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1.
Oxid Med Cell Longev ; 2022: 1269747, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35136484

RESUMO

Sepsis is a systemic inflammatory response syndrome caused by a dysregulated host response to infection. Peroxisome proliferator-activated receptor gamma (PPARγ) exerts anti-inflammatory and antioxidative properties. To investigate the potential effects of PPARγ on sepsis-induced liver injury and determine the related mechanisms, C57BL/6 male mice were subjected to cecal ligation and puncture (CLP) to create a sepsis model which was treated with GW1929 or GW9662 to upregulate or downregulate the expression of PPARγ. We found that upregulation of PPARγ decreased the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), and liver pathological damage and improved the 5-day survival rate. Increased expression of PPARγ also decreased sepsis-induced reactive oxygen species (ROS) by promoting the expression of Nrf2. In addition, upregulated PPARγ inhibited the expression of the TXNIP/NLRP3 signaling pathway by reducing ROS-induced injury in the liver during sepsis, which further reduced NLRP3-mediated pyroptosis and the inflammatory response. The role of PPARγ was further examined in in vitro experiments, where lipopolysaccharide- (LPS-) treated HepG2 and Hep3B cells were incubated with GW1929 or GW9662 to upregulate or downregulate the expression of PPARγ. We found that upregulated PPARγ ameliorated LDH release and improved cell viability. Our results indicated that increased expression of PPARγ reduced ROS levels and inhibited the TXNIP/NLRP3 signaling pathway, resulting in decreased pyroptosis and reduced liver dysfunction during sepsis.


Assuntos
Proteínas de Transporte/metabolismo , Hepatócitos/metabolismo , Hepatopatias/etiologia , Hepatopatias/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , PPAR gama/metabolismo , Piroptose/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Sepse/complicações , Transdução de Sinais/efeitos dos fármacos , Tiorredoxinas/metabolismo , Anilidas/administração & dosagem , Animais , Benzofenonas/administração & dosagem , Modelos Animais de Doenças , Regulação para Baixo/efeitos dos fármacos , Células Hep G2 , Humanos , Hepatopatias/tratamento farmacológico , Masculino , Camundongos , Camundongos Endogâmicos C57BL , PPAR gama/agonistas , PPAR gama/antagonistas & inibidores , Resultado do Tratamento , Tirosina/administração & dosagem , Tirosina/análogos & derivados , Regulação para Cima/efeitos dos fármacos
2.
Drug Deliv ; 28(1): 1649-1663, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34338560

RESUMO

Existing biologically inert or unmodified implants to treat infectious bone defects or osteomyelitis still cannot effectively solve bacterial infection and osseointegration. In this work, a simple co-deposition strategy was developed to modify porous polyetheretherketone (PEEK) with improved antibacterial activity and controllable immunoregulatory ability. After PEEK was treated by H2SO4 to obtain porous PEEK (SPEEK), the self-polymerization of dopamine was operated on SPEEK in the solution of dopamine and gentamicin sulfate (GS) to prepare polydopamine (pDA) and GS layer-modified SPEEK (labeled as SPEEK-pDA-GS). The morphology, surface property, and molecular structure of SPEEK-pDA-GS were investigated. Besides the antibacterial property of SPEEK-pDA-GS ascribed to the successful immobilization of GS, SPEEK-pDA-GS exhibited promoted osseointegration through the results of mineralization, alkaline phosphatase (ALP) levels and osteogenic gene expression. Furthermore, the evaluation of the cell proliferation suggested that SPEEK-pDA-GS possessed the biocompatibility and the immunoregulatory ability that induced macrophages to anti-inflammatory M2 phenotype. Using rat as model, in vivo results containing X-ray, µ-CT, immunohistochemistry, and pathological analysis showed the excellent healing effect of SPEEK-pDA-GS on bone defect with infection with biological safety. This work illustrates a new insight into the simple and effective modification of PEEK and other implants with antibacterial, immunoregulatory, and osseointegration abilities for clinical requirement.


Assuntos
Antibacterianos/farmacologia , Benzofenonas/farmacologia , Implantes de Medicamento/química , Gentamicinas/farmacologia , Indóis/química , Polímeros/química , Polímeros/farmacologia , Fosfatase Alcalina/efeitos dos fármacos , Animais , Antibacterianos/administração & dosagem , Benzofenonas/administração & dosagem , Materiais Biocompatíveis , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Liberação Controlada de Fármacos , Escherichia coli/efeitos dos fármacos , Gentamicinas/administração & dosagem , Osteogênese/efeitos dos fármacos , Polímeros/administração & dosagem , Porosidade , Ratos , Ratos Sprague-Dawley , Staphylococcus aureus/efeitos dos fármacos , Propriedades de Superfície
3.
Acta Biochim Pol ; 68(4): 557-563, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34351731

RESUMO

Benzophenone-3 (2-hydroxy-4-methoxybenzophenone, oxybenzone, or BP-3) is one of the most frequently used UV radiation absorbents, which are commonly referred to as sunscreen filters. Its widespread use in industrial applications provides protection against the photodegradation of a wide range of products but at the same time creates the risk of human exposure to benzophenone-3 unbeknownst to the individuals exposed. Topically applied benzophenone-3 penetrates individual skin layers, enters the bloodstream, and is excreted in the urine. In addition, benzophenone-3 easily crosses the placental barrier, which creates the risk of exposure to this substance in the prenatal period. Despite the widespread use and occurrence of benzophenone-3 in the human environment, little knowledge of the mechanisms underlying the effect of benzophenone-3 on the nervous system was available until recently. Only the most recent research, including studies by our group, has enabled the identification of new molecular mechanisms through which benzophenone-3 affects embryonic neuronal cells and the developing mammalian brain. Benzophenone-3 has been shown to induce neurotoxicity and apoptotic processes and inhibit autophagy in embryonic neuronal cells. Benzophenone-3 also alters expression and impairs function of receptors necessary for the proper development and function of the nervous system. The most worrying finding seems to be that benzophenone-3 contributes to an increased risk of developmental abnormalities and/or epigenetically based degeneration of neuronal cells by changing the epigenetic status of neuronal cells.


Assuntos
Benzofenonas/toxicidade , Sistema Nervoso/efeitos dos fármacos , Protetores Solares/toxicidade , Raios Ultravioleta , Administração Tópica , Benzofenonas/administração & dosagem , Sistema Endócrino/efeitos dos fármacos , Exposição Ambiental , Humanos , Fatores de Risco , Pele/efeitos dos fármacos , Neoplasias Cutâneas/induzido quimicamente , Protetores Solares/administração & dosagem
4.
Drug Des Devel Ther ; 15: 3523-3533, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34408404

RESUMO

BACKGROUND: Cancer is a leading cause of death worldwide, with breast cancer being the most common invasive cancer type in women. Several therapeutic strategies have been explored to reduce the mortality rates of breast cancer. Chemotherapy is the most commonly used systemic treatment, but associated with numerous side-effects. Development of anticancer agents with high efficacy and minimal negative effects is therefore an important focus of research. Natural materials provide an excellent source of bioactive compounds. For instance, Garcinia porrecta from the Clusiaceae family has multiple pharmacological activities, including antioxidant, anti-inflammatory, antibacterial, antiviral, anti-HIV, antidepressant, and anticancer properties. PURPOSE: The main objective of this study was to investigate the potential anticancer effects of compounds extracted from the bark of G. porrecta. MATERIALS AND METHODS: Our experiments were divided into three steps: (1) chromatographic isolation of compounds using various separation techniques, such as extraction, separation and purification, (2) characterization via infrared (IR), nuclear magnetic resonance (NMR) and mass spectroscopy, and (3) evaluation of anticancer activity in vitro (MTT assay) and in silico (via analysis of molecular docking against caspase-9, tumor necrosis factor alpha (TNF-α), estrogen receptor alpha (ER-α), and human epidermal growth factor receptor 2 (HER-2)). RESULTS: Depsidone (1) and benzophenone (2) from the ethyl acetate extract of bark of G. porrecta were identified as bioactive components. Examination of the activities of these compounds against MCF-7 cells revealed an IC50 value of 119.3 µg/mL for benzophenone, whereas IC50 for depsidone could not be estimated. Benzophenone activity was lower than that of the positive control doxorubicin (6.9 µg/mL). Depsidone showed the highest binding affinity for HER-2 (-9.2 kcal.mol-1) and benzophenone for ER-α (-8.0 kcal.mol-1). CONCLUSION: Benzophenone displays potency as an anticancer agent through blocking ER-α.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Garcinia/química , Fenóis/farmacologia , Extratos Vegetais/farmacologia , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/isolamento & purificação , Antineoplásicos Fitogênicos/farmacologia , Benzofenonas/administração & dosagem , Benzofenonas/isolamento & purificação , Benzofenonas/farmacologia , Depsídeos/administração & dosagem , Depsídeos/isolamento & purificação , Depsídeos/farmacologia , Doxorrubicina/farmacologia , Receptor alfa de Estrogênio/antagonistas & inibidores , Feminino , Humanos , Concentração Inibidora 50 , Lactonas/administração & dosagem , Lactonas/isolamento & purificação , Lactonas/farmacologia , Células MCF-7 , Simulação de Acoplamento Molecular , Fenóis/química , Fenóis/isolamento & purificação , Extratos Vegetais/química
5.
Front Immunol ; 12: 697362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34234785

RESUMO

Hepatic injury induced by ischemia and reperfusion (HIRI) is a major clinical problem after liver resection or transplantation. The polarization of macrophages plays an important role in regulating the severity of hepatic ischemia/reperfusion injury. Recent evidence had indicated that the ischemia induces an acidic microenvironment by causing increased anaerobic glycolysis and accumulation of lactic acid. We hypothesize that the acidic microenvironment might cause the imbalance of intrahepatic immunity which aggravated HIRI. The hepatic ischemia/reperfusion injury model was established to investigate the effect of the acidic microenvironment to liver injury. Liposomes were used to deplete macrophages in vivo. Macrophages were cultured under low pH conditions to analyze the polarization of macrophages in vitro. Activation of the PPAR-γ signal was determined by Western blot. PPAR-γ agonist GW1929 was administrated to functionally test the role of PPAR-γ in regulating macrophage-mediated effects in the acidic microenvironment during HIRI. We demonstrate that acidic microenvironment aggravated HIRI while NaHCO3 reduced liver injury through neutralizing the acid, besides, liposome abolished the protective ability of NaHCO3 through depleting the macrophages. In vivo and vitro experiment showed that acidic microenvironment markedly promoted M1 polarization but inhibited M2 polarization of macrophage. Furthermore, the mechanistic study proved that the PPAR-γ signal was suppressed during the polarization of macrophages under pH = 6.5 culture media. The addition of PPAR-γ agonist GW1929 inhibited M1 polarization under acidic environment and reduced HIRI. Our results indicate that acidic microenvironment is a key regulator in HIRI which promoted M1 polarization of macrophages through regulating PPAR-γ. Conversely, PPAR-γ activation reduced liver injury, which provides a novel therapeutic concept to prevent HIRI.


Assuntos
Fígado/lesões , Fígado/metabolismo , Macrófagos/metabolismo , PPAR gama/metabolismo , Traumatismo por Reperfusão/metabolismo , Animais , Benzofenonas/administração & dosagem , Células Cultivadas , Microambiente Celular/efeitos dos fármacos , Microambiente Celular/fisiologia , Modelos Animais de Doenças , Concentração de Íons de Hidrogênio , Imunidade Inata/efeitos dos fármacos , Células de Kupffer/efeitos dos fármacos , Células de Kupffer/imunologia , Células de Kupffer/metabolismo , Fígado/patologia , Macrófagos/classificação , Macrófagos/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , PPAR gama/agonistas , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/patologia , Índice de Gravidade de Doença , Transdução de Sinais , Bicarbonato de Sódio/farmacologia , Tirosina/administração & dosagem , Tirosina/análogos & derivados
6.
Clin Transl Sci ; 14(5): 1924-1934, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34058067

RESUMO

The impact of organic anion-transporting polypeptide (OATP) inhibition on systemic and liver exposures of three OATP substrates was investigated in cynomolgus monkeys. A monkey physiologically-based pharmacokinetic (PBPK) model was constructed to describe the exposure changes followed by OATP functional attenuation. Rosuvastatin, bromfenac, and carotegrast were administered as a single intravenous cassette dose (0.5 mg/kg each) in monkeys with and without predosing with rifampin (RIF; 20 mg/kg) orally. The plasma exposure of rosuvastatin, bromfenac, carotegrast, and OATP biomarkers, coproporphyrin I (CP-I) and CP-III were increased 2.3, 2.1, 9.1, 5.4, and 8.8-fold, respectively, when compared to the vehicle group. The liver to plasma ratios of rosuvastatin and bromfenac were reduced but the liver concentration of the drugs remained unchanged by RIF treatment. The liver concentrations of carotegrast, CP-I, and CP-III were unchanged at 1 h but increased at 6 h in the RIF-treated group. The passive permeability, active uptake, and biliary excretion were characterized in suspended and sandwich-cultured monkey hepatocytes and then incorporated into the monkey PBPK model. As demonstrated by the PBPK model, the plasma exposure is increased through OATP inhibition while liver exposure is maintained by passive permeability driven from an elevated plasma level. Liver exposure is sensitive to the changes of metabolism and biliary clearances. The model further suggested the involvement of additional mechanisms for hepatic uptakes of rosuvastatin and bromfenac, and of the inhibition of biliary excretion for carotegrast, CP-I, and CP-III by RIF. Collectively, impaired OATP function would not reduce the liver exposure of its substrates in monkeys.


Assuntos
Benzofenonas/farmacocinética , Bromobenzenos/farmacocinética , Modelos Biológicos , Transportadores de Ânions Orgânicos/antagonistas & inibidores , Fenilalanina/análogos & derivados , Quinazolinonas/farmacocinética , Rosuvastatina Cálcica/farmacocinética , Animais , Área Sob a Curva , Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Interações Medicamentosas , Eliminação Hepatobiliar , Fígado/metabolismo , Macaca fascicularis , Masculino , Modelos Animais , Transportadores de Ânions Orgânicos/metabolismo , Fenilalanina/administração & dosagem , Fenilalanina/farmacocinética , Quinazolinonas/administração & dosagem , Rosuvastatina Cálcica/administração & dosagem
7.
Invest New Drugs ; 39(5): 1335-1347, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33829355

RESUMO

Introduction The combination of an anti-angiogenic agent with cytotoxic chemotherapy is a standard treatment strategy for metastatic colorectal cancer. CKD-516 is an oral vascular disrupting agent that was preliminarily shown to be safe and efficacious as a monotherapy in refractory solid cancers. We evaluated the recommended phase 2 dose, safety, and preliminary efficacy of CKD-516 in combination with irinotecan in treatment-refractory metastatic colorectal cancer. Methods This phase 1 dose-escalation and dose-expansion study included patients with treatment-refractory metastatic colorectal cancer. CKD-516 tablets were administered for five consecutive days followed by two days off in combination with intravenous irinotecan (120 mg/m2) administered on day one of each treatment cycle every two weeks. A traditional 3 + 3 dose-escalation design was used. Results In total, 16 and 23 patients were enrolled in the dose-escalation and dose-expansion cohorts, respectively. The most common adverse events included diarrhea (79%), nausea (74%), vomiting (67%), and neutropenia (62%). No dose-limiting toxicity occurred, and the recommended phase 2 dose was determined at CKD-516/irinotecan doses of 11/120 mg/m2. No cases of cardiac ischemia, cardiac dysfunction, or thromboembolism were reported. Among the 34 patients with available tumor response assessments, one patient achieved partial response (3%) and 26 patients achieved stable disease (76%). The median progression-free survival and overall survival were 4.1 and 11.6 months, respectively. Conclusion This phase 1 study showed that the combination of oral CKD-516 and irinotecan is safe and tolerable in metastatic, treatment-refractory colorectal patients and showed favorable efficacy outcomes. Further studies to confirm these preliminary findings are warranted. Trial registration number NCT03076957 (Registered at March 10, 2017).


Assuntos
Antineoplásicos/uso terapêutico , Benzofenonas/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Valina/análogos & derivados , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Área Sob a Curva , Benzofenonas/administração & dosagem , Benzofenonas/efeitos adversos , Benzofenonas/farmacocinética , Neoplasias Colorretais/patologia , Relação Dose-Resposta a Droga , Feminino , Meia-Vida , Humanos , Irinotecano/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Dose Máxima Tolerável , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Metástase Neoplásica , Intervalo Livre de Progressão , Valina/administração & dosagem , Valina/efeitos adversos , Valina/farmacocinética , Valina/uso terapêutico
8.
Sci Rep ; 11(1): 6018, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727659

RESUMO

Intraocular surgery is associated with increased ocular inflammation. If maintained for a prolonged period after surgery, this inflammation can cause various complications, including subconjunctival fibrosis and bleb scarring. This clinical trial was a prospective, randomised, single-blind, interventional study comparing the efficacy and safety of 0.1% bromfenac sodium ophthalmic solution and 0.02% fluorometholone ophthalmic suspension in the inhibition of multiple inflammatory cytokines in the aqueous humour of 26 patients with pseudophakic eyes who had undergone phacoemulsification and intraocular lens implantation. The patients were randomly assigned to one of the trial drugs, and aqueous humour samples were collected before and after drug administration. Platelet-derived growth factor-AA levels significantly decreased in both drug groups, but they were significantly higher in the fluorometholone group than in the bromfenac group (P = 0.034). Bromfenac also significantly decreased vascular endothelial growth factor level (P = 0.0077), as well as monocyte chemoattractant protein-1 level (P = 0.013), which was elevated for a prolonged period after phacoemulsification. These data suggest that bromfenac is useful to alleviate prolonged microenvironmental alterations in the aqueous humour of pseudophakic eyes.


Assuntos
Humor Aquoso/metabolismo , Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Citocinas/metabolismo , Pseudofacia , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Pseudofacia/tratamento farmacológico , Pseudofacia/metabolismo
9.
Pharm Res ; 38(2): 361-367, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33404991

RESUMO

PURPOSE: Diazepam is utilized as a convulsion antidote following nerve gas attacks. As an emergency medicine, it requires storage at ambient temperatures which often doesn't meet manufacturers' requirements, leading to an early invalidation of the product. Current work investigated this issue. METHODS: Long-term stability of diazepam ampoules for injection stored in an ambient temperature of the Mediterranean climate for ~10 years vs storage at room temperature was studied. RESULTS: Diazepam assay and pH remained within pharmacopeial specifications irrespective of storage conditions. A major degradation product 2-methylamino-5-chlorobenzophenone (MACB) showed a clear trend of accumulation as a function of storage time, exceeding the permitted limit at ~2 years, irrespective of storage conditions. A strong correlation between the discoloration of the solutions and the concentration of MACB was obtained. Intravenous administration of MACB to rats at doses ~2200-fold higher than permissible specification levels caused neither mortality nor any toxicological nor post-mortem findings. CONCLUSIONS: Regarding the parameters tested: diazepam assay, MACB assay, and pH, storing ampoules of diazepam solution for injection in field conditions of high temperatures of the Mediterranean climate did not cause accelerated degradation as compared to room temperature. These findings open an option for the usage of expired ampoules in special scenarios.


Assuntos
Antídotos/química , Terrorismo Químico , Diazepam/química , Intoxicação por Gás/tratamento farmacológico , Agentes Neurotóxicos/toxicidade , Animais , Antídotos/administração & dosagem , Benzofenonas/administração & dosagem , Benzofenonas/química , Benzofenonas/toxicidade , Diazepam/administração & dosagem , Diazepam/toxicidade , Estabilidade de Medicamentos , Armazenamento de Medicamentos/normas , Feminino , Intoxicação por Gás/etiologia , Temperatura Alta/efeitos adversos , Humanos , Injeções Intravenosas , Israel , Masculino , Modelos Animais , Ratos , Fatores de Tempo , Testes de Toxicidade Aguda
10.
Medicine (Baltimore) ; 99(49): e23131, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285687

RESUMO

BACKGROUND: A cataract is a degenerative change in the optical quality of the lens caused by protein denaturation. Modern medicine is mainly based on surgical treatment. Cataract surgery is often accompanied by severe inflammation, and glucocorticoid therapy has many adverse reactions and side effects. The non-steroidal anti-inflammatory drug sodium bromfenac not only has good anti-inflammatory, analgesic and anti-allergic effects, but also does not produce side effects caused by hormone drugs. Clinical studies have shown that sodium bromfenac eye drops have a good curative effect in treating postoperative inflammation of cataract, with low recurrence rate and certain therapeutic advantages, but lack of evidence-based medicine evidence. The purpose of this study is to systematically evaluate the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataracts. METHODS: Use computer to search English and Chinese databases, such as PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, Weipu, China Biomedical Database, and Chinese Clinical Trial Registry for randomized controlled trials on the treatment of postoperative postoperative inflammation in cataract surgery with sodium bromfenac eye drops from the establishment of the database to September 2020, and data extraction and literature quality evaluation were conducted independently by two researchers, and Meta analysis was conducted on the included literature using RevMan5.3 software. RESULTS: In this study, the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataract surgery were evaluated by the effective rate, symptom score, adverse reactions, incidence, recurrence rate, etc. CONCLUSION:: This study will provide reliable evidence-based evidence for the clinical application of bromofenac sodium eye drops in the treatment of postoperative inflammation of cataract. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/3KP7R.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Extração de Catarata , Inflamação/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Humanos , Metanálise como Assunto , Soluções Oftálmicas , Revisões Sistemáticas como Assunto
11.
BMC Cancer ; 20(1): 1057, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143663

RESUMO

BACKGROUND: Hypoxic tumors are known to be highly resistant to radiotherapy and cause poor prognosis in non-small cell lung cancer (NSCLC) patients. CKD-516, a novel vascular disrupting agent (VDA), mainly affects blood vessels in the central area of the tumor and blocks tubulin polymerization, thereby destroying the aberrant tumor vasculature with a rapid decrease in blood, resulting in rapid tumor cell death. Therefore, we evaluated the anti-tumor efficacy of CKD-516 in combination with irradiation (IR) and examined tumor necrosis, delayed tumor growth, and expression of proteins involved in hypoxia and angiogenesis in this study. METHODS: A xenograft mouse model of lung squamous cell carcinoma was established, and the tumor was exposed to IR 5 days per week. CKD-516 was administered with two treatment schedules (day 1 or days 1 and 5) 1 h after IR. After treatment, tumor tissues were stained with hematoxylin and eosin, and pimonidazole. HIF-1α, Glut-1, VEGF, CD31, and Ki-67 expression levels were evaluated using immunohistochemical staining. RESULTS: Short-term treatment with IR alone and CKD-516 + IR (d1) significantly reduced tumor volume (p = 0.006 and p = 0.048, respectively). Treatment with CKD-516 + IR (d1 and d1, 5) resulted in a marked reduction in the number of blood vessels (p < 0.005). More specifically, CKD-516 + IR (d1) caused the most extensive tumor necrosis, which resulted in a significantly large hypoxic area (p = 0.02) and decreased HIF-1α, Glut-1, VEGF, and Ki-67 expression. Long-term administration of CKD-516 + IR reduced tumor volume and delayed tumor growth. This combination also greatly reduced the number of blood vessels (p = 0.0006) and significantly enhanced tumor necrosis (p = 0.004). CKD-516 + IR significantly increased HIF-1α expression (p = 0.0047), but significantly reduced VEGF expression (p = 0.0046). CONCLUSIONS: Taken together, our data show that when used in combination, CKD-516 and IR can significantly enhance anti-tumor efficacy compared to monotherapy in lung cancer xenograft mice.


Assuntos
Benzofenonas/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/terapia , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Neoplasias Pulmonares/terapia , Valina/análogos & derivados , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Benzofenonas/farmacologia , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Linhagem Celular Tumoral , Fracionamento da Dose de Radiação , Esquema de Medicação , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Transportador de Glucose Tipo 1/metabolismo , Humanos , Antígeno Ki-67/metabolismo , Neoplasias Pulmonares/metabolismo , Masculino , Camundongos , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Radioterapia , Resultado do Tratamento , Valina/administração & dosagem , Valina/farmacologia
12.
Food Funct ; 11(9): 8297-8308, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32909594

RESUMO

Benzophenone glycosides are a major type of polyphenols present in guava. To date, there is still poor understanding of the relationship between benzophenone glycosides and the hepatoprotective effects attributed to this edible fruit. Herein, the protective effects of guavinoside B (GUB), a main benzophenone glycoside present in guava fruit, against acetaminophen (APAP)-induced liver injury were investigated in vitro and in vivo. Fluorescence measurement demonstrated that GUB (at a concentration of 30 µM) significantly reduced the intracellular ROS levels in APAP-treated HepG2 cells. In addition, GUB (100 mg kg-1 d-1) pretreatment markedly alleviated APAP-induced hepatocyte infiltration and necrosis in C57BL/6 mice, and improved serum and hepatic biochemical parameters, such as ALT, AST, SOD, GSH, ROS, MDA, and TNF-α levels. RT-PCR and western blot experiments revealed that GUB up-regulated Nrf2, GCLC and NQO1, while reducing p-JNK gene expression in the liver. The fermentation experiment further revealed that the displayed beneficial effects of GUB in vivo might be related to the gut microbial metabolite gallic acid. These promising data suggested that GUB showed potent hepatoprotective effects through regulating the Nrf2 and JNK signaling pathways. Further investigation of the absorption and metabolism of benzophenones would be warranted to promote the utilization of these phenolics as functional food ingredients against oxidative stress-induced chronic diseases.


Assuntos
Benzofenonas/administração & dosagem , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , MAP Quinase Quinase 4/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Extratos Vegetais/administração & dosagem , Psidium/química , Acetaminofen/efeitos adversos , Animais , Doença Hepática Induzida por Substâncias e Drogas/genética , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Frutas/química , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Humanos , MAP Quinase Quinase 4/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fator 2 Relacionado a NF-E2/genética , Estresse Oxidativo/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos
13.
Theranostics ; 10(19): 8541-8557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32754262

RESUMO

Rationale: Endophthalmitis, which is one of the severest complications of cataract surgeries, can seriously threaten vision and even lead to irreversible blindness owing to its complicated microenvironment, including both local bacterial infection and severe inflammation. It is urgent to develop a comprehensive treatment for both anti-bacterial and anti-inflammatory effects. Methods: Herein, we developed AuAgCu2O-bromfenac sodium nanoparticles (AuAgCu2O-BS NPs), which was designed to combine anti-bacterial and anti-inflammatory effects for integrated therapy of endophthalmitis after cataract surgery. The AuAgCu2O-BS NPs could eradicate methicillin-resistant Staphylococcus aureus (MRSA) bacterial strain relied on their photodynamic effects and the release of metal ions (Ag+ and Cu+) by the hollow AuAgCu2O nanostructures mediated mild photothermal effects. The anti-inflammatory drug, bromfenac sodium, released from the nanoparticles were able to significantly reduce the local inflammation of the endophthalmitis and promote tissue rehabilitation. In vivo bacterial elimination and anti-inflammation were confirmed by a postcataract endophthalmitis rabbit model. Results: Excellent antibacterial ability of AuAgCu2O-BS NPs was verified both in vitro and in vivo. Ophthalmological clinical observation and pathologic histology analysis showed prominent treatment of inflammatory reaction. Importantly, the mild temperature photothermal effect not only promoted the release of metal ions and bromfenac sodium but also avoided the thermal damage of the surrounding tissues, which was more suitable for the practical application of ophthalmology due to the complex structure of the eyeball. Moreover, superior biocompatibility was approved by the preliminary toxicity investigations, including low cytotoxicity, negligible damage to major organs, and stable intraocular pressure. Conclusions: Our studies of nanosystem provide a promising synergic therapeutic strategy for postcataract endophthalmitis treatment with favorable prognosis and promise in clinical translations.


Assuntos
Antibacterianos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Extração de Catarata/efeitos adversos , Cobre/administração & dosagem , Endoftalmite/terapia , Ouro/administração & dosagem , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Prata/administração & dosagem , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Benzofenonas/química , Benzofenonas/farmacologia , Bromobenzenos/química , Bromobenzenos/farmacologia , Cobre/química , Cobre/farmacologia , Modelos Animais de Doenças , Sinergismo Farmacológico , Tratamento Farmacológico , Endoftalmite/etiologia , Endoftalmite/microbiologia , Ouro/química , Ouro/farmacologia , Humanos , Nanopartículas Metálicas , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Viabilidade Microbiana/efeitos dos fármacos , Terapia Fototérmica , Coelhos , Prata/química , Prata/farmacologia , Resultado do Tratamento
14.
Mol Med Rep ; 22(3): 2433-2441, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32705205

RESUMO

Cataract is a blinding­caused disease and affects millions of individuals worldwide. Although conventional phacoemulsification (CPCS) has been widely used for treatment of cataract, the incidence of cataract­caused blindness still increased year by year. Recently, femtosecond laser technology has been expanded to variety of clinical applications, including cataract surgery. The present study evaluated the curative effect of bromfenac sodium (BS) after femtosecond laser­assisted cataract surgery (FLACS) and analyzed the mechanism of action. A total of 90 patients were randomly divided into five groups: Group I, conventional phacoemulsification treatment (CPCS) + dexamethasone (DEX)/tobramycin (TOB); group II, CPCS + bromfenac sodium (BS); group III, Femtosecond laser­assisted cataract surgery (FLACS) + DEX/TOB; group IV, FLACS + BS; and group V, FLACS + pranoprofen. Aqueous humor was collected from these patients post­surgery. For in vitro studies, SRA01/04 cells were irradiated using UV, followed by the collection of culture media and cell lysate. Prostaglandin E2 (PGE2) levels, an indicator of inflammation, were measured using ELISA both in vivo and in vitro. In addition, cyclooxygenase (COX) and cleaved caspase­1 p20 expression levels were analyzed using western blotting. The findings suggested that BS was more effective and safer compared with glucocorticoids (GCs) after cataract surgery. BS can protect against post­operative inflammation by inhibiting PGE2 production. Under in vitro conditions BS prevented the SRA01/04 cells from undergoing apoptosis after UV treatment and also suppressed PGE2 release from UV­irradiated SRA01/04 cells by modulating COX­2 expression. Furthermore, BS may have an inhibitory effect on the inflammatory form of cell death. Overall, these results indicated that BS could replace existing GCs as a reliable drug for a perioperative period of cataract surgery. It was also identified that the inhibitory effect of BS on PGE2 production was mediated via the regulation of COX­2.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Ciclo-Oxigenase 2/metabolismo , Dinoprostona/metabolismo , Facoemulsificação/métodos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/farmacologia , Benzofenonas/farmacologia , Bromobenzenos/farmacologia , Extração de Catarata , Linhagem Celular , Regulação para Baixo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória
15.
Arch Toxicol ; 94(8): 2847-2859, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32430675

RESUMO

The aim of this study was to analyze whether dermal exposure to benzophenone 3 (BP-3) during pregnancy affects critical parameters of pregnancy, and whether this exposure may affect the outcome of a second pregnancy in mice. Pregnant mice were exposed to 50-mg BP-3/kg body weight/day or olive oil (vehicle) from gestation day (gd) 0 to gd6 by dermal exposure. High-frequency ultrasound imaging was used to follow up fetal and placental growth in vivo. Blood flow parameters in uterine and umbilical arteries were analyzed by Doppler measurements. Mice were killed at gd5, gd10, and gd14 on the first pregnancy, and at gd10 and 14 on the second pregnancy. The weight of the first and second progenies was recorded, and sex ratio was analyzed. BP-3 levels were analyzed in serum and amniotic fluid. BP-3 reduced the fetal weight at gd14 and feto-placenta index of first pregnancy, with 16.13% of fetuses under the 5th percentile; arteria uterina parameters showed altered pattern at gd10. BP-3 was detected in serum 4 h after the exposure at gd6, and in amniotic fluid at gd14. Offspring weight of first progeny was lower in BP-3 group. Placenta weights of BP-3 group were decreased in second pregnancy. First and second progenies of mothers exposed to BP-3 showed a higher percentage of females (female sex ratio). Dermal exposure to low dose of BP-3 during early pregnancy resulted in an intrauterine growth restriction (IUGR) phenotype, disturbed sex ratio and alterations in the growth curve of the offspring in mouse model.


Assuntos
Benzofenonas/toxicidade , Desenvolvimento Fetal/efeitos dos fármacos , Retardo do Crescimento Fetal/induzido quimicamente , Razão de Masculinidade , Protetores Solares/toxicidade , Administração Cutânea , Líquido Amniótico/metabolismo , Animais , Benzofenonas/administração & dosagem , Benzofenonas/sangue , Feminino , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/fisiopatologia , Idade Gestacional , Masculino , Exposição Materna , Troca Materno-Fetal , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Placentação/efeitos dos fármacos , Gravidez , Medição de Risco , Protetores Solares/administração & dosagem , Protetores Solares/metabolismo
16.
Exp Eye Res ; 194: 108020, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32209318

RESUMO

INTRODUCTION: There is a need to find alternative treatments for MEe. Bromfenac has shown promise in inhibiting the COX-2 enzymatic pathway that partially causes the inflammatory cascade which contributes to the precipitation of ME. However, like other NSAID's, its intraocular half-life is limited. We hypothesize that a delayed-release liposome formulation containing bromfenac might provide a similar anti-inflammatory effect as long-lasting steroid release systems without the well-known steroidal side-effects. We introduced a novel formulation with these characteristics into the vitreous cavity of rabbit eyes in order to evaluate its safety profile. MATERIAL AND METHODS: 10 left eyes of rabbits were injected with the liposome-encapsulated bromfenac suspension (100 µg/0.1 ml). Basal ERG's were recorded. Total follow-up time was 3 months, at which point ERG's were repeated and eyes were enucleated for histopathological study. Total amplitude and implicit times were recorded. A difference of 25% in either recording was considered significant. Significance was assessed using the paired-t test and Wilcoxon matched-pairs signed-rank test. A p-value of <0.05 was considered significant. RESULTS: No significant changes were recorded in ERG measurements after 3 months when compared to basal measurements. Histopathological analysis of retinal specimens found no traces of liposome-induced toxicity. CONCLUSION: The liposome-encapsulated bromfenac suspension (100 µg/0.1 ml) is not toxic and has been proven safe to use in an animal model. Therefore, this formulation shows promise as a possible future alternative treatment for ME and should be further studied to show its biological effect and efficacy.


Assuntos
Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Eletrorretinografia , Injeções Intravítreas , Lipossomos , Macula Lutea/efeitos dos fármacos , Edema Macular/metabolismo , Edema Macular/patologia , Coelhos , Suspensões/administração & dosagem , Resultado do Tratamento
17.
Int J Hyg Environ Health ; 227: 113509, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32174481

RESUMO

Hexyl 2-[4-(diethylamino)-2-hydroxybenzoyl]benzoate, better known under its trading name Uvinul A plus® is a UV filter mainly used in sunscreens, but also present in other cosmetic products with a maximum concentration of 10% (w/w) according to the EU directive. In this study we investigated the human metabolism after a single oral and a single dermal dose of Uvinul A plus®, respectively. Samples collected within 72 h of administration were analyzed with a newly developed UHPLC-MS/MS method. Results of the study revealed three major urinary metabolites, namely 2-(4-amino-2-hydroxybenzoyl)benzoic acid (AHB), 2-(4-(ethylamino)-2-hydroxybenzoyl)benzoic acid (EHB) and 2-(4-(diethylamino)-2-hydroxybenzoyl)benzoic acid (DHB), representing 52% of the administered oral dose. The three major metabolites are further converted into four minor metabolites with an additional hydroxyl group in the aniline moiety. Toxicokinetic parameters (amount excreted, tmax, elimination constant and half-life t1/2) and conversion factors were determined for the three major metabolites. The conversion factors were used to estimate the mean daily exposure to Uvinul A plus® in spot urine samples from 58 volunteers not intentionally exposed to Uvinul A plus® derived from a pilot study. The three major metabolites were quantifiable in 26% of the samples. In 35% of the samples, at least one major metabolite could be quantified. The daily systemic exposure to Uvinul A plus® was estimated to approximately 8.1-9.3 µg/d by applying the combined conversion factor for all three major metabolites. In conclusion, a very low systemic exposure to DHHB was observed with regard to the no observed adverse effect level (NOAEL) as an established threshold for chronic uptake.


Assuntos
Aminofenóis/farmacocinética , Benzofenonas/farmacocinética , Protetores Solares/farmacocinética , Administração Cutânea , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminofenóis/administração & dosagem , Aminofenóis/urina , Benzofenonas/administração & dosagem , Benzofenonas/urina , Biomarcadores/urina , Exposição Ambiental/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Absorção Cutânea , Protetores Solares/administração & dosagem , Adulto Jovem
18.
Regul Toxicol Pharmacol ; 113: 104619, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32088184

RESUMO

Combined use of photochemical and pharmacokinetic (PK) data for phototoxic risk assessment was previously proposed, and the system provided reliable phototoxic risk predictions of chemicals in same chemical series. This study aimed to verify the feasibility of the screening system for phototoxic risk assessment on dermally-applied chemicals with wide structural diversity, as a first attempt. Photochemical properties of test chemicals, 2-acetonaphthalene, 4'-methylbenzylidene camphor, 6-methylcoumarin, methyl N-methylanthranilate, and sulisobenzone, were evaluated in terms of UV absorption and reactive oxygen species (ROS) generation, and PK profiles of the test chemicals in rat skin were characterized after dermal co-application. All test chemicals showed strong UVA/B absorption with molar extinction coefficients of over 3000 M-1⋅cm-1, and irradiated 2-acetonaphthalene, 6-methylcoumarin, and methyl N-methylanthranilate exhibited significant ROS generation. Dermally-applied 2-acetonaphthalene and 4'-methylbenzylidene camphor indicated high and long-lasting skin deposition compared with the other test chemicals. Based on the photochemical and PK data, 2-acetonaphthalene was predicted to have potent phototoxic risk. The predicted phototoxic risk of the test chemicals by integration of obtained data was mostly consistent with their in vivo phototoxicity observed in rat skin. The screening strategy employing photochemical and PK data would have high prediction capacity and wide applicability for photosafety evaluation of chemicals.


Assuntos
Benzofenonas/toxicidade , Cânfora/análogos & derivados , Cumarínicos/toxicidade , Dermatite Fototóxica/metabolismo , Naftalenos/toxicidade , Pele/efeitos dos fármacos , ortoaminobenzoatos/toxicidade , Administração Cutânea , Animais , Benzofenonas/administração & dosagem , Benzofenonas/farmacocinética , Cânfora/administração & dosagem , Cânfora/farmacocinética , Cânfora/toxicidade , Cumarínicos/administração & dosagem , Cumarínicos/farmacocinética , Masculino , Estrutura Molecular , Naftalenos/administração & dosagem , Naftalenos/farmacocinética , Processos Fotoquímicos , Ratos , Ratos Sprague-Dawley , Medição de Risco , Raios Ultravioleta , ortoaminobenzoatos/administração & dosagem , ortoaminobenzoatos/farmacocinética
19.
Korean J Ophthalmol ; 34(1): 46-55, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32037749

RESUMO

PURPOSE: To investigate the effect of 0.1% bromfenac sodium hydrate ophthalmic solution for prevention of macular edema after cataract surgery in patients with diabetes. METHODS: A retrospective analysis of 75 patients with diabetes who underwent cataract surgery was performed. Thirty-eight patients (52 eyes) were instilled with 0.1% bromfenac solution (bromfenac group) and 37 patients (46 eyes) were not (control group). RESULTS: There were no significant preoperative between-group differences. Compared to the control group, at 1 month after surgery, the bromfenac group showed slightly better best-corrected visual acuity (0.12 ± 0.12 vs. 0.32 ± 0.42, p = 0.142), lower central macular thickness (265.58 ± 31.28 vs. 314.15 ± 76.11 µm, p < 0.001), and lower macular volume (8.46 ± 0.60 vs. 9.14 ± 1.53 mm³, p = 0.022). There were no significant differences between the two groups at 4 and 6 months postoperatively (p > 0.05). Mean changes in central macular thickness showed significant differences at 1 and 4 months postoperatively (-1.44 ± 11.72 and 10.44 ± 22.48 µm in bromfenac group vs. 47.19 ± 70.24 and 31.69 ± 48.04 µm in control group, p < 0.001 and p = 0.016) and mean changes in macular volume showed a significant difference at 1 month postoperatively (-0.08 ± 0.47 mm³ in bromfenac group vs. 0.58 ± 1.28 mm³ in control group, p < 0.001). There were no significant differences thereafter (p > 0.05). CONCLUSIONS: Treatment with 0.1% bromfenac sodium hydrate ophthalmic solution showed good efficacy for preventing cystoid macular edema early after cataract surgery in patients with diabetes.


Assuntos
Benzofenonas/administração & dosagem , Bromobenzenos/administração & dosagem , Extração de Catarata , Catarata/complicações , Retinopatia Diabética/tratamento farmacológico , Edema Macular/prevenção & controle , Acuidade Visual , Anti-Inflamatórios não Esteroides/administração & dosagem , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/administração & dosagem , Período Pós-Operatório , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
20.
Neurotox Res ; 37(3): 683-701, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31970650

RESUMO

Benzophenone-3 (BP-3), the most widely used UV chemical filter, is absorbed well through the skin and gastrointestinal tract and can affect some body functions, including the survival of nerve cells. Previously, we showed that BP-3 evoked a neurotoxic effect in male rats, but since the effects of this compound are known to depend on gender, the aim of the present study was to show the concentration and potential neurotoxic action of this compound in the female rat brain. BP-3 was administered dermally to female rats during pregnancy, and then in the 7th and 8th weeks of age to their female offspring. The effect of BP-3 exposure on short-term and spatial memory, its concentrations in blood, the liver, the frontal cortex, and the hippocampus, and the effect on selected markers of brain damage were determined. Also, the impact of BP-3 on sex and thyroid hormone levels in blood and hematological parameters was examined. It has been found that this compound was present in blood and brain structures in females at a lower concentration than in males. BP-3 in both examined brain structures increased extracellular glutamate concentration and enhanced lipid peroxidation, but did not induce the apoptotic process. The tested compound also evoked hyperthyroidism and decreased the blood progesterone level and the number of erythrocytes. The presented data indicated that, after the same exposure to BP-3, this compound was at a lower concentration in the female brain than in that of the males. Although BP-3 did not induce apoptosis in the hippocampus and frontal cortex, the increased extracellular glutamate concentration and lipid peroxidation, as well as impaired spatial memory, suggested that this compound also had adverse effects in the female brain yet was weaker than in males. In contrast to the weaker effects of the BP-3 on females than the brain of males, this compound affected the endocrine system and evoked a disturbance in hematological parameters more strongly than in male rats.


Assuntos
Apoptose/efeitos dos fármacos , Benzofenonas/toxicidade , Lobo Frontal/efeitos dos fármacos , Hormônios Esteroides Gonadais/sangue , Hipocampo/efeitos dos fármacos , Protetores Solares/toxicidade , Hormônios Tireóideos/sangue , Administração Cutânea , Animais , Proteínas Reguladoras de Apoptose/efeitos dos fármacos , Benzofenonas/administração & dosagem , Feminino , Lobo Frontal/metabolismo , Ácido Glutâmico/metabolismo , Hipocampo/metabolismo , Ratos Sprague-Dawley , Receptores de Hidrocarboneto Arílico/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Protetores Solares/administração & dosagem
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