Intestinal barrier dysfunction in liver cirrhosis assessed by iohexol test.

OBJECTIVE: To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the intestinal permeability (IP) and its relationship with the severity and etiology of the disease. PATIENTS AND METHODS: The study included 31 patients with LC and 25 healthy controls. Child-Pugh score was used for evaluation of the LC severity. IP was assessed by the rise in levels of iohexol, which was administered orally (25 mL, 350 mg/mL) 2 h after breakfast. Three and six hours later serum (SIC mg/L) and urine (UIC g/mol) iohexol concentrations were determined by a validated HPLC-UV technique. RESULTS: Patients with LC had significantly higher mean SIC value compared with control group at 3 h (2.05 ± 1.67 vs. 1.25 ± 1.41 mg/L, p=0.021, as well as at 6 h (2.20 ± 2.65 vs. 1.11 ± 1.06 mg/L, p=0.001) after ingestion. No significant difference was found in mean SIC value of patients at 3 and 6 h. 23% of the patients had an increased IP. The mean iohexol urine recovery of patients was similar to that of the controls both at 3 h and at 6 h. Mean SIC values were significantly higher in patients with advanced Child C class than in healthy controls or the subgroup with Child B class, both at 3 h (2.54 ± 1.95 mg/L vs. 1.11 ± 1.06 mg/L, p=0.007) or (2.57 ± 1.85 mg/L vs. 1.35±1.32 mg/L, p=0.005) and at 6 h (2.57 ± 1.85 mg/L vs. 1.25 ± 1.40 mg/L, p=0.002) or 2.54 ± 1.95 mg/L vs. 1.07 ± 0.35 mg/L, p=0.02). Cirrhotic patients with ascites had significantly higher SIC in comparison with the controls, both at 3 h (2.31 ± 1.74 vs. 1.25 ± 1.41 mg/, p=0.009) and at 6 h (2.20 ± 1.87 vs. 1.11 ± 1.06 mg/l, p=0.007). In the subgroup of patients with alcoholic LC, the mean SIC values at 3 and 6 h (2.29 ± 1.80, 2.33 ± 1.85 mg/L, respectively) were significantly higher (p= 0.016, p=0.003) compared to the control group (1.25 ± 1.41, 1.11 ± 1.06 mg/L, respectively). CONCLUSIONS: Increased IP is found in 23% of cirrhotic patients. Permeability alterations are significantly more pronounced in patients with advanced LC with the presence of ascites and in those with alcoholic etiology.

Efficacy, safety and tolerability of vidofludimus in patients with inflammatory bowel disease: the ENTRANCE study.

BACKGROUND: Vidofludimus (SC12267) is a novel oral immunomodulator inhibiting dihydroorotate dehydrogenase (DHODH) and the expression of proinflammatory cytokines including interleukin-17 (IL17A and IL17F) and interferon-gamma. The objective of the study was to explore the efficacy, safety and tolerability of vidofludimus in steroid-dependent inflammatory bowel disease (IBD). METHODS: The open label uncontrolled ENTRANCE study (ClinicalTrials.gov NCT00820365) has been conducted at 13 study centers in Germany, Bulgaria and Romania. Thirty-four steroid-dependent patients with a confirmed diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were treated with a once daily 35mg oral dose of vidofludimus over 12weeks. Steroids were tapered during the first 8weeks followed by a steroid-free treatment period of 4weeks. Complete response was defined as steroid-free clinical remission at week 12; partial response was defined as being in remission at steroid dose equal or lower than the individual patient's threshold dose for relapse. RESULTS: Of the thirty-four patients enrolled in this trial 26 were evaluable for primary efficacy assessment. After completion of the 12weeks treatment phase 8 out of 14 (57.1%) patients with CD and 6 out of 12 (50.0%) patients with UC were in steroid-free remission (complete responders). Another 4 (28.6%) patients in CD and 5 (41.7%) patients in UC were partial responders. Vidofludimus was well tolerated, no drug-related serious adverse events were observed. CONCLUSIONS: This trial provides first evidence of clinical efficacy of vidofludimus in IBD. Although the safety and tolerability profile seems favorable, long-term controlled studies are needed to further investigate its potential as novel IBD therapy.

Supercoiling unwinds two-micrometer plasmid yeast DNA at the origin of replication.

All studied origins of replication of DNA in Saccharomyces cerevisiae contain DNA unwinding elements. The introduction of unrestrained negative supercoiling leads to melting of the two DNA strands in DNA unwinding elements. To understand the mechanism of DNA replication it is important to know whether the most unstable region of DNA coincides with the origin of replication. Two-micrometer plasmid DNA from S. cerevisiae inserted in pBR322 was investigated by cleaving with snake venom phosphodiesterase. Its single-strand endonucleolytic activity allows cutting of negatively supercoiled DNA in the DNA unwinding elements. The sites of the venom phosphodiesterase hydrolysis were mapped by restriction enzymes. This study shows that the unwinding of the two-micrometers plasmid DNA of S. cerevisiae takes place only in the origin of replication as a result of unrestrained negative supercoiling.

Emergence of the active site of spleen exonuclease upon association of the two basic monomers of the tetrameric enzyme.

The 5'-->3' exonuclease from beef spleen is a 160-kDa tetramer consisting of four subunits of two types. Partial reduction of the tetramer led to one stable intermediate state of the enzyme with Mr = 80 kDa. The aim of this paper was to attribute the exonucleolytic activity to one of the two monomers, to the dimer or to the tetramer. The different forms of the exonuclease were separated by SDS-polyacrylamide gel electrophoresis, transferred on an Immobilon-P membrane and subsequently renaturated. Antibodies monospecific against each of the two monomers as well as against the dimer were isolated and their inhibitory effect on the holoenzyme determined. It was found that after renaturation the two monomers did not possess any exonuclease activity while the 80-kDa dimer showed a lower recovery of the specific activity of the enzyme (20.8+/-0.23 nkat/nmol, (n = 5)) in comparison with the 160-kDa tetramer (64.8+/-0.75 nkat/nmol (n = 5)). It was demonstrated that the antibodies monospecific against the dimer caused 53% maximum inhibition of the 160-kDa exonuclease. The antibodies monospecific against 25- and 55-kDa monomers did not inhibit the activity of the holoenzyme. No single-strand endonuclease activity of the spleen exonuclease was observed when using supercoiled Bluescript KS+ plasmid DNA as a substrate. This data suggest the emergence of an 80 kDa active form of beef spleen exonuclease upon association of two monomers of the tetrameric enzyme.

Oligomeric protein structure of beef spleen exonuclease.

A one-step purification of beef spleen exonuclease in the form of a DNA-enzyme complex is described. The purity of the exonuclease was verified by two-dimensional gel electrophoresis. It possesses molecular mass 160 kDa and pI 6.92. The one-dimensional sodium dodecyl sulfate gel after reduction with beta-mercaptoethanol suggests that the 160-kDa exonuclease consists of four polypeptide chains of two different types with molecular masses 55 and 25 kDa. The tetrameric structure of the exonuclease is supported by intermolecular disulfide bonds, and their partial reduction leads to the formation of one stable intermediate with molecular mass 80 kDa formed by binding one 55-kDa with one 25-kDa subunit into a dimer. During two-dimensional gel electrophoresis, the dimer showed pI 6.92 while monomers showed pI 6.78 for the 55-kDa and pI 6.29 for the 25-kDa. Two other intermediate states of two big and one small (135 kDa) and two small and one big subunit (105 kDa) were also visualized. They are unstable and easily dissociated into one 80-kDa dimer and either one 55-kDa or one 25-kDa monomer. The immunoblotting analysis with specific polyclonal antibodies against 160-kDa protein confirmed the subunit structure of the exonuclease. It was found that both monomers are glycosylated.

Single-strand-specific DNase activity is an inherent property of the 140-kDa protein of the snake venom exonuclease.

Polyclonal antibodies against the exonuclease from Crotalus adamanteus venom (the 140-kDa protein) inhibit both the exonucleolytic and the single-strand-specific endonucleolytic activities, present in the exonuclease preparation. The antibodies also diminish the ability of the enzyme to split the negatively supercoiled Bluescript KS+ in the AT-rich fragment near-by the transcription termination site of the Ampicillin gene. Therefore the single-strand-specific endonucleolytic activity was attributed to the protein molecule of the exonuclease. The processivity of the exonucleolytic action was found to be less than 3 monomers as indicated by the heparin trapping method.