PET Imaging and Neurohistochemistry Reveal that Curcumin Attenuates Brain Hypometabolism and Hippocampal Damage Induced by Status Epilepticus in Rats.

Numerous preclinical studies provide evidence that curcumin, a polyphenolic phytochemical extracted from Curcuma longa (turmeric) has neuroprotective, anti-inflammatory and antioxidant properties against various neurological disorders. Curcumin neuroprotective effects have been reported in different animal models of epilepsy, but its potential effect attenuating brain glucose hypometabolism, considered as an early marker of epileptogenesis that occurs during the silent period following status epilepticus (SE), still has not been addressed. To this end, we used the lithium-pilocarpine rat model to induce SE. Curcumin was administered orally (300 mg/kg/day, for 17 days). Brain glucose metabolism was evaluated in vivo by 2-deoxy-2-[18F]Fluoro-D-Glucose ([18F]FDG) positron emission tomography (PET). In addition, hippocampal integrity, neurodegeneration, microglia-mediated neuroinflammation, and reactive astrogliosis were evaluated as markers of brain damage. SE resulted in brain glucose hypometabolism accompanied by body weight (BW) loss, hippocampal neuronal damage, and neuroinflammation. Curcumin did not reduce the latency time to the SE onset, nor the mortality rate associated with SE. Nevertheless, it reduced the number of seizures, and in the surviving rats, curcumin protected BW and attenuated the short-term glucose brain hypometabolism as well as the signs of neuronal damage and neuroinflammation induced by the SE. Overall, our results support the potential adaptogen-like effects of curcumin attenuating key features of SE-induced brain damage.

Discovery of the c-Jun N-Terminal Kinase Inhibitor CC-90001.

As a result of emerging biological data suggesting that within the c-Jun N-terminal kinase (JNK) family, JNK1 and not JNK2 or JNK3 may be primarily responsible for fibrosis pathology, we sought to identify JNK inhibitors with an increased JNK1 bias relative to our previous clinical compound tanzisertib (CC-930). This manuscript reports the synthesis and structure-activity relationship (SAR) studies for a novel series of JNK inhibitors demonstrating an increased JNK1 bias. SAR optimization on a series of 2,4-dialkylamino-pyrimidine-5-carboxamides resulted in the identification of compounds possessing low nanomolar JNK inhibitory potency, overall kinome selectivity, and the ability to inhibit cellular phosphorylation of the direct JNK substrate c-Jun. Optimization of physicochemical properties in this series resulted in compounds that demonstrated excellent systemic exposure following oral dosing, enabling in vivo efficacy studies and the selection of a candidate for clinical development, CC-90001, which is currently in clinical trials (Phase II) in patients with idiopathic pulmonary fibrosis (NCT03142191).

[Causal analysis and impact of a systematic error detected about consumption associated with trastuzumab]. / Análisis causal e impacto de un error sistemático detectado en el consumo de trastuzumab.

OBJECTIVE: determine the cause of the constant difference between the theoretical and real number of trastuzumab units consumed in an Intravenous Mixtures Unit. METHODS: was studied the manual and electronic full procedure about preparing mixtures with trastuzumab. Was performed by visual observation and review of quantitative monitoring data from the electronic preparation support and safe system of the application Farmis-Oncofarm®. RESULTS: difference between the optimum volume of trastuzumab contained in the summary of product characteristics and the same included in Farmis_Oncofarm® was found. Also found a defect of the optimum volume of 10ml syringes used in the reconstitution vials process. CONCLUSIONS: the default in the optimal volume of 10ml syringes used in the reconstitution process increases the real consumed units of trastuzumab. This produces a significant economic impact calculated in an annual additional cost in approximately 46.508 € without negative consequences for the patient.

Objetivo: determinar la causa de la diferencia constante entre las unidades teóricas de trastuzumab consumidas y las reales en una unidad de mezclas intravenosas. Métodos: se realizó un estudio del procedimiento completo manual y electrónico de la preparación de mezclas con trastuzumab mediante observación visual y revisión de los datos de control cuantitativo proporcionados por el sistema electrónico de preparación asistida y segura de la aplicación Farmis-Oncofarm ®. Resultados: se encontró diferencia entre el volumen óptimo del vial de trastuzumab que informa la ficha técnica del producto y el contenido en la ficha del medicamento de la aplicación. Además se encontró un defecto del volumen óptimo de las jeringas de 10 ml utilizadas en el proceso de reconstitución del vial. Conclusiones: el defecto de volumen óptimo de las jeringas de 10 ml utilizadas en el proceso de reconstitución es la causa del mayor número de viales reales consumidos en la preparación de mezclas con trastuzumab. Esto produce un impacto económico muy importante, estimando un sobrecoste anual de aproximadamente 46.508 €, sin provocar consecuencias negativas en el paciente.

Mutation prevalence of cerebral cavernous malformation genes in Spanish patients.

OBJECTIVE: To study the molecular genetic and clinical features of cerebral cavernous malformations (CCM) in a cohort of Spanish patients. METHODS: We analyzed the CCM1, CCM2, and CCM3 genes by MLPA and direct sequencing of exons and intronic boundaries in 94 familial forms and 41 sporadic cases of CCM patients of Spanish extraction. When available, RNA studies were performed seeking for alternative or cryptic splicing. RESULTS: A total of 26 pathogenic mutations, 22 of which predict truncated proteins, were identified in 29 familial forms and in three sporadic cases. The repertoire includes six novel non-sense and frameshift mutations in CCM1 and CCM3. We also found four missense mutations, one of them located at the third NPXY motif of CCM1 and another one that leads to cryptic splicing of CCM1 exon 6. We found four genomic deletions with the loss of the whole CCM2 gene in one patient and a partial loss of CCM1and CCM2 genes in three other patients. Four families had mutations in CCM3. The results include a high frequency of intronic variants, although most of them localize out of consensus splicing sequences. The main symptoms associated to clinical debut consisted of cerebral haemorrhage, migraines and epileptic seizures. The rare co-occurrence of CCM with Noonan and Chiari syndromes and delayed menarche is reported. CONCLUSIONS: Analysis of CCM genes by sequencing and MLPA has detected mutations in almost 35% of a Spanish cohort (36% of familial cases and 10% of sporadic patients). The results include 13 new mutations of CCM genes and the main clinical symptoms that deserves consideration in molecular diagnosis and genetic counselling of cerebral cavernous malformations.

Increased dosage of Ink4/Arf protects against glucose intolerance and insulin resistance associated with aging.

Recent genome-wide association studies have linked type-2 diabetes mellitus to a genomic region in chromosome 9p21 near the Ink4/Arf locus, which encodes tumor suppressors that are up-regulated in a variety of mammalian organs during aging. However, it is unclear whether the susceptibility to type-2 diabetes is associated with altered expression of the Ink4/Arf locus. In the present study, we investigated the role of Ink4/Arf in age-dependent alterations of insulin and glucose homeostasis using Super-Ink4/Arf mice which bear an extra copy of the entire Ink4/Arf locus. We find that, in contrast to age-matched wild-type controls, Super-Ink4/Arf mice do not develop glucose intolerance with aging. Insulin tolerance tests demonstrated increased insulin sensitivity in Super-Ink4/Arf compared with wild-type mice, which was accompanied by higher activation of the insulin receptor substrate (IRS)-PI3K-AKT pathway in liver, skeletal muscle and heart. Glucose uptake studies in Super-Ink4/Arf mice showed a tendency toward increased (18)F-fluorodeoxyglucose uptake in skeletal muscle compared with wild-type mice (P = 0.079). Furthermore, a positive correlation between glucose uptake and baseline glucose levels was observed in Super-Ink4/Arf mice (P < 0.008) but not in wild-type mice. Our studies reveal a protective role of the Ink4/Arf locus against the development of age-dependent insulin resistance and glucose intolerance.

Discovery of CC-930, an orally active anti-fibrotic JNK inhibitor.

In this Letter we describe the discovery of potent, selective, and orally active aminopurine JNK inhibitors. Improving the physico-chemical properties as well as increasing the potency and selectivity of a subseries with rat plasma exposure, led to the identification of four structurally diverse inhibitors. Differentiation based on PK profiles in multiple species as well as activity in a chronic efficacy model led to the identification of 1 (CC-930) as a development candidate, which is currently in Phase II clinical trial for IPF.

Spleen tyrosine kinase promotes acute neutrophil-mediated glomerular injury via activation of JNK and p38 MAPK in rat nephrotoxic serum nephritis.

Glomerular antibody deposition induces acute neutrophil-mediated glomerular injury via activation of c-Jun amino terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK). However, the link between antibody deposition and activation of JNK/p38 MAPK signalling is unclear. This study tested the postulate that spleen tyrosine kinase (Syk), which is activated via Fcγ-receptor ligation, is required for activation of JNK and p38 signalling and acute neutrophil-mediated glomerular injury. We used a Syk inhibitor (SYKi) in rat nephrotoxic serum nephritis (NTN) in which neutrophil-mediated glomerular injury is dependent upon JNK and p38 signalling. SYKi or vehicle treatment of Sprague-Dawley rats began 30 min before administration of anti-GBM serum with rats killed 3 or 24 h later. Immunostaining identified de novo glomerular Syk activation (p-Tyr 525/526) in untreated NTN, being most prominent in neutrophils. Vehicle and untreated NTN exhibited heavy proteinuria and glomerular thrombosis at 24 h with P-selectin and fibrin immunostaining within capillaries, glomerular macrophage and T cell infiltration, activation of JNK and p38 MAPK signalling, and upregulation of glomerular mRNA levels of pro-inflammatory molecules (TNF-α, NOS2, MMP-12 and CCL2). In contrast, SYKi treatment provided complete protection from proteinuria, with a profound reduction in glomerular thrombosis and immunostaining for P-selectin and fibrin, and a substantial reduction in glomerular mRNA levels of pro-inflammatory molecules. SYKi treatment also reduced the acute glomerular neutrophil influx and pro-inflammatory response at 3 h in NTN. These protective effects were associated with a significant reduction in glomerular JNK and p38 MAPK activation. In addition, activation of Syk, JNK and p38 was identified in human biopsy samples of acute crescentic glomerulonephritis. In conclusion, this study demonstrates that Syk signalling is required for JNK and p38 MAPK signalling and acute neutrophil-dependent glomerular injury in rat NTN. These findings identify Syk as a potential therapeutic target in antibody-dependent kidney disease.

Changes in NPY and POMC, but not serotonin transporter, following a restricted feeding/repletion protocol in rats.

Serotonin (5-HT) plays a key role in controlling food intake and feeding behaviour and drugs targeting the 5-HT transporter (SERT) at the synaptic cleft have been used to treat feeding related disorders. To test the hypothesis that SERT might be one of the etiologic factors in the rebound hyperphagia that frequently follows the abandoning of calorie restriction diets, brain SERT content and gene expression were assessed in a restricted feeding/repletion (RFR) protocol in female rats. Animals were food-restricted (2 h access to food per day) for 7 consecutive days and then allowed constant free access to food (FAF). This intermittent fasting protocol resulted in rebound hyperphagia. Higher levels of plasma corticosterone during fasting in food-deprived rats were used as an index of hypothalamic-pituitary-adrenal axis activation. Neither brain SERT density nor expression was modified following the RFR protocol. Nevertheless, with respect to other messengers involved in eating behaviour, in the presence of low plasma leptin levels, an increase in NPY expression and a parallel decrease in POMC expression were observed in the hypothalamic arcuate nucleus of rats killed just before rebound hyperphagia. Food-restricted animals provide a tool for the further study of neurochemical alterations and for the development of new drugs to treat alterations that may occur in humans when dieting is abandoned.

La gestión por procesos en las instituciones de información / Process management in information institutions

La aplicación del enfoque basado en procesos o gestión por procesos en las organizaciones de información es la forma más eficaz para desarrollar acciones que satisfagan las necesidades de los usuarios, tanto internos como externos. Asimismo, permite identificar y gestionar numerosos procesos interrelacionados, analizar y seguir coherentemente su desarrollo en conjunto, así como obtener una mejora continua de los resultados por medio de la erradicación de errores y procesos redundantes en las diferentes funciones de la organización. Se abordan los conceptos de sistema, proceso y flujo de información y se estudia su interrelación. Se analiza la importancia de la gestión por procesos y su aplicación en las instituciones de información

Photo-induced Stevens-Johnson syndrome due to sulfasalazine therapy.

OBJECTIVE: To report a case of photo-induced Stevens-Johnson Syndrome (SJS) due to sulfasalazine therapy. CASE SUMMARY: Photo-induced SJS associated with sulfasalazine therapy occurred in a 34-year-old white man diagnosed as having seronegative symmetrical polyarthritis with no predisposing factors. According to his medical record, the patient had received methotrexate, levofolinate calcium, deflazacort, and diclofenac sodium as needed. Two months prior to admission, methotrexate and diclofenac sodium were suspended and treatment with sulfasalazine was started. The patient presented to our emergency department because of severe erythema confined to sun-exposed areas; annular lesions on the extremities and the mucosa were affected. Nikolsky's sign was present. A skin biopsy was compatible with SJS, and the clinical diagnosis was SJS induced by sulfasalazine. Administration of sulfasalazine was suspended, which resulted in an improvement in the skin lesions and general state of health. The patient was discharged without further symptoms. DISCUSSION: The observed reaction to sulfasalazine was considered phototoxic, as lesions appeared like a burn rash reaction in sun-exposed areas when sulfasalazine treatment was started and the reaction progressed to SJS. It seems that there was a correlation between the time course of the reaction and the administration of sulfasalazine. An objective causality assessment revealed that the adverse effect was possible. CONCLUSIONS: To our knowledge, this is the first report of photo-induced SJS due to sulfasalazine therapy. Clinicians should be aware of this infrequent but severe reaction. If clinical evaluation leads to the suspicion of SJS, sulfasalazine should be discontinued immediately.

Histamine up-regulates phosphodiesterase IV activity in U-937 cells through H2 receptor stimulation and cAMP increase.

BACKGROUND: An increase of phosphodiesterase 4 (PDE4) has been described in blood mononuclear white cells of patients with atopic dermatitis (AD). This study was intended to search for the putative relationship between histamine and PDE4 in inflammatory cells. MATERIAL/METHODS: The human monocyte cell line U-937 was used as a model of blood mononuclear leucocytes. PDE4 activity was determined as the increase of cAMP degradation, which is specifically inhibited by rolipram. Intracellular cAMP content was measured and correlated to PDE4 activity. RESULTS: 1 microM histamine produced a 2- to 3-fold selective increase in PDE4 activity in U-937 cells after 4 hours of incubation. Enzyme activation was reversible, concentration- and time dependent. Cycloheximide (10 microM) prevented histamine-induced stimulation of PDE4. The H2-receptor antagonist, ranitidine, but not the H1-receptor antagonist, diphenhydramine, prevented histamine-induced activation of PDE4 in a concentration-dependent manner. Inhibition of cAMP degradation in the presence of histamine plus rolipram after 4 h of incubation further increased cAMP levels and PDE4 activity. CONCLUSIONS: These results suggest that histamine-induced stimulation of PDE4 is mediated by the H2 receptor and related to intracellular levels of cAMP. AMPc enhancement of the cyclic nucleotide levels may trigger expression and synthesis of this enzyme.

Effect of adrenaline and glucocorticoids on monocyte cAMP-specific phosphodiesterase (PDE4) in a monocytic cell line.

An increase in phosphodiesterase 4 (PDE4) in blood mononuclear white cells of patients with atopic dermatitis (AD) has been described. This and other skin disorders worsen during stress, during which there are increased circulating levels of adrenaline and glucocorticoids. The aim of this study was to analyse the effect of both these hormones on PDE4 in inflammatory cells. The human monocyte cell line U-937 was used as a model of blood mononuclear leucocytes. For this purpose, (1) the effect of adrenaline on PDE4 activity was determined, (2) the receptor mediating adrenaline actions was characterized, (3) the role of intracellular cAMP in PDE4 activation was investigated and (4) the effect of glucocorticoids on PDE4 activity was also ascertained. Adrenaline at a concentration of 1 micro M produced a two- to threefold selective increase in PDE4 activity in U-937 cells after 4 h of incubation with the hormone. This stimulation was reversible, as well as concentration- and time-dependent. Cycloheximide (10 micro M) induced a blockade of adrenaline-induced stimulation of PDE4. The stimulatory effect was inhibited by propranolol, but not by atenolol or phentolamine, in a concentration-dependent manner and was mimicked by salbutamol. The stimulation of PDE4 was paralleled by an increase in intracellular levels of cAMP. 8-Br-cAMP and forskolin also increased PDE4 activity. After 4 h of incubation in the presence of adrenaline, inhibition of cAMP degradation by rolipram further increased cAMP levels by about 300% and also enhanced PDE4 activity. These results suggest that adrenaline-induced stimulation of PDE4 is mediated by the beta(2)-adrenoceptor and is related to intracellular levels of cAMP, which might trigger expression and synthesis of the enzyme. The synthetic glucocorticoid dexamethasone (in the concentration range 10(-8) to 10(-6) M) showed no effect on PDE4 activity or on the cAMP accumulation induced by adrenaline, even after prolonged (24 h) incubation with the cells. Of the two stress hormones assayed, PDE4 activity was shown to be sensitive to adrenaline elevation but resistant to changes in glucocorticoid levels in the U-937 monocytic cell line.

A parallel approach to the discovery of carrier delivery vehicles to enhance antigen immunogenicity.

As part of an ongoing effort to generate human and murine monoclonal antibodies against poorly immunogenic tumor-associated antigens we have merged the rapidly expanding disciplines of parallel polymer synthesis and controlled-release technology with immunology to produce a rapid and generic approach to improve the immunogenicity of carrier-bound antigens. The process involves three stages: An array of cross-linked hydrogel materials containing a carrier protein (at various concentrations) is prepared in parallel in one step. The array is then screened in mice to determine the most effective hydrogel at enhancing the immunogenicity of the encapsulated versus nonencapsulated carrier. Finally, the most efficient hydrogel is prepared containing the critical carrier-antigen conjugate and is used for immunization protocols. The strategy was successful for the BSA-glycoconjugate of the tumor-associated antigen GM3 analogue 4. When encapsulated within the hydrogel array member most efficient at elevating BSA immunogenicity, the BSA-4 glycoconjugate was significantly more immunogenic that when administered as a free antigen.

Cáncer tiroideo en niños: terapia y seguimiento en carcinoma bien diferenciado / Thyroid cancer in children: Therapy and follow up in differentiated carcinoma

We report two cases of well differentiated thyroid carcinoma (DTC) in two girls who showed their first symptoms at 4 years 6 months and 7 years 2 months. Both ubderwent total thyroidectomy and removal of metastatic lymph modes. In the first case pathology informed a mixed DTC (papillar/follicular). In the first case we discuss the difficulties that may arise due to the unspecified signs and symptoms that led to an initial diagnosis of goiter and thyroiditis. We emphasize the importance of age, sex, the presence of cervical adenopathy and associated hoarness in order to establish the diagnosis of DTC. In the second case we point out the diagnosis importance of the progressive growth of the cold thyroid nodule. We review the different surgical approaches of resection supporting the advantages of the total over the subtotal thyroidectomy wehad done on our patients. We analyze the concepts of uni and multifocality of DTC taking into consideration the possibility of death even among low risk patients. We discuss the higher frecuency of relapse in patients who were not treated with radioactive iodine (I.131) or who were given low doses of iodine. We establish the advantages of post-surgical ablation with high doses (100 to 150 mCi) of I-131, based on the longer patient survivaland minimum recurrences. The first studied case has had 15 years 9 month of survival with no recurrences up to date. Teh second studied case has had 6 years 10 month of survival, also with no recurrences up to date. We also emphasize the importance of an adequate suppresive hormone dose (200 mcg day of thyroxine) bases on the concept of the TSH dependance of this tumors. We conclude mentioning that the prognosis depends an adequate follow up schedule.