The clinical and nutritional implications of lipid-lowering drugs that act in the gastrointestinal tract

PURPOSE OF REVIEW: A new class of cholesterol-lowering therapy that reduces intestinal sterol absorption has recently been introduced. This increases the number of classes of lipid-lowering agents that directly affect gastrointestinal function and raises questions concerning the overall effect of these agents on absorption and nutritional status. RECENT FINDINGS: A recent assessment notes a paucity of information concerning the factors that affect the bioavailability and intestinal absorption of lipophilic nutrients. By contrast, the specificity of the mechanisms of action of new drugs acting on the gastrointestinal tract may circumvent some of the detrimental effects on nutrient and drug bioavailability that have been noted with older forms of treatment. SUMMARY: The clinical imperative for aggressive control of lipid and metabolic risk factors makes widespread use, alone or in combination, of lipid-lowering agents that affect the gastrointestinal tract seem increasingly likely. Whilst the opportunity for therapeutic synergy is attractive, care will be required to avoid interference with intestinal absorptive function.     

益生菌的治疗现状与前景以及 对呼吸道有益菌探索的研究进展

益生菌是调节机体微生态失衡的有效途径。肝功能异常影响肠道微生物,慢性肝衰竭、2型糖尿病、动脉粥样硬化相关心血管疾病等与肠道微生态失衡密切相关。同时肠道菌群亦受环境、遗传等复合条件影响,改变菌群组成可能导致疾病的发生发展。提倡益生菌对疾病的预防、治疗、预后,改善机体微环境,提高生命质量。近年来,益生菌、益生元、合生元三方面的研究飞速发展,对肠道益生菌研发已经取得一定成果。呼吸道作为与外界相通的腔道其优势菌群已经有相关报道,但对呼吸道益生菌的探索尚不明确,呼吸道内的优势菌是否可以制成益生菌制剂尚有待研究。     

Gas fIIIed lipid bilayers as imaging contrast agents

Abstract

Gas bubbles are highly efficient reflectors of sound and are therefore useful as contrast agents for diagnostic ultrasound. In general, in order to pass through the pulmonary circulation and provide contrast for the systemic circulation the gas bubbles must be of defined diameter and stabilized by a coating material. Our group has developed gas bubbles which are stabilized within lipid bilayers. These bubbles may be formed with stable size and gas content. In vivo studies in rabbit and porcine models show sustained ventricular enhancement, increased arterial doppler signal following intravenous injection and myocardial perfusion enhancement following injection into the aortic root of pigs. Preliminary toxicity studies suggest that the therapeutic index (LD50 dose divided by imaging dose) is greater than 400 to 1. For therapy, these agents may be used to increase the capture of ultrasonic energy for hyperthermia to augment local tissue heating. An exciting new class of agents based upon gas fIIIed lipid bilayers has been developed. Work is presently underway to take these agents into clinical trials.     

氢气与肠道菌群的关系研究进展

目前,氢气已被证实在多种疾病中具有显著的医学效应,然而其发挥效应的分子机制并不清楚。肠道菌群被人们看作人体的一个重要“器官”,与人类健康的关系密不可分。研究表明,人类肠道菌群中存在着大量能够进行氢气代谢的菌群,这些菌群的变化可能与多种疾病的发生发展密切相关。此外,研究还发现外源氢气干预可能通过重塑肠道菌群改善炎症性肠病、脂肪性肝病等。综述了肠道菌群的氢气代谢及其与疾病发生发展的关系以及外源氢气干预通过调节肠道菌群影响疾病进展的相关研究,希望能为致力于从肠道菌群角度研究氢气医学效应的科研工作者提供帮助。     

Molecular biology of weed control

The vast commercial effort to utilize chemical and molecular tools to solve weed control problems has had a major impact on the basic biological sciences as well as benefits to agriculture, and the first generation of transgenic products has been successful, while somewhat crude. More sophisticated products are envisaged and expected. Biotechnologically-derived herbicide-resistant crops have been a considerable benefit, yet in some cases there is a risk that the same useful transgenes may introgress into related weeds, specifically the weeds that are hardest to control without such transgenic crops. Biotechnology can also be used to mitigate the risks. Molecular tools should be considered for weed control without the use of, or with less chemicals, whether by enhancing crop competitiveness with weeds for light, nutrients and water, or via allelochemicals. Biocontrol agents may become more effective as well as more safe when rendered hypervirulent yet non-spreading by biotechnology. There might be ways to disperse deleterious transposons throughout weed populations, obviating the need to modify the crops. This revised version was published online in August 2006 with corrections to the Cover Date.     

Complex method for epizootiological and epidemiological surveillance

A complex method for the epizootological and epidemiological surveillance of a number of bacterial and viral infections on the territories inside and outside their natural foci has been developed. The investigation techniques are described and the data on the isolation rate of each causative agent in different geographical zones are presented. In the natural foci of plague and tularemia, as well as on the territories outside such foci, the causative agents of intestinal yersiniosis, pseudotuberculosis, salmonellosis, erysipeloid, staphylococci and streptococci, arena- and arboviruses have been isolated from the rodents and ectoparasites under study. The results of this investigation suggest that the method may be recommended for use in medical institutions dealing with the problems of infections originating from natural foci.     

Failure to reverse cholera toxin induced intestinal secretion by agents which decrease mucosal cAMP.

The feasibility of reducing intestinal secretion by the use of agents which decrease intestinal mucosal cAMP concentration has been investigated in the weanling pig and the rabbit. Three different agents for decreasing mucosal cAMP concentration were studied. The cyclic nucleotide phosphodiesterase activator, imidazole, significantly reduced mucosal cAMP concentrations only in the weanling pig. Intraluminal 2'-deoxyadenosine-3'AMP inhibited adenylate cyclase and caused a decrease in mucosal cAMP concentration in both the pig and the rabbit. The introduction of the heat-stable enterotoxin of Escherichia coli into pig jejunal segments also gave lowered mucosal cAMP concentrations. While these three agents effectively reduced cAMP concentrations in intestinal mucosa, they were ineffective in reducing the net fluid secretory effects of cholera toxin. Secretion caused by cholera toxin apparently persists independent of the temporary changes in cAMP concentration which can be induced by pharmacological agents.     

The protective potency of probiotic bacteria and their microbial products against enteric infections-review

The intestinal environment accommodates a wide range of contents ranging from harmless beneficial dietary and microbial flora to harmful pathogenic bacteria. This has resulted in the development of highly adapted epithelial cells lining the intestine. This adaptation involves the potential of crypt cells to proliferate and to constantly replace villous cells that are lost due to maturity or death. As a result, the normal intestinal epithelial integrity and functions are maintained. This phenomenon is eminent in intestinal defense whereby the intestinal epithelial cells serve as a physical barrier against luminal agents. The protection against agents in the gut lumen can only be effective if the epithelium is intact. Restitution of the damaged epithelium is therefore crucial in this type of defense.     

大熊猫粪便乳酸菌的分离鉴定

大熊猫作为国家保护动物,其健康问题备受瞩目。为了维护大熊猫的肠道健康,本研究从大熊猫肠道内分离出适宜于大熊猫肠道环境的乳酸菌菌株,有望将其制成熊猫肠道微生物制剂,从而改善大熊猫肠道菌群环境。从雅安市宝兴县蜂桶寨自然保护区选取圈养与野生大熊猫的粪便,通过体外培养分离出9个菌株。分离菌株经过革兰氏染色镜检、过氧化氢产气、菌落形态观察等方法与技术初步鉴定为乳酸菌。对这9株乳酸菌进行耐酸试验、耐胆盐试验、抑菌能力试验和产酸能力等测试,筛选出了3个适应性较强,有望制成调节大熊猫肠道内环境平衡作用的微生态菌剂的菌株。16S rRNA基因序列分析表明:分离菌株J1、J2和J4分别为融合魏斯氏菌（Weissella confusa）,海氏肠球菌（Enterococcus heynei）和非解乳糖链球菌（Streptococcus alactolyticus）,有望被应用于大熊猫肠道微生态制剂的研究。     

Chemotherapy of breast cancer: focus on paclitaxel

Paclitaxel is among the most effective agents in the treatment of breast cancer. Both as a single agent and in combinations, paclitaxel is effective as first-line therapy and as a salvage therapy in patients with locally advanced or metastatic disease. Paclitaxel also demonstrated efficacy in patients who received prior anthracyclin therapy and those with anthracyclin-resistant disease. In the adjuvant setting, data from randomized study have supported the sequential use of paclitaxel after therapy with doxorubicin / cyclophosphamide for patients with node-positive disease. The drug may be used in combination with other chemotherapeutical agents and immune stymulatory agents. Therapy on weekly and every-three-week schedules has been effective.     

肠道菌群与相关疾病

近年来肠道菌群的研究发展迅速,肠道菌群对宿主消化、代谢和免疫功能的影响逐渐被人们所熟知并重视。大量研究提示,肠道菌群的改变可能引发代谢、肝脏和肠道等方面的多种相关疾病。因此,研究肠道菌群对宿主健康及疾病的影响尤为重要,也能为预防和治疗肠道菌群相关疾病提供建议。     

Studies on the role of iron binding ligands and the intestinal brush border receptors in iron absorption.

With a view to identifying ligands that could be used as promoters of iron absorption, the affinity of a number of iron chelating agents and the efficiency with which they can donate iron to the brush border receptors has been studied. A number of organic and inorganic compounds were found to chelate iron and keep it soluble at pH 7.5 of the intestinal lumen. This ligand-bound iron was taken up by the intestinal brush border receptors with varying degree of efficiency; ascorbic acid being the most effective and EDTA and citrate the least effective in donating the chelated iron to the receptors. Several polyphosphate compounds, used as food additives, chelated iron and kept it in solution but showed moderate potency for donating iron to the receptors.     

Physiological basis for novel drug therapies used to treat the inflammatory bowel diseases. I. Immunology and therapeutic potential of antiadhesion molecule therapy in inflammatory bowel disease

Adhesion molecules regulate the influx of leukocytes in normal and inflamed gut. They are also involved in local lymphocyte stimulation and antigen presentation within the intestinal mucosa. In intestinal inflammation, many adhesion molecules are upregulated, but alpha4-integrins most likely hold a key position in directing leukocytes into the inflamed bowel wall. Therapeutic compounds directed against trafficking of leukocytes have been designed and are being developed as a novel class of drugs in the treatment of Crohn's disease and ulcerative colitis. This review deals with the immunological aspects of leukocyte trafficking focused on gut homing of T cells. Second, the changes in adhesion molecules and T cell trafficking during intestinal inflammation are discussed. Finally, we review the clinical data that have been gathered with respect to the therapeutic potential and the safety of antiadhesion molecule treatment. Antegren, or natalizumab, a humanized anti-alpha4 integrin IgG4 antibody, has been most extensively evaluated and may be close to registration. A more specific humanized alpha4beta7-integrin MLN-02 has shown preliminary clinical efficacy in ulcerative colitis, and both antergren and MLN-02 appear to be very safe. Trials with the anti-ICAM-1 antisense oligonucleotide ISIS-2302 in steroid refractory Crohn's disease have provided conflicting efficacy data. In the near future, some of these novel biological agents may prove valuable therapeutic tools in the management of refractory inflammatory bowel disease, although it is too early to define the patient population that will benefit most from these agents.     

Mast cell heterogeneity

Increasing evidence for the existence of inter- and intra-species mast cell heterogeneity has expanded the potential biological role of this cell. Early studies suggesting that mast cells at mucosal sites differ morphologically and histochemically from connective tissue mast cells have been confirmed using isolated intestinal mucosal mast cells in the rat and more recently in man. These studies also established that mucosal mast cells are functionally distinct from connective tissue mast cells. Thus, mucosal and connective tissue mast cells differ in their responsiveness to a variety of mast cell secretagogues and antiallergic agents. Speculation about the therapeutic use of antiallergic drugs in disorders involving intestinal mast cells cannot, therefore, be based on extrapolation from studies of their effects on mast cells from other sites. Regulatory mechanisms for mast cell secretion may also be heterogeneous since mucosal mast cells differ from connective tissue mast cells in their response to a variety of physiologically occurring regulatory peptides. The development of techniques to purify isolated mast cell subpopulations will facilitate future analysis of the biochemical basis of the functional heterogeneity of mast cells.     

Retinoid metabolism and cancer

Retinoids play important roles in cell differentiation and apoptosis, notably in epithelial tissues. Their utility in cancer therapy has been demonstrated in specific cancer types. Use of retinoic acid (RA) in the treatment of acute promyelocytic leukemia was the first successful example of retinoid-based differentiation therapy. RA has since been evaluated for treatment of other cancers, revealing variable effectiveness. The observation that expression of enzymes involved in RA biosynthesis is suppressed during tumorigenesis suggests that intra-tumor depletion in RA levels may contribute to tumor development and argues for the use of retinoids in cancer treatment. However, the induction of RA-inactivating enzymes is one of the mechanisms that may limit the efficacy of retinoid therapy and contribute to acquired resistance to RA treatment, suggesting that retinoic acid metabolism blocking agents may be effective agents in differentiation therapy.     

Menopausal symptoms emerging during hormonal therapy of breast cancer, and their treatment

Hormonal compounds play an important role in the treatment of breast cancer. Their side effects may lead to suspension of therapy and consequently to the failure of the expected effect. Common and the same way most prevalent side effects of hormonal compounds are the menopausal complaints which can alter quality of life significantly. The early recognition and treatment of menopausal complaints and symptoms help to reach therapeutic success. In general, of menopausal related complaints the role of hot flash, atrophic vaginitis and sexual dysfunction is emphasized. Within the topic, it is possible to mention some musculo-skeletal complaints according to their similar etiology, the failure of estrogen effect. In the treatment of hot flash non-pharmacologic and pharmacologic methods can be distinguished. Based on meta-analyses anti-depressants, some anti-convulsants and clonidine proved to be effective. Musculo-skeletal complaints explained by the lack of estrogen effect do not cause permanent impairment but may indicate greater efficacy of endocrine treatment. In the context of osteoporosis it is important to emphasize prevention. The main goal of endocrine therapies is to ameliorate remission rate or survival, but we should not forget to treat side effects which can influence quality of life.     

Biological functions of NLRP3 inflammasome: A therapeutic target in inflammatory bowel disease

Cases of inflammatory bowel disease (IBD), a debilitating intestinal disorder with complex pathological mechanisms, have been increasing in recent years, straining the capacity of healthcare systems. Thus, novel therapeutic targets and innovative agents must be developed. Notably, the NLRP3 inflammasome is upregulated in patients with IBD and/or in animal experimental models. As an innate immune supramolecular assembly, the NLRP3 inflammasome is persistently activated during the pathogenesis of IBD by multiple stimuli. Moreover, this protein complex regulates pro-inflammatory cytokines. Thus, targeting this multiprotein oligomer may offer a feasible way to relieve IBD symptoms and improve clinical outcomes. The mechanisms by which the NLRP3 inflammasome is activated, its role in IBD pathogenesis, and the drugs administered to target this protein complex are reviewed herein. This review establishes that the use of inflammasome-targeting drugs are effective for IBD treatment. Moreover, this review suggests that the value and potential of naturally sourced or derived medicines for IBD treatment must be recognized and appreciated.     

The biochemical protective mechanisms against non-steroidal anti-inflammatory drug induced G-I mucosal damage

Conventional anti-ulcer agents give some protection against NSAID-induced GI injury, but they are by no means totally effective nor without some disadvantage for their side effects cost and for lack of efficacy. More selective protective effects may be achieved by use of agents which counteract the biochemical and cytological changes induced by the NSAIDs. The relative success of these approaches has yet to be fully evaluated but at least some of these procedures may prove cheaper and devoid of side effects encountered with traditional anti-ulcer therapies.     

A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: Urticae radix

Nettle root is recommended for complaints associated with benign prostatic hyperplasia (BPH). We therefore conducted a comprehensive review of the literature to summarise the pharmacological and clinical effects of this plant material. Only a few components of the active principle have been identified and the mechanism of action is still unclear. It seems likely that sex hormone binding globulin (SHBG), aromatase, epidermal growth factor and prostate steroid membrane receptors are involved in the anti-prostatic effect, but less likely that 5alpha-reductase or androgen receptors are involved. Extract and a polysaccharide fraction were shown to exert anti-inflammatory activity. A proprietary methanolic nettle root extract and particular fractions inhibited cell proliferation. Isolated lectins (UDA) were shown to be promising immunomodulatory agents, having also anti-viral and fungistatic effects. However, despite these in vitro studies it is unclear whether the in-vitro or animal data are a surrogate for clinical effects. The clinical evidence of effectiveness for nettle root in the treatment of BPH is based on many open studies. A small number of randomised controlled studies indicate that a proprietary methanolic extract is effective in improving BPH complaints. However, the significance and magnitude of the effect remains to be established in further confirmatory studies before nettle root treatment may be accepted in the guidelines for BPH treatment. The risk for adverse events during nettle root treatment is very low, as is its toxicity. Pre-clinical safety data remain to be completed.