The Use of an Antioxidant Enables Accurate Evaluation of the Interaction of Curcumin on Organic Anion-Transporting Polypeptides 4C1 by Preventing Auto-Oxidation.

Flavonoids have garnered attention because of their beneficial bioactivities. However, some flavonoids reportedly interact with drugs via transporters and may induce adverse drug reactions. This study investigated the effects of food ingredients on organic anion-transporting polypeptide (OATP) 4C1, which handles uremic toxins and some drugs, to understand the safety profile of food ingredients in renal drug excretion. Twenty-eight food ingredients, including flavonoids, were screened. We used ascorbic acid (AA) to prevent curcumin oxidative degradation in our method. Twelve compounds, including apigenin, daidzein, fisetin, genistein, isorhamnetin, kaempferol, luteolin, morin, quercetin, curcumin, resveratrol, and ellagic acid, altered OATP4C1-mediated transport. Kaempferol and curcumin strongly inhibited OATP4C1, and the Ki values of kaempferol (AA(-)), curcumin (AA(-)), and curcumin (AA(+)) were 25.1, 52.2, and 23.5 µM, respectively. The kinetic analysis revealed that these compounds affected OATP4C1 transport in a competitive manner. Antioxidant supplementation was determined to benefit transporter interaction studies investigating the effects of curcumin because the concentration-dependent curve evidently shifted in the presence of AA. In this study, we elucidated the food-drug interaction via OATP4C1 and indicated the utility of antioxidant usage. Our findings will provide essential information regarding food-drug interactions for both clinical practice and the commercial development of supplements.

Calcium-Phosphorus Product Is Associated with Adverse Prognosis in Hospitalized Patients with Heart Failure and Chronic Kidney Disease.

It has been reported that high levels of calcium-phosphorus (Ca-P) product are an indicator of coronary calcification and mortality risk in patients undergoing chronic hemodialysis. In the present study, we aimed to evaluate the significance of Ca-P product to predict the prognosis of patients with heart failure (HF) and chronic kidney disease (CKD). We conducted a prospective observational study of 793 patients with decompensated HF and CKD, and measured the value of Ca-P product. The cut-off value was obtained from the survival classification and regression tree (CART) analysis to predict post-discharge all-cause mortality and/or worsening HF, and the patients were divided into 2 groups: a high group (Ca-P product > 28, n = 594) and a low group (Ca-P product ≤ 28, n = 199). We compared the patient baseline characteristics and post-discharge prognosis between the 2 groups. The age as well as the prevalence of male sex, ischemic etiology, and anemia were significantly higher in the low group than in the high group. In contrast, there was no difference in echocardiographic parameters between the 2 groups. In the Kaplan-Meier analysis (mean follow-up 1089 days), all-cause mortality and/or worsening HF event rates were higher in the low group than in the high group (log-rank P = 0.001). In the multivariable Cox proportional hazard analysis, lower Ca-P product was found to be an independent predictor of all-cause mortality and/or worsening HF (hazard ratio 0.981, P = 0.031). Lower Ca-P product predicts adverse prognosis in patients with HF and CKD.

Long-term safety and decrease of pill burden by tenapanor therapy: a phase 3 open-label study in hemodialysis patients with hyperphosphatemia.

Phosphate binders (PBs) generally have a high pill burden. Tenapanor selectively inhibits sodium/hydrogen exchanger isoform 3, reducing intestinal phosphate absorption. Tenapanor is a novel drug administered as a small tablet, twice daily. This multicenter, open-label, single-arm, phase 3 study aimed to evaluate the long-term safety of tenapanor and its efficacy in decreasing PB pill burden. Tenapanor 5 mg twice daily was administered to hemodialysis patients with serum phosphorus level 3.5-7.0 mg/dl at baseline; the dose could be increased up to 30 mg twice daily. Patients could also switch from PBs. The primary endpoint was safety during 52-week administration. The key secondary endpoint was a ≥ 30% reduction in the total pill number of daily PBs and tenapanor from baseline. Of 212 patients starting treatment, 154 completed the study. Diarrhea was the most frequent adverse event, occurring in 135 patients (63.7%); most events were classified as mild (74.8%). No clinically significant changes occurred other than serum phosphorus level. At Week 52/discontinuation, 158/204 patients (77.5%) achieved the key secondary endpoint. Complete switching from PBs to tenapanor was achieved in 50-76 patients (26.7%-41.5%), and 80 patients (51.9%) at Week 8-12 and Week 50, respectively. Serum phosphorus remained generally stable within the target range (3.5-6.0 mg/dl). These findings suggest the long-term safety and tolerability of tenapanor. Tenapanor could reduce or eliminate PB pill burden while controlling serum phosphorus levels.Trial registration: NCT04771780.

Diagnosing Pollen-food Allergy Syndrome Allergologically in a Patient with Suspected Eosinophilic Gastroenteritis.

Pollen-food allergy syndrome (PFAS) consists of type I allergy to pollen and multiple food items that are cross-reactive to the pollen. PFAS typically occurs in the oral cavity and can co-occur with eosinophilic esophagitis. However, it is infrequently reported to present with symptoms of eosinophilic gastroenteritis (EGE), such as abdominal pain and eosinophilic infiltration of the gastrointestinal tract. We herein report a patient with a condition initially suspected of being EGE based on symptoms and pathological findings that was later diagnosed as PFAS associated with birch pollen. PFAS should be considered as a differential diagnosis in patients with EGE-like symptoms.

The updated five-year overall survival and long-term oxaliplatin-related neurotoxicity assessment of the FACOS study.

PURPOSE: We previously reported the first evidence of oncological benefits from a Japanese phase II trial of oxaliplatin-based adjuvant chemotherapy in patients with stage III colon cancer (the FACOS study). We herein report the long-term survival and persistent oxaliplatin-related peripheral sensory neuropathy (PSN) for patients enrolled in this trial. METHODS: Patients were scheduled to receive the mFOLFOX6 or CAPOX regimen in the adjuvant setting. The five-year overall survival (OS) rate and persistent PSN were evaluated. RESULTS: A total of 130 patients (mFOLFOX6, n = 73; CAPOX, n = 57) were eligible. The 5-year OS rate was 91.4%. No significant difference in the OS rate was observed between regimens (mFOLFOX6, 94.4%; CAPOX, 87.4%; P = 0.25). The incidence of PSN during adjuvant treatment was 55.4% in grade 1 (G1), 30.0% in G2, and 4.6% in G3. No patients showed G3 PSN at 12 months, but G1 or G2 residual PSN after 5 years was observed in 21.8% (G1, 20%; G2, 1.8%). CONCLUSIONS: Updated results from the FACOS study support the benefits of oxaliplatin-based adjuvant chemotherapy in terms of the long-term survival among Japanese patients with stage III colon cancer. However, long-term persistent PSN occurs in about 20% of survivors, counterbalancing the favorable OS.

A case of ileocecal actinomycosis treated by preoperative antibiotic treatment to reduce mass size followed by surgical resection.

A 65-year-old woman presented to a nearby clinic with a painful mass in the right lower abdominal region. She was suspected of having an appendiceal tumor on abdominal computed tomography (CT) and was referred to our hospital for surgery. Blood testing revealed increased inflammatory markers. Contrast-enhanced abdominal CT revealed a mass with poorly defined margins in the ileocecal region, which was adjacent to the external iliac vessels. A barium enema revealed unilateral wall deformities in the cecum through to the terminal ileum, whereas lower gastrointestinal endoscopy showed no clear epithelial tumor component. The patient was clinically diagnosed with ileocecal actinomycosis and treated with high-dose penicillin G. On day 15 of treatment, contrast-enhanced abdominal CT showed a reduction in mass size. On day 26, right hemicolectomy (D3) with combined resection of the external iliac vein (which could not be separated from the mass) was performed. Pathological examination revealed granulation tissue with granules of actinomyces, with filamentous bacteria detected by Grocott staining. With no evidence of malignancy, the final diagnosis of ileocecal actinomycosis was made. This report presents a case of clinically suspected ileocecal actinomycosis treated by preoperative antibiotic treatment to reduce mass size, followed by surgical resection.

Behavioral modulation of neural encoding of click-trains in the primary and nonprimary auditory cortex of cats.

Neural representation of acoustic stimuli in the mammal auditory cortex (AC) has been extensively studied using anesthetized or awake nonbehaving animals. Recently, several studies have shown that active engagement in an auditory behavioral task can substantially change the neuron response properties compared with when animals were passively listening to the same sounds; however, these studies mainly investigated the effect of behavioral state on the primary auditory cortex and the reported effects were inconsistent. Here, we examined the single-unit spike activities in both the primary and nonprimary areas along the dorsal-to-ventral direction of the cat's AC, when the cat was actively discriminating click-trains at different repetition rates and when it was passively listening to the same stimuli. We found that the changes due to task engagement were heterogeneous in the primary AC; some neurons showed significant increases in driven firing rate, others showed decreases. But in the nonprimary AC, task engagement predominantly enhanced the neural responses, resulting in a substantial improvement of the neural discriminability of click-trains. Additionally, our results revealed that neural responses synchronizing to click-trains gradually decreased along the dorsal-to-ventral direction of cat AC, while nonsynchronizing responses remained less changed. The present study provides new insights into the hierarchical organization of AC along the dorsal-to-ventral direction and highlights the importance of using behavioral animals to investigate the later stages of cortical processing.

Development of a quantitative bioassay to assess preventive compounds against inflammation-based carcinogenesis.

Reducing cancer incidence and mortality by use of cancer-chemopreventive agents is an important goal. We have established an in vitro bioassay that is able to screen large numbers of candidate chemicals that are positive for prevention of inflammation-related carcinogenesis. To accomplish this we have added candidate chemicals or vehicles and freshly isolated, fluorescent dye-labeled inflammatory cells that were overlaid on TNF-alpha-stimulated mouse endothelial cells in a 96-well plate. Inhibition of inflammatory cell attachment to the endothelial cells by the chemicals was quantified by the intensity of fluorescence from the adherent inflammatory cells after removing unattached cells. Using this assay, we selected two chemicals, auraptene and turmerones, for further study. As an in vivo test, diets containing these test chemicals were administered to mice with a piece of foreign body, gelatin sponge, that had been implanted to cause inflammation, and we found that the number of inflammatory cells that infiltrated into the subcutaneously implanted gelatin sponge was reduced compared to that found in the mice fed with a control diet. Moreover, diets containing either of the two chemicals prevented inflammation-based carcinogenesis in a mouse model. We found that the compounds reduced not only the number of infiltrating cells but also the expression of inducible nitric oxide synthase (iNOS) or formation of 8-hydroxy-2'-deoxyguanine (8-OHdG) in the infiltrated cells. Moreover, both compounds but not controls sustained the reducing activity in the inflammatory lesion, and this finding was confirmed by using non-invasive in vivo electron spin resonance. The newly established in vitro screening assay will be useful for finding biologically effective chemopreventive agents against inflammation-related carcinogenesis.

Cat's behavioral sensitivity and cortical spatiotemporal responses to the sweep direction of frequency-modulated tones.

Neural responses to frequency modulated (FM) sweeps have been well investigated in single-units using electrophysiological recording methods. However, rare psychophysical experiments were conducted to investigate behavioral discrimination of FM-sweeps in the same species used in physiological experiments. Also, the previous studies have not focused on how the population of cortical neurons works together to encode the direction of FM-sweeps. To investigate the relation between the behavioral perception of FM direction and the population coding, we examined the cat's capability to discriminate the upward and downward FM-sweeps and recorded the neural responses to the same stimuli from the primary auditory cortex (A1) in different awake cats. We found that cats showed high performance to detect the change of direction of FM-sweeps, which linearly swept between 0.1 and 16kHz in 40-160ms duration; however, the behavioral performance obviously deteriorated when the sweeps were shortened to 10-20ms. Physiological results indicated that the upward sweeps elicited a temporal sequence of responses among the A1 neurons, in which neurons tuning to low-frequencies responded earlier and those tuning to high-frequencies later, while the response sequence was reversed when A1 was driven by the downward sweeps. The rank-order of response latencies could provide a reliable discrimination of the FM direction, and the discrimination performance paralleled with the cat's behavioral performance. Our result suggests that the relative response timings in A1 contain enough information used by subsequent processing stages to make the decision of FM direction.

Heterogeneous neuronal responses to frequency-modulated tones in the primary auditory cortex of awake cats.

Previous studies in anesthetized animals reported that the primary auditory cortex (A1) showed homogenous phasic responses to FM tones, namely a transient response to a particular instantaneous frequency when FM sweeps traversed a neuron's tone-evoked receptive field (TRF). Here, in awake cats, we report that A1 cells exhibit heterogeneous FM responses, consisting of three patterns. The first is continuous firing when a slow FM sweep traverses the receptive field of a cell with a sustained tonal response. The duration and amplitude of FM response decrease with increasing sweep speed. The second pattern is transient firing corresponding to the cell's phasic tonal response. This response could be evoked only by a fast FM sweep through the cell's TRF, suggesting a preference for fast FM. The third pattern was associated with the off response to pure tones and was composed of several discrete response peaks during slow FM stimulus. These peaks were not predictable from the cell's tonal response but reliably reflected the time when FM swept across specific frequencies. Our A1 samples often exhibited a complex response pattern, combining two or three of the basic patterns above, resulting in a heterogeneous response population. The diversity of FM responses suggests that A1 use multiple mechanisms to fully represent the whole range of FM parameters, including frequency extent, sweep speed, and direction.

Comparison between offset and onset responses of primary auditory cortex ON-OFF neurons in awake cats.

Primary auditory cortex (A1) neurons are believed not to carry much information about tonal offsets because A1 neurons in barbiturate-anesthetized animals are usually described as having only onset responses. We investigated tonal offset responses in comparison with onset responses in the caudal part of A1 of awake cats. Cells responding to both onsets and offsets were commonly found (59.2% of recorded cells). Offset responses usually co-occurred with phasic onset responses or phasic components of sustained responses. These ON-OFF cells had diverse combinations of offset- and onset-frequency-receptive field (FRF): offset-FRF was similar to onset-FRF, or narrower, wider, lower, or higher than onset-FRF. The distribution of FRF patterns was diffuse with no boundaries between the different FRF-pattern groups. The onset- versus offset-FRF pattern of each cell remained unchanged across multiple stimulus intensities. Mean offset response showed similar peak latency (19.5 vs. 21.5 ms), longer half-decay time (74.5 vs. 48.5 ms), and lower peak amplitude (20.4 vs. 35.9 spikes/s) compared with the mean onset response. Although offset responses were facilitated when preceded by the suppression of spike activity, they were still elicited without preceding spike suppression. It is concluded that neurons showing paired onset and offset responses are predominant in the caudal A1. Their frequency-filtering property is usually not static but dynamic, changing between sound onsets and offsets. Offset responses are similarly precise and salient as onset responses for effectively encoding sound offsets. They may be elicited as active spike responses to sound offset rather than simple rebound facilitation.

Voiceless affricate/fricative distinction by frication duration and amplitude rise slope.

Previous psychophysical studies have shown that the perceptual distinction between voiceless fricatives and affricates in consonant-vowel syllables depends primarily on frication duration, whereas amplitude rise slope was suggested as the cue in automatic classification experiments. The effects of both cues on the manner of articulation between /integral of/ and /t integral of/ were investigated. Subjects performed a forced-choice task (/integral of/ or /t integral of) in response to edited waveforms of Japanese fricatives /integral of i/, /integral of u/, and /integral of a/. We found that frication duration, onset slope, and the interaction between duration and onset slope influenced the perceptual distinction. That is, the percent of /integral of/ responses increased with an increase in frication duration (experiments 1-3). The percent of /integral of/ responses also increased with a decrease in slope steepness (experiment 3), and the relative importance between slope portions was not even but weighted at onset (experiments 1 and 2). There was an interaction between the two cues of frication duration and steepness. The relative importance of the slope cue was maximum at a frication duration of 150 ms (experiment 3). It is concluded that the frication duration and amplitude rise slope at frication onset are acoustic cues that discriminate between /integral of/ and /t integral of/, and that the two cues interact with each other.

Time course of tonal frequency-response-area of primary auditory cortex neurons in alert cats.

Cells in the A1 auditory cortex of alert animals show various response time-courses during pure-tone stimuli: tonic, phasic-tonic, and phasic. Previously the time course of the spike firing rates was examined at a characteristic frequency (CF) or in a range of frequencies including CF. We investigated time-course of the frequency-response-area (FRA) during pure-tone stimuli in A1 cells of alert cats. The short rise/fall time (0.1-2 ms) and long stimulus duration (0.5 s) was used for investigation of the time course. FRA changed with time drastically in the phasic cells, mildly in the phasic-tonic cells, but not in the tonic cells. The best-response frequency (BF) within FRA was constant throughout the stimulus duration in the tonic and phasic-tonic cells, but was difficult to define in the phasic cells. The phasic firing properties of the phasic cells were preserved even during the bandnoise stimuli at various bandwidth and spectral locations. The variability of FRA time-course between cell types may play a role for analyzing auditory spectral cues that vary with a wide range of time constant.