Vegetarian diets and gut microbiota: important shifts in markers of metabolism and cardiovascular disease.

Vegetarian diets have been associated with a lower incidence of several chronic diseases. The benefits of plant-based diets are related mainly to the improvement of metabolic parameters that can indicate risk for such diseases. Some metabolic factors, such as oxidative balance, lipid profile, and glucose homeostasis, can be improved directly by diet, but paradoxically, some characteristics of vegetarian diets may promote a negative scenario that increases the risk of certain chronic diseases. Additionally, many benefits of a vegetarian diet are mediated by the gut microbiota, members of which not only have taxonomic and functional differences but also produce diverse, specific metabolites that vary according to whether the host consumes an omnivorous or a vegetarian diet. This review examines the modulation of human metabolism and gut microbiota by vegetarian and omnivorous dietary patterns and explores how this modulation may affect the risk of cardiovascular disease.

An essential role for mast cells as modulators of neutrophils influx in collagen-induced arthritis in the mouse.

Mast cells are involved in immune disorders so that many of the proinflammatory and tissue destructive mediators produced by these cells have been implicated in the pathogenesis of rheumatoid arthritis. This scenario prompted us to investigate the correlation between mast cell degranulation and neutrophil influx within the digits and knees joints of arthritic mice assessing what could be the functional role(s) of joint mast cells in the response to collagen immunization. DBA/1J mice were submitted to collagen-induced arthritis and disease was assessed on day 21, 32 and 42 post-immunization. Pharmacological treatment with the glucocorticoid prednisolone, commonly used in the clinic, and nedocromil, a mast cell stabilizer, was performed from day 21 to 30. Arthritis develop after immunization, gradually increased up to day 42. Neutrophil infiltration peaked on day 32 and 21, in the digits and knees, respectively, showing an unequal pattern of recruitment between these tissues. This difference emerged for mast cells: they peaked in the digits on day 21, but a higher degree of degranulation could be measured in the knee joints. Uneven modulation of arthritis occurred after treatment of mice with prednisolone or nedocromil. Neutrophils migration to the tissue was reduced after both therapies, but only prednisolone augmented mast cell migration to the joints. Nedocromil exerted inhibitory properties both on mast cell proliferation and migration, more effectively on the digit joints. Thus, collagen induced an inflammatory process characterized by tissue mast cells activation and degranulation, suggesting a potential driving force in propagating inflammatory circuits yielding recruitment of neutrophils. However, the different degree of affected joint involvement suggests a time-related implication of digits and knees during collagen-induced arthritis development. These results provide evidence for local alterations whereby mast cells contribute to the initiation of inflammatory arthritis and may be targeted in intervention strategies.

Relationship between mast cells and the colitis with relapse induced by trinitrobenzesulphonic acid in Wistar rats.

The present study aimed to clarify the role of mast cells in colitis with relapse induced in Wistar rats by trinitrobenzenosulphonic acid. Colitis induction increased the histamine concentration in the colon, which peaked on day 26. The number of mast cells, probably immature, was ten times higher on day 8. Different from animals infected with intestinal parasites, after colitis remission, mast cells do not migrate to the spleen, showing that mast cell proliferation presents different characteristics depending on the inflammation stimuli. Treatment with sulfasalazine, doxantrazole, quercetin, or nedocromil did not increase the histamine concentration or the mast cell number in the colon on day 26, thereby showing absence of degranulation of these cells. In conclusion, although mast cell proliferation is associated with colitis, these cells and their mediators appear to play no clear role in the colitis with relapses.

Association of VEGF polymorphisms with childhood asthma, lung function and airway responsiveness.

Vascular endothelial growth factor (VEGF) is an angiogenic factor implicated in asthma severity. The objective of the present study was to determine whether VEGF single nucleotide polymorphisms (SNPs) are associated with asthma, lung function and airway responsiveness. The present authors analysed 10 SNPs in 458 white families in the Childhood Asthma Management Program (CAMP). Tests of association with asthma, lung function and airway responsiveness were performed using PBAT software (Golden Helix, Inc. Bozeman, MT, USA; available at www.goldenhelix.com). Family and population-based, revpeated measures analysis of airflow obstruction were conducted. Replication studies were performed in 412 asthmatic children and their parents from Costa Rica. Associations with asthma, lung function and airway responsiveness were observed in both cohorts. SNP rs833058 was associated with asthma in both cohorts. This SNP was also associated with increased airway responsiveness in both populations. An association of rs4711750 and its haplotype with forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) ratio in both cohorts was observed. Longitudinal analysis in CAMP confirmed an association of rs4711750 with FEV(1)/FVC decline over approximately 4.5 yrs of observation. VEGF polymorphisms are associated with childhood asthma, lung function and airway responsiveness in two populations, suggesting that VEGF polymorphisms influence asthma susceptibility, airflow obstruction and airways responsiveness.

Long-term budesonide or nedocromil treatment, once discontinued, does not alter the course of mild to moderate asthma in children and adolescents.

OBJECTIVES: To determine whether long-term, continuous use of inhaled anti-inflammatory medications affects asthma outcomes in children with mild to moderate asthma after use is discontinued. STUDY DESIGN: Of the 1041 participants in the Childhood Asthma Management Program randomized clinical trial, 941 (90%) were followed to determine whether 4.3 years of twice-daily budesonide or nedocromil administration (each compared with placebo) affected subsequent asthma outcomes during a 4.8-year posttrial period in which treatment was managed by the participants' physicians. RESULTS: The groups treated continuously during the trial with either budesonide or nedocromil did not differ from the group given placebo in terms of lung function, control of asthma, or psychological status at the end of 4.8 years of posttrial follow-up. However, the decreased mean height in the budesonide group relative to the placebo group at the end of the trial (1.1 cm; P = .005) remained statistically significant (0.9 cm; P = .01) after an additional 4.8 years and was more pronounced in girls (1.7 cm; P = .001) than in boys (0.3 cm; P = .49). Participants in all groups used inhaled corticosteroids during 30% of the posttrial period. CONCLUSIONS: Clinically meaningful improvements in the control of asthma and in airway responsiveness achieved during continuous treatment with inhaled corticosteroids do not persist after continuous treatment is discontinued.

Estrategia terapéutica para prevenir la remodelación de las vías aéreas / Therapeutic strategy to prevent airways remodeling in asthma

La remodelación de las vías aéreas en el asma da como resultado un engrosamiento de las vías aéreas, lo cual a su vez explica su asociación con una reversibilidad incompleta de la obstrucción al flujo aéreo. Se ha observado en asma que la inflamación es un contribuyente importante tanto a la remodelación de las vías aéreas como a la irreversibilidad de su obstrucción. En este artículo se revisan las evidencias epidemiológicas que apoyan la existencia de remodelación de vías aéreas en asmáticos. La administración de esteroides inhalados para prevenir la remodelación de las vías aéreas en el asma debe ser iniciada en una fase precoz de esta enfermedad, como fue demostrado en el estudio START. La Iniciativa Global para el Asma -GINA- ha propuesto una intervención precoz en asma con corticoesteroides inhalados para prevenir la remodelación de vías aéreas y sus efectos funcionales.

Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma.

OBJECTIVE: Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed. STUDY DESIGN: FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout. RESULTS: Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly. CONCLUSIONS: Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.

Aerossolterapia na asma da criança / Aerosol therapy in childhood asthma

Objetivos: Os objetivos dessa revisäo säo apresentar resultados de pesquisas em aerossolterapia e discutir a otimizaçäo dessa forma de administraçäo de medicamentos. Método: Foram revistos alguns dos principais trabalhos publicados sobre aerosslterapia, sobre aparelhos geradores de aerossol, e sobre farmacocinética e farmacodinâmica das drogas inaladas. Resultados: Säo apresentados os fatores que interferem sobre o padräo de deposiçäo das drogas inaladas, sua farmacocinética e a influência da deposiçäo e da farmacocinética sobre os efeitos do tratamento. Os aparelhos geradores de aerossol säo comparados, em seus aspectos positivos e negativos, e procura-se estabelecer equivalência entre doses com diferentes dispositivos inalatórios. Conclusöes: Os aparelhos geradores de aerossol e as técnicas inalatórias determinam o padräo de deposiçäo e os efeitos clínicos das drogas. Esses fatores devem ser bem conhecidos, afim de se alcançarem os melhores resultados possíveis no tratamento por via inalatória...

Pode o nedocromil ser útil na asma córtico-dependente? / Can the nedocromil will used in corticosteroids-dependent asthma

A participaçao dos mastócitos e respectivos mediadores químicos e citocinas na reaçao inflamatória alérgica justifica o emprego de drogas profiláticas no tratamento da asma. Embora o nedocromil seja recomendado para asma leve e persistente, há evidências de oferecer uma alternativa de tratamento para os asmáticos córtico-dependentes com a finalidade de reduzir a dose de corticóides administrados.

Nedocromil sódico y cromoglicato de sodio en la prevención del asma inducida por ejercicio / Sodium nedocromil and sodium cromoglycate in the prevention of exercise induced asthma

Se comparó la efectividad de nedocromil sódico, cromoglicato de sodio y placebo (beclometasona) en la prevención de la broncoconstricción provocada por ejercicio en 22 niños con asma leve o moderado de 6 a 14 años de edad, mediante el registro de la caída del flujo espiratorio máximo después de una carrera libre de 6 minutos de duración en espacio abierto. Para estos efectos todos los pacientes fueron sometidos a una serie de 4 ejercicios (basal, después de inhalación de beclometasona, cromoglicato y nedocromil, estos dos últimos fueron suministrados bajo un régimen de doble ciego). El índice de caída promedio basal (sin medicamentos) fue 33 por ciento, ante 28,9 por ciento (NS) después de inhalar placebo y 15 por ciento después de inhalar cromoglicato y nedocromil

Action of nedocromil sodium in exercise-induced asthma in adolescents.

In view of the high incidence of exercise-induced asthma (EIA) in asthmatic adolescents and adults, the aim of the present study was to examine the preventive effect of nedocromil sodium administered prior to an exercise provocation test. The study involved 30 adolescents with EIA, aged between 14 and 19 years, who attended gymnastics classes at the Children's Hospital and Aerobics School. Baseline spirometry, six-minute treadmill running and spirometry for 7-15 minutes post-exercise were performed. During the same week and under identical temperature and humidity conditions, the same test was carried out with 4 mg nedocromil sodium (two inhalations) administered 30 minutes before exercise. Original post-exercise FEV1 values were compared with the findings after administration of nedocromil sodium. Seventeen subjects (56%) were totally protected (< 5% decrease in FEV1) and 13 subjects (44%) were partially protected (< 10% decrease in FEV1). EIA persisted in the fifteen subjects who received placebo pretreatment. Nedocromil sodium, administered 30 minutes prior to exercise, was effective, providing an opportunity to enhance the quality of life of the asthmatic patient troubled by exercise-induced symptoms.

Modulation of the bronchial inflammation in sensitized guinea-pigs by FK506, nedocromil sodium and dexamethasone.

Guinea-pigs sensitized by a subcutaneous injection of ovalbumin in Al(OH)3 and boosted 2 weeks later exhibit marked bronchial hyperresponsiveness to various agonists and intense bronchial wall infiltration by CD4+ T-lymphocytes and eosinophils. We have compared the effect of FK506, a novel immunosuppressive agent, on the mucosal infiltration by T-cells and eosinophils with the well established drugs, nedocromil sodium and dexamethasone. Sensitized Hartley guinea-pigs were treated subcutaneously for 5 days with FK506 (100 micrograms.kg-1 daily), nedocromil sodium (30 micrograms.kg-1 daily), or dexamethasone (200 micrograms.kg-1 daily). On the day of the experiment, i.e. one week after the booster injection of antigen, the animals were killed, the lungs dissected, frozen and cryostat sections stained by immunohistochemical methods using monoclonal antibodies specific for total T-lymphocytes, CD4+ and CD8+ T-cells. Cyanide-resistant eosinophil peroxidase activity was used to stain the eosinophils. Sections were coded and positive cells enumerated in the lamina propria and adventitia of the bronchi. Sensitized and antigen-stimulated vehicle-treated guinea-pigs showed marked infiltration of the bronchial wall by CD4+ T-lymphocytes and eosinophils compared with sensitized, non-antigen stimulated animals. As compared to vehicle, FK506 or dexamethasone abolished the T-cell/eosinophil invasion in the bronchial wall, whereas nedocromil sodium was ineffective in protecting the lungs from T-lymphocyte or eosinophil infiltration. We conclude that both FK506 and dexamethasone are effective in curtailing bronchial inflammation in allergic guinea-pigs, whereas nedocromil sodium did not resolve the inflammation associated with T-lymphocytes or eosinophils.

Acciones de diversos fármacos sobre la hiperreactividad bronquial y el asma: consideraciones fisiopatogénicas y terapéuticas / Actions of different drugs on the bronchial hyperreactivity and the asthma: considerations physiopathogenic and therapy

En 48 pacientes asmáticos atópicos leves o moderados se investigó la respuesta a diversos fármacos. Luego de una semana de tratamiento con dipropionato de beclometasona (BECLO) o terfenadina (TER) o cetirizina (CET) o cromoglicato disódico (CGDS) o nedocromil sódico (NED), se evaluó: a)la evolución espirográfica tomando como parámetros VEF y FM antes y después de cada uno de los tratamientos. En el cotejo de los resultados obtenidos con cada fármaco se encontró que, tomando los promedios de ambos parámetros, el CGDDS, con el 50 por ciento, es el fármaco que mejor actua; luego siguen en orden decreciente, TER 38 por ciento, BECLO 35 por ciento, CET 29 por ciento y NED 7 por ciento. Las diferencias son estadísticamente significativas entre CGDS vs. NED, p<0,05. b) La capacidad de protección de cada uno de esos fármacos sobre la hiperreactividad bronquial con aire frío (HRB). Aquí el orden de protección para la broncoobstrucción, si se toman ambos parámetros(VEF y FM) es para la CET, del 65 por ciento, BECLO 50 por ciento, CGDS 46 por ciento y TER 8 por ciento. Si en lugar de considerar los promedios para ambos parámetros, se toma el número de evaluaciones espirográficas que son protegidas más del 10 por ciento ante la estimulación con aire frío, se observa que a la CET le corresponde el 90 por ciento de protección, al CGDS al 61,5 por ciento, a la BECLO el 60 por ciento a la TER el 28,6 por ciento y al NED el 12.5 por ciento. Estadísdicamente la CET es superior a TER y NED (P<0,02) y CGDS también vs. TER y NED p<0,02. Se concluye que si bien la HRB es una expresión del asma, en ésta se suma a la inflamación basal y broncoobstrucción, donde la histamina tiene un papel más importante que en las respuestas de HRB. Y que en la HRB por aire frío la acción antiinflamatoria de los fármacos u otras acciones, como anti PAF, puedan ofrecer mejores resultados, por lo que habría que elaborar criterios terapéuticos individuales de acuerdo con la mejor acción preventiva para cada una de las situaciones

Acciones de diversos fármacos sobre la hiperreactividad bronquial y el asma: consideraciones fisiopatogénicas y terapéuticas / Actions of different drugs on the bronchial hyperreactivity and the asthma: considerations physiopathogenic and therapy

En 48 pacientes asmáticos atópicos leves o moderados se investigó la respuesta a diversos fármacos. Luego de una semana de tratamiento con dipropionato de beclometasona (BECLO) o terfenadina (TER) o cetirizina (CET) o cromoglicato disódico (CGDS) o nedocromil sódico (NED), se evaluó: a)la evolución espirográfica tomando como parámetros VEF y FM antes y después de cada uno de los tratamientos. En el cotejo de los resultados obtenidos con cada fármaco se encontró que, tomando los promedios de ambos parámetros, el CGDDS, con el 50 por ciento, es el fármaco que mejor actua; luego siguen en orden decreciente, TER 38 por ciento, BECLO 35 por ciento, CET 29 por ciento y NED 7 por ciento. Las diferencias son estadísticamente significativas entre CGDS vs. NED, p<0,05. b) La capacidad de protección de cada uno de esos fármacos sobre la hiperreactividad bronquial con aire frío (HRB). Aquí el orden de protección para la broncoobstrucción, si se toman ambos parámetros(VEF y FM) es para la CET, del 65 por ciento, BECLO 50 por ciento, CGDS 46 por ciento y TER 8 por ciento. Si en lugar de considerar los promedios para ambos parámetros, se toma el número de evaluaciones espirográficas que son protegidas más del 10 por ciento ante la estimulación con aire frío, se observa que a la CET le corresponde el 90 por ciento de protección, al CGDS al 61,5 por ciento, a la BECLO el 60 por ciento a la TER el 28,6 por ciento y al NED el 12.5 por ciento. Estadísdicamente la CET es superior a TER y NED (P<0,02) y CGDS también vs. TER y NED p<0,02. Se concluye que si bien la HRB es una expresión del asma, en ésta se suma a la inflamación basal y broncoobstrucción, donde la histamina tiene un papel más importante que en las respuestas de HRB. Y que en la HRB por aire frío la acción antiinflamatoria de los fármacos u otras acciones, como anti PAF, puedan ofrecer mejores resultados, por lo que habría que elaborar criterios terapéuticos individuales de acuerdo con la mejor acción preventiva para cada una de las situaciones (AU)

Nedocromil sodium prevents in vivo generation of the eosinophilotactic substance induced by PAF but fails to antagonize its effects.

1 The intrathoracic injection of platelet activating factor (PAF) into rats induced a decrease in the pleural leucocyte numbers within 15 min, accompanied by a marked exudation, maximal 1 h later. After 6 h, concomitantly with the reduction of exudation, a marked increase in the number of mononuclear cells, neutrophils and eosinophils was observed. Within 24 h, the pleural eosinophil accumulation peaked and persisted up to 96 h. 2 Topical treatment with nedocromil sodium affected pleural exudation by PAF under conditions where systemic meclizine was ineffective. Nedocromil sodium blocked, dose-dependently, the increase in the pleural content of mononuclear cells, neutrophils and eosinophils, observed 6 h after PAF administration, as well as the eosinophilia 24 h later. Moreover, the co-incubation of peritoneal eosinophils with nedocromil sodium did not interfere with the migration triggered by PAF. 3 The transfer of the 6 h-PAF pleural washings from donor to recipient rats caused a selective pleural eosinophilia, which was clearly inhibited when nedocromil sodium was administered to donor, but not to recipient animals, showing that this drug interferes with the generation rather than with the expression of the eosinophilotactic activity(ies). 4 These findings indicate that the nedocromil sodium interferes with PAF-induced exudation and leucocyte accumulation, by a mechanism other than its ability to reduce the local effects of histamine and which may relate to suppression of the eosinophilotactic principle generation.

The acceptability, safety and efficacy of nedocromil sodium in long-term clinical use in patients with perennial asthma.

The safety, acceptability and efficacy of nedocromil sodium, given by metered dose inhaler at a dosage of 4 mg four times daily, were investigated in a 52-week open assessment study of 79 perennial bronchial asthmatic patients maintained on oral bronchodilator therapy. Extensive laboratory monitoring of renal, hepatic and haematological functions before, during and at the end of the study failed to provide any evidence of drug-induced toxic effects. Nedocromil sodium was well tolerated with no serious adverse effects reported. Nineteen patients were withdrawn from the study, two complaining of sore throats and one of severe cough after nearly 1 year of treatment. The remainder were withdrawn because of intolerance to theophylline (one patient), non-cooperation (three), relocation outside the trial area (seven), onset of uncontrolled asthma (two) and pregnancy (three patients). Although this was an open assessment study, analysis of the diary card measurements and clinic assessments indicated that nedocromil sodium is an effective long-term therapy in the maintenance treatment of bronchial asthma.