Maintenance treatment with esomeprazole following initial relief of non-steroidal anti-inflammatory drug-associated upper gastrointestinal symptoms: the NASA2 and SPACE2 studies

Non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 (COX-2) inhibitors, cause upper gastrointestinal (GI) symptoms that are relieved by treatment with esomeprazole. We assessed esomeprazole for maintaining long-term relief of such symptoms. Six hundred and ten patients with a chronic condition requiring anti-inflammatory therapy who achieved relief of NSAID-associated symptoms of pain, discomfort, or burning in the upper abdomen during two previous studies were enrolled and randomly assigned into two identical, multicentre, parallel-group, placebo-controlled studies of esomeprazole 20 mg or 40 mg treatment (NASA2 [Nexium Anti-inflammatory Symptom Amelioration] and SPACE2 [Symptom Prevention by Acid Control with Esomeprazole] studies; ClinicalTrials.gov identifiers NCT00241514 and NCT00241553, respectively) performed at various rheumatology, gastroenterology, and primary care clinics. Four hundred and twenty-six patients completed the 6-month treatment period. The primary measure was the proportion of patients with relapse of upper GI symptoms, recorded in daily diary cards, after 6 months. Relapse was defined as moderate-to-severe upper GI symptoms (a score of more than or equal to 3 on a 7-grade scale) for 3 days or more in any 7-day period. Esomeprazole was significantly more effective than placebo in maintaining relief of upper GI symptoms throughout 6 months of treatment. Life-table estimates (95% confidence intervals) of the proportion of patients with relapse at 6 months (pooled population) were placebo, 39.1% (32.2% to 46.0%); esomeprazole 20 mg, 29.3% (22.3% to 36.2%) (p = 0.006 versus placebo); and esomeprazole 40 mg, 26.1% (19.4% to 32.9%) (p = 0.001 versus placebo). Patients on either non-selective NSAIDs or selective COX-2 inhibitors appeared to benefit. The frequency of adverse events was similar in the three groups. Esomeprazole maintains relief of NSAID-associated upper GI symptoms in patients taking continuous NSAIDs, including selective COX-2 inhibitors.     

Cytokine-mediated β-cell damage in PARP-1-deficient islets

Poly(ADP)-ribose polymerase (PARP) is an abundant nuclear protein that is activated by DNA damage; once active, it modifies nuclear proteins through attachment of poly(ADP)-ribose units derived from β-nicotinamide adenine dinucleotide (NAD(+)). In mice, the deletion of PARP-1 attenuates tissue injury in a number of animal models of human disease, including streptozotocin-induced diabetes. Also, inflammatory cell signaling and inflammatory gene expression are attenuated in macrophages isolated from endotoxin-treated PARP-1-deficient mice. In this study, the effects of PARP-1 deletion on cytokine-mediated β-cell damage and macrophage activation were evaluated. There are no defects in inflammatory mediator signaling or inflammatory gene expression in macrophages and islets isolated from PARP-1-deficient mice. While PARP-1 deficiency protects islets against cytokine-induced islet cell death as measured by biochemical assays of membrane polarization, the genetic absence of PARP-1 does not effect cytokine-induced inhibition of insulin secretion or cytokine-induced DNA damage in islets. While PARP-1 deficiency appears to provide protection from cell death, it fails to provide protection against the inhibitory actions of cytokines on insulin secretion or the damaging actions on islet DNA integrity.     

A novel role for Gq alpha in alpha-thrombin-mediated mitogenic signalling pathways

alpha-Thrombin activates several G-proteins including members of the Gq, Gi, and G12/13 families, although the physiological importance of these proteins is still not completely understood. We specifically investigated the role of Gq alpha in modulating alpha-thrombin-induced mitogenesis. In Gqa1 cells, a stable cell line expressing reduced amounts of Gq alpha, concentrations of alpha-thrombin (1 NIH unit/ml), which induce cell cycle reentry and progression into S phase in wild-type IIC9 cells, do not stimulate phosphatidylinositol (PI) hydrolysis, the rapid early phase of ERK activity, and transit through G1 into S phase as quantified by cyclin-dependent kinase (CDK)4-cyclin D activity and [3H]thymidine incorporation. Interestingly, high concentrations of alpha-thrombin restore these activities and cell cycle progression into S phase. While, it is well documented that alpha-thrombin-induced sustained ERK activity mediates important responses for transit through G1 into S phase, the importance of the rapid, Gq-dependent phase as a prerequisite for alpha-thrombin-mediated mitogenesis has not been appreciated.     

Functional Characterization of Phospholipid N-Methyltransferases from Arabidopsis and Soybean

Phospholipid N-methyltransferase (PLMT) enzymes catalyze the S-adenosylmethionine-dependent methylation of ethanolamine-containing phospholipids to produce the abundant membrane lipid phosphatidylcholine (PtdCho). In mammals and yeast, PLMT activities are required for the de novo synthesis of the choline headgroup found in PtdCho. PLMT enzyme activities have also been reported in plants, yet their roles in PtdCho biosynthesis are less clear because most plants can produce the choline headgroup entirely via soluble substrates, initiated by the methylation of free ethanolamine-phosphate. To gain further insights into the function of PLMT enzymes in plants, we isolated PLMT cDNAs from Arabidopsis and soybean (Glycine max) based upon primary amino acid sequence homology to the rat PLMT, phosphatidylethanolamine N-methyltransferase. Using a heterologous yeast expression system, it was shown that plant PLMTs methylate phosphatidylmonomethylethanolamine and phosphatidyldimethylethanolamine but cannot utilize phosphatidylethanolamine as a substrate. Identification of an Arabidopsis line containing a knock-out dissociator transposon insertion within the single copy AtPLMT gene allowed us to investigate the consequences of loss of PLMT function. Although the accumulation of the PLMT substrates phosphatidylmonomethylethanolamine and phosphatidyldimethylethanolamine was considerably elevated in the atplmt knock-out line, PtdCho levels remained normal, and no obvious differences were observed in plant morphology or development under standard growth conditions. However, because the metabolic routes through which PtdCho is synthesized in plants vary greatly among differing species, it is predicted that the degree with which PtdCho synthesis is dependent upon PLMT activities will also vary widely throughout the plant kingdom.Phosphatidylcholine (PtdCho)2 is the most abundant phospholipid in most non-plastid membranes of eukaryotes. PtdCho biosynthesis has been studied intensively in plants not only because of its importance as a structural membrane lipid, but also because of its role as a precursor to important lipid-based signaling molecules, such as phosphatidic acid, and phospholipase A₂-derived free fatty acids (1). The choline headgroup of PtdCho serves multiple functions as well. In addition to being an essential human nutrient (2), in many plant species choline can be oxidized to produce the potent osmoprotectant glycine betaine (3, 4).For over 2 decades it has been apparent that there are fundamental differences between the manner in which PtdCho is produced in plants versus how it is synthesized in mammals and fungi. In the latter two systems, PtdCho can be formed through two distinct pathways as follows: (a) the “nucleotide pathway” in which free choline is incorporated in PtdCho using CDP-choline as an intermediate, and (b) the “methylation pathway” whereby PtdCho is produced directly from phosphatidylethanolamine (PtdEtn) via three sequential methylation reactions using S-adenosylmethionine (AdoMet) as the methyl donor (5, 6). In contrast, PtdCho biosynthesis in plants occurs through a branched pathway that utilizes components of both the nucleotide and methylation pathways (7). The greatest distinction between the contrasting mechanisms of PtdCho biosynthesis can be attributed to the presence of plant enzymes that are capable of converting ethanolamine headgroups to choline at the phospho-base level, activities that are absent in mammals and yeast. Conversely, mammals and fungi possess methylation enzymes that act directly on PtdEtn, a reaction that cannot be detected in most plant systems investigated (reviewed in Ref. 7).A diagram of the most widely accepted model of phosphoamino alcohol biosynthesis in plants is shown in Fig. 1. Similar to animals and yeast, free choline can be directly incorporated into PtdCho via nucleotide pathway enzymes in plants. In the absence of choline, however, the methylation of Etn-phosphate represents the first committed step in PtdCho biosynthesis. The resulting monomethylethanolamine-phosphate (MMEtn-P) metabolite can be further methylated at the phospho-base level to produce Cho-P. Alternatively, MMEtn-P can be incorporated into phosphatidylmonomethylethanolamine (PtdMMEtn) via the cytidylyltransferase and amino alcohol phosphotransferase activities of the nucleotide pathway and then methylated at the phosphatidyl-base level to complete the synthesis of PtdCho (Fig. 1). The extent with which PtdCho is formed by the flow of metabolites through phospho-bases as opposed to phosphatidyl-bases varies greatly among different plant species. In most higher plants, it is likely that the methylation of the phosphoamino alcohol headgroups involves the flow of metabolites through both branches of the pathway, as has been shown in species such as barley, carrot, and tobacco (3, 8, 9). Nevertheless, examples have also been reported where only one of the branches appears to be utilized. In Lemna paucicostata, for example, the methylation steps in PtdCho biosynthesis were shown to occur almost exclusively at the phospho-base level (10). At the other end of the spectrum is soybean, where all methylations beyond the initial formation of MMEtn-P were reported to occur on phosphatidyl-bases (8, 11). The tremendous variability observed among plants with regard to PtdCho formation is also exemplified by a study conducted by Williams and Harwood (12) where it was shown that the predominant route of PtdCho synthesis in olive culture cells involved the first two methylation reactions taking place at the phospho-base level (producing dimethylethanolamine phosphate) and the final methylation occurring on a phosphatidyldimethylethanolamine (PtdDMEtn) substrate.Open in a separate windowFIGURE 1.Phosphatidylcholine biosynthetic pathways. Steps common to plants, mammals, and yeast are indicated by black arrows. Dashed arrows indicate pathways specific to plants. Methylation of PtdEtn, which occurs in mammals and yeast, is indicated by on open arrow. Enzymes catalyzing phosphoamino alcohol methylation reactions in plants, mammals, and yeast are indicated.Our understanding on the mechanisms by which plants synthesize PtdCho and regulate its accumulation has been further enhanced as the genes encoding the various steps of the phosphoamino alcohol pathway have been isolated and characterized. For example, molecular characterizations led to the conclusion that all of the amino alcohol phosphotransferase reactions depicted in Fig. 1 can be mediated by the product of a single gene (designated AAPT1) that displays a broad substrate specificity (13, 14). Similarly, it was the isolation of the phosphoethanolamine methyltransferase (PEAMT) genes from Arabidopsis and spinach that led to the discovery that all three phospho-base methylation reactions could be catalyzed by a single enzyme (15, 16). Inhibition of PEAMT gene function in Arabidopsis through T-DNA insertion or co-suppression revealed unexpected associations between the phosphoamino alcohol pathway and root development, salt hypersensitivity, and male sterility (17, 18).Although most of the reactions depicted in Fig. 1 have been characterized at the molecular genetic level, conspicuously absent is information on the plant genes/enzymes responsible for the methylation reactions conducted at the phosphatidyl-base level. In contrast, these reactions are among the most well characterized in animals and yeast, catalyzed by enzymes commonly referred to as phospholipid N-methyltransferases (PLMTs). In mammals, the 18-kDa integral membrane protein phosphatidylethanolamine N-methyltransferase (PEMT) is a PLMT that is expressed primarily in the liver (19). PEMT catalyzes all three of the methylation reactions needed to convert PtdEtn to PtdCho. Yeast uses two distinct PLMT enzymes to catalyze the three methylation reactions as follows: Cho2p/Pem1p that mediates the direct methylation of PtdEtn to produce PtdMMEtn (20, 21), and Opi3p/Pem2p, an enzyme homologous to the mammalian PEMT, that primarily catalyzes the methylation of PtdMMEtn to PtdDMEtn and PtdDMEtn to PtdCho, the final two steps of the methylation pathway (20, 22). PLMT activities are critical in both of these systems. Mice possessing pemt knock-out mutations are completely dependent on dietary choline for survival, and they display abnormal levels of choline metabolites within the liver and develop hepatic steatosis even when fed diets supplemented with choline (23). Yeast lacking PLMT activities (cho2/opi3 double mutants) are obligate choline auxotrophs, unable to synthesize PtdCho de novo in the absence of exogenous choline.To gain a greater understanding of the specific function of PLMT reactions in higher plants, and their contribution toward PtdCho biosynthesis, we cloned and characterized PLMT homologs from Arabidopsis and soybean. By expressing the candidate cDNAs in yeast, we were able to confirm that they encoded functional PLMT activities as well as to establish their substrate specificities. We also identified a mutant Arabidopsis line containing a knock-out allele in the single copy PLMT gene found in the Arabidopsis genome, allowing us to characterize the consequences of loss of gene function in this model species.     

Androgens exacerbate motor asymmetry in male rats with unilateral 6-hydroxydopamine lesion

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by dopamine neuron loss in the nigrostriatal pathway that shows greater incidence in men than women. The mechanisms underlying this gender bias remain elusive, although one possibility is that androgens may increase dopamine neuronal vulnerability to oxidative stress. Motor impairment can be modeled in rats receiving a unilateral injection of 6-hydroxydopamine (6-OHDA), a neurotoxin producing nigrostriatal degeneration. To investigate the role of androgens in PD, we compared young (2 months) and aged (24 months) male rats receiving gonadectomy (GDX) and their corresponding intact controls. One month after GDX, rats were unilaterally injected with 6-OHDA, and their motor impairment and asymmetry were assessed 2 weeks later using the cylinder test and the amphetamine-induced rotation test. Plasma samples were also collected to assess the concentration of testosterone and advanced oxidation protein products, a product of oxidative stress. GDX decreased lesion-induced asymmetry along with oxidative stress and increased amphetamine-induced rotations. These results show that GDX improves motor behaviors by decreasing motor asymmetry in 6-OHDA-treated rats, an effect that may be ascribed to increased release of striatal dopamine and decreased oxidative stress. Collectively, the data support the hypothesis that androgens may underlie the gender bias observed in PD.     

Iron-ion radiation accelerates atherosclerosis in apolipoprotein E-deficient mice

Radiation exposure from a number of terrestrial sources is associated with an increased risk for atherosclerosis. Recently, concern over whether exposure to cosmic radiation might pose a similar risk for astronauts has increased. To address this question, we examined the effect of 2 to 5 Gy iron ions ((56)Fe), a particularly damaging component of cosmic radiation, targeted to specific arterial sites in male apolipoprotein E-deficient (apoE(-/-)) mice. Radiation accelerated the development of atherosclerosis in irradiated portions of the aorta independent of any systemic effects on plasma lipid profiles or circulating leukocytes. Further, radiation exposure resulted in a more rapid progression of advanced aortic root lesions, characterized by larger necrotic cores associated with greater numbers of apoptotic macrophages and reduced lesional collagen compared to sham-treated mice. Intima media thickening of the carotid arteries was also exacerbated. Exposure to (56)Fe ions can therefore accelerate the development of atherosclerotic lesions and promote their progression to an advanced stage characterized by compositional changes indicative of increased thrombogenicity and instability. We conclude that the potential consequences of radiation exposure for astronauts on prolonged deep-space missions are a major concern. Knowledge gained from further studies with animal models should lead to a better understanding of the pathophysiological effects of accelerated ion radiation to better estimate atherogenic risk and develop appropriate countermeasures to mitigate its damaging effects.     

Sexual selection on protamine and transition nuclear protein expression in mouse species

Post-copulatory sexual selection in the form of sperm competition is known to influence the evolution of male reproductive proteins in mammals. The relationship between sperm competition and regulatory evolution, however, remains to be explored. Protamines and transition nuclear proteins are involved in the condensation of sperm chromatin and are expected to affect the shape of the sperm head. A hydrodynamically efficient head allows for fast swimming velocity and, therefore, more competitive sperm. Previous comparative studies in rodents have documented a significant association between the level of sperm competition (as measured by relative testes mass) and DNA sequence evolution in both the coding and promoter sequences of protamine 2. Here, we investigate the influence of sexual selection on protamine and transition nuclear protein mRNA expression in the testes of eight mouse species that differ widely in levels of sperm competition. We also examined the relationship between relative gene expression levels and sperm head shape, assessed using geometric morphometrics. We found that species with higher levels of sperm competition express less protamine 2 in relation to protamine 1 and transition nuclear proteins. Moreover, there was a significant association between relative protamine 2 expression and sperm head shape. Reduction in the relative abundance of protamine 2 may increase the competitive ability of sperm in mice, possibly by affecting sperm head shape. Changes in gene regulatory sequences thus seem to be the basis of the evolutionary response to sexual selection in these proteins.