Is Curcumine Useful in the Treatment and Prevention of the Tendinopathy and Myotendinous Junction Injury? A Scoping Review.

Physical activity in general and sports in particular, is a mechanism that produces stress and generates great force in the tendon and in the muscle-tendon unit, which increases the risk of injury (tendinopathies). Eccentric and repetitive contraction of the muscle precipitates persistent microtraumatism in the tendon unit. In the development of tendinopathies, the cellular process includes inflammation, apoptosis, vascular, and neuronal changes. Currently, treatments with oral supplements are frequently used. Curcumin seems to preserve, and even repair, damaged tendons. In this systematic review, we focus more especially on the benefits of curcumin. The biological actions of curcumin are diverse, but act around three systems: (a) inflammatory, (b) nuclear factor B (NF-κB) related apoptosis pathways, and (c) oxidative stress systems. A bibliographic search is conducted under the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as a basis for reporting reliable systematic reviews to perform a Scoping review. After analysing the manuscripts, we can conclude that curcumin is a product that demonstrates a significant biological antialgic, anti-inflammatory, and antioxidant power. Therefore, supplementation has a positive effect on the inflammatory and regenerative response in tendinopathies. In addition, curcumin decreases and modulates the cell infiltration, activation, and maturation of leukocytes, as well as the production of pro-inflammatory mediators at the site of inflammation.

Immune-Mediated Diseases from the Point of View of Psychoneuroimmunoendocrinology.

Immune-mediated inflammatory diseases (IMIDs) represent a large group of diseases (Crohn's, ulcerative colitis, psoriasis, lupus, and rheumatoid arthritis) evidenced by systemic inflammation and multiorgan involvement. IMIDs result in a reduced quality of life and an economic burden for individuals, health care systems, and countries. In this brief descriptive review, we will focus on some of the common biological pathways of these diseases from the point of view of psychoneuroimmunoendocrinology (PNIE). PNIE consists of four medical disciplines (psychology, nervous system, immune system, and endocrine system), which are key drivers behind the health-disease concept that a human being functions as a unit. We examine these drivers and emphasize the need for integrative treatments that addresses the disease from a psychosomatic point of view.

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities.

Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2-3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, particularly in hypoxic regions, also exerting antimicrobial, immunomodulatory and angiogenic properties, among others. In this review, we will discuss in detail the physiological relevance of oxygen and the therapeutical basis of HBOT, collecting current indications and underlying mechanisms. Furthermore, potential areas of research will also be examined, including inflammatory and systemic maladies, COVID-19 and cancer. Finally, the adverse effects and contraindications associated with this therapy and future directions of research will be considered. Overall, we encourage further research in this field to extend the possible uses of this procedure. The inclusion of HBOT in future clinical research could be an additional support in the clinical management of multiple pathologies.

Molécula 1 de Adhesión Intercelular Soluble en menopáusicas tratadas con estradiol oral o transdérmico / Soluble Intercellular Adhesion Molecule 1 In Postmenopausal Women Treated With Oral Or Transdermal Estradiol

El objetivo de la investigación fue comparar las modificaciones de las concentraciones plasmáticas de la molécula 1 de adhesión intercelular soluble en menopáusicas tratadas con estradiol oral o transdérmico después de 3 meses de uso. Se realizó una investigación con una muestra de 140 pacientes menopáusicas que asistieron a la consulta de Medicina Interna, Endocrinología y Menopausia del Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Se asignó a 70 pacientes tratamiento con estradiol oral (grupo A) y a 70 pacientes tratamiento con estradiol transdérmico (grupo B). Se evaluaron las concentraciones plasmáticas de molécula 1 de adhesión intercelular soluble antes y después de 3 meses de tratamiento. (p = ns). Las concentraciones plasmáticas de la molécula 1 de adhesión intercelular soluble demostraron una reducción después de 3 meses de tratamiento en ambos grupos (grupo A: 279,1 +/- 76,5 ng/ml al inicio comparado con 241,7 +/- 68,4 ng/ml después del tratamiento y grupo B: 251,9 +/- 73,2 ng/ml después del tratamiento comparado con el valor promedio inicial de 288,7 +/- 62,7 ng/ml; p < 0,05). Se concluye que el uso de estradiol transdérmico puede ser una alternativa eficaz al uso de estradiol oral después de 3 meses de uso, debido a que ambos tratamientos producen disminuciones en las concentraciones plasmáticas de molécula 1 de adhesión intercelular soluble.

The objective of research was: to compare modifications of plasma concentrations of solubleintercellular adhesion molecule 1 in postmenopausal women treated with oral or estradiol after 3 months of use. This study included 140 postmenopausal women attending the Internal Medicine, Endocrinology and Menopause Departments at the Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Seventy patients were assigned to be treated with oral estradiol (group A) and 70 patients were treated with transdermal estradiol (group B). Plasma concentrations of soluble intercellular adhesion molecule 1 were measured before and after 3 months of treatment. There were no statically significant differences in general characteristics between the two treatment groups (p = ns). In both groups, soluble intercellular adhesion molecule 1 was reduced after 3 months of treatment (group A: 279.1 +/- 76.5 ng/ml before treatment compared with 241.7 +/- 68.4 ng/ml after treatment and group B: 251.9 +/- 73.2 ng/ml after treatment compared with initial mean value of 288.7 +/- 62.7 ng/ml; p < 0.05). It is concluded that transdermal estradiol could be an effective alternative to oral estradiol after 3 months of use since both treatments decreased plasma concentrations of soluble intercellular adhesion molecule 1. KEYWORDS: Estradiol; Menopause; Transdermal; soluble intercellular adhesión.

The biological response modifier AM3 attenuates the inflammatory cell response and hepatic fibrosis in rats with biliary cirrhosis.

BACKGROUND: An inflammatory immune system response ensues in the liver and in the systemic circulation in cirrhosis, where it contributes to hepatic fibrosis and peripheral vasodilation. Modulation of the inflammatory response without increasing susceptibility to infection is a therapeutic target in cirrhosis. AM3 is a low-toxicity biological response modifier with regulatory effects on innate and adaptative immunity, and the ability to normalise the production of tumour necrosis factor alpha (TNFalpha). AIMS: This was an experimental study to investigate the effects of oral AM3 on the systemic and hepatic inflammatory response, liver fibrosis and on the haemodynamic abnormalities of portal hypertension in rats with biliary cirrhosis. DESIGN: Bile-duct ligated rats received a 3-week oral course of AM3 or placebo. RESULTS: In cirrhotic rats, AM3 blunted the inflammatory switch of circulating and intrahepatic monocytes and T-cells to TNFalpha and interferon gamma (IFNgamma) production, respectively. AM3 modified the intrahepatic polarisation pattern of the regulatory cytokines, decreasing the mRNA expression of transforming growth factor beta1 (TGFbeta1), interleukin 4 (IL4), and IFNgamma, and increasing that of IL10. Total and IFNgamma-producing natural killer (NK) cells were lowered by AM3 in the peripheral blood and liver of cirrhotic rats. The immunomodulatory effects of AM3 led to reduced hepatic fibrogenesis in cirrhotic rats, as shown by decreased area of liver fibrosis, hydroxyproline content and mRNA expression of procollagen alpha1(I). Besides, AM3 lowered portal pressure and systemic hyperaemia. CONCLUSIONS: The biological response modifier AM3 reverses the concurrent inflammatory immune system activation in peripheral blood and liver of experimental established cirrhosis, which results in reductions of hepatic fibrosis, portal pressure and peripheral vasodilation.

Treatment with AM3 restores defective T-cell function in COPD patients.

BACKGROUND: Lymphocyte alterations have been associated with an increased prevalence of acute respiratory infections in COPD patients. AM3 is an oral immunomodulator that normalizes the defective functions of peripheral blood natural killer and phagocytic cells in COPD patients and improves their health-related quality of life. OBJECTIVES: To characterize putative systemic abnormalities of the T-cell compartment in COPD patients, and to investigate whether AM3 can restore such abnormalities. DESIGN: The study was a randomized, prospective, double-blind, placebo-controlled trial in a cohort of COPD patients. The results were also compared to those of nonsmoker and ex-smoker healthy control subjects. SETTING: Outpatient departments of four hospitals. PATIENTS: Seventy COPD patients were randomized to receive either AM3 or a placebo orally for 90 consecutive days. Populations of 36 healthy nonsmokers and 36 healthy ex-smokers were used as control subjects. MEASUREMENTS: Peripheral blood mononuclear cell (PBMC) proliferation and production of interleukin (IL)-2, IL-4, IL-12p40, tumor necrosis factor-alpha, and interferon (IFN)-gamma proteins in response to the T-cell polyclonal mitogens were assessed at baseline and at the end of treatment. RESULTS: The proliferative response was significantly decreased in COPD patients. Decreased production of IFN-gamma was the only defect in the profiles of the cytokine measures, and was selectively observed in COPD patients, but not in nonsmoker and ex-smoker healthy control subjects. Treatment with AM3 significantly restored the PBMC proliferative response to polyclonal mitogens and significantly promoted stimulated IFN-gamma production in these patients. The normalization of these proliferative responses was not related to significant variations in the numbers of peripheral blood monocytes, CD3+, CD4+, CD8+ cells or of any major naïve/memory/activated T-cell subset. The increased IFN-gamma production in the AM3 study arm was associated with an increase in the mean of number of IFN-gamma molecules produced per CD8+ T cells. CONCLUSIONS: PBMCs of COPD patients showed clear functional T-lymphocyte abnormalities that are rescued by AM3 treatment.

Treatment with the immunomodulator AM3 improves the health-related quality of life of patients with COPD.

BACKGROUND: COPD has a severe impact on patient quality of life. AM3 is an orally effective immunomodulator that can normalize the defective antimicrobial functions of the immune system effector cells of COPD patients. OBJECTIVES: We analyzed the effect of AM3 on exacerbation frequency and health-related quality of life (HRQL) of COPD patients with moderate disease. DESIGN: A randomized, double-blind, placebo-controlled trial. SETTING: Outpatient departments of 21 hospitals. METHODS: A total of 253 COPD patients with a mean age of 67.7 years (SD, 8.1 years) and mean FEV(1) percentage of predicted of 49.6% (SD, 10.2%) were evaluated. Patients received (orally) either 3 g/d AM3 or a matched placebo for 180 consecutive days. Patient quality of life was measured using the St. George's Respiratory Questionnaire (SGRQ). RESULTS: There were no differences in the exacerbation frequency of the two groups (0.82 episodes per patient in the AM3 arm vs 0.84 in the placebo arm), and 55.3% of patients were exacerbation free in the AM3 arm compared to 48.8% in the placebo arm (p = 0.11). At the end of treatment, quality of life was significantly better in the AM3 arm than in the placebo arm (SGRQ total score, 32.9; SD, 16.4, compared to 37.5; SD, 17.5 [p < 0.05]: activity score, 47.5; SD, 22.4, compared to 54.6; SD, 20.5 [p < 0.05]). The improvements in total SGRQ scores were 8.9 U (SD, 13.4 U) in the AM3 arm and 5.6 U (SD, 15.9 U) in the placebo arm (p = 0.076). Improvements on the symptoms subscale were 15.9 U (SD, 20.7 U) for the AM3 arm and 10.2 U (SD, 21.3 U) for the placebo arm (p < 0.05). Both AM3 and the placebo were clinically, biochemically, and hematologically well tolerated. CONCLUSIONS: AM3 is a safe, easily tolerated, effective treatment that improves the quality of life of COPD patients as measured by SGRQ scores. This effect was observed with no significant reduction in the frequency of exacerbations.

Protection against muscle damage in competitive sports players: the effect of the immunomodulator AM3.

Strenuous physical exercise of the limb muscles commonly results in damage, especially when that exercise is intense, prolonged and includes eccentric contractions. Many factors contribute to exercise-induced muscle injury and the mechanism is likely to differ with the type of exercise. Competitive sports players are highly susceptible to this type of injury. AM3 is an orally administered immunomodulator that reduces the synthesis of proinflammatory cytokines and normalizes defective cellular immune fractions. The ability of AM3 to prevent chronic muscle injury following strenuous exercise characterized by eccentric muscle contraction was evaluated in a double-blind and randomized pilot study. Fourteen professional male volleyball players from the First Division of the Spanish Volleyball League volunteered to take part. The participants were randomized to receive either placebo (n=7) or AM3 (n=7). The physical characteristics (mean+/-s) of the placebo group were as follows: age 25.7+/-2.1 years, body mass 87.2+/-4.1 kg, height 1.89+/-0.07 m, maximal oxygen uptake 65.3+/-4.2 ml.kg(-1).min(-1). Those of the AM3 group were as follows: age 26.1+/-1.9 years, body mass 85.8+/-6.1 kg, height 1.91+/-0.07 m, maximal oxygen uptake 64.6+/-4.5 ml.kg(-1).min(-1). All participants were evaluated for biochemical indices of muscle damage, including concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, creatine kinase (CK) and its MB fraction (CK-MB), myoglobin, lactate dehydrogenase, urea, creatinine and gamma-glutamyltranspeptidase, both before and 30 days after treatment (over the peak of the competitive season). In the placebo group, competitive exercise (i.e. volleyball) was accompanied by significant increases in creatine kinase (494+/-51 to 560+/-53 IU.l(-1), P < 0.05) and myoglobin (76.8+/-2.9 to 83.9+/-3.1 microg.l(-1), P < 0.05); aspartate aminotransferase (30.8+/-3.0 to 31.1+/-2.9 IU.l(-1)) and lactate dehydrogenase (380+/-31 to 376+/-29 IU.l(-1)) were relatively unchanged after the 30 days maximum effort. AM3 not only inhibited these changes, it led to a decrease from baseline serum concentrations of creatine kinase (503+/-49 to 316+/-37 IU.l(-1), P < 0.05) and myoglobin (80.1+/-3.2 to 44.1+/-2.6 IU.l(-1), P < 0.05), as well as aspartate aminotransferase (31.1+/-3.3 to 26.1+/-2.7 IU.l(-1), P < 0.05) and lactate dehydrogenase (368+/-34 to 310+/-3 IU.l(-1), P < 0.05). The concentration of CK-MB was also significantly decreased from baseline with AM3 treatment (11.6+/-1.2 to 5.0+/-0.7 IU.l(-1), P < 0.05), but not with placebo (11.4+/-1.1 to 10.8+/-1.4 IU.l(-1)). In conclusion, the use of immunomodulators, such as AM3, by elite sportspersons during competition significantly reduces serum concentrations of proteins associated with muscle damage.

AM3 (Inmunoferón) as an adjuvant to hepatitis B vaccination in hemodialysis patients.

BACKGROUND: Patients with end-stage renal disease (ESRD) undergoing hemodialysis have severe alterations in cell-mediated immunity (CMI) that increases their risk of contracting chronic hepatitis B virus (HBV) infection and decreases their protective responses to HBV vaccine. In an effort to improve the humoral response to an accelerated HBV vaccine protocol in these patients, the ability of an immunomodulator, AM3, to improve seroconversion was investigated. METHODS: A total of 269 patients were enrolled in a multicenter trial. All patients received a DNA recombinant vaccine (40 microg HBsAg/dose/day) on days 0, 10, 21, and 90. AM3 or placebo (3 g/day) was given orally for 30 consecutive days beginning 15 days prior to the first vaccine dose. Anti-HBsAg titers were measured on days 120 and 270 after the beginning of the trial. RESULTS: After one month, 207 patients could be evaluated and 132 patients after six months. The placebo and AM3-treated groups had comparable seroconversion and protective response rates one month after the final vaccine dose. The AM3 treatment group, but not the placebo group, maintained these protective titers up to six months after the final vaccine dose. At this time, the percentage of high responders (anti-HBsAg>100 IU/L) and mean anti-HBsAg titers in the AM3 group was significantly higher than in the placebo group. CONCLUSIONS: AM3 is a safe and easily tolerated oral agent that potentiates long-term serological immunity to hepatitis B in hemodialysis patients after vaccination.