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1.
Cell Death Dis ; 13(7): 659, 2022 07 28.
Article in English | MEDLINE | ID: mdl-35902579

ABSTRACT

Palmitic acid (PA) is significantly increased in the hypothalamus of mice, when fed chronically with a high-fat diet (HFD). PA impairs insulin signaling in hypothalamic neurons, by a mechanism dependent on autophagy, a process of lysosomal-mediated degradation of cytoplasmic material. In addition, previous work shows a crosstalk between autophagy and the primary cilium (hereafter cilium), an antenna-like structure on the cell surface that acts as a signaling platform for the cell. Ciliopathies, human diseases characterized by cilia dysfunction, manifest, type 2 diabetes, among other features, suggesting a role of the cilium in insulin signaling. Cilium depletion in hypothalamic pro-opiomelanocortin (POMC) neurons triggers obesity and insulin resistance in mice, the same phenotype as mice deficient in autophagy in POMC neurons. Here we investigated the effect of chronic consumption of HFD on cilia; and our results indicate that chronic feeding with HFD reduces the percentage of cilia in hypothalamic POMC neurons. This effect may be due to an increased amount of PA, as treatment with this saturated fatty acid in vitro reduces the percentage of ciliated cells and cilia length in hypothalamic neurons. Importantly, the same effect of cilia depletion was obtained following chemical and genetic inhibition of autophagy, indicating autophagy is required for ciliogenesis. We further demonstrate a role for the cilium in insulin sensitivity, as cilium loss in hypothalamic neuronal cells disrupts insulin signaling and insulin-dependent glucose uptake, an effect that correlates with the ciliary localization of the insulin receptor (IR). Consistently, increased percentage of ciliated hypothalamic neuronal cells promotes insulin signaling, even when cells are exposed to PA. Altogether, our results indicate that, in hypothalamic neurons, impairment of autophagy, either by PA exposure, chemical or genetic manipulation, cause cilia loss that impairs insulin sensitivity.


Subject(s)
Diabetes Mellitus, Type 2 , Insulin Resistance , Animals , Autophagy , Cilia/metabolism , Diabetes Mellitus, Type 2/metabolism , Humans , Hypothalamus/metabolism , Insulin/metabolism , Insulin Resistance/genetics , Mice , Neurons/metabolism , Palmitic Acid/metabolism , Palmitic Acid/pharmacology , Pro-Opiomelanocortin/metabolism , Pro-Opiomelanocortin/pharmacology
2.
Biomed Pharmacother ; 150: 112994, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35483188

ABSTRACT

Increasing evidence shows that hypothalamic dysfunction, insulin resistance, and weight loss precede and progress along with the cognitive decline in sporadic Alzheimer's Disease (AD) with sex differences. This study aimed to determine the effect of oral dietary administration of D-Chiro-inositol (DCI), an inositol used against insulin resistance associated with polycystic ovary, on the occurrence of metabolic disorders in the transgenic 5xFAD mouse model of AD (FAD: Family Alzheimer's Disease). DCI was administered from 6 to 10 months of age to male and female 5xFAD mice and control (non-Tg) littermates. Energy balance and multiple metabolic and inflammatory parameters in the hypothalamus, liver and plasma were evaluated to assess the central and peripheral effects of DCI. Results indicated that weight loss and reduced food intake in 5xFAD mice were associated with decreased neuropeptides controlling food intake and the appearance of a pro-inflammatory state in the hypothalamus. Oral administration of DCI partially restored energy balance and hypothalamic parameters, highlighting an increased expression of Npy and Agrp and female-specific downregulation of Gfap and Igf1. DCI also partially normalized impaired insulin signaling and circulating insulin, GLP-1, and GIP deficiencies in 5xFAD mice. Principal component analysis of metabolic parameters indicated the presence of a female-specific fatty liver in 5xFAD mice: DCI administration reversed hepatic fat accumulation, ß-oxidation, inflammation and increased GOT and GPT levels. Our study depicts that metabolic impairment along with the cognitive decline in a mouse model of AD, which is exacerbated in females, can be ameliorated by oral supplementation with insulin-sensitizing DCI.


Subject(s)
Alzheimer Disease , Insulin Resistance , Alzheimer Disease/drug therapy , Alzheimer Disease/metabolism , Animals , Disease Models, Animal , Female , Humans , Inositol/pharmacology , Inositol/therapeutic use , Insulin/metabolism , Insulin Resistance/physiology , Male , Mice , Mice, Transgenic , Weight Loss
3.
Nutr Neurosci ; 25(5): 931-944, 2022 May.
Article in English | MEDLINE | ID: mdl-32954972

ABSTRACT

Aim: We aimed to investigate whether maternal malnutrition during gestation/lactation induces long-lasting changes on inflammation, lipid metabolism and endocannabinoid signaling in the adult offspring hypothalamus and the role of hypothalamic astrocytes in these changes.Methods: We analyzed the effects of a free-choice hypercaloric palatable diet (P) during (pre)gestation, lactation and/or post-weaning on inflammation, lipid metabolism and endogenous cannabinoid signaling in the adult offspring hypothalamus. We also evaluated the response of primary hypothalamic astrocytes to palmitic acid and anandamide.Results: Postnatal exposure to a P diet induced factors involved in hypothalamic inflammation (Tnfa and Il6) and gliosis (Gfap, vimentin and Iba1) in adult offspring, being more significant in females. In contrast, maternal P diet reduced factors involved in astrogliosis (vimentin), fatty acid oxidation (Cpt1a) and monounsaturated fatty acid synthesis (Scd1). These changes were accompanied by an increase in the expression of the genes for the cannabinoid receptor (Cnr1) and Nape-pld, an enzyme involved in endocannabinoid synthesis, in females and a decrease in the endocannabinoid degradation enzyme Faah in males. These changes suggest that the maternal P diet results in sex-specific alterations in hypothalamic endocannabinoid signaling and lipid metabolism. This hypothesis was tested in hypothalamic astrocyte cultures, where palmitic acid (PA) and the polyunsaturated fatty acid N-arachidonoylethanolamine (anandamide or AEA) were found to induce similar changes in the endocannabinoid system (ECS) and lipid metabolism.Conclusion: These results stress the importance of both maternal diet and sex in long term metabolic programming and suggest a possible role of hypothalamic astrocytes in this process.


Subject(s)
Cannabinoids , Endocannabinoids , Adult Children , Arachidonic Acids , Astrocytes/metabolism , Cannabinoids/metabolism , Diet , Female , Gliosis/metabolism , Humans , Hypothalamus/metabolism , Inflammation/metabolism , Lipid Metabolism , Male , Palmitic Acid/metabolism , Polyunsaturated Alkamides , Vimentin/metabolism
4.
Int J Mol Sci ; 22(12)2021 Jun 11.
Article in English | MEDLINE | ID: mdl-34208173

ABSTRACT

Maternal malnutrition in critical periods of development increases the risk of developing short- and long-term diseases in the offspring. The alterations induced by this nutritional programming in the hypothalamus of the offspring are of special relevance due to its role in energy homeostasis, especially in the endocannabinoid system (ECS), which is involved in metabolic functions. Since astrocytes are essential for neuronal energy efficiency and are implicated in brain endocannabinoid signaling, here we have used a rat model to investigate whether a moderate caloric restriction (R) spanning from two weeks prior to the start of gestation to its end induced changes in offspring hypothalamic (a) ECS, (b) lipid metabolism (LM) and/or (c) hypothalamic astrocytes. Monitorization was performed by analyzing both the gene and protein expression of proteins involved in LM and ECS signaling. Offspring born from caloric-restricted mothers presented hypothalamic alterations in both the main enzymes involved in LM and endocannabinoids synthesis/degradation. Furthermore, most of these changes were similar to those observed in hypothalamic offspring astrocytes in culture. In conclusion, a maternal low caloric intake altered LM and ECS in both the hypothalamus and its astrocytes, pointing to these glial cells as responsible for a large part of the alterations seen in the total hypothalamus and suggesting a high degree of involvement of astrocytes in nutritional programming.


Subject(s)
Astrocytes/metabolism , Caloric Restriction , Endocannabinoids/metabolism , Hypothalamus/metabolism , Lipid Metabolism , Signal Transduction , Animals , Animals, Newborn , Body Weight , Brain/pathology , Female , Gene Expression Regulation , Gliosis/genetics , Gliosis/pathology , Inflammation/genetics , Inflammation/pathology , Lipid Metabolism/genetics , Pregnancy , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats , Signal Transduction/genetics
5.
Int J Mol Sci ; 22(10)2021 May 20.
Article in English | MEDLINE | ID: mdl-34065168

ABSTRACT

Increasing evidence links metabolic disorders with neurodegenerative processes including Alzheimer's disease (AD). Late AD is associated with amyloid (Aß) plaque accumulation, neuroinflammation, and central insulin resistance. Here, a humanized AD model, the 5xFAD mouse model, was used to further explore food intake, energy expenditure, neuroinflammation, and neuroendocrine signaling in the hypothalamus. Experiments were performed on 6-month-old male and female full transgenic (Tg5xFAD/5xFAD), heterozygous (Tg5xFAD/-), and non-transgenic (Non-Tg) littermates. Although histological analysis showed absence of Aß plaques in the hypothalamus of 5xFAD mice, this brain region displayed increased protein levels of GFAP and IBA1 in both Tg5xFAD/- and Tg5xFAD/5xFAD mice and increased expression of IL-1ß in Tg5xFAD/5xFAD mice, suggesting neuroinflammation. This condition was accompanied by decreased body weight, food intake, and energy expenditure in both Tg5xFAD/- and Tg5xFAD/5xFAD mice. Negative energy balance was associated with altered circulating levels of insulin, GLP-1, GIP, ghrelin, and resistin; decreased insulin and leptin hypothalamic signaling; dysregulation in main metabolic sensors (phosphorylated IRS1, STAT5, AMPK, mTOR, ERK2); and neuropeptides controlling energy balance (NPY, AgRP, orexin, MCH). These results suggest that glial activation and metabolic dysfunctions in the hypothalamus of a mouse model of AD likely result in negative energy balance, which may contribute to AD pathogenesis development.


Subject(s)
Alzheimer Disease/metabolism , Energy Metabolism/physiology , Hypothalamus/metabolism , Metabolic Diseases/metabolism , Amyloid/metabolism , Amyloid beta-Peptides/metabolism , Amyloid beta-Protein Precursor/metabolism , Amyloidogenic Proteins/metabolism , Animals , Brain/metabolism , Disease Models, Animal , Female , Gastric Inhibitory Polypeptide/metabolism , Ghrelin/metabolism , Glucagon-Like Peptide 1/metabolism , Insulin/metabolism , Male , Mice , Mice, Transgenic , Plaque, Amyloid/metabolism , Resistin/metabolism
6.
Int J Mol Sci ; 20(14)2019 Jul 19.
Article in English | MEDLINE | ID: mdl-31331069

ABSTRACT

Mutant mice with respect to the splicing factor Zrsr1 present altered spermatogenesis and infertility. To investigate whether Zrsr1 is involved in the homeostatic control that the hypothalamus exerts over reproductive functions, we first analyzed both differential gene and isoform expression and alternative splicing alterations in Zrsr1 mutant (Zrsr1mu) hypothalamus; second, we analyzed the spontaneous and social behavior of Zrsr1mu mice; and third, we analyzed adult cell proliferation and survival in the Zrsr1mu hypothalamus. The Zrsr1mu hypothalamus showed altered expression of genes and isoforms related to the glutathione metabolic process, synaptonemal complex assembly, mRNA transport, and altered splicing events involving the enrichment of U12-type intron retention (IR). Furthermore, increased IR in U12-containing genes related with the prolactin, progesterone, and gonadotropin-releasing hormone (GnRH) reproductive signaling pathway was observed. This was associated with a hyperactive phenotype in both males and females, with an anxious phenotype in females, and with increased social interaction in males, instead of the classical aggressive behavior. In addition, Zrsr1mu females but not males exhibited reduced cell proliferation in both the hypothalamus and the subventricular zone. Overall, these results suggest that Zrsr1 expression and function are relevant to organization of the hypothalamic cell network controlling behavior.


Subject(s)
Introns , Mutation , Neurogenesis , RNA Splicing Factors/genetics , RNA Splicing , Alternative Splicing , Animals , Behavior, Animal , Cell Line, Tumor , Cell Proliferation , Cell Survival/genetics , Gene Expression Regulation , Humans , Hypothalamus/metabolism , Mice , Mice, Knockout , Phenotype , RNA Splicing Factors/metabolism , Social Behavior
7.
Acta Physiol (Oxf) ; 226(2): e13244, 2019 06.
Article in English | MEDLINE | ID: mdl-30589509

ABSTRACT

AIM: We aimed to investigate whether a dysregulated maternal diet during gestation and lactation induces long-lasting changes in the hypothalamic control of feeding behavior in the offspring and whether this effect is sex specific. METHODS: The study included an analysis of appetite-regulating metabolic hormones and hypothalamic signaling in male and female offspring in adulthood after exposure to a free-choice high-calorie palatable low-protein (P) diet or standard chow (C) during (pre)gestation/lactation (maternal) and/or postweaning (offspring). RESULTS: Maternal exposure to the P diet resulted in decreased protein intake and body weight gain in dams and decreased body weight gain in offspring during lactation. The maternal P diet (PC) specifically increased feed efficacy and decreased body weight and cholesterol levels in the female offspring in adulthood, but no changes in adiposity or leptin levels were found. In contrast, P diet exposure after weaning (CP and PP) increased caloric intake, adiposity and circulating levels of leptin in the male and female offspring in adulthood. The hypothalami of the female offspring exposed to the maternal P diet (PC and PP) expressed high levels of the phospho-leptin receptor and low levels of SOCS3, phospho-IRS1 and phospho-AMPK, regardless of the postweaning diet. The hypothalami of the female rats in the PC group also showed increased levels of STAT3 and the orexigenic neuropeptide Agrp. CONCLUSIONS: Maternal exposure to a free-choice high-calorie low-protein diet induces a long-term feed efficacy associated with changes in leptin signaling through IRS-1 and AMPK dephosphorylation in the hypothalami of female offspring in adulthood.


Subject(s)
Behavior, Animal/drug effects , Diet, Protein-Restricted/adverse effects , Leptin/pharmacology , Prenatal Exposure Delayed Effects , AMP-Activated Protein Kinases/drug effects , AMP-Activated Protein Kinases/metabolism , Animals , Behavior, Animal/physiology , Feeding Behavior/drug effects , Feeding Behavior/physiology , Female , Hypothalamus/drug effects , Hypothalamus/metabolism , Leptin/metabolism , Pregnancy , Prenatal Exposure Delayed Effects/metabolism , Rats, Wistar , Receptors, Leptin/drug effects , Signal Transduction/drug effects
8.
Sci Rep ; 8(1): 9858, 2018 06 29.
Article in English | MEDLINE | ID: mdl-29959379

ABSTRACT

Chronic NP-1 administration reduces body weight and hepatic steatosis despite induction of tolerance in adiponectin gene transcription with respect to the acute actions of this drug. This study explored the hypothesis that NP-1 could exert these effects through mechanisms independent of adiponectin. To this aim, we took advantage of the Zucker (fa/fa) rat model, which exhibits obesity, fatty liver and elevated leptin and adiponectin levels. Body weight and food intake were reduced after chronic NP-1 treatment. Plasma TNFα concentrations were elevated but no increase in adiponectin was found. Even so, NP-1 ameliorated fatty liver and corrected dyslipidemia by mechanisms probably associated with reduced feeding, transcription of Cpt1 and down-regulation of Hmgcr-CoA expression. In brown fat tissue NP-1 increased Dnmt1 (inhibitor of Adipoq) while it reduced Ucp1 expression and heat production, which excludes thermogenesis as a mechanism of the NP-1 slimming effect. The anti-obesity action of chronic NP-1 administration might be mediated by TNFα, which is known to have anorectic actions in the hypothalamus and to regulate both Dmnt1 and Ucp1 expression in adipose tissues. This finding opens up the possibility of using NP-1-mediated TNFα-induced weight loss as an innovative treatment of complicated obesity under strict pharmacologic control.


Subject(s)
Adiponectin/metabolism , Dyslipidemias/prevention & control , Gene Expression Regulation/drug effects , Obesity/complications , Thiazoles/pharmacology , Tumor Necrosis Factor-alpha/blood , Adiponectin/genetics , Adipose Tissue, Brown/drug effects , Adipose Tissue, Brown/metabolism , Animals , Body Weight , DNA (Cytosine-5-)-Methyltransferase 1/genetics , DNA (Cytosine-5-)-Methyltransferase 1/metabolism , Dyslipidemias/etiology , Dyslipidemias/metabolism , Dyslipidemias/pathology , Feeding Behavior , Hypothalamus/drug effects , Hypothalamus/metabolism , Liver/drug effects , Liver/metabolism , Male , Promoter Regions, Genetic , Rats , Rats, Zucker , Thinness/complications , Weight Loss
9.
Article in Spanish | LILACS, MTYCI | ID: biblio-910899

ABSTRACT

Este trabajo aborda la importancia de prevenir el uso indiscriminado de productos naturales o macrobióticos, sus posibles efectos perjudiciales en la salud, así concienciar a profesionales en el área de la salud sobre la importancia de incluir este tema durante la historia médica. Se analiza el incremento en el uso de productos naturales o macrobióticos, las ventajas de la etnomedicina como un resurgimiento de la industria farmacéutica y las desventajas que acarrea este tipo de productos. Las hierbas ofrecen una alternativa terapéutica como la creación de nuevos fármacos, aunque poseen efectos secundarios que podrían arriesgar la salud de los pacientes.


Subject(s)
Humans , Plants, Medicinal , Biological Products , Medicine, Traditional , Public Health , Ginkgo biloba , Costa Rica
10.
Biofactors ; 42(6): 600-611, 2016 Nov 12.
Article in English | MEDLINE | ID: mdl-27213962

ABSTRACT

To investigate the role of glucagon-like-peptide-1 receptor (GLP-1R) in peripheral lipid metabolism. Both lean and high-fat diet (HFD)-induced obesity (DIO) rats were used to compare the peripheral effects of the subcutaneous and repeated administration of the GLP-1R agonist liraglutide on the expression of key regulators involved in lipid metabolism, ß-oxidation and thermogenesis in liver, abdominal muscle, and epididymal white adipose tissue (eWAT). We observed that liraglutide reduced caloric intake, body weight, and plasma levels of triglycerides and VLDL in a diet-independent manner. However, changes in liver fat content and the expression of lipid metabolism regulators were produced in a diet and tissue-dependent manner. In lean rats, liraglutide increased the gene/protein expression of elements involved in lipogenesis (ChREBP, Acaca/ACC, Fasn/FAS, Scd1/SCD1, PPARα/γ), ß-oxidation (CPT1b), and thermogenesis (Cox4i1, Ucp1/UCP1) in eWAT and muscle, which suggest an increase in fatty-acid flux and utilization to activate energy expenditure. Regarding DIO rats, the specific reduction of liver lipid content by liraglutide was associated with a decreased expression of main elements involved in lipogenesis (phospho-ACC), peroxisomal ß-oxidation (ACOX1), and lipid flux/storage (Pparγ/PPARγ) in liver, which suggest a recovery of lipid homeostasis. Interestingly, the muscle of DIO rats treated with liraglutide showed a decreased expression of PPARγ and the thermogenic factor UCP1. These results help us to better understand the peripheral mechanisms regulating lipid metabolism that underlay the effectiveness of GLP-1 analogues for the treatment of diabetes and obesity. © 2016 BioFactors, 42(6):600-611, 2016.


Subject(s)
Anti-Obesity Agents/pharmacology , Lipid Metabolism/drug effects , Liraglutide/pharmacology , Obesity/drug therapy , Animals , Anti-Obesity Agents/therapeutic use , Drug Evaluation, Preclinical , Electron Transport Complex IV/metabolism , Energy Intake/drug effects , Fatty Acids/metabolism , Glucagon-Like Peptide-1 Receptor/agonists , Liraglutide/therapeutic use , Liver/drug effects , Liver/enzymology , Male , Metabolic Networks and Pathways , Obesity/metabolism , Organ Specificity , PPAR alpha/metabolism , PPAR gamma/metabolism , Rats, Sprague-Dawley , Thermogenesis/drug effects , Uncoupling Protein 1/metabolism , Uncoupling Protein 2/metabolism
11.
PLoS One ; 8(5): e64750, 2013.
Article in English | MEDLINE | ID: mdl-23741384

ABSTRACT

Soy extracts have been claimed to be neuroprotective against brain insults, an effect related to the estrogenic properties of isoflavones. However, the effects of individual isoflavones on obesity-induced disruption of adult neurogenesis have not yet been analyzed. In the present study we explore the effects of pharmacological administration of daidzein, a main soy isoflavone, in cell proliferation, cell apoptosis and gliosis in the adult hippocampus of animals exposed to a very high-fat diet. Rats made obese after 12-week exposure to a standard or high-fat (HFD, 60%) diets were treated with daidzein (50 mg kg(-1)) for 13 days. Then, plasma levels of metabolites and metabolic hormones, cell proliferation in the subgranular zone of the dentate gyrus (SGZ), and immunohistochemical markers of hippocampal cell apoptosis (caspase-3), gliosis (GFAP and Iba-1), food reward factor FosB and estrogen receptor alpha (ERα) were analyzed. Treatment with daidzein reduced food/caloric intake and body weight gain in obese rats. This was associated with glucose tolerance, low levels of HDL-cholesterol, insulin, adiponectin and testosterone, and high levels of leptin and 17ß-estradiol. Daidzein increased the number of phospho-histone H3 and 5-bromo-2-deoxyuridine (BrdU)-ir cells detected in the SGZ of standard diet and HFD-fed rats. Daidzein reversed the HFD-associated enhanced immunohistochemical expression of caspase-3, FosB, GFAP, Iba-1 and ERα in the hippocampus, being more prominent in the dentate gyrus. These results suggest that pharmacological treatment with isoflavones regulates metabolic alterations associated with enhancement of cell proliferation and reduction of apoptosis and gliosis in response to high-fat diet.


Subject(s)
Dentate Gyrus/drug effects , Gliosis/prevention & control , Isoflavones/pharmacology , Neuroglia/drug effects , Neurons/drug effects , Neuroprotective Agents/pharmacology , Obesity/prevention & control , Animals , Apoptosis/drug effects , Calcium-Binding Proteins/genetics , Calcium-Binding Proteins/metabolism , Caspase 3/genetics , Caspase 3/metabolism , Cell Proliferation , Dentate Gyrus/metabolism , Dentate Gyrus/pathology , Diet, High-Fat/adverse effects , Energy Intake/drug effects , Estrogen Receptor alpha/genetics , Estrogen Receptor alpha/metabolism , Gene Expression/drug effects , Glial Fibrillary Acidic Protein/genetics , Glial Fibrillary Acidic Protein/metabolism , Gliosis/etiology , Gliosis/genetics , Gliosis/metabolism , Isoflavones/isolation & purification , Male , Microfilament Proteins/genetics , Microfilament Proteins/metabolism , Neuroglia/metabolism , Neuroglia/pathology , Neurons/metabolism , Neurons/pathology , Neuroprotective Agents/isolation & purification , Obesity/etiology , Obesity/genetics , Obesity/metabolism , Plant Extracts/chemistry , Proto-Oncogene Proteins c-fos/genetics , Proto-Oncogene Proteins c-fos/metabolism , Rats , Rats, Wistar , Glycine max/chemistry
12.
Rev. costarric. cienc. méd ; 24(3/4): 149-165, jul.-dic. 2003. ilus
Article in Spanish | LILACS | ID: lil-400999

ABSTRACT

Los miembros del género Helicobacter, descrito en 1989, colonizan el estómago e intestino de humanos y algunas especies animales. El número de especies en este género se ha expandido desde 1983, cuando se describió H. pylori, la especie tipo; actualmente el género incluye más de 20 especies. En humanos, descrita en 1983, es reconocida como la principal causa de gastritis crónica, úlceras gástricas y duodenales y algunos tipos de cáncer gástrico. También, algunas especies relacionadas se han asociado ocasionalmente con septicemias en pacientes con SIDA. Helicobacter spp. son bacilos Gram negativos, catalasa, oxidasa y ureasa positivos, miden de 2,5 a 3,5 mm de largo por 0,5 a 1 mm de diámetro, son microaerofílicos, curvados o espirales con uno o varios flagelos envainados polares, localizados en uno de los extremos de la bacteria y al menos tres especies tienen fibras periplásmaticas. Los estudios epidemiológicos revelan que la infección con H. pylori es más común en países en desarrollo que en los desarrollados, debido a muchos factores del ambiente como hacinamiento, disponibilidad de agua potable, nivel económico, contaminación fetal y otros factores de hospedero y de agente como la edad y el tipo de cepa, respectivamente. Aunque este agente es sensible a muchos antimicrobianos in vitor, es difícil de erradicar del estómago, debido a su nicho ácido y su localización extracelular, pues reside en la cepa de mucho del estoómago y desarrolla resistencia a los antibióticos que usualmente se utilizan en su tratamiento, especialmente el metronidazol. Las monoterapias o las terapias duales muestran niveles inaceptablemente bajos de curación; por esta razón, se han propuesto varios esquemas triples o cuádruples de terapia; los primeros utilizan uno o dos antibióticos (metronidazol, amoxicilina, claritromicina, tetraciclina), una droga supresora de la secreción ácida y compuesto de bismuto (Pepto Bismol o citrato de bismuto). Las terapias cuádruples incorporan adicionalmente un inhibidor de la bomba protónica. Comúnmente, la tasa de erradicación de los diferentes esquemas oscila entre un 70 y 90 por ciento. El alto costo del tratamiento, especialmente de los esquemas cuádruples, su baja tolerabilidad, su abandono y la emergencia de cepas de H. pylori resistentes a los antibióticos, son responsables de la talla en un 10 a 30 por ciento de los casos...


Subject(s)
Humans , Gastritis , Helicobacter , Helicobacter pylori , Plants, Medicinal , Peptic Ulcer/drug therapy , Peptic Ulcer/therapy , Costa Rica
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