Evidence of nigericin as a potential therapeutic candidate for cancers: A review.

Emerging studies have shown that nigericin, an H+, K+ and Pb2+ ionophore, has exhibited a promising anti-cancer activity in various cancers. However, its anti-cancer mechanisms have not been fully elucidated. In this review, the recent progresses on the use of nigericin in human cancers have been summarized. By exchanging H+ and K+ across cell membranes, nigericin shows promising anti-cancer activities in in vitro and in vivo as a single agent or in combination with other anti-cancer drugs through decreasing intracellular pH (pHi). The underlying mechanisms of nigericin also include the inactivation of Wnt/ß-catenin signals, blockade of Androgen Receptor (AR) signaling, and activation of Stress-Activated Protein Kinase/c-Jun N-terminal Kinase (SAPK/JNK) signaling pathways. In many cancers, nigericin is proved to specifically target putative Cancer Stem Cells (CSCs), and its synergistic effects on photodynamic therapy are also reported. Other mechanisms of nigericin including influencing the mitochondrial membrane potentials, inducing an increase in drug accumulation and autophagy, controlling insulin accumulation in nuclei, and increasing the cytotoxic activity of liposome-entrapped drugs, are also discussed. Notably, the potential adverse effects such as teratogenic effects, insulin resistance and eryptosis shall not be ignored. Taken together, these reports suggest that treatment of cancer cells with nigericin may offer a novel therapeutic strategy and future potential of translation to clinics.

A zwitterionic near-infrared fluorophore for real-time ureter identification during laparoscopic abdominopelvic surgery.

Iatrogenic injury of the ureters is a feared complication of abdominal surgery. Zwitterionic near-infrared fluorophores are molecules with geometrically-balanced, electrically-neutral surface charge, which leads to renal-exclusive clearance and ultralow non-specific background binding. Such molecules could solve the ureter mapping problem by providing real-time anatomic and functional imaging, even through intact peritoneum. Here we present the first-in-human experience of this chemical class, as well as the efficacy study in patients undergoing laparoscopic abdominopelvic surgery. The zwitterionic near-infrared fluorophore ZW800-1 is safe, has pharmacokinetic properties consistent with an ideal blood pool agent, and rapid elimination into urine after a single low-dose intravenous injection. Visualization of structure and function of the ureters starts within minutes after ZW800-1 injection and lasts several hours. Zwitterionic near-infrared fluorophores add value during laparoscopic abdominopelvic surgeries and could potentially decrease iatrogenic urethral injury. Moreover, ZW800-1 is engineered for one-step covalent conjugatability, creating possibilities for developing novel targeted ligands.

Salinomycin and other ionophores as a new class of antimalarial drugs with transmission-blocking activity.

The drug target profile proposed by the Medicines for Malaria Venture for a malaria elimination/eradication policy focuses on molecules active on both asexual and sexual stages of Plasmodium, thus with both curative and transmission-blocking activities. The aim of the present work was to investigate whether the class of monovalent ionophores, which includes drugs used in veterinary medicine and that were recently proposed as human anticancer agents, meets these requirements. The activity of salinomycin, monensin, and nigericin on Plasmodium falciparum asexual and sexual erythrocytic stages and on the development of the Plasmodium berghei and P. falciparum mosquito stages is reported here. Gametocytogenesis of the P. falciparum strain 3D7 was induced in vitro, and gametocytes at stage II and III or stage IV and V of development were treated for different lengths of time with the ionophores and their viability measured with the parasite lactate dehydrogenase (pLDH) assay. The monovalent ionophores efficiently killed both asexual parasites and gametocytes with a nanomolar 50% inhibitory concentration (IC50). Salinomycin showed a fast speed of kill compared to that of standard drugs, and the potency was higher on stage IV and V than on stage II and III gametocytes. The ionophores inhibited ookinete development and subsequent oocyst formation in the mosquito midgut, confirming their transmission-blocking activity. Potential toxicity due to hemolysis was excluded, since only infected and not normal erythrocytes were damaged by ionophores. Our data strongly support the downstream exploration of monovalent ionophores for repositioning as new antimalarial and transmission-blocking leads.

Intoxicação espontânea de bovinos por Senna obtusifolia no Estado do Paraná / Spontaneous Senna obtusifolia poisoning in cattle in the state of Parana, Brazil

Plantas do gênero Senna causam miopatia degenerativa em bovinos e o maior número de relatos envolve Senna occidentalis. O objetivo desse trabalho é relatar, pela segunda vez no Brasil, um surto de intoxicação natural por Senna obtusifolia. É descrito um surto de intoxicação por Senna obtusifolia, na região noroeste do estado do Paraná, que aconteceu em um lote de 200 vacas, com idade entre 45 e 152 meses, introduzidas em um confinamento para melhorar a condição corporal antes do parto. A área do confinamento estava invadida pela planta e as vacas permaneceram no local durante oito dias. Entre quatro e nove dias após a entrada no confinamento 20 vacas adoeceram e somente uma se recuperou. Os sinais consistiram em mioglobinúria, incoordenação e decúbito esternal permanente. As vacas doentes apresentaram aumento das atividades das enzimas creatina quinase, aspartato aminotransferase, gamaglutamiltransferase e fosfatase alcalina. Lesões na musculatura esquelética dos membros posteriores caracterizadas por áreas pálidas representaram as principais alterações observadas à necropsia de quatro bovinos. Necrose segmentar multifocal da musculatura esquelética e necrose paracentral multifocal no fígado foram as alterações histopatológicas mais relevantes. As evidências epidemiológicas, clínicas e patológicas indicam o diagnóstico de intoxicação por Senna obtusifolia. A planta demonstrou ter efeito miotóxico e hepatotóxico nos animais intoxicados e a doença foi quase sempre fatal.

Plants of the genus Senna cause a degenerative myopathy in cattle and most of the reports refer to Senna occidentalis. The aim of this paper is to report, for the second time in Brazil, an outbreak of natural poisoning by Senna obtusifolia. It happened in the northwestern Paraná in a herd of 200 cows, 45 to 152 months of age, which had been placed into a feedlot to improve their nutritional status before the calving period. The cows stayed for eight days in this feedlot infested by the plant. Four to nine days after they got into the feedlot, 20 cows became ill and only one recovered. The clinical signs consisted of myoglobinuria, incoordination and permanent sternal recumbency. The affected cows showed increased activity of creatine phosphokinase, aspartate aminotransferase, gama-glutamyltransferase, and alkaline phosphatase. The main postmortem changes were in skeletal muscles of the hind limbs characterized by pale areas. The histological alterations were multifocal segmental necrosis of skeletal muscles and hepatic multifocal paracentral necrosis. Epidemiological, clinical and pathological data led to the diagnosis of Senna obtusifolia poisoning. The plant showed miotoxic and hepatotoxic effects on the poisoned animals and the disease was almost always lethal.

A phase I study of the metal ionophore clioquinol in patients with advanced hematologic malignancies.

UNLABELLED: Clioquinol is a small-molecule metal ionophore that inhibits the proteasome through a metal-dependent mechanism. Here, we report a phase I study of clioquinol in patients with refractory hematologic malignancies. Neuropathy and abdominal pain were dose-limiting toxicities. Minimal pharmacodynamic effects were observed, and there were no clinical responses. BACKGROUND: Clioquinol is a small-molecule metal ionophore that inhibits the enzymatic activity of the proteasome and displays preclinical efficacy in hematologic malignancies in vitro and in vivo. Therefore, we conducted a phase I clinical trial of clioquinol in patients with refractory hematologic malignancies to assess its safety and determine its biological activity in this patient population. METHODS: Patients with refractory hematologic malignancies were treated with increasing doses of oral clioquinol twice daily for 15 doses. Plasma and intracellular levels of clioquinol were measured. Enzymatic activity of the proteasome was measured before and after drug administration. RESULTS: Sixteen cycles of clioquinol were administered to 11 patients with 5 patients reenrolled at the next dose level as per the permitted intrapatient dose escalation. Dose-limiting neurotoxicity and abdominal pain were observed at a dose of 1600 mg twice daily. Intracellular drug levels were low. Minimal inhibition of the proteasome was observed. No clinical responses were observed. CONCLUSION: In patients with refractory hematologic malignancies, the maximal tolerated dose of clioquinol was determined. Minimal inhibition of the proteasome was observed at tolerable doses, likely due to low intracellular levels of the drug.

Surtos de intoxicação por salinomicina em chinchilas (Chinchilla lanigera) / Outbreaks of salinomycin toxicosis in Chinchillas (Chinchilla lanigera)

Quatro surtos de intoxicação por salinomicina são descrito em chinchilas de três municípios do Estado do Rio Grande do Sul. Uma semana após a ingestão de ração contendo 37 ppm de salinomicina, aproximadamente duas mil chinchilas de quatro fazendas expostas diminuíram o consumo da ração. Quatrocentos e vinte sete chinchilas demonstraram apatia. Dessas, duzentos e setenta e sete desenvolveram decúbito esternal e lateral, dispneia e coma, seguidos de morte. As primeiras mortes ocorreram oito dias após a ingestão da ração. A evolução dos sinais clínicos até a morte ou eutanásia foi de 2-5 dias. Os exames bioquímicos do soro sanguíneo em quatro chinchilas revelaram níveis aumentados da alanina aminotransferase, aspartato transaminase, fosfatase alcalina, creatina cinase, glicose, triglicerídeos e colesterol total. Quarenta e cinco chinchilas foram submetidas à necropsia. Os achados macroscópicos consistiam de marcada lipidose hepática em todas as chinchilas necropsiadas; fetos em estado de decomposição em doze chinchilas que estavam prenhes. Microscopicamente, múltiplas fibras musculares esqueléticas estavam hipereosinofílicas, tumefeitas e com perda das estriações. Nas chinchilas que sobreviveram por mais dias era possível observar segmentos fragmentados de miofibras afetadas (necrose flocular) e regeneração de miofibras. No fígado foi observada marcada degeneração gordurosa. Não foram observadas anormalidades microscópicas nos demais órgãos analisados. Análises à procura de aflatoxinas, resíduos de pesticidas e isolamento bacteriano foram negativos. A análise da ração por cromatografia líquida revelou 37ppm de salinomicina na ração. A ração suspeita foi administrada a 12 chinchilas, três das quais (25 por cento) morreram apresentando lesões semelhantes às observadas nas chinchilas com a doença natural. O diagnóstico de intoxicação por salinomicina foi baseado na epidemiologia, lesões histológicas características e na presença de salinomicina na ração administrada nas quatro criações envolvidas.

Four outbreaks of ionophore toxicosis are described in chinchillas from four commercial farms located in three municipalities in the state of Rio Grande do Sul, southern Brazil. Approximately 2,000 chinchillas showed decrease in food intake one week after start ingesting a ration containing 37 ppm of salinomycin. Four hundred and twenty seven chinchillas showed apathy. Of those 277 develop sternal and lateral recumbence, dyspnea and coma followed by death. First deaths occurred eight days after the start on the salinomycin containing ration; clinical course was 2-5 days. Serum chemistry carried out in four chinchillas revealed increased levels of alanine transaminase, aspartate transaminase, alkaline phosphatase, creatinenin kinase, glucose, triglicerids and total cholesterol. Forty five affected chinchillas were necropsied; consistent necropsy findings were marked hepatic lipidosis; additionally twelve pregnant chinchillas had dead decomposing fetuses. Microscopically skeletal muscles had multifocally swollen hypereosinophilic myofibers with loss of cross striations. In those chinchillas that survived longer than a few days, microscopic features in the skeletal muscle included segmental fragmentation of dead fibers (floccular necrosis) and myofiber regeneration. Marked fatty degeneration was observed in the livers of all affected chinchillas. No microscopic changes were observed in other organs. Chemical analysis in the feed consumed by the chinchillas did not detect aflatoxins or pesticides residues; bacterial culture performed in samples of liver and intestinal contents from necropsied chinchillas yielded no significant bacterial growth. Analysis by thin layer chromatography performed in the ration consumed by the chinchillas detected 37 ppm of salinomycin. The suspected ration was fed to 12 chinchillas three of which (25 percent) died with similar lesions to those observed in the natural cases. The diagnosis of salinomycin toxicosis was based in the epidemiology, histology of the lesions, on the detection of significant amounts of salinomycin in the ration used to feed the chinchillas in the four involved farms and on the reproduction of disease by feeding the suspected ration to susceptible chinchillas.

Intoxicação por antibióticos ionóforos em animais:[revisão] / Ionophore poisoning in animals: [review]

O uso terapêutico de antibióticos ionóforos em medicina veterinária difundiu-se muito nos últimos anos, com conseqüente aumento no risco de intoxicação em animais. Antibióticos ionóforos são usados como coccidiostáticos e como aditivo em alimentos para animais, com o propósito de estimular o desenvolvimento e o ganho de peso. Os ionóforos mais utilizados na alimentação de animais são a monensina, lasalocida, nasarina e salinomicina. Há uma grande variação na susceptibilidade dos efeitos tóxicos dos ionóforos de acordo com a espécie animal. A intoxicação pode ocorrer quando dosagens elevadas de ionóforos são adicionadas aos alimentos, ou quando ionóforos são incluídos inadvertidamente ou acidentalmente em dosagens não corretas para determinada espécie animal. Casos de intoxicação têm sido descritos em bovinos, ovinos, suínos, eqüinos, cães e aves. Para os eqüinos os ionóforos são extremamente tóxicos. São considerados seguros quando usados nas espécies-alvo, dentro das dosagens recomendadas pelo fabricante.

The therapeutic use of ionophores in veterinary medicine has grown in the last years, with resultant increase in the risk of poisoning in animals. Ionophores are used as food additives as coccidiostacts in several animal species and growth promoter and bloat prevention in ruminants. The most often used ionophores are monensin, lasalocid, narasin and salinomycin. There is a great variation in the susceptibility to the toxic effect of ionophores in different animal species. Poisoning can occur when the dosage is too high or when not correct doses for a certain animal species are given. Cases of poisoning have been described in sheep, swine, horses, dogs and poultry. For horses ionophores are extremely toxic. The use of ionophores is only safe when used accordingly to the instructions of the manufacturer and especially for each animal species. In this paper the most important data regarding clinical-pathological and pathogenic aspects, and also the conditions in which the poisoning may occur are critically reviewed.

Parâmetros digestivos e produção de proteína microbiana em novilhas em crescimento compensatório / Digestive parameters and protein microbial production in heifers under compensatory growth

Avaliaram-se o manejo para crescimento compensatório e o efeito da suplementação com ionóforo na dieta sobre os parâmetros digestivos e sobre a produção de proteína microbiana de novilhas leiteiras. Foram utilizadas 20 animais puros da raça Pardo-Suíça, com média de peso inicial de 200kg aos cinco meses de idade. Os tratamentos foram arranjados em um esquema fatorial 2x2x2, e os animais foram alocados, aleatoriamente, em cada uma das combinações. O fator 1 consistiu dos sistemas de alimentação (convencional e crescimento compensatório), o fator 2, da utilização (200mg de monensina/animal/dia) ou não de ionóforo e o fator 3, dos períodos de alimentação (P1 e P2). A inclusão de ionóforo na dieta aumentou os coeficientes de digestibilidade total da matéria seca, da matéria orgânica, dos carboidratos totais e da fibra em detergente neutro. Não houve efeito do sistema de alimentação, da adição de ionóforo à dieta e do período sobre a produção microbiana. A eficiência microbiana (g PB microbiana/kg de NDT consumido) no período de restrição foi maior que no período de realimentação.

The effects of compensatory growth and ionophore supplementation of diet of dairy heifer on digestive parameters and protein microbial production were evaluated. Twenty five-month-old Brown-Swiss heifers averaging 200kg b.w. were used. The treatments were arranged in a factorial design (2x2x2) with the animals randomly allocated to each of the combinations. Factor 1 was based on the feeding systems (conventional and compensatory growth), factor 2 on ionophore supplementation option (200mg of monensin/animal/day or not) and factor 3, on the feeding periods (P1 and P2). The diet supplemented with ionophore increased the total digestibility coefficients of dry matter, organic matter, total carbohydrates, and neutral detergent fiber. No effect of feeding systems, ionophore supplementation, or feeding periods based on microbial production was oberved. The microbial efficiency (g of microbial crude protein/kg of NDT intake) during the restriction period was higher than the re-feeding period.

Efeitos da adição de propilenoglicol ou monensina à silagem de milho sobre a cinética de degradação dos carboidratos e produção cumulativa de gases in vitro / Effects of adding propylene glycol or monensin to corn silage on the degradation kinetics of carbohydrates and in vitro cumulative gas production

Avaliaram-se os efeitos dos aditivos propilenoglicol e/ou monensina sobre a degradabilidade média e efetiva dos carboidratos totais, pH e produção cumulativa de gases da silagem de milho por meio da técnica in vitro semi-automática de produção de gases. Os tratamentos constituíram-se de silagem de milho (SM); SM associada ao propilenoglicol (SM+PG); SM associada à monensina (SM+MO); SM associada ao propilenoglicol e à monensina (SM+PG+MO) avaliados com duas, quatro, seis, 12, 24, 48 e 96 horas. A adição de monensina ou monensina associada ao propilenoglicol aumentou (P<0,05) a degradabilidade dos carboidratos totais às duas horas. SM+MO apresentou maior degradabilidade efetiva dos carboidratos totais em todas as taxas de passagem. A utilização de monensina reduziu a produção cumulativa de gases das 12 às 96 horas. Entre os tratamentos, SM+MO apresentou o menor potencial de produção de gases (221ml/g carboidratos totais) e o menor tempo de colonização (1,08 horas) em relação aos tratamentos SM e SM+PG (1,58 e 1,49 horas, respectivamente). A produção cumulativa de gases e degradabilidade dos carboidratos totais apresentaram elevada correlação, variando de 94 a 97 por cento (P<0,01). O pH do meio foi inversamente correlacionado à degradabilidade dos carboidratos totais (r= -79 por cento, P<0,01). O uso de monensina pode ser uma boa alternativa para se melhorarem os parâmetros da cinética de degradação da silagem de milho.

The effects of the additives propylene glycol and/or monensin on the degradation of total carbohydrates, pH, and cumulative gas production of corn silage by the semi-automated in vitro gas production technique were evaluated. The treatments were corn silage (CS); CS plus propylene glycol (CS+PG); CS plus monensin (CS+MO), and CS plus propylene glycol and monensin (CS+PG+MO), which were evaluated at two, four, six, 12, 24, 48, and 96 hours. The addition of monensin or monensin plus propylene glycol increased (P<0.05) the degradation of total carbohydrates at 2h. The effective degradations of total carbohydrates for CS+MO treatment (55.2; 42.7; and 36.5 percent) were the highest in all passage rates. The use of monensin reduced cumulative gas production from 12 to 96h. CS+MO treatment had the lowest potential of gas production (221ml/g total carbohydrates), and the lowest Lag phase (1.08h), as compared to CS and CS+PG treatment (1.58 and 1.49h, respectively). Cumulative gas production and degradation of total carbohydrates were highly correlated (94 to 97 percent; P<0.01). The pH was inversely correlated to degradability of total carbohydrates (r= -0.79; P<0.01). Thus, monensin may be used for improving the ruminal degradability of corn silage.

Intoxicação experimental por monensina em búfalos e bovinos / Experimental monensin poisoning in water buffaloes (Bubalus bubalis) and cattle

Sinais clínicos e lesões característicos de intoxicação por monensina foram induzidos em búfalos dosados (1 dia) com 15, 10, 7,5 e 5mg/kg de monensina. Apenas os búfalos dosados com 2,5 (1 dia) e 1 mg/kg (7 dias) de monensina não morreram. Os sinais clínicos iniciaram cerca de 6 h após dosagem com monensina e incluíram apatia, anorexia, diarréia, sialorréia, fraqueza muscular, taquicardia, dificuldade locomotora, dispnéia, distensão da jugular, decúbito e morte. As dosagens de creatinina quinase (CK) dos búfalos aumentaram acentuadamente após dosagem com monensina. As alterações macroscópicas foram ascite, hidrotórax, hidropericárdio, cardiomegalia, hepatomegalia e áreas pálidas focais no miocárdio e nos músculos esqueléticos. Degeneração e necrose de miofibras foram os principais achados histopatológicos. Por outro lado, nenhuma evidência de doença, nem mesmo alteração nos níveis de CK, foram observados nos bovinos dosados com as mesmas dosagens de monensina, confirmando observações preliminares que esses animais são mais resistentes à monensina que os búfalos.

Monensin is widely used as a feed additive to improve performance of livestock; however accidental poisoning by this ionophore compound has been reported in a number of animal species. Typical clinical signs and lesions of monensin poisoning were induced in water buffaloes dosed with single dosages of 15, 10, 7.5, and 5mg/kg of the compound. Only buffaloes dosed with 2.5 mg/kg (1 day) and 1mg/kg (7 days) survived. Clinical signs initiated about 6 h post-dosing and included apathy, anorexia, diarrhea, drooling, muscular weakness, locomotion disorders, dyspnea, tachycardia, jugular distension and pulse, recumbency and death. The creatine kinase (CK) levels were highly augmented in blood samples of buffaloes dosed with monensin. Most prominent gross changes were ascites, hydrothorax, hydropericardium, cardiomegaly, hepatomegaly, and focal pale areas in the myocardium and in skeletal muscles. Degeneration and necrosis of myofibers were the principal histopathological findings. Conversely, no evidence of disease, neither change in CK levels were observed in the beef cattle steers dosed with same doses, confirming preliminary findings that buffaloes are more susceptible to monensin than cattle. In addition, this communication presents the minimal toxic dosage of monensin to buffaloes and suggests that CK tests may serve as health monitoring tools in the management of buffalo herds supplemented with monensin.

The Arctic Alzheimer mutation enhances sensitivity to toxic stress in human neuroblastoma cells.

The E693G (Arctic) mutation of the amyloid precursor protein was recently found to lead to early-onset Alzheimer's disease in a Swedish family. In the present study, we report that the Arctic mutation decreases cell viability in human neuroblastoma cells. The cell viability, as measured by the MTT assay and propidium iodide staining, was further compromised following exposure to calcium ionophore A23187, microtubule-binding colchicine or oxidative stress inducer hydrogen peroxide. The manner of cell death was found to be apoptotic. During apoptosis, cells with the Arctic mutation also decreased their secretion of beta-secretase cleaved amyloid precursor protein. The enhanced sensitivity to toxic stress in cells with the Arctic mutation most likely contributes to the pathogenic pathway leading to Alzheimer's disease.

Alguns aspectos da funçäo endotelial em cirurgia cardíaca / Some aspects of the endothelial function in cardiac surgery

Este estudo mostra alguns aspectos da funçäo endotelial relacionados, diretamente, com a cirurgia cardíaca: 1) Após isquemia miocárdica global seguida de reperfusäo, o endotélio coronariano perde a habilidade de expressar vasodilataçäo endotélio-dependente mediada por receptores, ao passo que o relaxamento endotélio-dependente mediado pelo cálcio ionóforo A23187 e a fosfolipasec C, que näo dependem de estimulaçäo de receptores, encontra-se inalterada. O relaxamento produzido pelo fluoreto de sódio, o qual atua através de G-proteína(s), encontra-se comprometido. Estes experimentos indicam que o comprometimento da produçäo de EDRF/NO mediada por receptores após a lesäo de reperfusäo possa ser devido a uma disfunçäo de G-proteínas que liga os receptores da célula endotelial à via da sínese de EDRF/NO; 2) Quarenta e cinco minutos de parada cardioplégica de coraçöes de cäes, pela soluçäo St. Thomas näo comprometem a produçäo de EDRF/NO em artérias epicárdicas coronárias. Estudos farmacológicos in vitro semelhantes, testando-se os efeitos da soluçäo UW, suportaram o conceito de que ela näo lesa o endotélio coronariano, sendo segura para a preservaçäo cardíaca durantes transplantes cardíacos; 3) Em segmentos de artérias coronárias, renais, femorais, e em segmentos de artéria pulmonar, a protamina induziu vasodilataçäo endotélio-dependente, mediada pela estimulaçäo da liberaçäo de EDRF/NO. Nas circulaçöes coronariana e sistêmica, ao contrário do que se verificou nos experimentos envolvendo a circulaçäo pulmonar, este efeito foi independente da presença de heparina; 4) Em 83 por cento dos ensaios biológicos, o efluente da AMI esquerda induziu um relaxamento maior do anel coronariano bioensaiado do que o efluente da AMI direita, por liberaçäo basal de EDRF/NO. Este inibe a adesividade e a agregaçäo plaquetárias e a aterogêne, contribuindo para os resultados superiores obtidos quando se utiliza esta artéria para a revascularizaçäo do miocárdi. Quando expostos à hipoxia, as atividades vasodilatadoras da AMI e da veia safena foram maiores. Esta acentuaçäo da vasodilataçäo causada pela hipóxia foi inibida pelo tratamento com a indometacina, e, rapidamente, revertida, quando se restabeleceu a normóxia.