Circulating microRNAs as novel biomarkers for measuring the potency of ginger extract against cyclophosphamide toxicity in rat renal tissues: molecular and histopathological study.

OBJECTIVE: This study aims to explore underlying molecular variations in the expression of miRNAs in kidney tissues of ginger-treated and non-treated cyclophosphamide (CP)-intoxicated rats. MATERIALS AND METHODS:   A total of 40 adult male Wistar rats were randomly divided into four groups of 10 each: Group I (control: received normal food and water), Group II (received ginger at a dose of 300 mg/kg), Group III (received CP 75 mg/kg, i.p.), and Group IV (received the same dose of CP and ginger extract).  Rats received a single injection of 75 mg/kg CP on days 3, 4, 5, 19, 20, and 21. In CP-intoxicated rats, the treatment with ginger extract at a dose of 300 mg/kg was received by oral gavage starting seven days before CP and continuing throughout the duration of the experiment for four weeks. Molecular variations in the expression of miRNAs, apoptotic genes, histological kidney damage, and abnormal kidney function in control, ginger, and CP-intoxicated rats were identified by using real-time RT-PCR Analysis, immunohistochemical, and colorimetric assays. In addition, HPLC analysis and liquid chromatography spectrophotometry analysis using Diphenyl-1-picrylhydrazyl (DPPH) radical, and Β-Carotene-linoleic acid reagents were applied respectively for in-vitro screening of phytoconstituents and antioxidant activity for ginger extract. RESULTS: The kidney tissues of CP-intoxicated rats displayed an increase in lipid peroxidation marker malonaldehyde (MDA), DNA damage, and fibrosis markers like hyaluronic acid (HA) and hydroxyproline Hypx) with a decrease in the superoxide dismutase (SOD) and total antioxidant capacity (TAC). In addition, molecular expressions of mRNA fibrotic genes such as collagen, type 1, alpha 1 (COL1A1), and α-smooth muscle actin (αSMA). Molecular expressions of levels of B-cell lymphoma 2 (BCl-2) mRNA gene were down-regulated, and the expression of mRNA apoptotic; BCL2 associated X gene (Bax), caspase-3, Bax/BCl-2 ratio genes were significantly up-regulated respectively. Moreover, cellular oxidative genes, erythroid 2-related factor (Nrf2), and heme oxygenase-1 (HO-1) were down-regulated, respectively. The miR-155-5p, miR-34a-5p, miR-21-5p significantly increased while the miR-193b-3p, miR-455-3p, and miR-342-3p significantly decreased. Ginger also increased the expression of Nrf2, HO-1, and BCl-2 genes in the kidneys of rats induced with CP. In addition, active phytoconstituents, particularly 6]]-shogaol and 6]]-gingerol, were significantly identified in ginger extract using HPLC analysis. Antioxidant activity of these active metabolites were shown to be higher against in vitro free radicals (DPPH and Β-Carotene-linoleic acid), suggesting the potential antioxidant and antiapoptotic properties of ginger against CP-toxicity. CONCLUSIONS: Treatment with ginger in rats induced with CP resulted in significant improvement in the expression of certain molecular miRNAs. The kidney tissues of these rats showed a marked decrease in the expression of miR-155-5p, miR-34a-5p, and miR-21-5p, while the levels of miR-193b-3p, miR-455-3p, and miR-342-3p were observed to increase significantly. In conclusion, ginger can protect rats from CP-induced nephrotoxicity.

Simultaneous detection of ketamine, lorazepam, midazolam and sufentanil in human serum with liquid chromatography-tandem mass spectrometry for monitoring of analgosedation in critically ill patients.

A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the determination and quantification of four predominantly used analgosedatives in the intensive care unit: ketamine, lorazepam, midazolam and sufentanil in human serum. The extraction procedure consisted of protein precipitation of serum samples with acetonitrile and subsequent centrifugation. D5-fentanyl and D4-midazolam served as internal standards (ISTD). Separation of analytes was performed with a Hypersil C18 column and a mobile phase with acetonitrile and 0.1% formic acid (60/40, v/v) under isocratic conditions at a flow rate of 280µl/min. Analytes were simultaneously detected with a triple-stage quadrupole mass spectrometer (LC-MS/MS) in a selected reaction monitoring (SRM) mode with positive heated electrospray ionization (HESI) within a single 2-min run. Calibration curves were linear over a range of 50-2000 for ketamine, 10-1000 for lorazepam, 5-500 for midazolam and 1-100 for sufentanil (ng/ml). The limit of detection and the lower limit of quantification were 0.01 and 10.00 for ketamine, 0.005 and 10.00 for lorazepam, 0.018 and 5.00 for midazolam and 0.068 and 0.25 for sufentanil (ng/ml). Intra- and inter-day accuracies and precisions of all analytes were less than 15%. Bench stability with spiked serum samples was ensured after 12, 24 and 48h at room temperature, freeze- and thaw-stability after 3 cycles of thawing and freezing. The method was successfully established according to International Conference on Harmonization (ICH) guideline Q2 (R1) "Validation of Analytical Procedures" and applied in critically ill adult patients in the intensive care unit. We suggest its suitability for parallel quantification of the sedative analgesics ketamine, lorazepam, midazolam and sufentanil. The method serves as an instrumental tool for therapeutic drug monitoring (TDM) and pharmacokinetic studies [1].

[Therapeutic Drug Monitoring of antiinfectives in intensive care medicine]. / Therapeutisches Drug Monitoring (TDM) von Antiinfektiva in der Intensivmedizin.

Therapeutic Drug Monitoring (TDM) is based on drug-level control in biological matrices and serves as a diagnostic approach for individualization of pharmacotherapy and drug safety. Drug levels of antibiotics are distinctly influenced by comorbidity, physiological changes and various concomitant drugs in patients on intensive care units. Several factors should be taken into account for calculation of relevant pharmacokinetic parameters (elimination half-life, bioavailability, and clearance) to deduce a recommendation for dosage. TDM is a diagnostic standard for the individualization of polypharmcotherapy based on validated analytical methods (in particular LC-MS/MS and HPLC-methods) in order to optimize dosing and drug safety.