Paraoxonases (PON) 1, 2, and 3 Polymorphisms and PON-1 Activities in Patients with Sickle Cell Disease.

(1) Background: Oxidative stress, chronic inflammation, vasoocclusion, and free iron are all features present in sickle cell disease. Paraoxonases (PON) are a family (PON-1, PON-2, PON-3) of antioxidant enzymes with anti-inflammatory action. Here, for the first time, we described PON-1 activities and PON-1, PON-2, PON-3 polymorphisms in patients with sickle cell disease, homozygous for HbSS, compared with healthy controls. (2) Methods: The groups were matched for age and gender. PON-1 activities (arylesterase and paraoxonase) were determined by enzymatic hydrolysis of phenylcetate and paraoxon, respectively. Polymorphisms were determined by Restriction Fragment Length Polymorphism- Polymerase Chain Reaction (RFLP-PCR). (3) Results: Plasma cholesterol and fractions, ApoA1 and ApoB levels were all decreased in sickle cell disease patients, while anti-oxidized low-density lipoprotein (LDL) antibodies and C-reactive protein were increased. Serum arylesterase activity was lower in sickle cell disease patients when compared with healthy controls. In patients, paraoxonase activity was higher in those with PON-1 RR Q192R polymorphism. In these patients, the increase of serum iron and ferritin levels and transferrin saturation were less pronounced than those observed in patients with QQ or QR polymorphism. No differences were observed with PON-1 L55M, and PON-2 and PON-3 polymorphisms. Multivariate regression analysis showed that transferrin and ferritin concentrations correlated with arylesterase and paraoxonase activities. (4) Conclusions: Both transferrin and ferritin were the main predictors of decreased arylesterase and paraoxonase activities in patients with sickle cell disease. LDL oxidation increased, and RR PON-1 Q192R polymorphism is likely to be a protective factor against oxidative damage in these patients.

Hepcidin: Homeostasis and Diseases Related to Iron Metabolism.

Iron is an essential metal for cell survival that is regulated by the peptide hormone hepcidin. However, its influence on certain diseases is directly related to iron metabolism or secondary to underlying diseases. Genetic alterations influence the serum hepcidin concentration, which can lead to an iron overload in tissues, as observed in haemochromatosis, in which serum hepcidin or defective hepcidin synthesis is observed. Another genetic imbalance of iron is iron-refractory anaemia, in which serum concentrations of hepcidin are increased, precluding the flow and efflux of extra- and intracellular iron. During the pathogenesis of certain diseases, the resulting oxidative stress, as well as the increase in inflammatory cytokines, influences the transcription of the HAMP gene to generate a secondary anaemia due to the increase in the serum concentration of hepcidin. To date, there is no available drug to inhibit or enhance hepcidin transcription, mostly due to the cytotoxicity described in the in vitro models. The proposed therapeutic targets are still in the early stages of clinical trials. Some candidates are promising, such as heparin derivatives and minihepcidins. This review describes the main pathways of systemic and genetic regulation of hepcidin, as well as its influence on the disorders related to iron metabolism.

Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs.

For human immunodeficiency virus (HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy (HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.

Plasmodium falciparum in the southeastern Atlantic forest: a challenge to the bromeliad-malaria paradigm?

BACKGROUND: Recently an unexpectedly high prevalence of Plasmodium falciparum was found in asymptomatic blood donors living in the southeastern Brazilian Atlantic forest. The bromeliad-malaria paradigm assumes that transmission of Plasmodium vivax and Plasmodium malariae involves species of the subgenus Kerteszia of Anopheles and only a few cases of P. vivax malaria are reported annually in this region. The expectations of this paradigm are a low prevalence of P. vivax and a null prevalence of P. falciparum. Therefore, the aim of this study was to verify if P. falciparum is actively circulating in the southeastern Brazilian Atlantic forest remains. METHODS: In this study, anophelines were collected with Shannon and CDC-light traps in seven distinct Atlantic forest landscapes over a 4-month period. Field-collected Anopheles mosquitoes were tested by real-time PCR assay in pools of ten, and then each mosquito from every positive pool, separately for P. falciparum and P. vivax. Genomic DNA of P. falciparum or P. vivax from positive anophelines was then amplified by traditional PCR for sequencing of the 18S ribosomal DNA to confirm Plasmodium species. Binomial probabilities were calculated to identify non-random results of the P. falciparum-infected anopheline findings. RESULTS: The overall proportion of anophelines naturally infected with P. falciparum was 4.4% (21/480) and only 0.8% (4/480) with P. vivax. All of the infected mosquitoes were found in intermixed natural and human-modified environments and most were Anopheles cruzii (22/25 = 88%, 18 P. falciparum plus 4 P. vivax). Plasmodium falciparum was confirmed by sequencing in 76% (16/21) of positive mosquitoes, whereas P. vivax was confirmed in only 25% (1/4). Binomial probabilities suggest that P. falciparum actively circulates throughout the region and that there may be a threshold of the forested over human-modified environment ratio upon which the proportion of P. falciparum-infected anophelines increases significantly. CONCLUSIONS: These results show that P. falciparum actively circulates, in higher proportion than P. vivax, among Anopheles mosquitoes of fragments of the southeastern Brazilian Atlantic forest. This finding challenges the classical bromeliad-malaria paradigm, which considers P. vivax circulation as the driver for the dynamics of residual malaria transmission in this region.

Finding connections in the unexpected detection of Plasmodium vivax and Plasmodium falciparum DNA in asymptomatic blood donors: a fact in the Atlantic Forest.

A recent paper in Malaria Journal reported the observation of unexpected prevalence rates of healthy individuals carrying Plasmodium falciparum (5.14%) or Plasmodium vivax (2.26%) DNA among blood donors from the main transfusion centre in the metropolitan São Paulo, a non-endemic area for malaria. The article has been challenged by a group of authors who argued that the percentages reported were higher than those found in blood banks of the endemic Amazon Region and also that that paper had not considered the literature on the classical dynamics of malaria transmission in the Atlantic Forest, which involves Anopheles (Kerteszia) cruzii and bromeliad malaria, due to P. vivax and Plasmodium malariae parasites, but not P. falciparum. The present commentary paper responds to this challenge and brings evidence and literature data supporting that the observed prevalence ratios may indicate a proportion of individuals that are exposed to Plasmodium transmission in permissive environments; that blood carrying parasite DNA may not be necessarily infective if used in transfusion; and that in the literature, there are examples supporting the circulation of P. falciparum in the area.

Human paraoxonase-1 activity is related to the number of CD4+ T-cells and is restored by antiretroviral therapy in HIV-1-infected individuals.

BACKGROUND: Paraoxonase-1 (PON1) activity is suggested to be altered in individuals infected with human immunodeficiency virus type-1 (HIV-1). We investigated PON1 activity in individuals receiving different regimens of highly active antiretroviral therapy (HAART). METHODS: PON1 activity was evaluated in 91 HIV-1 seronegative and 624 HIV-1 infected individuals (115 were not undergoing therapy (ART-naïve), and 509 were receiving HAART). HIV-1 infected individuals were treated with the following: efavirenz (EFV; n = 195) or nevirapine (NVP; n = 95) or lopinavir/ritonavir (LOP/r; n = 219). Serum levels of total cholesterol (TC), HDL, and low-density lipoprotein (LDL) fractions and the atherogenic indices (AI, TC : HDL, and LDL : HDL ratios) were determined. RESULTS: PON1 activity (U/L) was lower in the ART-naïve group compared with the other groups. PON1 activity correlated with CD4+ T-cell number of ART-naïve group (r = 0,121; P = 0,014). The LOP/r group showed a reduction in HDL and an increase in AI (TC : HDL ratio) in comparison with other groups. CONCLUSION: PON1 activity was reduced in untreated individuals, but not in individuals receiving HAART. PON1 activity correlated with the number of CD4+ T-cells. The findings suggest that the activity of PON1 is associated with the immune status of HIV-1 infected individuals.

Estudo dos polimorfismos das paraoxonases 1 e 2 em pacientes portadores do vírus da imunodeficiência humana e avaliação do potencial de peroxidação lipídica / Frequency of the paraoxonase 1 and 2 genetic polymorphisms and analysis of the lipid peroxidation in plasma of HIV positive patients

A paraoxonase sérica humana (PON) vem sendo amplamente estudada. Além da capacidade de PON1 em hidrolisar compostos organofosfatados, sabe-se, atualmente, que toda a família PON (composta por PON1, PON2 e PON3) promove a proteção de lípides, incluindo-se a lipoproteína de baixa densidade (LDL) contra a oxidação. O gene da PON1 sérica apresenta dois sítios polimórficos bem determinados: a troca Gln192Arg (Q/R) e Met55Leu, os quais estão associados com diferenças na atividade e concentrações séricas da enzima, respectivamente. Também o polimorfismo Cys311Ser parece contribuir sinergisticamente com o alelo PON1-192R quanto ao risco cardiovascular em algumas populações. Já foi demonstrado, por sua vez, que pacientes infectados pelo vírus HIV podem desenvolver dislipidemia e que tanto a atividade como a concentração de PON1 podem ser influenciadas por esta infecção. O objetivo deste estudo foi determinar as freqüências alélicas dos polimorfismos genéticos PON1-192QR, PON1-55LM, PON2-311SC e PON2-148AG, bem como avaliar a atividade de PON1 e a peroxidação lipídica no plasma de indivíduos portadores de HIV. Materiais e Métodos após aprovação pela comissão de ética e da aplicação do termo de consentimento pós-esclarecido, 350 (264 homens e 86 mulheres) pacientes infectados pelo HIV foram incluídos no estudo. Foi avaliado ainda um grupo de 32 (23 homens e 9 mulheres) indivíduos recentemente diagnosticados como portadores do vírus. Uma população saudável composta por 179 doadores de sangue, todos de sexo masculino, foi avaliada como controle. Após a extração do DNA, procedeu-se à genotipagem para os polimorfismos de PON1 e PON2 através de PCR-RFLP. A atividade paraoxonase de PON1 foi avaliada por espectrofotometria empregando-se paraoxon como substrato. O colesterol total, VLDL-colesterol, HDL-colesterol e triglicérides foram determinados por métodos padrão. A fração LDL-colesterol foi calculada pela fórmula de Friedwald. Resultados As frequências alélicas...

Human serum paraoxonase (PON) has been the subject of a number of studies. Beside the capacity of PON1 in hydrolyzing organophosphate compounds, it is known now that the entire PON family (which comprises PON1, PON2 and PON3) protects lipids, including low-density lipoprotein (LDL), from oxidation. Serum PON1 gene presents two well-determined genetic polymorphic sites: a Gln192 Arg (Q/R) and Met55 Leu, which are associated with differences in enzymatic activity and serum concentrations, respectively. Moreover, PON2 Cys311 Ser polymorphism seems to contribute synergistically with PON-192R allele to cardiovascular risk in some populations. It has been shown that HIV infected patients may develop dyslipidemia and that PON1 activity and concentration may be influenced by this infection. The aim of this study was to determine allelic frequencies of PON1-192QR, PON1-55LM, PON2-311SC and PON2-148AG genetic polymorphisms, evaluate PON1 activity and lipid peroxidation in plasma of HIV patients. Methods and Subjects after ethical committee approval and written consent, 350 (264 men and 86 women) HIV infected patients were included in the study. It was also evaluated a group of 32 recently diagnosed HIV individuals (23 men and 9 women). As controls, a healthy population formed by 179 men, blood donors, was studied. After DNA extraction PON1 and PON2 genotyping were performed by PCR-RFLP. Paraoxonase activity of PON1 was evaluated spectrofotometrically using paraoxon as substrate. Serum cholesterol, VLDL-cholesterol, HDL-cholesterol and triglycerides were analyzed by standard methods. LDL-cholesterol was calculated by Friedewald formula. Results: Allelic frequencies for PON1 polymorphisms in patients were: 36,43% for PON1-192R, 57,86% for PON1-55L, 65,57% for PON2-311S and 76,43% for PON2-148A. In recently diagnosed individuals these frequencies were 37,50%, 51,56%, 81,25% and 68,75% respectively. In controls, PON1-192R allelic frequency was 43,02%, PON1-55L...