Water-soluble rice bran enzymatic extract attenuates dyslipidemia, hypertension and insulin resistance in obese Zucker rats.

BACKGROUND AND PURPOSE: Rice bran enzymatic extract (RBEE) has advantages compared to the original rice bran or its oils including water solubility, lack of rancidity and increased content in high nutritional proteins and nutraceutical compounds, particularly phytosterols, γ-oryzanol and tocols. Our aim was to determine the beneficial effects of RBEE in the pathogenesis of metabolic syndrome in obese Zucker rats. METHODS: Obese Zucker rats and their lean littermates were fed a 1 and 5 % RBEE-supplemented diet (O1, O5, L1 and L5). Simultaneously, obese and lean Zucker rats, fed a standard diet, were used as controls (OC and LC, respectively). Body weight, food and water intake, and systolic blood pressure were weekly evaluated. After treatment, biochemical assays of serum glucose, insulin, triglycerides (TG), total cholesterol (TC), non-esterified fatty acids (NEFA), adiponectin and nitrates (NO((x))) were determined. RESULTS: RBEE treatment reduced circulating levels of TG and TC, whereas increased HDL-cholesterol without altering NEFA values in obese rats. The extract also induced a significant dose-dependent reduction of hypertension linked to obesity. RBEE of 5 % improved insulin resistance and subsequently reduced HOMA-IR index without altering serum glucose levels. Obese animals treated with RBEE showed partial restoration of adiponectin levels and a significant attenuation of pro-inflammatory values of NO((x)). CONCLUSION: These findings evidence the nutraceutical properties of RBEE against the pathogenesis of metabolic syndrome by attenuating dyslipidemia, hypertension and insulin resistance as well as by restoring hypoadiponectinemia associated to obesity.

Impact of Frailty on Outcomes of First-Line Pembrolizumab Monotherapy in a Real-World Population with Advanced Non-Small Cell Lung Cancer.

ICIs have been able to improve overall survival in advanced-stage lung cancer. The benefit of this therapy is limited in patients with poor ECOG PS. However, this scale is imprecise and can be influenced by different factors, such as frailty. Cancer patients have a high risk of frailty independently of age. In this observational, single-center, retrospective study, we investigated the effect of frailty on the effectiveness of pembrolizumab in first-line use in a cohort of 101 patients with metastatic NSCLC. Frailty was determined using a frailty score system developed by Sakakida et al. Univariate and multivariate analysis was performed to determine the prognostic role of frailty on OS and PFS. Median OS was significantly higher in patients with low frailty compared with intermediate and high frailty (23.8 vs. 7.0 and 1.8 months, respectively; p < 0.001). Median PFS was also significantly higher in patients with low frailty compared with intermediate and high frailty (10.5 vs. 3.9 and 1.6 months; p < 0.001, respectively). Frailty was the only variable that showed significant differences in OS and PFS. Multivariate analysis confirms frailty as an independent predictor of OS and PFS. Frailty assessment could help to select which patients are candidates for ICIs in NSCLC.

Social cognition and emotional rehabilitation in participants with schizofrenia.

Introduction: People with schizophrenia have deficits in social cognition, emotion and social perception, as well as attributional style. The purpose of this study was to evaluate the efficacy of a multicomponent social cognition training program, e-Motional Training® (ET), in people with schizophrenia and to compare its efficacy with people who did not receive it. Therefore, a single-blind RCT was conducted in participants with a diagnosis of schizophrenia. Methods: A randomized, single-blind, clinical trial was conducted with 50 stable outparticipants with schizophrenia (registry number CHUC_2019_109). All participants (control and intervention) were treated with pharmacotherapy, case management and were on Individual Placement and Support methodology for competitive employment. The intervention group was treated with ET, an online program designed for social cognition rehabilitation. Pre and post assessment was performed using different battery of tests. General mixed models with subject identification and repeated measures over time were used. Results: Different pre and post measurements were performed in the two groups. No significant differences were found in sociodemographic characteristics between the control and intervention groups. Improvements were obtained in the intervention group in the Ekman test (p = 0.009), mainly enhanced by the improvement shown in three emotions: fear, sadness and disgust (p = 0.041, p = 0.021 and p = 0.038 respectively). Conclusion: ET is a promising online training tool for social cognition deficits in schizophrenia, in particular, for the improvement of emotions.Clinical Trial Registration: https://beta.clinicaltrials.gov, NCT05866328.

The cognitive and psychiatric subacute impairment in severe Covid-19.

Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains and the existence of related biomarkers. Cross-sectional multicentric study of patients who survived severe infection with SARS-CoV-2 consecutively recruited between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory, neurotrophic factors and light-chain neurofilaments. A principal component analysis extracted the main independent characteristics of the syndrome. 152 patients were recruited. The results of our study preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of other cortical functions. In addition, anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population. Severe Covid-19 patients can develop an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and if this can trigger or accelerate the onset of neurodegenerative diseases.

Oral supplementation of propionyl-l-carnitine reduces body weight and hyperinsulinaemia in obese Zucker rats.

Propionyl-L-carnitine (PLC) is an SCFA esterified to carnitine that plays an important role in fatty acid oxidation and energy expenditure, in addition to having a protective effect on the endothelium. In order to evaluate the effect of PLC on an animal model of obesity, insulin resistance and, consequently, endothelial dysfunction, lean and obese Zucker rats (OZR) received either vehicle- or PLC-supplemented drinking water (200 mg/kg per d) for 20 weeks. Body weight, food intake, systolic blood pressure and heart rate were controlled weekly and an oral glucose tolerance test was performed. Fasting glucose, TAG, cholesterol, HDL, NEFA, adiponectin and insulin were analysed in serum. Visceral adipose tissue and liver were weighed and liver TAG liver composition was evaluated. Endothelial and vascular functions were assessed in the aorta and small mesenteric arteries by response to acetylcholine, sodium nitroprusside and phenylephrine (Phe); NO participation was evaluated after incubation with the NO synthase (NOS) inhibitor NG-nitro-L-arginine methyl ester (L-NAME) and endothelial NOS protein expression by Western blotting. PLC decreased body-weight gain, food intake, adiposity, insulin serum concentration and TAG liver content and improved insulin resistance. Aortae from OZR receiving either vehicle or PLC exhibited a lower contractile response to Phe. PLC-treated OZR showed an enhanced release of endothelial NO upon the adrenergic stimulation. The protection of vascular function found after treatment with PLC in an animal model of insulin resistance supports the necessity of clinical trials showing the effect of L-carnitine supplements on metabolic disorders.

[Mechanism involved in aged-related endothelial dysfunction]. / Mecanismos implicados en la disfunción endotelial asociada al envejecimiento.

Ageing is an important risk factor for many cardiovascular diseases with a common underlying circumstance: the progressive decline of endothelial function. This work summarizes the mechanisms involved in such dysfunction focusing our attention in the vasoactive substances released by the endothelium. The decrease of nitric oxide contribution, the enhancement of vasoconstrictor prostanoids and the modification of the action of either the endothelium-derived hyperpolarizing factor or the vasoconstrictor peptide endothelin are some of the manifestations that appear as the consequence of ageing in endothelial cells. The increase in oxidative stress, the higher production of reactive oxygen species and the proinflammatory phenotype of the vascular wall contribute to explain these facts. The role played by the senescence of endothelial cells and their progenitors is also revised.

Effects of HMG-CoA reductase inhibition by simvastatin on vascular dysfunction induced by lipopolysaccharide in rats.

AIMS: Statins have been identified as a potentially interesting treatment against sepsis. Here, we study the vascular reactivity of aortae from rats treated with lipopolysaccharide (LPS), 4 mg . kg(-1), following chronic administration of simvastatin (SV) 10 mg . kg(-1). METHODS: The rats were treated with either vehicle or SV for 4 weeks before administration of LPS. After 18 h, the systolic blood pressure (SBP) was measured using a tail cuff and vascular and endothelial responses of aortic rings to several agonists were studied in an organ bath. RESULTS: LPS injection decreased the SBP by 38 mm Hg and vascular response to phenylephrine (Phe) by 60%. Plasma nitrates and nitrites (NO(x)) were 3-fold higher after LPS. This attenuated response to Phe was prevented by incubation with either the inducible-nitric-oxide-synthase (iNOS)-selective inhibitor 1400W or the endothelial nitric oxide synthase (eNOS)/iNOS nonselective blocker L-NAME. The presence of endothelium did not alter these findings. Administering LPS to SV-treated rats also decreased the SBP and increased the NO(x) concentration. The impaired response to Phe was restored by blocking NO synthesis in endothelium-denuded but not in intact aortic rings. The response to acetylcholine demonstrated an enhanced reduction in arteries from the SV + LPS group compared with the LPS group. The inhibition of iNOS prevented acetylcholine-induced relaxation in rings from LPS-treated rats but not in those from the SV + LPS group. CONCLUSION: These results suggest that statins may reduce iNOS-mediated NO production in endothelial but not in vascular smooth-muscle cells.

Cedrelopsis grevei improves endothelial vasodilatation in aged rats through an increase of NO participation.

Cedrelopsis grevei Baill. (Ptaeroxylaceae) trunk bark extract is empirically used in Madagascar against several pathologies, from persistent catarrh to hypertension. The effect C. grevei extract on age-related changes in systolic blood pressure (SBP) and endothelial function was investigated. Rats (90-100 week-old) received treatment either with C. grevei extract (80 mg kg(-1)) or vehicle for 8 weeks. SBP was evaluated by tail-cuff and vascular reactivity and endothelial vasodilatation of both aortae and small mesenteric arteries (SMA) were assessed by acetylcholine (ACh) in the presence or in the absence of either reactive oxygen species (ROS) scavengers superoxide dismutase (SOD) plus catalase or the nitric oxide synthase inhibitor, NG-L-arginine methyl ester (L-NAME). Plasma nitric oxide (NO) was evaluated by nitrite assay and expressions of eNOS, Cu/Zn-, Mn- and EC-SOD were determined by Western Blot. C. grevei administration prevented the increase of SBP and improved endothelium-dependent relaxations in aortae and SMA from aged rat via increased NO and decreased participation of ROS. Furthermore, C. grevei treatment enhanced plasma nitrite content but did not modify eNOS, Cu/Zn-, Mn- or EC-SOD expressions in the two arteries studied. These results suggest that C. grevei prevents both increased blood pressure and age-related endothelial dysfunction supporting the empirical use of C. grevei trunk bark extract against mild hypertension often associated with aging.

The challenge of aging and pharmacoterapeutic complexity in the HIV + patient.

OBJECTIVE: To describe the current knowledge and management of aging and  pharmacotherapeutic complexity in HIV + patients. METHOD: A review of literature was carried out, including articles, originals or  reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms  «Polypharmacy¼/¼Polypharmacy¼, «Aging¼/¼Aging¼, «Frailty¼/¼Fragility¼,  «Pharmacotherapeutic Complexity¼/¼Medication Regimen Complexity¼ and  «HIV¼/"HIV¼ were combined. The review was carried out independently by two  authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An  aging of the population and an increase in associated comorbidities have been  identified, especially over 50 years-old. Immunological changes similar to those  that are generated in a non-infected elderly population have been described.  These conditions influencing the prescription of antiretroviral treatment,  according to studies identified. In parallel, polypharmacy is increasingly present,  being defined exclusively by the concomitant use of five drugs.  Pharmacotherapeutic complexity, through the Medication Regimen Complexity  Index, has begun to analyse and relate to health outcomes. There has been a  need to know and apply concepts already known in non-HIV-aged population,  such as de-prescription, potentially inappropriate medication, cholinergic risk, although few results are available. CONCLUSIONS: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is  beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new  concepts that help pharmacotherapeutic optimization in this population.

Objetivo: Describir el conocimiento actual y el manejo del envejecimiento y la  complejidad farmacoterapéutica en pacientes VIH ≥ .Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica  en pacientes VIH ≥ . Se combinaron los términos:  "Polypharmacy"/"Polifarmacia", "Aging"/"Envejecimiento", "Frailty"/"Fragilidad",  "Complejidad Farmacoterapéutica"/"Medication Regimen Complexity" y  "HIV"/"VIH". La revisión se realizó de forma independiente por dos autores. Se  analizó el grado de concordancia según el índice Kappa.Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la  población y un incremento de las comorbilidades asociadas, especialmente a  partir de los 50 años. Se han descrito cambios inmunológicos similares a los que  se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más  presente, definiéndose exclusivamente por el uso concomitante de cinco  fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con  resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como  desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles.Conclusiones: Existe un interés creciente en profundizar en la relación VIH y  envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse  como criterio de seguimiento farmacoterapéutico por su influencia en los  resultados en salud. Es necesario manejar e incorporar nuevos conceptos que  ayuden a la optimización farmacoterapéutica en esta población.

Fenofibrate improves age-related endothelial dysfunction in rat resistance arteries.

This study was designed to test the hypothesis that fenofibrate, the peroxisome proliferator-activated receptor alpha (PPARalpha) activator, improves age-related endothelial dysfunction in small mesenteric arteries (SMA). Adult and aged rats were treated with fenofibrate and then endothelium-dependent relaxations of SMA; expressions of endothelial NO synthase (eNOS), cyclo-oxygenase (COX-1 and COX-2) and superoxide dismutases (SOD) (Cu/Zn SOD, Mn SOD and EC SOD) proteins and release of TXB(2) and 6-keto-PGF(1alpha) were assessed. Fenofibrate improved endothelium-dependent vasodilatation of arteries from old rats and decreased participation of endothelial vasoconstrictor products, sensitive to COX-1 and COX-2 inhibitors and acting on Tp receptor. Fenofibrate decreased expressions of COX-1 and COX-2, and generation of TXA(2). Release of vasodilator PGI(2) and U46619-induced contraction remained unaltered. Neither NO-mediated vasodilatation nor eNOS expression was affected. The addition of the scavengers, SOD and catalase increased relaxation only in SMA from control rats. Finally, fenofibrate did not change expressions of Cu/Zn SOD and Mn SOD but it increased EC SOD towards that observed in arteries from adult rats. Fenofibrate improves endothelial function in resistance arteries from aged rats by decreasing expression of COX-1 and COX-2 together with enhancing anti-oxidant capacity of the vessel wall probably through the increased expression of EC SOD. This study provides evidence that PPARalpha may have clinical applications toward maintaining endothelial function during ageing.

Effect of L-carnitine and propionyl-L-carnitine on endothelial function of small mesenteric arteries from SHR.

BACKGROUND: The effect of treatment with either 200 mg x kg(-1) of L-carnitine (LC) or propionyl-L-carnitine (PLC) was studied on endothelial dysfunction of small mesenteric arteries (SMA) from spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats. METHODS: Systolic blood pressure (SBP) was measured and endothelial and vascular functions were assessed by the effect of carbachol (CCh) and phenylephrine (Phe). O2- produced by SMA and eNOS expression were evaluated by chemiluminescence and Western blot, respectively. RESULTS: Although SBP was not affected, endothelial relaxation increased in both LC- and PLC-treated SHR. Nevertheless, the CCh-induced contraction remained sensitive to indomethacin in these rats. On the contrary, NO participation was increased in all the groups except for LC-treated WKY. Furthermore, high concentrations of Phe produced NO-dependent relaxation of SMA from PLC-treated rats. Both compounds decreased basal and NADPH-stimulated O2- in SHR toward values observed in WKY. Only PLC increased eNOS protein expression in SHR. Neither LC nor PLC affected endothelium-derived hyperpolarizing factor-induced relaxation. CONCLUSIONS: LC and its propionate improved endothelial responses of SMA from SHR by decreasing O2- production and thus increasing NO availability. PLC also increased NO synthesis by enhancing eNOS expression.

Rice bran enzymatic extract reduces atherosclerotic plaque development and steatosis in high-fat fed ApoE-/- mice.

OBJECTIVE: Rice bran is a by-product of rice milling and is rich in bioactive molecules such as γ-oryzanol, phytosterols, and tocotrienols. The rice bran enzymatic extract (RBEE) previously showed vessel remodeling prevention and lipid-lowering, antioxidant, anti-inflammatory, and antiapoptotic activities. The aim of this study was to identify RBEE hypolipidemic mechanisms and to study the effects of RBEE on the progression of atherosclerosis disease and linked vascular dysfunction and liver steatosis in apolipoprotein E-knockout (ApoE-/-) mice fed low- or high-fat (LFD, HFD, respectively) and cholesterol diets. METHODS: ApoE-/- mice were fed LFD (13% kcal) or HFD (42% kcal) supplemented or not supplemented with 1 or 5% RBEE (w/w) for 23 wk. Then, serum, aorta, liver, and feces were collected and flash frozen for further analysis. RESULTS: RBEE supplementation of HFD improved serum values by augmenting high-density lipoprotein cholesterol and preventing total cholesterol and aspartate aminotransferase increase. 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase activity was attenuated (1 and 5% RBEE) and cholesterol excretion increased (5% RBEE). Diet supplementation with 5% RBEE reduced plaque development regardless of the diet. In HFD-fed mice, both doses of RBEE reduced lipid deposition and macrophage infiltration in the aortic sinus and downregulated intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expression. None of these effects was observed in mice fed LFD. Liver steatosis was reduced by RBEE supplementation of LFD (1% RBEE) and HFD (1 and 5% RBEE) and nuclear peroxisome proliferator-activated receptor-α expression upregulated in the HDF 5% RBEE group. CONCLUSION: Regular consumption of RBEE-supplemented HFD reduced plaque development and liver steatosis by decreasing inflammation and hyperlipidemia through an HMG-CoA reductase activity and lipid excretion-related mechanism.

Ferulic acid, a bioactive component of rice bran, improves oxidative stress and mitochondrial biogenesis and dynamics in mice and in human mononuclear cells.

The aim of the study was to characterize the vascular effects of rice bran enzymatic extract (RBEE). ApoE-/- mice were fed a high-fat/cholesterol diet (HFD) or HFD supplemented with 5% RBEE for 21 weeks. RBEE prevented development of atherosclerotic plaques and oxidative stress in mouse aorta as well as the down-regulation of markers of mitochondrial biogenesis. Analysis of the bioactive components identified ferulic acid (FA) as responsible component. In healthy human volunteers, FA intake reduced NADPH oxidase activity, superoxide release, apoptosis and necrosis in peripheral blood mononuclear cells. Differentiation and proliferation of endothelial progenitor cells were improved. In summary, the study identifies FA as a major active component of rice bran, which improves expression of mitochondrial biogenesis and dynamics markers and reduces oxidative stress in a mouse model of vascular damage as well as in endothelial cells and human mononuclear cells.

Diet supplementation with rice bran enzymatic extract restores endothelial impairment and wall remodelling of ApoE(-/-) mice microvessels.

BACKGROUND AND AIMS: Small mesenteric artery resistance and functionality are key factors for the maintenance of blood homeostasis. We attained to evaluate the effects of a rice bran enzymatic extract (RBEE) on structural, mechanic and myogenic alterations and endothelial dysfunction secondary to atherosclerosis disease. METHODS: Seven week-old ApoE(-/-) mice were fed on standard (ST) or high fat (HF) diets supplemented or not with 1 or 5% RBEE (w/w) for 23 weeks. Wild-type C57BL/6J mice fed on ST diet served as controls. Small mesenteric arteries were mounted in a pressure myograph in order to evaluate structural, mechanical and myogenic properties. Vascular reactivity was assessed in the presence of different combinations of inhibitors: l-NAME, indometacin, apamin and charybdotoxin. RESULTS: ApoE(-/-) mice fed on ST and HF diets showed different structural and mechanical alterations, alleviated by RBEE supplementation of ST and HF diets. C57BL/6J was characterized by increased expression of IKCa (199.3%, p = 0.023) and SKCa (133.2%, p = 0.026), resulting in higher EDHF participation (p = 0.0001). However, NO release was more relevant to ApoE(-/-) mice vasodilatation. HF diet reduced the amount of NO released due to 2-fold increase of eNOS phosphorylation in the inhibitory residue Thr495 (p = 0.034), which was fully counteracted by RBEE supplementation (p = 0.028), restoring ACh-induced vasodilatation (p = 0.00006). Dihydroethidium fluorescence of superoxide and picrosirius red staining of collagen were reduced by RBEE supplementation of HF diet by 76.91% (p = 0.022) and 65.87% (p = 0.030), respectively. CONCLUSION: RBEE supplemented diet reduced vessel remodeling and oxidative stress. Moreover, RBEE supplemented diet increased NO release by downregulating p-eNOS(Thr495), thus, protecting the endothelial function.

Development of a taxonomy for pharmaceutical interventions in HIV+ patients based on the CMO model.

OBJECTIVE: To agree on a proposal for pharmaceutical interventions and establish their classification taxonomy according to the CMO-Pharmaceutical Care Model (Capacity-Motivation- Opportunity). METHOD: A study conducted between March and May, 2016. Two phases of development were defined. A literature review was initially conducted. Then, the DELPHI-Rand-UCLA methodology was used in order to reach a consensus about those interventions selected, and to define the taxonomy. Fifteen (15) experts, specialists in Pharmaceutical Care for HIV+ patients, were selected. This selection was explicitly conducted, following a protocol in order to avoid any bias. An initial proposal was developed according to the interventions extracted from Phase 1. These were tentatively classified according to the CMO Model, in a category based on their design and utility. Three issues were raised from the initial question: Do you agree with the proposed classification? If not, there was an option to re-categorize. Additionally, they were asked about the importance, priority and impact to achieve pharmacotherapeutic objectives that they would assign to it. Interventions were classified according to the degree of agreement. Once a consensus was reached, the final taxonomy was established. RESULTS: Eighteen (18) articles were finally considered. The initial proposal included 20 pharmaceutical interventions with the following classification: seven in Capacity, eight in Motivation, and five in Opportunity. Those interventions considered to have greater importance and priority were: Review and Validation, Safety, and Adherence. The interventions with the greatest impact were: Review and Validation, Coordination, Adherence, and Motivation. On the other hand, the lowest scores for importance were for: Planning and Social Coordination; and in terms of impact: Social Coordination. CONCLUSIONS: The taxonomy reached by consensus will allow to classify pharmaceutical interventions with the new model, and therefore to conduct an improved research and patient care.

Objetivo: Consensuar una propuesta de intervenciones farmacéuticas y llevar a cabo su taxonomía de clasificación según el modelo de Atención Farmacéutica-CMO (Capacidad-Motivación- Oportunidad). Método: Estudio realizado entre marzo-mayo de 2016. Se definieron dos fases de desarrollo. Inicialmente, se realizó una revisión bibliográfica. A continuación, para consensuar las intervenciones seleccionadas y definir la taxonomía se utilizó metodología DELPHI-Rand-UCLA. Se seleccionaron 15 expertos, especialistas en Atención Farmacéutica al paciente VIH+. La selección se realizó explícitamente, siguiendo un protocolo para evitar sesgos. Se elaboró, inicialmente, una propuesta a partir de las intervenciones extraídas de la fase-1. Se clasificaron tentativamente según el Modelo-CMO en una categoría según su diseño y utilidad. Se plantearon tres preguntas a partir de la cuestión inicial: ¿Está de acuerdo con la clasificación propuesta? En caso negativo, se daba opción de recategorizar. Adicionalmente, se planteó qué importancia, prioridad e impacto en la consecución de objetivos farmacoterapéuticos le daría. Las intervenciones se clasificaron en función del grado de acuerdo. Una vez consensuadas, se realizó la taxonomía definitiva. Resultados: Se consideraron finalmente 18 artículos. La propuesta inicial incluyó 20 intervenciones farmacéuticas clasificadas siete en Capacidad, ocho en Motivación y cinco en Oportunidad. Las intervenciones consideradas de mayor importancia y prioridad fueron: revisión y validación, seguridad y adherencia. Las de mayor impacto fueron: revisión y validación, coordinación, adherencia y motivación. Por contra, las de menor puntuación en importancia fueron: planificación y coordinación social y, en impacto, coordinación social. Conclusiones: La taxonomía consensuada permitirá clasificar las intervenciones farmacéuticas realizadas con el nuevo modelo y, así, profundizar en la investigación y la mejora asistencial.

L-carnitine and propionyl-L-carnitine improve endothelial dysfunction in spontaneously hypertensive rats: different participation of NO and COX-products.

L-carnitine and propionyl-L-carnitine are supplements to therapy in cardiovascular pathologies. Their effect on endothelial dysfunction in hypertension was studied after treatment with either 200 mg/kg of L-carnitine or propionyl-L-carnitine during 8 weeks of spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY). Endothelial function was assessed in aortic rings by carbachol-induced relaxation (CCh 10(-8) to 10(-4) M) and factors involved were characterized in the presence of the inhibitors: L-NAME, indomethacin, the TXA2/PGH2 Tp receptor antagonist ICI-192,605 and the thromboxane synthetase inhibitor-Tp receptor antagonist, Ro-68,070. The effect on phenylephrine-induced contractions was also observed. To identify the nature of vasoactive COX-derived products, enzyme-immunoassay of incubation media was assessed. Involvement of reactive oxygen species was evaluated by incubating with superoxide dismutase and catalase. Nitric oxide production was evaluated by serum concentration of NO2+NO3.Treatment with both compounds improved endothelial function of rings from SHR without blood pressure change. Propionyl-L-carnitine increased NO participation in WKY and SHR. L-carnitine reduced endothelium-dependent responses to CCh in WKY due to an increase of TXA2 production. In both SHR and WKY, L-carnitine enhanced concentration of PGI2 and increased participation of NO. Results in the presence of SOD plus catalase show that it might be related to antioxidant properties of L-carnitine and propionyl-L-carnitine. Comparison between the effect of both compounds shows that both may reduce reactive oxygen species and increase NO participation in endothelium-dependent relaxations in SHR. However, only L-carnitine was able to increase the release of the vasodilator PGI2 and even enhanced TXA2 production in normotensive rats.

Structural, mechanical and myogenic properties of small mesenteric arteries from ApoE KO mice: characterization and effects of virgin olive oil diets.

OBJECTIVE: We analyzed the structural, mechanical, myogenic and functional properties of resistance arteries of ApoE KO compared to wild type (WT) mice. We also determined the influence of saturated fat in comparison to virgin olive oil-enriched diets in vascular wall abnormalities. METHODS: Male ApoE KO (ApoE) and WT mice (8-weeks-old) were assigned to the groups: standard chow diet (SD), high fat diet (HFD), virgin olive oil (VOO) and high polyphenol-VOO-enriched diet (Oleaster(®)) (OT) (15% w/w). After 20 weeks, structural, mechanical and myogenic properties of isolated small mesenteric arteries (SMA) were analyzed by pressure myography. For functional studies, vasodilatation to acetylcholine was assessed. Arterial superoxide anion production was measured by ethidium fluorescence. RESULTS: Hypertrophic remodeling and distensibility in ApoE KO SMA was lower compared to WT mice, suggesting an alteration in the autoregulation mechanisms aimed to compensate disease progression. However, ApoE deficiency resulted in a lower impairment in myogenic tone in response to intraluminal pressure, in addition to an improved endothelium-dependent hyperpolarizing vasodilatation. Also, we evidenced the beneficial effects of VOO in contrast to a saturated fat-enriched diet on SMA wall disorders. Only the endothelial function improvement induced by olive oil was dependent on polyphenols content. CONCLUSION: Resistance arteries structure, mechanic, myogenic and functional responses from ApoE KO mice significantly differ from WT mice, evidencing the influence of the type of diet on these disorders. These results are particularly useful to determine the contribution of resistance arteries during the atherosclerotic process and to provide novel insights into the Mediterranean dietary pattern to reduce the burden of atherosclerotic disease.

Simvastatin improves endothelial function in spontaneously hypertensive rats through a superoxide dismutase mediated antioxidant effect.

BACKGROUND: Hydroxymethylglutaryl coenzyme A (HMGCoA) reductase inhibitors have beneficial effects beyond their cholesterol-lowering properties. The antioxidant mechanism of HMGCoA reductase inhibitors is not completely understood. OBJECTIVES: To elucidate the antioxidant effect of simvastatin. METHODS: We studied the influence of simvastatin treatment on the development of hypertension, modification of antioxidant systems, and reactivity of aortic rings in Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. RESULTS: Simvastatin had no effect on blood pressure (BP). Simvastatin treatment (either 1 or 2 mg/kg body weight for 12 or 20 weeks) increased superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities in SHR rats compared with untreated control SHR rats. Carbachol-induced relaxation of aortic rings was impaired in control SHR rats and was restored by simvastatin treatment. Addition of SOD improved the response in control SHR rats and did not have any effect in treated SHR rats. Addition of diethyldithiocarbamic acid, a selective inhibitor of SOD, produced a mild non-significant impairment in carbachol-induced relaxation in control SHR rats, suggesting a deficient antioxidant system in these animals. However, in treated SHR and in WKY rats, impairment of the relaxation was marked, implying that SOD activity in these animals was important to maintain endothelial function. In aortic rings without endothelium from SHR rats, contraction induced by free radicals was substantially higher than in WKY rats. This effect was attenuated in 1-mg-treated rats and abolished in 2-mg-treated rats. CONCLUSIONS: Simvastatin promotes intracellular antioxidant systems, fundamentally SOD, restoring endothelial function but not having any effect on blood pressure.

Preservation of vascular contraction during ageing: dual effect on calcium handling and sensitization.

(1) The present study was aimed to characterize the effects of ageing on vascular contraction by noradrenaline in rat isolated arteries. The existence of vascular bed heterogeneity was investigated in endothelium-denuded conductance (aorta) and resistance (small mesenteric artery, SMA) arteries, with respect to Ca(2+) handling, Ca(2+) sensitization or Ca(2+)-independent mechanisms. (2) In both arteries, contractions to noradrenaline were not different between adult and aged rats. (3) In Ca(2+)- free medium, noradrenaline elicited a transient increase in tension that was reduced by the Ca(2+) mobilizing agents, ryanodine and thapsigargin, in arteries from adult rats. A loss of the thapsigargin- but not the ryanodine-sensitive component of noradrenaline-induced contraction was observed in the two arteries from aged rats. (4) After depletion of Ca(2+) stores with noradrenaline, addition of exogenous CaCl(2) produced a sustained contraction that was decreased to the same extent by the protein kinase C inhibitor, GF 109203X and the tyrosine kinase inhibitor, tyrphostin A-23, in arteries from adult and aged rats. The Rho-associated protein kinase inhibitor, Y-27632, caused identical relaxation of noradrenaline pre-contracted arteries from both age groups. (5) Basal intracellular calcium ([Ca(2+)](i)) was higher in SMA from aged than from adult rats. In addition, the noradrenaline [Ca(2+)](i)-force relationship was significantly shifted to the right in the SMA from aged rats. (6) Altogether, these data indicate that responsiveness to noradrenaline is preserved both in conductance and resistance arteries with ageing. The latter results from the association of increased basal [Ca(2+)](i), changes in Ca(2+) handling at the level of thapsigargin-sensitive sarcoplasmic reticulum Ca(2+)-ATPases and decreased myofilament sensitivity to Ca(2+).

Endothelium-dependent vasodilator and antioxidant properties of a novel enzymatic extract of grape pomace from wine industrial waste.

The aim of the present study was to evaluate the vascular effects of an enzymatic extract of grape pomace (GP-EE) on isolated arteries, focusing our attention on endothelium-derived relaxation and on its antioxidant properties. Grape pomace derived from wine making was extracted by an enzymatic process and its composition of polyphenols was evaluated by HPLC and ESI-MS/MS, detecting kaempferol, catechin, quercetin and procyanidins B1 and B2, trace levels of resveratrol and tracing out gallocatechin and anthocyanidins. GP-EE induced endothelium- and NO-dependent vasodilatation of both rat aorta and small mesenteric artery (SMA) segments and reduced Phe-induced response in aortic rings. Both ORAC and DPPH assays confirmed antioxidant scavenging properties of GP-EE, which also prevented O(2)(·-) production (assessed by DHE fluorescence) and contraction elicited by ET-1. These results provide evidence that GP-EE possesses interesting antioxidant and protective vascular properties and highlight the potential interest of this extract as a functional food.