cells that eventually come specific organs that's all me to say about it because wage may come in here and blow our minds until us a whole lot more with what stem cells are so for my all intensive purposes on coming here knowing stem cells can become other cells – easier to tell us way more with that so basically after you fast and then you re-feed you flip a regenerative switch which promotes stem cell regeneration in the blood making organs so that the important thing so when you go into starvation mode the body will save energy and one ways to recycle immune cells and that causes autophagy so old and sick and dying cells are programmed to hate go away right and then the autophagy gets rid of the old site sells them when you re-feed the stem cells wake up and they go around there's a bunch of fallen soldiers they don't bother them but they go around and say we need new people to replace this over simplistic way to lead into a much cooler explanation of that and then with each cycle you re-feed you get rid of sick and dying cells and replace them is like a janitor it's exactly like a janitor so five day fast three times a year you just cannot quit you just doing some serious housecleaning I member Saturn panda when he talks about that that's the godfather of circadian rhythm fasting or intermittent fasting right he's got mouse models he still does a prolonged fast because he describes it as you brush your teeth every day and then you a couple times a year you going to get the deep cleaning from the dentist I like that analogy you're always doing maintenance which is you keep in the nine date of of what you're eating but every once while you get to do that deeply definitely and then trying to fast for the first time you you can look at you like why would I not want to eat but if you look at the history of time where people were in the movement nowadays to return to health where people are trying to get healthier and you look at things like Paleolithic's for instance they talk about new diets and ways to eat in a pale lifestyle some of that also includes fasting and the reason is the primal man also went a long time without having food and for a few days at a time they would have intermittent fasting org or a few days fasting themselves yeah and so basically you're just returning to what it is that we've all been programmed to do for a long time that it just so happens the last several generations we've had ubiquitous amount of food here in the US and so now we it'll thicker bigger let's okay so this is no doubt about it feet eating is awesome right but eating is an inflammatory process so when you eat your you to become inflamed a little bit and then you incorporate the nutrients and so will the way that were doing and how will we eat so much it's probably not the healthiest way so right now where the fast let's talk about was actually a lot going on with our bodies before talk about Howard to tie all this together two stencils. So day one this is basically the five defenses what's happened to you and I so day one just upon your body day to start doing some fat burning day three start doing some cellular recycling basically you're going to clean up start realizing were on day three now for backing cavemen times they one day to that's normal day three your body starts going up oh we better get ready for something because were you have to go out and get some food soon and that's when you start doing the cleanup and this is when a lot of people will reach ketosis day for you and I right now are in this this is the cell regeneration this is where autophagy started yesterday in autophagy is when those old sick and dying cells are programmed to go away much like we talked about with the polyphenols when they get in there in your list and causes my top a G5 in the foods we eat will do that then this starts artists are stem cell-based regeneration is starting to ramp up so when people talk about how I fascinated 24 hours 09 and identity a fast we've come this far when were this far into it tomorrow's what all the real magic happens all the magic day five regeneration continues now we've turned on our stem cells and the body is being rejuvenated from with it now the first time you and I did this did this are fast I think it was tonight will this happen to both of us we both slept what two hours yeah I even so every time that a fast so far I feel great whenever I go to bed and feel really rested but don't last night that of the of my fast I basically went to bed and then I thought I woke up again as a man what a great night sleep again and I looked over the clock I been asleep for two hours and 15 minutes and then I sat around the house like what am I going to do for the rest this morning about tired right now and then later I learned that was over Rex and it was being released telling me I always forget that all Rex and O Rex and so is released from hormone release my brain saying it's time for you to go and eat and I had in them and an abundant oriented interview time for you to get up have the energy to go kill the woolly mammoth so that you can eat and you can feel it a mere year manic and it was time and you saw me run when I quit the fast I mean I think of the time I my blood sugar was 54 and and and I felt fine with that and at key tones I think for 4.8 and the moment that we drew ride today the labs and that in the blood that one time it was it's time to eat yeah so both of us have ever similar expenses this is the third day that we done this so now let a geek out here for the last four minutes because this is where I think it comes in really cool and so we found an article that has a really long title and I just like I like saying it just because I realize that this is the kind of stuff I'm reading ditto for the show treatment of periodontal ligament stem cells with Emil Warren CBD promote cell survival and Ronald differentiation via the P 13 K a K TM tour pathway that would scare most people scared me off at first but our graduate student said this is a fantastic article hundred 11 so basically what this whole article shows is you can get stem cells from a few places Dr. McKenna will explain where bone marrow fat but one of the places periodontal ligament so these are known as mesenchymal stem cells meaning that they are the least differentiated cells and they can trying to become anything so one of the important things is quality of stem cells keep that in mind because we'll talk about that coming up quality stencils so one of the things about stem cells is that there are a lot of different qualities but once you get the stem sellout you have to keep the stencil healthy so you have to keep it alive and you have to keep it in the best environment possible so there's different mediums to do this this study looked at taking stem cells out in vitro meeting in a dish and they bathed them in CBD and more range in MO R which is a program to sign a day in which is a polyphenol which is the same stuff that upfront deals made of so they they bathed them in CBD and in a polyphenol blend amazing supercool they did it for $40 and what they showed is that they demonstrated longer survival less a pop ptosis or programmed cell death decrease the M tour pathway the M tour pathways the pathway that makes cells grow right so bodybuilders lots and tour pathway but guess what cancer enter pathway also so to growth pathway increased differentiation capacity meaning they can become more of something quicker they increase nesting and DDN after which neurogenesis or new nerves new brain tissue right and then it did a deep dive into the genes that these stem cells turned on that gets into the cool epigenetic stuff that we talked about before base will have these genes so they concluded that in the field of stem cell research it may be improved by bathing them in CBD and a polyphenol mix so if you not get injected anytime soon might not be a bad idea to start from the inside using some CBD and possibly some upfront it sounds to me like the research is probably on the on the cusp ears are going into that that's why they're bathing them in the point assignment in the CBD but it's weird that just three weeks ago when we had Mark on he was talking about his D differentiated contra sarcoma test stem cells that basically were released and they didn't know exactly where to go they begin to proliferate and he even said it could be found in an organ anywhere in your body even when you feel like you taken so it's critically important that your stem cells are differentiated they get to the place they're going to be and do what you need them to do you don't want them growing out of control so maybe possibly will find on the future that combining a polyphenol set with a plant a point of sanity and CBD along with stem cell therapy would be a protocol I be awesome to get people started here or should they go to get I would eagerly for you go to K BMT health.com and go to the store you can find both are trying to heal and the new KB MD CVD or you can always go to love my tummy.com/spooning and hearing about four minutes really joined by the Dr. Wayne McKenna so if you know anybody that has joint issues back issues knee issues and take it one step further autoimmune disease there's so many things that now look into the science of stem cells that is going to be supercool to geek out and this guy knows his stuff I am excited to have youth if you had any questions about stem cells is the witness of the main unit turn to Dr. Wade McCain is going to join us here we can take a break in about 10 seconds thing wrap up now just thank you guys for the prolonged high talk Elson if you are trying to quit drinking or doing too many drugs listen to me you don't know me and will never meet I had a problem like you want I drank and used a party a little too much till he got out of control and almost ruined my life I realize I needed help to fix my problem before it totally destroyed me if you tried to fix your drinking and drug problem and you know you can't do it alone you need to call the national treatment advisors they'll immerse you into a 30 day program to replace your old habits with new habits and totally change your life and if you have PPL private health insurance the entire program may be covered fix your problem right now before it gets any worse get clean call now and learn more 800-296-1252 800-296-1252 800-296-1252 800-296-1252 it looks like you're losing I am I losing weight I am losing my lost about 10 pounds how are you doing it funny name but I done it with review zone RAD use zone.com and the stuff works it's you you get it all that the molecule this that found in that all I can tell you is it it's a it makes you feel full and he keeps your mind off of wanting to overeat and also boost your metabolism yes you're done and more guys try it today it's gonna work for you like his work for Brad and countless other people read you zone.com are IDUs owners.com fast track student loans can get your student loans out of the vault stop any wage garnishments stop collection calls and stop seizure of your tax refund give yourself a break to stop the stress and get your student loan payments down to as little as $25 a month based on what you can afford to pay 800-709-4395 800-709-4395 800-709-4395 800-709-4395 okay were back it's now the second half hour episode number seven of the gut check project we are now joined with Dr. Wade McKenna but McKenna thanks so much for coming in today really appreciate absolutely so see what I do know him yeah you know whatever no word of her Rhonda Patrick goes on Joe Rogan's economy gets better paper out you'll be taking some notes I favor Gerardi, Patrick never feels more like absolutely just a caveman. Dr. she's a lot of knowledge of sausage yellow management so you since you do already went through a couple of small things in the last half-hour you played football look on the state you been orthopedic surgeon for several years but that's not really what you here to talk about today the cool part is I actually can you hear we good we are little my problem were going to get something fixed here real quick right area is going the cool part for me they spent is kind of been allowed to reinvent myself as a traditional surgeon when the science, caught up to what we do and figure out that a lot of what we would think of as traditional medical approaches were less than optimal from patients and point so exited a fellowship in trauma and post dramatic reconstruction after an orthopedic surgery residency and after a general surgery internship so in during a general surgery internship when I thought I was going to do transplant surgery because that was the coolest guys at the hospitalists on which Trina here in Dallas Fort Worth multiple hospitals with DFW medical service rendered him orthopedic residency I did my fellowship and trauma to the general I was Roy Sanders 2000 but hospital where as to trauma fellows panorama the program we had 10 residents in for helicopters and no sleep with a whole new episode on what lack of sleep will do to your stem cells well it lack of sleep and not healthiest UW not like lack of sleep induced by fasting where you feel like Superman lack of sleep induced of note falling asleep in the boat in the lounge chair waiting for the nurse to tapping the short essays time to go from zero to hero so but during the trauma fellowship we became very adept because we got stuck with a lot of the fractures that other people treated heel so the posttraumatic part of that is acutely we were stabilizing multiple extremity injuries but we also do those people over multiple extremity injuries and we would get referred a lot of the trauma patients the gentleman traumas what we called it which comes to visit you in clinic does it come to you in the middle night by helicopter gentlemen trauma that watching your clinic is like I get this knife stuck out as well hey I've had five surgeries on my femur fracture I still can't walk and still no bonus I have is soon healed and we had to find a way to not only promote tried to trick the body and the human something that already showed didn't want to heal but in the least invasive way possible to turn the table can help the patient generate new bone best way to do that early on was Boomer us were concentrate the very Baston first uses of bone roster concentrated in traditional surgery was in the treatment of nonunion when someone has a fracture that doesn't heal there is delayed union which is means takes forever that but there's nonunion wishes means it doesn't heal there's no bone if you have a leg doesn't have a hip fracture can't walk can't but wait on it given upper extremity with an unhealed fracture pretty much flail you can you have a non-nonfunctional extremity bone rest will concentrate in the treatment protocol this allowed us to be much less invasive instead of just it doesn't make a lot of sense to just take out all the other plates and stripped the blood supply room muscle replay fracture further destroying the blood supply to the fracture that already the numbness blood supply to heal so let's go ahead and revisit that really quick because as a surgeon it's interesting to dear somebody because that's typically that's a knee-jerk reaction all that last surged and worked when he operated as exactly so say one more time with re-operating guys will here's the problem with re-operating if you didn't heal the first time it's because of the formation of scar tissue not healed tissue so the healing gets stopped the fibrotic tissue begins scar tissue hurts scar tissue does not much blood supply and scar tissue is very functional it's fibrotic it it can take up some space for the most part the difference between the interface between healthy tissue and scar tissue continues to be painful forever every time you move something severe big fibrotic knot of scar with an attendant and you have some healthy tissue that generate the connects to it the mismatch in pliability that mismatch of you would never use metals that have different hardness when you put together an engine it is the soft metal in the hard metal caused threading and corrosion in significant problems and and metal mismatch soft tissue mismatches just as big a problem we create scar tissue and people hurts generates pain generates an inflammatory response or chronic inflammatory response from cytokines that without decent blood supply to scar tissue you want to get rid of so you end up with long-term and continued muscle that and a lot of our surgery approaches and a lot of surgery where you just strip off the blood supply to the bone that it needs to help heal don't work very well because were not focused on how the body needs to really heal this fracture were focused on making x-ray and I did just make you look nice so your I think it's fascinating because essentially I've done the same I've done the same thing in my practice rub to move from traditional gastroenterology become almost a functional orthopedist yeah I would like to think that that I I just come to the table with some of the extra tools that I need to kinda set the table for the patient to help them heal I the body has unique ability to overcome a lot of things and in our body actually wants to heal a lot of times I'm just try to help people get our own way the same way the gastro neurology diet you're trying to help people get their own way from being about health right with with orthopedics I have to help the body the body knows the triggers and mechanisms and has the entire growth factors to help your body heal as we get a little older as we have chronic injury you rely radiation cigarettes coffee alcohol late nights cortisol stress we impair our body's ability to respond appropriately to injuries what the stem cell does for you is that the cell that helps you respond injury the problem is is you get a little older you have less of them and they don't do as much as a used I would guess that a second I'm still I want to hear the history only here got half because you ended with during residency restarted down do bone marrow concentrate bone marrow aspirate concentrate for nonunion fracture not only fractions your worst people so you guys were willing to try some things other people work well we had the opportunity because these people had no other options so the best part about doing a trauma fellowship is we were there last Hope we were the the Island of misfit toys so to speak Ryland Mr. Toyo we will use the we stood especially around Christmas time when that movie comes out with Chris Pringle we we would literally collect the injured patients from all over South Florida South North Florida Alabama Georgia we were the only level I trauma center on the West Coast of Florida and so when people would fail multiple surgeries we they walk into the resident clinic and you had to come up with a way to solve the problem and a lot of times it was as easy as finding a way to put more stress on the fracture you did have some plate that was plated and distraction so last times was just taken some screws out sometimes it was loosening up a frame that was holding the fracture apart and then let the fracture heal we would compress the frame so that the P0 electric effect fractures need stress to generate bone so stress across bone generates electronegative charge calcium and phosphorus are positively charged the biomechanics of basic physiology which unfortunately is certain's only when were supposed to forget that but apparently we do is trained out of us is what I was told the residence when the witnesses don't let don't let basic science and in physiology be trained out of you it into a surgical approach but when you create electronegative chars from a compression fracture calcium goes in and she get some healing without blood supply there is the rule in an osteopathic physician so it's a deal medical school because our team Dr. local state was the and and did manipulated felt good and I want to know how to do that I didn't even notice a difference on your will to be an orthopedic surgeon I said can I be an orthopedic surgeon because the he said absolutely yes that's about how I made that decision Okemos they had a deal medical school oh use was MD the last thing the world I wanted was a red diploma so state fans of loyalty I got a mistake know you was an easy decision I do know what the deal was but one of the owners of the time give me a book called the difference of genomics and you trying to teach me about the school just decided to go to and they said that when it comes to healing that the rule of the artery is supreme rule of the rings have the right to rule the artery is supreme but lymphatics have veto power I never heard this so that was the it's it's the foundation of a T still creation illustrate your stupid mess was created by the write a few stills and indeed he started the first year medical school in Kansas but he did it because he was unhappy with traditional medical approaches mobilization the joint instead of letting it get all swollen up seem to make the patient's function will be better and execute the plan by creating with: Patty pump people would read out all the way to push down her chest and he let it would create open up the alveoli to get people over dramatic pulmonary effusions by crating the sink on the lymphatic pump widget side of my chylomicrons on the lung tissue will with what we are doing it literally goes back to the foundations of what created a lot of modern medical sciences that without blood spiders and healing and that's true for orthopedic fractures is true for muscles tendon injuries we first started doing Bomer go back to that point on the trauma surgeon we were real sure that if we put bone marrow into a tendon that would make that was her fear with that we thought when we took Bomer Asper concentrate were real careful to make sure we we kept it in the in the osseous chart of the animals yet or you got it in the mentor factor was that there some really good studies published a bummer go back to the mid-90s there is a there was there was actually a really great study but here's a little they knew about what we're doing in Israel 1520 years ago there was a study on product complex possible tibial fractures which is a disaster if you have a tibial plateau the base you need if it's a complex fracture more than one particle shot six rights of Shatzer's fracture if you have a Shatzer six we used to call foobar that was our classification so we we with the Shatzer six what they did in Israel is they treated half of them with bone browser concentrate and half of them which is plating without moments were concentrated but interestingly because it was so early they added PRP to the bone restaurant concentrate thinking that it made work better and really all it does is dilute down so PRP the machine I have developed our tears I called them on sale define what you okay so the machine that we work with the machine I've been working with for for quite a while and have actually helped hopefully without taking real credit for anything but but knowing that that a been a significant part of innovation the development of their kit I'm actually patented the bone Ross Britt Catherine Catherine comes like it is my my design PRP is when you take whole blood and spin it down the machine to concentrate the growth factors get rid of some of the white cells and so you create was called platelet rich plasma write an platelet rich plasma is generated from the centrifugation of whole blood into the growth factors and platelets there needed to help get rid of inflammatory change a lot of times getting rid of the inflammatory change is the way to start the healing cycle inflammation gets in the way you put out the fire before you can grow new graphs right and so with inflammatory change if you turn the inflammation off ligaments tissue tendons heal faster with Bomer Esper concentrate what was it really understood as well in the 90s early 2000 and it is now hopefully is that bone marrow is still 97% whole blood so when we spend down bone marrow you're getting platelet rich plasma so your you are actually doing PRP yeah but you're doing PRP with stem cells yet so bone respite concentrate has the stem cells needed to help you heal and we know that those stem cells is when went on to hold your but while I was in school there wasn't such a thing as a musical social musical stem cell was named the music will stem cell 1995 by Dr. Arnie Case Western and Arnie Kaplan named a cell that previously in medicine what we do is we name cells based on the characteristics right so before it was musical stem cell was in a plastic undifferentiated employee potential adherent so that I liked it way better back in that day. I call it Mrs. a couple of them so well and and I doubt that there's terms equals some so most commonly know what they're talking about right so there's a CD marker a surface cell marker verse 600 different types of the cells based on their surface marker so we talked about was equal stem cells people think there's like one time no there someone that we don't really need help you heal the sum of the week need crucially to help you heal and we know the difference between these based on their CD markers we've actually quantitated what cells we want was told we don't want found a way to concentrate the cells want we do the spends so with bone marrow you're getting platelet rich plasma but you're getting the best platelet rich plasma because you're spending it from the most immature blood when you spend on whole blood you're getting PRP we are getting them no stem cells alright so let's clarify because it's a definition is really that what you're saying is that saying just stem cells doesn't mean just themselves how stem cells we have these mesenchymal stem cells which is the earliest of the stencil correct you guys have markers where you can determine the type of one that you know which ones do you need what was preferentially help you grow Cartledge what was professorship tendon what was preferentially grow fat right so fat stem cells that if you make if you make fat graph or stem so graph from fat those cells grow fat really well yeah we know what they don't grow really well's cartilage because there's a peptide called Sox nine this are secreted by the frustum so so when we quantitate stem cells I'm not interested in what those cells could become a me to say right now is this my pet. If you get a stem cell lecture in the first slide they show is this one so become these five types of cells in the differentiation and the building of the cells become these five is what makes somatic that's completely wrong that's true in the lab that's not how it works in the body what happens in the body is your set your body season injury it secretes cells starting with the humor putting stem cell which is the CD34 right so thrive for all the one second I got a good message where it says I can get a little stressed out I feel like I'm producing the wrong stem cells because I putting on weight change my stem cells to get rid of the adipose tissue and so sent there just go I got lost that CD something or other yeah you are way more so than I thought I would be as a orthopedist at the document bone bent may make straight actually know the medical school the running joke at time UNIX was the hardest residency to get into W had to become stupid right away take the smartest guys we need only to talk about when I mean I mean it when I say don't unlearn medicine right you the orthopedic resident was the hardest residency get to but you are expected to never even look at an EKG again if you walked into the surgery patient and you're like looking at their head or their EKG the attendings walking to go one the how you do know that you talk about this is Eric little people to sleep we have a certain dog like no dying right thing will similarly used to put my patients asleep so you feel like Dr. McKenna the CD six and 07 mesenchymal cells ready there's a joke that was that he found an orthopedist and the radiologist near going opposite direction of the code blue running away from the seed that what we used to say you know if you want if you have a dollar and you want to hide from a surgeon or from any kind of position there different places you put it right 100 from radiologist to tape to patient if you want to hide it if you want to hide it from orthopedic surgeon you put it in a book if you want to hide up a plastic surgeon we can hundred dollars from plastics are you going at a rabbit hole there went out on CD34 what were your talk was initiation healing right so with the CD34 it secretes a peptide for PG to PGE2 is is one of those keys and starting new vessel growth will the way to grow hair the way to have ED go away way to have stress urinary incontinence go away the way to have your wrinkles go away the way to have your fracture healed way to have your tendon remote you had me at wrinkles ED hair okay so so now we start out treating nonunion fractures right what we figure out pretty quick that if you put Bomer Asper concentrate it was it wasn't and is a great study published it was a limb salvage patient in Japan where 15 surgeries big proximal defect it's possible to be a and the the general surgeon was was livid at the orthopedic surgeons want to to put bone restaurant concentrate a fracture because he was proving that there was no vascularity to the way so to back door the orthopedic surgeon the supposed case report that a vascular surgeon does this arteriogram a lower extremity and it shows that there's literally no collateral flow around the fracture site is kid basically has a limb salvage frame on his leg this big proximal defect two years out multiple fascia economies nonmusical leg mask were really high needs needs annotation orthopedic surgeon is busy all the stuff about Mercer concentrate wants to inject bone marrow before he takes frame off eventually as a surgeon you become kind of emotionally connected to to your work right the guy does not want to cut the slide off the vascular surgeon try to prove needs come off he does arteriogram family Stone will it cut off so they have bone marrow injected in the fracture site at eight weeks they redo the arteriogram because the orthopedic surgeon the arterial was ordered by him but you start to see new bone kids have less pain from weight on lag you get new bone formation but they have this arteriogram set out to the shows no blood flow so they redo the arteriogram and there's all this collateral circulation on the fracture site so basically forever listening arteriogram is a study were it actually shows the arteries they put Diana vessel and shows up on x-ray and there is no blood flow going below over the fracture risers no.the die stops and there's a little bitty pattern this will trickle that I injected something into the bone not into the are not in the artery into the Perry steel sleeve the covering of the bone with the with the board there was no bone produces big bony defect there but Bomer us for concentrating their the way the bone roster concentrate work it didn't become bone which is what we thought what it does is it secretes the peptides and proteins necessary to bring new blood flow which allowed the bone to heal now there's a certain paragraphs that out there shows no collateral flow say that saying again that blood flow the rule of the artery is supreme the arteries and she still give him credit for that from the 1800s rule the arteries supreme lymphatics have veto power and that's a Dr. Graham from local states manipulation class, add on that if everything so swollen of blood flow can't get to it okay yeah so you guys injected this is the first time you saw that Ballmer answer because this can be a great segue will be go to the next half hour more we really do jump into the stem cell we got a little will try and keep it as it at a level that we can help people because I get a lot of back to let me make sure I'm being asked questions like it doesn't help with back yes to the health of the components were next on but on the great papers published read everyone says oh there's no literature published there's been 3500 papers published with my little Catherine the kit was designed for bummer aspirate 3500 papers published there's never been in toward report there's never been a tumor there's never been you can't reject your own bone marrow so this is the bone marrow aspirate injections you guys are doing this is the very beginning of Stansberry Reese is the only sell the US are allowed to cost himself you cannot you guys really literally were the first people playing around stems the trauma surgeon department: bone marrow yet not not knowing what we were doing we are using Bomer Asper concentrate for the fatty component of marrow that seem to help fracture so faster which is where microfracture surgery the knee all this comes in my mind from we would we do niece go there's an uncovered Carla Jerry would put a couple holes in the bone where in the bone the lesson bone marrow leak into the knee thinking that I hope the cards losing hills, microfracture doesn't work very well it creates a cartilaginous Good Cartilage but It Does Heal Something But My Thought Was When I Credit This Catheter If a Couple Drops of Bone Marrow Makes a Difference What Would What Would 60 ML Concentrated on the 45 That Was Where We Started with This During Joliet Harlan's Injuries at Work That's Where That Slow Beginning That's That's Only for Mia Do You Think I Do Think That Today's Bone Marrow in the Stem Cells Come from Bone Marrow Are Really Adapt to This Type of Healing to the Because That's Where We Release Our Red Blood Cells for Your Body Does Yeah Okay so This Is How Your Body Is Ready Right Right That You Were Not Were Inventing a New Way to Make Something He'll This Is How the Body Heals This Is Where Those You Know It This How God Does It Right He Sends the Cell There Is Secretes As Protein Vessel Grows You Get Your Butts by Tenant's Right This Is How It Works Already Is Just As We Get Older Or If You Get Your Lymphedema Swelling Only for the Lymphatic Flow Attacker Has Veto Power Is a Big Swollen Leg Give a Big Swollen Foot Good Books I Can't Get to It Right so It's All about Mobilizing Ankle Fracture and Also so That Blood Flow Can Get to It Because Official Swollen You Can't Put Any Extra Water in a Full Glass So New Water Can't Get to It That All Contaminated Dead Water Sits There yet to Pour the Glass out a Little Bit to Put Some New Healthy Water Back in That's How Bloodflow Work Which Is Why the Lymphedema and Lymphedema Is so Dangerous and Has It Has Absolute Control over Blood Flow to the to the Injured Tissue before We Dive Deep into Stem Cells Does PRP Work I Love You so Here's the Deal so Peer Peas like Boomer Light Okay so PRP Is Bone Marrow Announced Himself It's It's a Good Growth Component It's Great at It's a One-Time Shot Right so You When You Pop European Something You Get a One-Time Shot Growth Factors That Limits and Stops the Inflammatory Response from Cytokines You Undergo Tissue There's No Stem Cells You're Not Getting a Stem Cell Injection Which Is One of the Things He Pushes Me over the Edges Somewhere with I Went Got Stem Cells from My Blood Union You Got an Injection Visitor Was a Stem so That PRP Player Was Positive Now PRP Is Also a Bummer With Our Stem Cells in Bone Marrow so When You Say PRP Splenda If You Got It from Your Whole Blood It's Just Pure. If You Got Boom Roster Concentrate It's All the Best Components of European Stencils about That That Study Is Telling about So Here's How the Little so Even Though the They Publish Is Great Study Showing the Bonus Request Rate Help the Complex Factors Heal 50% Faster and All of Them Healed The Ones That Didn't Have Bone Marrow Not All of Them Healed and They Took Twice As Long Hill That Was Published 20 Years Ago Right with Bomer Asper Concentrate but Would They Knew so Little about Bomer Also Concentrate That They Spun down Whole Blood to In the Same Machine to Try to Give It More Volume Because We Thought the PRP Might Help the Bummer Work Better When in Actuality You're Already Getting PRP When You Spend Them Boomers of All We Were Doing Were Literally in a Study in Israel What They Were Just Alluding It's Just Laughing This Is Similar When You Say No You Think It's Them so You Got Blood You Are Talking about Fasting And I Had Some Friends and Maybe Overdone It on Adderall Little Bit like Three Days without Eating and Not Basing Radiology Headsets of Money I Was in Jail All Weekend and You Know There's a Great View We Talked about Intermittent Fasting There's a Great Study Published in Cell Metabolism Last Year That Showed That the That Are Correlated to Longevity in Mice And the the Mice Had the Longest Food Free Intervals Actually Increase Life Plaintiff Please Got a Hold of Our Dr. Wayne McKenna I Will Lose Track down the Same 10,000 This Is the Only 24 Hour Take Anywhere Platforms Dedicated to Food and Fun Clear Spoony Our Townhall.com, Where the Mother Report about to Be Released Atty. 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Nice Because I Think I Spent Some There with the Trying to Keep up with Dr. McKenna I Went through to Believe That I Write the Name That It It It but It Was Some System Select for I Was Looking See Who's behind Me but It But Literally We Been over 10,000 Cases in US Now so so Let Me Let Me Throw One out for You We Got a Message from Victoria That Says Can You Fix Bone on Bone Degenerative Discs so Here's the Short Answer in the You Know Me Enough Already by Now You Notice the In a Good Prospective Randomized Study of This Started with Just Pure P Because Again Bo Mastro Concentrate the Only Reason PRP Exists Is a Product Is Because We Couldn't Get Approval for Bone Marrow so We Were Spinning down Horseplay on the Equine Market You Could Sell PRP into People Pay More to Have Their Horse Injected My World Are Kid and That Horse Has Four Extremities and so Were Spinning on Whole Blood Created PRP While We're Waiting on the FDA to Approve Bone Marrow Whole Blood Is Exempt In Bone Marrow Was an and so Did Get the Validations on Bone Marrow and A Lot Of Pure P Was Created so There You Go so the Short Answer Is Enter Disco Injections Hemorrhoids Are Several Great Papers Are Republished and the Most Recent One at Two Years 92% of the Patients Had Inner Disco Injections on Degenerative Disc Disease And and I Would I Would Take It Even Step Farther and That in Our in Our Clinical Practice with over 300 Discs Now In That If You Have an Annular Tear Bring a Tear in the Covering of the Desk That Is a Primary Pain Generator It's a Bright Spot on the MRI Called Heisey Lesion Are High in Tinsel Science Is a Signal A Lot Of Radiologist Don't Now Failed to Mention That I Guess but If There's an Annular Tear High Intensity Signal within That within the Disc That Alone Is a Dramatic Pain Generator It Can Even Cause This Exact Same Symptoms As a Herniated Disc Would As Far As Lower Extremity Pain and Weakness Because the Nerve Crosses the Annular Tear in Your Tear Generate Substance P Generates the Cytokines Generates Exact Same Pain Response so Those Two Times of Radicular Pain Coming from the Back Leg and Hip Pain Radicular so That's the Old Folks Called Sciatica If It Can Be Pressure Because My Big Herniated Disc Neural Foraminal Stenosis Meeting the Canal Gets to Tie the Facets Your Baguette Hypertrophic Get Extra-Large They Were out so There's There's You Can Have Pressure Stenotic Pressure on Her Nerve Were Still Think It's Just Been Crushed That Causes Leg and Hip Pain and Back Pain Or You Can Have a Chemical Radiculopathy Created by a Tear in the Desk and It Feels the Same Patient until Difference One of Almost Everybody Else Is My Bulging Disc yet I Could Be There but but but Bulging to Start the Problem Because Here's What We Know Here's What's Already Published If Either MRIs and A Lot Of People Have No Back and Leg Pain A Lot Of Them Have Bulging This So How's It Happen How How Can Some People Smoking Just Hurts a Bit Was Bulging the Stone Right Now Is That If You Experience If You Have a Bulging Disc the Nonoperative Follow-Up At Two Years Is the Same As Opera Follow If You Don't Have Weakness If You Have Pain That You Can Tolerate and You Have Weakness in the Lower Extremity at Two Years Your Doom the Same As a People How Discectomy If You Don't Have Surgery What That's Published For Long Time so Were Not so If You Intrude a Free Fragment That Free Fragment Will Absorb Your Body Is Really Adept at Getting Rid of Items Extruded into the Canal and It Will Actually Absorb and and Get Rid of a Free Fragment As Long As Every Fragment Is Important so Much Pressure on the Nerve That It Decreases the Blood Supply from the Pressure Causes Weakness in the Lower Extremity from the Pressure the Nurse Stops Working You Have Leg Pain Your Little Foot Drop below Witnessing That Surgery You Have Weakness and You Start Paying What's Publish Now Is If We Inject That Disk the Annular Tear That Doesn't Go Away on Its Own Will Heal And Most of the Time 92% in a Study If the Annular Tear Heals The Back and Leg Pain Go Away 92 Persons 92% of the Playhouse That Had an Injection Didn't Go on to a Primary Fusion While Now Now Here's the Other Side of The Patients Had a Fusion at Five Years 30% of Them Had Two Surgeries So If You Have Fusion at One Level 30% Time of the Next Five Years Your Risk of Having a Second Surgery Either Refused at the Level above or below or Hardware Removal or Revision or You Get Extra Bone from the Fusion at the Re-Open up the Nerve Roots Have To Do in Reframing Autonomy Every Time You Do Surgery The Muscles of the Back Diablo So the Paravertebral Muscles the Muscle Mass so It Would When You Look at Some of Been for You It Will Look like Dinosaur Right That Little Thing the Bridge the Sticks up Familiar Back Check Is Called the Spinous Process The Muscles That Lay on Each Side of the Spinous Process Have To Be Moved Out Of the Way For You to Do a Back Surgery Weeks Make Fun of Spine Surgeons When I Was a Fellow in Trauma Because They Don't Have One Incision Is Midline Low Back Tonight We Had Learn All These Other Incisions and Sponsors in Certain Were More Online But What They Don't Learn That Trauma Surgeons Learn As We Make an Incision The Is Designed to Not Limit the Structure Function Blood Spire Nerve to the Muscle Were Moving In the Spine The Multiply the Small Muscle Each Side of That Bridge The Nerve and Vessel Come from Midland in the Back but Were Moving Away Is It When You Do an MRI of Someone's Back Is Set Back Surgery Initially The Muscles on Each Side of That Look like Filet Mignon That's Tenderloin Right That's the Backstrap Vassar Hunters Were Not Talking Tenderly Farewell Real Hungry so When You Move That Muscle out a Way And You Go Back and You Do an MRI That Back That Had Surgery and Other Fibers out And Having Pain Again And the Neurosurgeon Looks at the Films Goes While the Disc Looks Great the Nerve Roots Wide Open Usual Payments and That There Is No Reason for Your Backs on Well If You Look at the MRI Used To Look like Tenderloin Now Looks like Prime Bootleg like Strip Steak or or or Worse Just We Call White Muscle Syndrome Is Just Whole Thing Just Looks like Fatting a Filtration like Arby's Like Times like More like Crime-Ridden Right Is a Little Bit of Muscle Aches and Their Diagnosis Are You You Are Fasting for What You Are Armies Roy Rogers for My Generation Has To Follow-Up Question That She Was Asking How Many Injections Did That Take to Achieve the Most of Time Is One One Engine One Treatment One Injection We Do What We What We Do Is We Will You Be More Specific Rest of My My Problems Stem Cell Science As a Whole Is A Lot Of Times Patients Get in the Mix Were There Never Really Diagnosed and I Am a Firm Believer That You Can't Treat Something If You Didn't Diagnose It If I Don't Know What I'm Treating My Chances of Making It Go Away Are Pretty Slim and Entered and Unfortunately A Lot Of Stem Cell Injectors out There Don't Make the Effort to Actually Diagnose a Problem but to Get There Won't Inject Anything Well That's That That's Very Nonspecific Treatment in It, It Kinda Puts Your Your Results Risk If You Don't Know What You're Treating Because You Know What You Can Heal What You Can't Heal When You Do What We so What We Do We Were Doing Disc Injections I Want to Know That Was the Painter So There's an Old Test That Used To Be the Standard of Care before You Had a Fusion Now Because Fusions Are so Rampant in Our Country We've Gotten Away from More Specific Diagnosis on Making Sure T
Core Questions: What structure controls body temperature and how does it go about controlling it? What are pyrogens and how are they classified? What is the difference between fever and hyperthermia? What is the role of PGE2 in fever and what medications can you give to combat its effects? List four factors that blunt the febrile response. What are the benefits and pitfalls of the febrile response? List five infectious and five non-infectious causes of fever. (see Box/Table 9.1) Describe your approach to the febrile patient. (see Figure 9.1/9.2) Wisecracks: What is the most accurate temperature measurement site? How are heart rate and body temperature related? How are respiratory rate and body temperature related? How high must a fever be to necessitate rapid cooling interventions?
Core Questions: What structure controls body temperature and how does it go about controlling it? What are pyrogens and how are they classified? What is the difference between fever and hyperthermia? What is the role of PGE2 in fever and what medications can you give to combat its effects? List four factors that blunt the febrile response. What are the benefits and pitfalls of the febrile response? List five infectious and five non-infectious causes of fever. (see Box/Table 9.1) Describe your approach to the febrile patient. (see Figure 9.1/9.2) Wisecracks: What is the most accurate temperature measurement site? How are heart rate and body temperature related? How are respiratory rate and body temperature related? How high must a fever be to necessitate rapid cooling interventions?
Thanks to the research being done in CKid, we know that children diagnosed with chronic kidney disease progress over time to dialysis and transplantation. That makes it very important to address therapies which can mitigate the progression of chronic kidney disease. Joining the show today is Tarak Srivastava, MD, he has been awarded R01 funding from the National Institutes of Health to work on targeting EP2, one of the four PGE2 receptors to mitigate hyperfiltration–mediated kidney injury as a way to delay the progression of chronic kidney disease in children born with congenital anomalies of kidney and urinary tract (CAKUT).
Carolyn: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Centre and Duke National University of Singapore. I am so excited to be joined in just a moment by Dr. Andrea [inaudible 00:00:21] and Dr. Wendy Post to discuss the feature paper this week about leisure-time physical activity and the risk of coronary heart disease in young women. First, here's the summary of this week's issue. The first paper, by Dr. Bohula and colleagues at the TIMI Study Group at Brigham and Women's Hospital in Boston, Massachusetts, aim to test the hypothesis that an atherothrombotic risk stratification tool may be useful to identify high-risk patients who have the greatest potential for benefit from more intensive secondary preventive therapy such as treatment with Vorapaxar following a myocardial infarction. As a reminder, Vorapaxar is a first-in-class anti-platelet agent that inhibits thrombin-mediated activation of platelets via the protease activator receptor 1. The authors studied almost 8,600 stable patients with a prior myocardial infarction followed for a median of two and a half years. In the thrombin receptor antagonist and secondary prevention of athrothrombotic ischemic events, TIMI 50 trial. They identified nine independent risk predictors which were age, diabetes, hypertension, smoking, peripheral artery disease, prior stroke, prior coronary bypass grafting, heart failure and renal dysfunction. A simple integer-based scheme using these predictors showed a strong graded relationship with the rates of cardiovascular death, myocardial infarction or ischemic stroke. Moreover, the net clinical outcome was increasingly favorable with Vorapaxar across the risk groups. In summary, this paper provides a practical strategy that could be used by clinicians to assist with risk stratification and therapeutic decision-making regarding Veropaxar use for secondary prevention after myocardial infarction. The next paper is by first author Dr. [inaudible 00:02:40] and corresponding authors, Dr. [Gerstein 00:02:43] from the Beth Israel Deaconess Medical Center and Dr. [Carr 00:02:47] from the Broad Institute of Harvard and MIT, who look at aptamer-based proteomic profiling. Now DNA aptamers are [alu 00:02:57] nucleotides of approximately 50 base pairs in length selected for their ability to bind proteins with high specificity and affinity. They therefore holds considerable promise for biomarker and pathway discovery in cardiovascular diseases. These authors applied a novel technology that uses single-stranded DNA aptamers to measure over 1,100 proteins in a single blood sample. They applied this to a model of planned myocardial injury and that is patients undergoing septal ablation for hypertrophic cardiomyopathy, and they found that 217 proteins were significantly changed in the peripheral vein blood after planned myocardial injury in this derivation cohort. They validated 79 of these proteins in an independent cohort. Furthermore, among 40 validated proteins that increase within one hour after myocardial injury, 23 were also elevated in patients with spontaneous myocardial infarction. Finally, the authors applied this to archive samples from the Framingham heart study and showed 156 significant protein associations with the Framingham risk score. This study is so exciting because it highlights any merging proteomics tool that captures a large number of low abundance analytes with high sensitivity and precision, thus providing important proof of principle for future clinical applications and this is discussed in an excellent editorial that accompanies this paper by doctors Graham [Malini 00:04:37], [Lau Enleui 00:04:39] from the University of Ottawa Heart Institute. The next paper is by Dr. [Anter 00:04:51] and colleagues from the Beth Israel Deaconess Medical Center in Boston, Massachusetts, who looked at post infarction, reentrant ventricular tachycardia and addressed the problem that in vivo descriptions of ventricular tachycardia circuits are currently limited by insufficient spatiotemporal resolution. The authors therefore utilize a novel, high resolution mapping technology to characterize the electrophysiological properties of these reentrant circuits in 15 swine. The main finding was that the zones of slow conduction within the reentrant circuits with the inward and outward curvatures while conduction velocity in the comment channel isthmus itself was nearly normal. The authors further demonstrated that entrainment mapping over estimated the true size of the isthmus. Thus, the conclusion was that high resolution activation mapping of ventricular tachycardia may better guide ablation therapy and ablation at zones of high curvature may be an attractive target for ablation. The final papers from first author, Dr. [Tang 00:06:08] and corresponding author Dr. [Fitzgerald 00:06:10] from the University of Pennsylvania Perlman School of Medicine in Philadelphia. These authors studied the cardiovascular consequences of prostanoid I-receptor deletion in microsomal prostaglandin E synthase-1 deficient hyperlipidemic mice. The clinical background to this research question is that inhibitors of cyclooxygenase-2 or Cox-2 are well-known to relieve pain, fever and inflammation by suppressing biosynthesis of prostacyclin and prostaglandin E2. However, suppression of these prostaglandins particularly prostacyclin by Cox-2 inhibitors or deletion of the I-prostanoid receptor for prostacyclin is known to accelerate atherogenesis and enhance thrombogenesis in mice. In contrast, deletion of the microsomal prostaglandin E synthase1 has been shown to suppress PGE2 but increase biosynthesis of prostacyclin. It therefore confers analgesia while attenuating atherogenesis and does not predispose mice to thrombogenesis. Therefore, possibly contributing to cardiovascular efficacy. In this particular study, therefore, the authors sought to determine the relative contribution of suppressing PGE2 versus augmenting prostacyclin to the impact of depletion of microsomal prostaglandin E synthase-1 in hyperlipidemic mice. The main findings were that augmentation of prostacyclin is the dominant contributor to the favorable thrombogenic profile of microsomal prostaglandin E synthase-1 depletion in these atherosclerotic mice while suppression of PGE2 accounted for the protective effects in atherosclerosis and the exciting clinical take-home message is that inhibitors of the microsomal prostaglandin E synthase-1 may be less likely to cause cardiovascular adverse effects than NSAIDS or specific inhibition of Cox-2. Those were the highlights of this week. Now for our feature paper. Our feature paper today is entitled "The frequency, [type 00:08:41] and volume of leisure time physical activity and risk of coronary heart disease in young women" and I am so excited to be joined by two lovely ladies today to discuss this paper. First, the first and corresponding author Dr. Andrea [Comastick 00:08:58] from the School of Public Health of Indiana University Bloomington and Dr. Wendy Post, associate editor from the Johns Hopkins University. Welcome Andrea and Wendy. Andrea: Hi. Thanks. Wendy: Thank you so much for having us. Carolyn: I am just so excited that we are talking about a paper about women being discussed by women. What more could you ask for? I have to say this is a first for Circulation on the Run, which is why I'm just so excited, so let's get straight into it. Andrea, maybe I could just ask you to start by sharing the story of how you and your team came up with some new questions and new data because I'm sure a lot of listeners are thinking there's a lot of data on exercise and how good it is for cardiovascular health in women already. Andrea: Yeah, that's a great question. When we started talking about conceptualizing this paper, the first thing was to focus on younger women. Most of the previous work on physical activity and heart disease has been in older adults and that's primarily because it's older adults that have heart attacks. It's hard to get a large enough study of young women that has enough coronary heart disease events to be able to study this. We were fortunate where we had a large cohort in the nurses health study too of women and because it's been followed for over 20 years, we had enough events to be able to examine this association. We did want to think about, "Okay, what can we add?" because there's a lot of information about just overall physical activity and health, so what can we do differently? I'm pretty familiar with the physical activity guidelines and really tried to look at what in the guidelines currently and then what could we add? What could be of interest when they start revising the guidelines which is actually going to happen very soon. That was when we started focusing on, "Okay, instead of looking at just overall activity, look at intensity, comparing moderate and vigorous." We also wanted to look at frequency of physical activity and looking at frequency but also adjusted for a total time or total amount of physical activity that somebody does. Then we are also, the third thing was that we thought was important was looking at adolescent physical activity. We know that kids, unfortunately as they get older and get into their teenage years, their activity declines quite a bit. Looking at how this physical activity during adolescence earlier life impact coronary heart disease risk in adulthood. Those were the three main things that we were focusing on when we first conceptualized the paper. Carolyn: Nice. Tell us, what did you find? Andrea: We did find that exercise is just as beneficial in younger woman as it is in older adults, which is great. We also found that moderate intensity exercise is just as beneficial as vigorous intensity exercise, which I think is a really important message to get out there. I think a lot of people, especially those that are really inactive to begin with are completely intimidated about the fact of trying to think about going to a gym or trying to jog or run a marathon or something like that. I think really emphasizing that moderate intensity activity is beneficial and we found that walking was actually the most beneficial activity that we looked at in our study, that brisk walking was really really good for everybody and really lowered risk of coronary heart disease. Carolyn: Hooray. Andrea: Yeah, and the other thing we found which might be of interest for those that are also extremely busy, especially this target population where a lot of people are moms and working was that frequency didn't seem to matter, that as long as people were exercising for a couple hours a week that they should be that they could accumulate it in a couple times a week or they could do it more frequently, four or five times a week. It didn't seem to matter. Carolyn: That's cool. You know what? I think a lot of these things we'll also discuss at the Editorial Board when we're looking at this paper. Wendy, we promised that we would give a backstage pass to the Editorial Board and The Journal, so could you share a little bit about what we talked about there? Wendy: Well, the Editorial Board was really excited about this paper. We loved the emphasis on young women and the important public health message about how we need to get out there and move and exercise to reduce our risk for cardiovascular disease. As was mentioned, there have been previous studies that also show the benefit of exercise but the Editorial Board especially liked the large sample size, the long duration of follow-up, the number of events that had been accrued that allowed for sophisticated analyses, adjustment for confounders and the very rigorous study design and excellent statistical methods that have been used in this study and so many other studies from the nurses health study, but I think we particularly just loved the message. The message was great. We need to get out there and move. We need to tell our patients, especially young women, that now we have data that if you start exercising now, it will help in the future but also the study showed that if you hadn't exercised much in early life that's starting to exercise more proximal to the event was also important as well. Carolyn: Thank you Wendy. I also remember that we talked about the lack of interaction with body mass index, and I thought that was a great message. Andrea, could you maybe share a little bit about that? Andrea: Yeah, this is something that previous investigators have looked at the interaction between body mass index and exercise. Unfortunately, we've all found the same thing so it doesn't seem to matter whether women are normal weight or overweight or obese that they still get benefit when they exercise, and I think that's really encouraging. I know a lot of people might start to exercise because they really want to drop some weight but just trying to emphasize even if the numbers on the scale aren't changing, that exercise still has all these really great benefits for heart disease and also for many other diseases. Carolyn: Exactly. Can I just ask both of you and maybe I'll start with Andrea, what will you do different now both as a woman and as a clinician seeing women now that you know what you do from your data? Andrea: Well, I'm not a clinician. I'm an epidemiologist so unfortunately I don't get to see patients and counsel them although I do try to talk to community members as a public health person and really get in the community on board with what we're talking about. I just try to tell people, I actually talked to a group of people last week, and just trying to say, "Anything is better than nothing and just trying to even start with some short walks." Again, just emphasizing you don't have to go to a gym or you don't have to be doing anything that's super strenuous but just do stuff that feels good and just try to get your heart rate up a little bit like going out for a brisk walk. I think that's my main message that I try to tell everybody is at least start with something and get moving a little bit. Carolyn: I love that. Wendy? Wendy: I like to emphasize the data about brisk walking. I thought that was great because many of our patients don't want to join a gym, don't have the time to join a gym so just getting out and walking is fabulous exercise and now we have the data here that in young women that after 20 years of follow-up, brisk walking was associated with I think it was a 35% reduction in risk for cardiovascular disease during follow-up. In addition, I liked the message about the total amount of time that you spend exercising in a week is what's important. It doesn't matter whether you divide that into seven days a week to get to that same amount of time or whether you do it in bursts of three days a week, and I think that's particularly important for the many women who have so many different responsibilities and may not have time every day to go out and exercise. The days that you do have time, just exercise a little bit more those days, so lots of really important messages for our patients and for ourselves. Carolyn: I really couldn't agree more and just from my point of view, because I see a lot of patients in Asia and I do acknowledge just like you did, Andrea, in your paper that your data are predominantly in white populations. Still one of the messages I like to get out to the women I see is we have very skinny women and when I see younger women, and I really like emphasizing that, "Hey, just because you're not struggling with an obesity issue or just because you're young, it doesn't mean you don't need to exercise and that we all should just get moving." Thank you very, very much for that Andrea. Andrea: Oh, no. It's my pleasure and thank you for having me come on today and talk about this. Carolyn: Thank you too, Wendy. Do you have any other comments? Wendy: No, but congratulations on your publication, Andrea. Andrea: Oh, thank you so much, Wendy. I was really happy to get the message that guys were excited about it. Thank you so much. Carolyn: You've been listening to Circulation on the Run. Thank you for joining us this week and please tune in next week.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 16/19
Mesenchymale Stammzellen (MSCs) besitzen eine Vielzahl einzigartiger Eigenschaften, hierunter ihr Differenzierungs- und immunregulatorisches Potenzial, die sie sehr interessant für die biomedizinische Forschung machen. Ziel der vorliegenden Arbeit war es zu untersuchen, welche Mechanismen der immunmodulierenden Wirkung der MSCs zugrunde liegen. Zu diesem Zweck wurden mesenchymale Stammzellen aus dem Knochenmark von 5-16 Wochen alten Balb/c-Mäusen isoliert und in der Zellkultur expandiert. Das Oberflächenmarkerprofil der Zellen wurde durch Durchflusszytometrie (FACS) charakterisiert und die Expression potenziell immunsuppressiver Faktoren durch ELISA, Reverse Transkriptase-PCR beziehungsweise Western-Blot bestimmt. Für die Untersuchung der MSC-vermittelten Immunmodulation wurde ein Proliferationsassay etabliert, in dem Lymphozyten aus C57Bl/6-Mäusen durch das Mitogen ConA stimuliert und mit den murinen MSCs kokultiviert wurden. Durch die Zugabe spezifischer Inhibitoren gegen TGFβ, die Prostaglandin E2-Synthese (Indomethacin), den HGF-Rezeptor und den Adenosinrezeptor (SCH58261) wurde die Vermittlung der immunmodulierenden Effekte durch die MSCs untersucht. In der Studie konnte eine reine Population muriner MSCs mit charakteristischen Oberflächenmarkern (CD29, CD73, CD90, CD105, CD140b, Sca-1) expandiert werden, die in vitro starke immunsuppressive Effekte im Proliferationsassay aufwies. Die Untersuchungen potenzieller Effektormoleküle zeigten, dass bei den murinen MSCs TGFβ, HGF und das Enzym IDO keine entscheidende Rolle spielten und von den bekannten Mechanismen vor allem die Produktion von PGE2 die Lymphozytenproliferation hemmte. Als wichtigstes Ergebnis kann der Nachweis, dass die murinen MSCs die Ektonukleotidasen CD39 und CD73 koexprimieren, die extrazelluläres ATP über 5’-AMP in das extrem stark immunsuppressiv wirkende Adenosin konvertieren können, angesehen werden. Zusammenfassend wurde in der vorliegenden Arbeit erstmals die Expression von CD39 auf murinen MSCs beschrieben. Die Koexpression von CD39/CD73 auf den MSCs und die daraus folgende Produktion von Adenosin stellt einen neuen Ansatz dar, um die Funktion der MSCs besser zu verstehen. Die CD39+/CD73+-MSCs sind demnach eine vielversprechende Zellpopulation für die Behandlung von Autoimmunerkrankungen und für die Entwicklung neuer lokaler oder systemischer Therapien zur Toleranzinduktion nach Transplantation.
The protein phosphatase activity of PTEN impairs macrophage phagocytosis of a fungal pathogen by promoting actin depolymerization.
This podcast covers the JBJS issue for November 2011. Featured are articles covering: Temperature-Sensitive Release of PGE2 and Diminished Energy Requirements in Synovial Tissue; Revision Surgery Following Operations for Lumbar Stenosis; Chronic Opioid Use Prior to Total Knee Arthroplasty; recorded commentary by Dr. Vail; Vacuum-Mixing Significantly Changes Antibiotic Elution Characteristics of Commercially Available Antibiotic-Impregnated Bone Cements; recorded commentary by Dr. Bowden.
This podcast covers the JBJS issue for November 2011. Featured are articles covering: Temperature-Sensitive Release of PGE2 and Diminished Energy Requirements in Synovial Tissue; Revision Surgery Following Operations for Lumbar Stenosis; Chronic Opioid Use Prior to Total Knee Arthroplasty; recorded commentary by Dr. Vail; Vacuum-Mixing Significantly Changes Antibiotic Elution Characteristics of Commercially Available Antibiotic-Impregnated Bone Cements; recorded commentary by Dr. Bowden.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 11/19
Im Mittelpunkt der Arbeit stehen die Auswirkungen des Prostanoids Prostaglandin E2 (PGE2) auf die Fähigkeit von Monozyten-abgeleiteten dendritischen Zellen (MoDC) zur Antigenpräsentation auf MHC-I- und MHC II Molekülen. Die Kreuzpräsentation von exogenem Antigen auf MHC I Molekülen ist eine entscheidende Fähigkeit der dendritischen Zellen (DC), die es ihnen ermöglicht zytotoxische T-Zellen zu aktivieren. PGE2 wird in Aktivierungsprotokollen als „Goldstandard“ in Kombination mit Zytokinen, wie TNF-α, IL-1β und IL 6, als Reifestimulus für DC in klinischen DC-basierten Tumorvakzinierungsstudien verwendet. Bisher wurde über den Effekt von PGE2 auf die Antigenpräsentation von Tumorantigen in Proteinform nicht berichtet. In dieser Arbeit wurde die Auswirkung von PGE2 und spezifischen EP Rezeptoragonisten auf verschiedene Funktionen von MoDC, die für die Antigenpräsentation auf MHC-I- und MHC-II-Molekülen relevant sind, untersucht. Zuerst wurde die Auswirkung von PGE2 und den EP Rezeptoragonisten auf die Ausreifung der MoDC untersucht. Hierbei wurde ersichtlich, dass MoDC nach Inkubation mit PGE2, vermittelt über EP2/4 Rezeptoren, die Aktivierungsmarker HLA A, HLA-B und HLA-C3, HLA-DR, CD83 und CD86 hochregulieren. Als nächstes wurde der Einfluss von PGE2 auf die Antigenaufnahmefähigkeit der MoDC untersucht. Hierbei wurde die Phagozytosefähigkeit anhand von Zelllysat und apoptotischen Tumorzellen und die Makropinozytosefähigkeit anhand von Dextran Partikeln analysiert. Es konnte gezeigt werden, dass weder PGE2 noch spezifische EP Rezeptoragonisten die Antigenaufnahme signifikant beeinflussten. Durch Präsentation von Antigen auf MHC-II-Molekülen sind DC in der Lage, tumorspezifische CD4+ T-Zellen zu aktivieren. Die MHC-II Präsentationsfähigkeit der MoDC unter dem Einfluss von PGE2 wurde mit NY-ESO-1157-170 Peptid, NY-ESO-1 Protein sowie mit NY ESO 1-transfiziertem CHO Zelllysat als Antigenquellen untersucht. PGE2 wurde zu den MoDC entweder 24 h vor (Präinkubation) oder zur gleichen Zeit wie das Antigen (Simultaninkubation) hinzugefügt. Die Versuche ergaben, dass die MHC-II-Antigenpräsentation der MoDC durch PGE2 nicht signifikant beeinflusst wird. Die Auswirkung von PGE2 auf die Kreuzpräsentationsfähigkeit der MoDC wurde mit einer Formulierung aus NY-ESO-1 Protein und dem ISCOMATRIX® adjuvant (NY ESO-1/IMX) und einem Immunkomplex bestehend aus NY-ESO-1 Protein und dem Antikörper anti NY ESO-1 mAk (Klon ES121; NY-ESO-1/IC) untersucht. Hierbei konnte gezeigt werden, dass sowohl die Kreuzpräsentation von NY-ESO-1/IMX als auch von NY ESO 1/IC durch PGE2 dosisabhängig signifikant gehemmt wurde. Dieser Effekt wird, ähnlich wie die Zell-Reifung, über die EP2/4-Rezeptoren vermittelt. Zusammenfassend erlauben die Ergebnisse den Schluss, dass PGE2 über einen EP2/4-Rezeptor-vermittelten Mechanismus die Kreuzpräsentationsfähigkeit der MoDC inhibiert, ohne jedoch die Antigenaufnahme oder die MHC-II Präsentation signifikant zu beeinflussen. Eine klinische Relevanz der Ergebnisse besteht bei der Verwendung von DC für therapeutische Tumorvakzinierungen zur Induktion einer gegen Malignome gerichteten Immunantwort. Die Benutzung von PGE2 als Reifestimulus für MoDC, die mit Protein-Antigenen gepulst werden, birgt das Risiko, die Induktion von tumorantigenspezifischen CD8+ T-Zellen negativ zu beeinflussen.
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 04/07
Epilepsien zählen zu den häufigsten chronischen neurologischen Erkrankungen des Menschen, aber auch der Hunde und Katzen. Sie sind mit erheblichen Einschränkungen der Lebensqualität und Lebenserwartung verbunden und führen zu einer fortschreitenden Schädigung des gesamten Nervensystems. Gegenwärtig ist die wichtigste Therapieform der Epilepsie nach wie vor die Pharmakotherapie. Ungeachtet einer Vielzahl neuer Antiepileptika kann jedoch bei über 30% der Patienten mit Epilepsien durch eine medikamentelle Therapie keine ausreichende Kontrolle der Anfälle herbeigeführt werden, was neue Therapie- und Behandlungsstrategien unbedingt erforderlich macht. Eine, der im Zusammenhang mit einer Pharmakoresistenz am häufigsten erwähnten Thesen, ist die Multidrug-Transporter-Hypothese. Hier wird davon ausgegangen, dass es, durch an der Blut-Hirn-Schranke überexprimierte Efflux-Transporter, nicht zu einer ausreichend hohen Konzentration eines Antiepileptikums im neuronalen Gewebe kommt. Dem Multidrug-Transporter P-Glycoprotein (Pgp) wird dabei eine besondere Bedeutung beigemessen. Basierend auf der Multidrug-Transporter-Hypothese war es ein Ziel dieses Dissertationsvorhabenes die Regulation der anfallsinduzierten Pgp-Überexpression genauer zu charakterisieren, um daraus resultierend mögliche neue Angriffspunkte für eine Modulation der Pgp-Überexpression zu identifizieren. In einem ersten Teil der Dissertation wurde deshalb die Spezifität der molekularen Veränderungen des verwendeten Tiermodells untersucht. Hierfür wurde die Wirkung von spontanen Anfällen und eines SE auf die Pgp-Expression im Kaninen Gehirn untersucht. Die Untersuchungen zeigten, dass wie im Tiermodell auch nach einem spontan ablaufenden SE eine deutliche Induktion des Mutlidrug-Transporters Pgp an der Blut-Hirn-Schranke nachweisbar ist. Da bisherige Forschungsarbeiten unserer Arbeitsgruppe auf eine besondere Bedeutung des Glutamat/NMDA-Rezeptor/COX 2-Weges für die anfallsinduzierte Pgp-Überexpression in Endothelzellen der Blut-Hirn-Schranke hinweisen, wurden in diesem Dissertationsprojekt eingehende Untersuchungen durchgeführt, die darauf abzielten diesen Signalweg weiter aufzuklären. Durch vorausgegangene in vitro Untersuchungen wurde davon ausgegangen, dass die weitere Pgp-Induktion über den EP-1-Rezeptor von PGE2 abläuft. Diese Annahme konnte durch die Verwendung des EP-1-Rezeptor Hemmers SC- 51089 in vivo im Rahmen dieses Dissertationsprojektes bestätigt werden. Ein neuroprotektiver Effekt dieser Substanz konnte jedoch bei der verwendeten Konzentration von SC 51089 in diesem SE-Modell im Hilus nicht nachgewiesen werden. Weiterhin wurden Untersuchungen zu möglichen Downstream-Elementen des EP-1-Rezeptors angeschlossen, den Transkriptionsfaktoren YB-1 und ZONAB. Erstmalig konnte eine Expression dieser Transkriptionsfaktoren im adulten Gehirn unterschiedlicher Spezies nachgewiesen werden, die jedoch vermutlich nicht mit der anfallsinduzierten Pgp-Überexpression im Zusammenhang steht. Die bisherigen Ergebnisse demonstrieren jedoch, dass durch eine genaue Kenntnis, der an der Regulation der Pgp-Überexpression beteiligten Faktoren, eine Modulation bzw. Inhibtion der anfallsinduzierten Induktion von Pgp möglich ist und dadurch eine hoffnungsvolle Möglichkeit zur Behandlung und zur Prävention einer Multidrug-Transporter basierten Pharmakoresistenz geschaffen werden kann.
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 02/07
The study is subdivided into two different parts: the first part deals with the development of a method to gain uterus milk in vivo during the preimplantation periode in cattle for the investigation of regulatory factors. The second part investigates different proteases in bovine follicles 20 hours after GnRH (Gonadotropin releasing hormone) injection (shortly bevor ovulation) for comparable as well as in the corpus luteum (CL) during oestrous cycle and induced luteolysis. In addition apoptotic as well as anti-apoptotic factors were evaluated in the CL during oestrous cycle and induced luteolysis. For the development of a method for gaining uterus milk in vivo during the first 24 days of gravidity in cattle, nine heifers were cycle synchronised using the Ovsynch method and artificially inseminated. Before flushing an epiduralanaesthesia was given and both uterus horns were flushed with 13ml 0.9% NaCl using a balloon embryo transfer catheter at day 5, 7, 12, 17 and 24 of gravidity. The catheter was placed 1cm cranial to the bifurcatio uteri in both horns. It was possible to retrive between 3ml and 13ml of the used flushing fluid. The uterus milk from the ipsilateral horn was inspected for an embryo and an EDTA-stabilisator was given to the uterus milk of both horns. An infection of the uterus occured in three heifers after the second and in five heifers after the third flushing. In one heifer no infection was found. Between day 17 and day 24 all heifers showed clear signs of oestrus. It was possible to detect progesterone, oestradiol-17-beta, PGF2alpha and VEGF via enzyme immunoassay (EIA) and radio immunoassay (RIA), respectively. Because of the occurred infection no statistic analysis was made. But it could be seen that the level of progesterone ranged between
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 05/19
Leukämische Blasten bei AML können ex vivo in DC umgewandelt werden, wodurch Anti-gen-präsentierende Zellen entstehen, welche leukämische Antigene präsentieren. Im kleineren Rahmen sollten zunächst Daten zu methodischen Vorversuchen ausgewertet werden, um bei AML und MDS unter serumfreien Bedingungen DC zu generieren. Diese me-thodischen Vorversuche an 50 AML-, 24 MDS-Patienten und 23 gesunden Probanden erga-ben, dass adhärente Zellfraktionen die DC-Ausbeute im Vergleich zu totalen MNC-Fraktionen nicht verbessern, dass bei MACS-depletierten `MNC(-)`- und aufgetauten MNC-Fraktionen niedrigere DC-Zahlen erreicht werden, und dass die DC-Ernte bei AML- und MDS-Patienten nach 10-14tägiger Kulturzeit, bei gesunden Probanden jedoch nach 7tägiger Kulturzeit höher ist. Außerdem zeigte sich, dass die Zugabe von FL die DC-Ernte erhöht, der Einsatz von autologem Plasma dagegen in vielen Fällen einen inhibitorischen Effekt auf die DC-Generierung hat. Die Kulturmedien CellGro und Xvivo erzielten vergleichbare DC-Ausbeuten. Nach Ermittlung der optimalen Zellfraktion, Kulturdauer und –zusätze, wurden serumfreie DC von 100 AML-, 55 MDS- und 38 gesunden Proben in einem 10-14-tägigem serumfreien Xvivo-Kultursystem mit GM-CSF, IL-4, FL und TNFα angezüchtet und charak-terisiert. Bei der DC-Generierung unter standardisierten Bedingungen betrug die Ausbeute der MNC-Fraktionen durchschnittlich 20% bei MDS, 34% bei AML und 25% bei gesunden Probanden. Zwischen 53-58% der DC waren reife CD83+DC. Die DC-Ernten waren in den monozytären FAB-Klassen (AML-M4/5, MDS-CMML) am höchsten, dagegen unabhängig von den zyto-genetischen Risikogruppen. Das Oberflächenmarkerprofil der DC von den AML- und MDS-Proben (einschließlich 1 MDS- und 3 AML-Zelllinien) war mit dem der gesunden DC ver-gleichbar. In parallelen Kulturansätzen konnte außerdem gezeigt werden, dass in einem `MCM-Mimic`-Medium mit PGE2 der Anteil reifer, CCR7+DC besonders hoch war. Der leu-kämische Ursprung der AML- und MDS-DC wurde bei 5 AML- und 4 MDS-Fällen mittels FISH durch die Persistenz klonaler, zytogenetischer Aberrationen in den DC oder in übrigen Fällen durch die Coexpression leukämischer Antigene auf den DC bewiesen. Durch eine kombinierte FISH/Immunophänotyp-Analyse (FISH-IPA) konnte zudem nachgewiesen wer-den, dass obige klonale, numerische Aberrationen konstant in Kombination mit DC-Markern detektierbar, jedoch nicht alle klonalen Zellen zu leukämischen DC umwandelbar waren (durchschnittlich 53% der AML- und MDS-Blasten). Umgekehrt trugen auch nicht alle gene-rierten DC die klonale Aberration (im Durchschnitt 51% der DC). In 41 AML-Fällen mit ei-ner Leukämie-spezifischen bzw. aberranten Antigenexpression oder in AML-Fällen mit ei-nem CD33+ Blastenphänotyp und gleichzeitig
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 04/19
Im Angesicht der augenscheinlichen Insuffizienz vorhandener Optionen in der Behandlung des metastasierten Pankreaskarzinoms stellt die Immuntherapie mit dendritischen Zellen einen möglichen neuen Therapieansatz dar. Bei einer Vielzahl von Malignomen wird diese Art der Therapie experimentell bereits klinisch getestet, bisher jedoch nicht mit ausreichendem Erfolg. Ziel dieser Arbeit war es, zu eruieren, welchen Einfluss der Modus der Aktivierung dendritischer Zellen auf eine gegen Pankreaskarzinomzellen gerichtete Immunantwort besitzt. Dabei sollten Wege identifiziert werden, eine aus dendritischen Zellen bestehenden Vakzine durch eine effektive Stimulation der enthaltenen Zellen möglichst potent in der Induktion dieser Immunantwort zu machen. Zu diesem Zwecke wurden von Monozyten abgeleitete dendritische Zellen mit dem Überstand apoptotischer Tumorzellen eines duktalen Pankreaskarzinoms inkubiert und dann nach verschiedenen Schemata stimuliert. Die Potenz der dendritischen Zellen wurde eruiert über die Expression von Reifemarkern und kostimulatorischen Molekülen, die Zytokinproduktion und die Induktion von Aktivierungsmarkern auf T-Zellen sowie der CTL-getragenen spezifischen Immunantwort gegen Pankreaskarzinomzellen in einer halbautologen Kokultur von dendritischen Zellen und naiven T-Zellen. Zur Stimulation der dendritischen Zellen kamen ATP mit TNFalpha und die Kombination von IL-1beta, IL-6, TNFalpha und PGE2 mit und ohne die Zugabe von CD40-Ligand, einem zellgebundenen, DC-aktivierenden Oberflächenmolekül, zur Anwendung. Die kombinierte Anwendung von CD40L und proinflammatorischen Mediatoren (TNFalpha, IL-6, IL-1beta und PGE2 bzw. ATP plus TNFalpha) besaß, verglichen mit der getrennten Anwendung dieser Stimuli, einen synergischen Effekt bei der Aktivierung dendritischer Zellen. So stimulierte Zellen zeigten eine hohe Expression von Aktivierungsmarkern und des Zytokinrezeptors CCR7, induzierten effektiv ein Th1-gerichtetes Zytokinmillieu und eine CTL-vermittelte spezifische Immunantwort gegen Pankreaskarzinomzellen. Die Zugabe von CD40-Ligand 12 h nach der Stimulation der dendritischen Zellen mit ATP und TNFalpha bzw. der Kombination von IL-1beta, IL-6, TNFalpha und PGE2 erwies sich dabei als optimal. Die Ergebnisse dieser Arbeit legen nahe, dass die Art der Stimulation der dendritischen Zellen im Rahmen der Immuntherapie des duktalen Pankreaskarzinoms einen wesentlichen Einflussfaktor in Bezug auf die Potenz der verwendeten Vakzine darstellt. Geht man von einer Übertragbarkeit dieser in-vitro-Daten auf das menschliche Immunsystem aus, so kann mit Hilfe einer optimalen Aktivierung dendritischer Zellen die Effektivität einer Vakzine wesentlich gesteigert werden.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 03/19
Das Krankheitsbild der chronisch rezidivierenden vulvovaginalen Candidose stellt sowohl diagnostisch als auch therapeutisch nach wie vor eine Herausforderung für den behandelnden Arzt dar. Wir untersuchten 104 Patientinnen, die klinisch Symptome wie Erythem, Pruritus, Brennen und weißlichen Fluor aufwiesen und mbei mindestens vier Episoden pro Jahr die Diagnose einer CRVVC gestellt wurde. Als Kontrollgruppe dienten 44 asymptomatische Patientinnen ohne anamnestische Pilzinfektion. Zum Nachweis von Candida und der Spezifizierung des Pilzes aus gewonnenem Vaginalsekret verwendeten wir sowohl die Methode der kulturellen Anzüchtung als die der PCR. Des Weiteren bestimmten wir mittels Elisa die Zytokine Interleukin-4, Interleukin-5, Interleukin-13 wie auch ProstaglandinE2, candidaspezifisches IgE und Gesamt-IgE aus dem Vaginalsekret. In der Gruppe der symptomatischen Patientinnen konnte bei nur 42,3% eine Pilzinfektion mittels PCR nachgewiesen werden, kulturell sogar nur bei 29,8% der Frauen, so dass bei 57,7% keine Pilzinfektion zum Zeitpunkt der Probenentnahme nachzuweisen war. Innerhalb der asymptomatischen und klinisch befundfreien Kontrollgruppe wurden 3 Patientinnen mit Hilfe der PCR positiv auf Candida getestet. Die Auswertung der Messergebnisse von IL-5, IL-13 und Gesamt-IgE zeigte im Vergleich der symptomatischen Patientinnen mit der Kontrollgruppe keine Zusammenhänge. Signifikante Unterschiede hingegen bestanden in der Konzentration von IL-4 (p
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19
Die Immunantwort auf ein Verbrennungstrauma beginnt im Moment der Verletzung und resultiert in einer Monozytenaktivierung, die mit einer vermehrten Synthese und Ausschüttung von inflammatorischen Mediatoren einhergeht. Unter physiologischen Bedingungen dient ein ausgewogenes Zusammenspiel von pro- und antiinflammatorischen Zytokinen der Homöostase, wohingegen das Immunsystem nach massivem Trauma mit einer oft exzessiven Freisetzung proinflammatorischer Mediatoren reagiert. Patienten mit schwerer Verbrennungsverletzung sind daher hochgradig gefährdet ein ausgedehntes „systemic inflammatory response syndrome, (SIRS)“, d. h. eine maligne Ganzkörperinflammation, eine Sepsis oder eine Multiorgandysfunktion, assoziiert mit einer hohen Letalität, zu entwickeln. Eine überwiegend antiinflammatorische Immunantwort dagegen manifestiert sich als systemische Immundefizienz und Anergie mit einer signifikant erhöhten Infektionsanfälligkeit. Es besteht eine eindeutige Ursache-Effekt-Beziehung zwischen Trauma und Zytokinsystem. Mechanischer Stress führt zu schweren Störungen der Interaktion von Monozyten und T-Zellen mit der Folge einer schwerwiegenden Immundysfunktion, wobei PGE2 als einer der Hauptmediatoren der traumainduzierten Immundepression angesehen wird. Erhöhte PGE2-Spiegel sind mit einer reduzierten T-Zellmitogenese, IL-2-Produktion und IL-2-Rezeptorexpression korreliert und für eine Verschiebung der T-Helfer-Aktivität in Richtung eines dominierenden TH2 Phänotyps mit erhöhter Synthese der immunsuppressiven Zytokine IL-4 und IL-10 verantwortlich. Zytokine sind für die Kommunikation im Immunsystem, vor allem bei der Koordination einer Immunantwort durch T-Lymphozyten, von entscheidender Bedeutung. Als sezernierte Proteine waren sie bis vor kurzem der durchflusszytometrischen Analyse nur begrenzt zugänglich. Wir konnten sie wie in vorliegender Arbeit beschrieben in fixierten Zellen intrazellulär nachweisen, d. h. vor der Sekretion. Dieses Verfahren erlaubte es uns, die Expression der Zytokingene quantitativ, kinetisch, korreliert mit Oberflächenproteinen und auf die Einzelzelle bezogen analytisch zu erfassen, zumindest bis zur posttranslationalen Ebene. In peripheren mononukleären Blutzellen (PBMC) von 10 Patienten mit schwerer Verbrennungsverletzung (KOF >30%) und 15 gesunden Kontrollpersonen wurde die Zytokinsynthese mit Ionomycin und PMA polyklonal induziert und die Zellen anschließend mit fluorochromkonjugierten monoklonalen Antikörpern gegen IL-2, IL 4 und IFN-g, sowie gegen CD4-, CD8-, CD45RA- und CD45RO-Zelloberflächenantigene in unterschiedlichen Kombinationen gefärbt. Massives Verbrennungstrauma führte nach polyklonaler Stimulation der T Lymphozyten zu teils signifikanten systemischen Veränderungen der Zytokinexpression in den Kulturüberständen. Verglichen mit einer exzessiven IL-4 Freisetzung und stark erhöhter IL-10 Sekretion zeigten die IFN-g- und die IL-2 Synthese eine nur mäßige Steigerung gegenüber den gesunden Kontrollen. Wir sahen somit eine traumatisch induzierte Veränderung des Zytokinprofils in Richtung eines überwiegend TH2-artigen, immunsuppressiven Phänotyps. Diese Verschiebung von einer eher zytotoxischen (TH1) zu einer weitgehend humoralen und daher abgeschwächten Immunantwort ist mit einer erhöhten Infektionsanfälligkeit verbunden. Mit der durchflusszytometrischen Einzelzellanalyse gelang uns dann erstmalig die Identifikation der CD8+ Zelle, die ursächlich für die gesteigerten Syntheseantworten im posttraumatischen Verlauf verantwortlich ist. Die Synthesekapazität der CD4+ T-Helferzellen blieb nahezu unverändert. Eine Ausnahme bildete die prozentuale Abnahme IFN-g positiver Gedächtniszellen (CD45RO+) zugunsten einer zunehmenden Zahl IFN-g produzierender naiver T Helferzellen (CD45RA+). In der CD8+ Subpopulation kam es in der ersten Woche nach Verbrennungsverletzung zu einer signifikanten Steigerung der IL-2, IL-4 und IFN-g de novo Synthese, die interessanterweise bei weiterer, differenzierter Analyse eine positive Korrelation mit dem klinischen Verlauf ergab. Patienten, die verstarben, zeigten im Vergleich zu den Überlebenden signifikant erhöhte IL-4 und IL-2 Syntheseraten der CD8+ Zellen. Betrachtet man die IL-2 Synthese dieser CD8+ Zellen genauer, nahm nur die Zahl IL-2-produzierender CD8+CD45RA+ Zellen signifikant zu, verglichen mit dem Kontrollkollektiv, wobei beide Patientenkollektive an dieser Entwicklung partizipierten. Auch die IFN-g Synthese der CD8+CD45RA+ Subpopulation zeigte an allen Tagen post Trauma eine signifikante Zunahme gegenüber den Kontrollen ohne aber mit der Überlebensrate zu korrelieren. Dagegen war der prozentuale Anteil IFN-g produzierender CD8+ CD45RO+ Zellen von Verstorbenen signifikant gegenüber den Überlebenden reduziert und blieb auch an allen Untersuchungstagen deutlich hinter dem Kontrollniveau zurück, das von den überlebenden Patienten z. T. signifikant übertroffen wurde. Neben der funktionellen Charakterisierung über die Zytokinexpression (intrazellulär) kann der Aktivierungsstatus des Immunsystems durchflusszytometrisch auch über eine Oberflächenphänotypisierung ermittelt werden, ohne aber damit funktionell unterschiedliche Subpopulationen von T Zellen definieren zu können. Einen ersten Hinweis auf die Aktivierung des Immunsystems von Verbrennungspatienten erhielten wir über die signifikante Zunahme von IL-2Ra (CD25) tragenden T-Zellen in der ersten Woche nach Trauma. Aktivierte T-Zellen exprimieren darüberhinaus MHC-Klasse II-Moleküle und verschiedene Adhäsionsmoleküle, denen bei der Wechselwirkung der Zellen entscheidende Bedeutung zukommt. Akzessorische Moleküle erhöhen beispielsweise die Avidität der T-Zell-APC Interaktion und wirken kostimulatorisch. Wir konnten nach schwerer Verbrennungsverletzung eine verstärkte Expression des vorherrschenden T-Zellrezeptors (TCR) a/b und der akzessorischen T Zellmoleküle CD2, CD7, CD28, CD29 und CD80 nachweisen. Die Zunahme von CD28-Molekülen auf der Oberfläche von CD4+ und CD8+ T-Zellen ist besonders bemerkenswert, da mit zunehmender Signalstärke des über CD28 vermittelten Signals die Differenzierung einer T-Zelle auf die TH2-Entwicklung ausgerichtet wird. Die Aktivierung von T-Lymphozyten ist außerdem mit markanten Veränderungen im Expressionsmuster einzelner CD45 Isoformen verknüpft. Die Induktion der CD45RO Isoform und der Verlust von CD45RA waren beim Schwerstverbrannten besonders auffällig. Die durchflusszytometrische Bestimmung des Aktivierungsstatus des Immunsystems hat unseres Erachtens das Potenzial einer Standardmethode zur Ermittlung von Hochrisikopatienten mit deren Hilfe immunsupprimierte Patienten und solche mit SIRS und Sepsis unterschieden werden können. Die zentrale Vorbedingung für eine effektivere Sepsistherapie stellt eine verbesserte Diagnostik im Sinne kontinuierlicher zellbiologischer Informationen („Online-Monitoring“) am Krankenbett dar, um die meist sehr schnell wechselnden immuninflammatorischen Zustandsbilder direkt zu erkennen und einer zeitgerechten, individuell adaptierten Behandlungsintervention zuzuführen.