锂对造血干细胞和神经干细胞作用影响的研究进展

锂在现代精神病学中使用超过65年,其构成了双相情感障碍（BD）长期治疗的基础。锂的许多生物学特性已经被证实,包括抗病毒、血液系统和神经系统保护作用。本文系统综述了锂对造血干细胞（HSCs）、神经干细胞（NSCs）以及诱导多能干细胞（iPSCs）作用影响的研究进展及其目前已证实的分子机制。自20世纪70年代以来,锂对保持HSCs和生长因子高水平的作用已被报道。锂可以改善HSCs的归巢能力、形成菌落的能力和自我更新的能力。关于锂对神经发生影响的研究表明,锂可促进海马齿状回的干细胞增殖,并导致施旺氏细胞有丝分裂活性增强。锂被证实与神经保护和神经营养作用相关,具体作用反映在锂可改善突触的可塑性,促进细胞存活,抑制细胞凋亡等。在临床研究中发现,锂离子的治疗可增加大脑灰质的成分,尤其作用在额叶、海马和杏仁核等位置。锂对干细胞的作用涉及多条介质和信号通路,其中最重要的介质和信号通路被认为是糖原合成酶激酶-3（GSK-3）和Wnt/β-catenin通路,另外包括调节cAMP、蛋白激酶B、磷脂酰肌醇3-激酶（pi3k）和肌醇单磷酸酶（IMP）水平的信号通路等也与锂作用有紧密的联系。锂在现阶段被利用于治疗BD和降低痴呆症患病风险的临床实验中,并对神经退行性疾病发挥有益作用。除此之外,为了研究的发病机制和锂离子在其中的作用机制,从BD患者中获得的iPSCs也被广泛应用。     

银杏叶提取物抗肿瘤机制研究进展

银杏叶提取物已被广泛应用于治疗心血管和外周血管灌注不足、过敏性疾病和神经性疾病等,最近研究证明银杏叶提取物对多种肿瘤具有抑制作用,其机制主要包括诱导凋亡、抗氧化和免疫调节等,银杏叶提取物抗肿瘤作用的具体研究对指导临床预防和治疗肿瘤有重要意义,对目前银杏叶提取物的抗肿瘤机制做一综述。     

microRNA参与体细胞重编程诱导分化为神经细胞的研究进展

神经退行性疾病是临床上常见的疾病,目前其治疗只停留在药物治疗及手术治疗阶段。由于神经细胞是难以再生的一种细胞类型,寻找替代神经细胞对神经退行性疾病移植治疗具有重要意义。现有研究表明,MSC(mesenchymal stem cell)、ESC(embryonic stem cell)或i PSC(induced pluripotent stem cell)能在体外分化为神经细胞,干细胞治疗神经退行性疾病具有良好的临床前景,但目前受到神经分化效率低、免疫排斥等因素的限制。研究显示,micro RNA具有参与神经发育和分化等作用,且具有重编程神经干细胞并治疗神经退行性疾病的能力。因此,该文就micro RNA参与体细胞的重编程诱导分化为神经细胞机制与作用等作一简要综述,探讨micro RNA对体细胞重编程调控作用和临床应用前景。     

促红细胞生成素的抗炎症作用研究进展

促红细胞生成素是一种造血因子,临床中广泛应用于治疗各种原因造成的贫血。近年的研究发现,EPO具有多种非造血生物作用．其中对各组织以及全身炎症反应的保护作用已成为目前的研究热点之一。但目前EPO抗炎症作用相关的机制尚不明确。本文对EPO的抗炎症作用及其可能机制作一综述,并对EPO在临床中的应用前景进行了展望。     

神经干细胞的研究进展及基因芯片技术的应用

神经干细胞(NSC)在发育过程中及治疗神经退行性疾病方面所起作用已引起广泛关注。体外实验证明,多种因素可调控神经干细胞的增殖及分化,但由于缺少特异的分子标识,我们对于体内的神经干细胞特性知之甚少。基因芯片技术的应用使寻找体内神经干细胞的特异标识成为可能,并且我们通过一种有效的数据分析方法(component plane presentation integrated self-organizing map,CPP-SOM)对神经干细胞的基因表达及调控机制进行了深入的研究。     

生物活性多糖的神经保护及对阿尔茨海默病的防治作用研究进展

阿尔茨海默病(AD)是一种中枢神经系统的退行性疾病,其发病机制复杂,目前临床尚未有能彻底治愈的有效药物。近年来研究发现,多糖具有广泛的生物活性,其中,多糖展现出的神经保护作用对AD的防治也显示出了一定积极的作用。本文综述了目前正在研究的不同来源的多糖类活性物质的神经保护作用机制及其在AD防治中的研究基础和应用,为筛选对AD防治有积极意义的活性物质提供有效信息。     

丙泊酚对创伤后应激障碍治疗作用的研究进展

丙泊酚作为一种广泛用于临床的短效静脉麻醉药,其复杂的作用机制和多样的效应促使人们不断探索其更广泛的临床用途。丙泊酚通过抑制中枢神经系统产生镇静催眠的作用,其遗忘效应有望改善焦虑状态,逆转快感缺乏,缓解抑郁症状,并在治疗创伤后应激障碍方面发挥作用。本文介绍了丙泊酚的临床应用现状和创伤后应激障碍的发病机制,综述了丙泊酚在创伤后应激障碍中的影响及可能的作用机制,并探讨了丙泊酚作为一种新的治疗手段应用于创伤后应激障碍及其他神经精神疾病的可能性。     

胸腺素α1的研究进展

胸腺素α1是机体内的一种免疫活性肽,目前已用于乙型、丙型肝炎及恶性肿瘤、免疫缺陷等疾病的研究和临床治疗中。其作用机制尚不十分清楚,一般被认为具有生物反应调节物的功能。现对胸腺素α1的分布、作用机制及临床应用进行综述,并总结胸腺素α1在生物制备上的进展。     

富氢水和富氢生理盐水生物医学研究进展——临床试验

氢分子已被证实具有广泛的生物学效应,研究表明,氢气对多种疾病具有显著的治疗作用。近年来,国内外关于氢分子临床应用的报道较多,为疾病治疗提供了新的途径。饮用富氢水或注射富氢生理盐水是常用的氢气摄入方式,因其摄入简单、安全性高得到了临床广泛地关注。主要综述了富氢水在代谢性疾病、神经系统疾病、炎症性疾病、肿瘤、皮肤病及运动疲劳等的临床研究进展,旨在为富氢水和富氢生理盐水的临床应用及作用机制研究提供理论参考。     

雌激素与女性缺血性脑卒中

雌激素具有广泛的生物学效应。大量研究表明,雌激素对缺血性脑损伤具有保护作用,其作用机制是多方面的。本文对雌激素的生物学特性和神经保护作用的可能机制以及雌激素替代治疗的现状做一综述。     

Psychiatry-epitomes of progress: stimulants and hyperkinesis

Although used around the world since 1949, lithium has come into extensive use in psychiatry in the United States only within the past decade. Before initiating treatment with this drug, physicians must be familiar with the diagnostic scheme of the major affective disorders, the indications and contraindications to lithium''s use, and its principles of treatment, including evaluation before lithium therapy, criteria for monitoring blood levels and signs of impending toxicity.Despite earlier reports about the toxicity of lithium when it was promoted as a salt substitute, lithium is a safe drug. Its use not only has revolutionized the treatment of the major affective disorders, but has opened up new and broad avenues of research into the regulation of man''s emotions.     

诱导型多能干细胞iPSc研究现状及其移植治疗帕金森综合症应用前景

诱导多能干细胞(i PS细胞)在小鼠和人上的成功获取,使干细胞领域的研究进入了一个崭新的时代。干细胞研究是再生医学的重要组成部分,研究干细胞的最终目的是应用干细胞治疗疾病,其在疾病模型建立、药物筛选、细胞移植等方面具有极大的应用潜力。i PSCs是由体细胞诱导分化而成的"多能细胞",具备和胚胎干细胞类似的功能,既解决了ESCs的伦理障碍,又为ESCs的获得提供了一条全新的途径,具有重要的理论和应用价值。i PS细胞不仅打破了道德理论的束缚,而且在再生医学、组织工程和药物发现及评价等方面具有积极的价值。神经系统遗传性疾病发病率居各系统遗传病之首,但其发病的分子机制仍不完全清楚,运用体细胞重编程技术建立的疾病特异性诱导多能干细胞模型将有助于揭示神经系统遗传性疾病的发病机理。近几年i PS细胞最新研究成果表明,利用疾病患者i PS细胞模型已逐渐应用于帕金森氏病、老年性痴呆症、脊髓侧索硬化症、脊髓肌肉萎缩症及舞蹈症等5种常见神经性退行性疾病发病机理的研究。本文主要对i PSc的发展历程,避免病毒基因干扰诱导i PS细胞进行的优化,以及干细胞尤其是i PS细胞移植治疗帕金森病等神经系统疾病的现状及应用前景进行系统阐述与论证。     

Beryllium is an inhibitor of cellular GSK-3β that is 1,000-fold more potent than lithium

Glycogen synthase kinase 3β (GSK-3β) is a key regulator in signaling networks that control cell proliferation, metabolism, development, and other processes. Lithium chloride is a GSK-3 family inhibitor that has been a mainstay of in vitro and in vivo studies for many years. Beryllium salt has the potential to act as a lithium-like inhibitor of GSK-3, but it is not known whether this agent is effective under physiologically relevant conditions. Here we show that BeSO₄ inhibits endogenous GSK-3β in cultured human cells. Exposure to 10 µM Be²⁺ produced a decrease in GSK-3β kinase activity that was comparable to that produced by 10 mM Li⁺, indicating that beryllium is about 1,000-fold more potent than the classical inhibitor when treating intact cells. There was a statistically significant dose-dependent reduction in specific activity of GSK-3β immunoprecipitated from cells that had been treated with either agent. Lithium inhibited GSK-3β kinase activity directly, and it also caused GSK-3β in cells to become phosphorylated at serine-9 (Ser-9), a post-translational modification that occurs as part of a well-known positive feedback loop that suppresses the kinase activity. Beryllium also inhibited the kinase directly, but unlike lithium it had little effect on Ser-9 phosphorylation in the cell types tested, suggesting that alternative modes of feedback inhibition may be elicited by this agent. These results indicate that beryllium, like lithium, can induce perturbations in the GSK-3β signaling network of treated cells.     

Substrate Competitive GSK-3 Inhibitors strategy and Implications

Glycogen synthase kinase-3 (GSK-3) is a highly conserved protein serine/threonine kinase ubiquitously distributed in eukaryotes as a constitutively active enzyme. Abnormally high GSK-3 activity has been implicated in several pathological disorders, including diabetes and neuron degenerative and affective disorders. This led to the hypothesis that inhibition of GSK-3 may have therapeutic benefit. Most GSK-3 inhibitors developed so far compete with ATP and often show limited specificity. Our goal is to develop inhibitors that compete with GSK-3 substrates, as this type of inhibitor is more specific and may be useful for clinical applications. We have employed computational, biochemical, and molecular analyses to gain in-depth understanding of GSK-3's substrate recognition. Here we argue that GSK-3 is a promising drug discovery target and describe the strategy and practice for developing specific substrate-competitive inhibitors of GSK-3.     

Evolution of antiretroviral drug costs in Brazil in the context of free and universal access to AIDS treatment

Background

Little is known about the long-term drug costs associated with treating AIDS in developing countries. Brazil''s AIDS treatment program has been cited widely as the developing world''s largest and most successful AIDS treatment program. The program guarantees free access to highly active antiretroviral therapy (HAART) for all people living with HIV/AIDS in need of treatment. Brazil produces non-patented generic antiretroviral drugs (ARVs), procures many patented ARVs with negotiated price reductions, and recently issued a compulsory license to import one patented ARV. In this study, we investigate the drivers of recent ARV cost trends in Brazil through analysis of drug-specific prices and expenditures between 2001 and 2005.

Methods and Findings

We compared Brazil''s ARV prices to those in other low- and middle-income countries. We analyzed trends in drug expenditures for HAART in Brazil from 2001 to 2005 on the basis of cost data disaggregated by each ARV purchased by the Brazilian program. We decomposed the overall changes in expenditures to compare the relative impacts of changes in drug prices and drug purchase quantities. We also estimated the excess costs attributable to the difference between prices for generics in Brazil and the lowest global prices for these drugs. Finally, we estimated the savings attributable to Brazil''s reduced prices for patented drugs. Negotiated drug prices in Brazil are lowest for patented ARVs for which generic competition is emerging. In recent years, the prices for efavirenz and lopinavir–ritonavir (lopinavir/r) have been lower in Brazil than in other middle-income countries. In contrast, the price of tenofovir is US$200 higher per patient per year than that reported in other middle-income countries. Despite precipitous price declines for four patented ARVs, total Brazilian drug expenditures doubled, to reach US$414 million in 2005. We find that the major driver of cost increases was increased purchase quantities of six specific drugs: patented lopinavir/r, efavirenz, tenofovir, atazanavir, enfuvirtide, and a locally produced generic, fixed-dose combination of zidovudine and lamivudine (AZT/3TC). Because prices declined for many of the patented drugs that constitute the largest share of drug costs, nearly the entire increase in overall drug expenditures between 2001 and 2005 is attributable to increases in drug quantities. Had all drug quantities been held constant from 2001 until 2005 (or for those drugs entering treatment guidelines after 2001, held constant between the year of introduction and 2005), total costs would have increased by only an estimated US$7 million. We estimate that in the absence of price declines for patented drugs, Brazil would have spent a cumulative total of US$2 billion on drugs for HAART between 2001 and 2005, implying a savings of US$1.2 billion from price declines. Finally, in comparing Brazilian prices for locally produced generic ARVs to the lowest international prices meeting global pharmaceutical quality standards, we find that current prices for Brazil''s locally produced generics are generally much higher than corresponding global prices, and note that these prices have risen in Brazil while declining globally. We estimate the excess costs of Brazil''s locally produced generics totaled US$110 million from 2001 to 2005.

Conclusions

Despite Brazil''s more costly generic ARVs, the net result of ARV price changes has been a cost savings of approximately US$1 billion since 2001. HAART costs have nevertheless risen steeply as Brazil has scaled up treatment. These trends may foreshadow future AIDS treatment cost trends in other developing countries as more people start treatment, AIDS patients live longer and move from first-line to second and third-line treatment, AIDS treatment becomes more complex, generic competition emerges, and newer patented drugs become available. The specific application of the Brazilian model to other countries will depend, however, on the strength of their health systems, intellectual property regulations, epidemiological profiles, AIDS treatment guidelines, and differing capacities to produce drugs locally.     

Recent advances in drug therapy for epilepsy.

Recent advances in drug therapy for epilepsy have contributed to the reduction in the proportion of persons whose epilepsy is uncontrolled. New knowledge of the pharmacokinetics of phenytoin has led to a better understanding of the drug''s bioavailability and uses. Carbamazepine has recently been introduced for the treatment of generalized tonic-clonic and partial seizures. Clonazepam has been found of particular benefit in the treatment of absence and myoclonic seizures. Valproic acid is a promising antiepileptic drug with broad-spectrum activity, and is particularly useful in the treatment of absence and myoclonic seizures, although further clinical experience is required before it can supplant ethosuximide as the preferred drug for the treatment of absence seizures. Monitoring of the plasma concentration of antiepileptic drugs has added greatly to the achievement of optimal drug therapy and the prevention of toxic effects.     

The use of lithium carbonate in the treatment of mood disorders

The use of lithium ions in the treatment of manic states is discussed. Lithium is possibly the only specific drug treatment presently available for the major psychoses and has met with enthusiasm in England, Scandinavia, Australia and, more recently, in Canada and the United States.A number of the published papers on the subject are not sufficiently comprehensive to provide guidance for even its empiric use; some lack the necessary controls and design to permit comparisons with other studies.Some clinicians with wide experience of lithium therapy do not maintain laboratory control of patients by ordering serum lithium determinations but rely entirely on clinical judgement in establishing drug schedules. This is not advised if one has little experience with lithium therapy because of the possible side effects and toxicity.     

神经母细胞瘤免疫治疗研究进展

神经母细胞瘤是最常见的儿童肿瘤疾病之一,对患者及其家属来了巨大的精神痛苦和经济损失,传统治疗方法对该疾病的预前及术后都效果极差,对该肿瘤的治疗一直是医学界研究的热点和难点。免疫治疗近年来在肿瘤疾病治疗中体现出来的有效、安全、毒副作用小等特点越来越引起临床科学界的重视,科学家对通过免疫疗法治愈神经母细胞瘤的研究进展迅速,并已经取得部分有效的治疗性研究结果,值得进行综述,但目前尚未有对该方面研究的综述出现。本文就近年来神经母细胞瘤治疗研究的热点——免疫逃逸的机理研究、神经母细胞瘤疫苗、免疫类药物开发等进行综述。可以预见,未来神经母细胞瘤免疫治疗的前景广阔,也将有越来越多的针对神经母细胞瘤的商品化免疫性药物、肿瘤疫苗出现,这些药物将对该疾病的治疗具有显著的疗效。     

Parkinson's disease.

In Parkinson''s disease there is degeneration of neurons in the substantia nigra, with consequent depletion of the neurotransmitter dopamine. The triad of tremor, rigidity and bradykinesia is the clinical hallmark. Drugs currently used for palliative therapy fall into three categories: anticholinergic agents, dopamine precursors (levodopa combined with extracerebral decarboxylase inhibitors) and artificial dopamine agonists. It has been argued, on theoretical grounds, that some drugs slow the progress of Parkinson''s disease, although no firm evidence has supported this. Treatment must be individualized, and more than one type of drug can be given concurrently after a careful build-up in dosage. We review the adverse effects of various drugs and consider new developments such as slow-release preparations, selective D-1 and D-2 agonists and transplants of dopaminergic cells into the brain. The treatment of Parkinson''s disease can be demanding, rewarding and sometimes frustrating, but it remains a most challenging exercise in pharmacotherapy.     

Genetic Architecture of Intrinsic Antibiotic Susceptibility

Background

Antibiotic exposure rapidly selects for more resistant bacterial strains, and both a drug''s chemical structure and a bacterium''s cellular network affect the types of mutations acquired.

Methodology/Principal Findings

To better characterize the genetic determinants of antibiotic susceptibility, we exposed a transposon-mutagenized library of Escherichia coli to each of 17 antibiotics that encompass a wide range of drug classes and mechanisms of action. Propagating the library for multiple generations with drug concentrations that moderately inhibited the growth of the isogenic parental strain caused the abundance of strains with even minor fitness advantages or disadvantages to change measurably and reproducibly. Using a microarray-based genetic footprinting strategy, we then determined the quantitative contribution of each gene to E. coli''s intrinsic antibiotic susceptibility. We found both loci whose removal increased general antibiotic tolerance as well as pathways whose down-regulation increased tolerance to specific drugs and drug classes. The beneficial mutations identified span multiple pathways, and we identified pairs of mutations that individually provide only minor decreases in antibiotic susceptibility but that combine to provide higher tolerance.

Conclusions/Significance

Our results illustrate that a wide-range of mutations can modulate the activity of many cellular resistance processes and demonstrate that E. coli has a large mutational target size for increasing antibiotic tolerance. Furthermore, the work suggests that clinical levels of antibiotic resistance might develop through the sequential accumulation of chromosomal mutations of small individual effect.