Endocrine, Metabolic & Immune Disorders-Drug Targets - Volume 17, Issue 2, 2017

Background and Objective: The incidence of diabetes has been on the rise and the rate of rise since the turn of this century has been phenomenal. One of the various battling issues faced by diabetics all over the globe is the management of diabetic wounds. Currently, there are several management strategies to deal with the treatment of diabetic wounds. The conventional methods have several limitations. One of the major limitations is the rate and progression of healing of a diabetic wound when adopting a conventional diabetic wound management therapy. Lately, several nano techniques and nano products have emerged in the market that offer promising results for such patients. The treatment outcomes are achieved more efficiently with such nanomedical products. Methods: This review attempts to consider the currently available nanotechnological applications in the management of diabetic wounds. We take a deeper look into the available nanotherapeutic agents and the different nanocarriers that could be used in the management of diabetic wound healing. Lately, researchers around the globe have started providing evidences on the effective use of such nanoparticles in various fields of Medicine extending from genetics to various other branches of medicine. This also includes the management of diabetic wounds. Conclusion: This paper discusses the challenges faced with these nanotherapies and nanoparticles with regard to the treatment of diabetic wounds.

Background and Objective: The present review investigated cold-induced anaphylaxis, a potentially life-threatening condition that occurs after exposure to cold stimuli and is characterized by respiratory distress and/or hypotension. Anaphylaxis is rarely associated to cold-induced urticarial (CU), a particular form of physical urticaria that is difficult to diagnose and manage. The incidence of cold-induced urticaria has been estimated at about 0.05%, higher in colder regions and in women; its pathological mechanisms are still unknown. Methods: The literature was searched via the Medline/PubMed database (http://www.ncbi.nlm.gov/ pubmed). Results and Conclusion: Patients affected by CU should be well-informed about the risk of anaphylaxis and preventive measures. The prevention of CU is based on the avoidance of cold exposure. The most effective treatment is antihistamines symptomatic therapy. Anyway, patients should also carry with them an emergency kit containing corticosteroids, antihistamines and an epinephrine injector. Future studies are necessary to determine the CU pathophysiology so to establish a more targeted management of this important and potentially life-threatening condition.

Background and Objectives: Common variable immunodeficiency (CVID) is the most important primary disorder that is associated with clinical complications including recurrent infections, malignancy and autoimmune diseases. The genetic cause of CVID is mostly unknown and only a few genetic causes are identified. The various options are proposed for determining the etiology of CVID patients, such as T- and B-cell defects, Toll-like receptors (TLRs) impairments, altered cytokine production as well as blemished dendritic cells (DCs). The patients with CVID show a reduction in number and frequency of DCs in blood, an altered expression of cell surface molecules, and defective activation through toll-like receptors (TLRs). Also loss of IFNα has a critical role in B-cell impairments of CVID patients. The aim of this review is to collect under one umbrella, all the recent knowledge about DCs defects of CVID patients. Methods: This review covers basic information about physiology of DCs followed by reports of DCs situation in CVID. Conclusion: According to the results of researches assessing DCs frequency and function in CVID, the roll of DCs in the pathogenesis of CVID cannot be ruled out. The article is expected to encourage the researchers to do comprehensive researches about complex connections between DCs and other immune cells in CVID.

Background: Nicotinamide phosphoribosyltransferase(Nampt) has a variety of biological effects, which can participate in the development of inflammatory diseases, metabolism diseases and chronic kidney disease, et al. However, the role of Nampt in T2DM and DN is still controversial. Objective: The study aimed to investigate changes in serum Nampt levels and its significance in diabetic nephropathy (DN). Method: A total of 321 type 2 diabetes (T2DM) were divided into normal albuminuria group (NA, n=110), microalbuminuria group (MA, n=106) and large amount of albuminuria group (LA, n=105). 105 healthy persons were selected forming the control group (NC, n=105).; 118 T2DM without insulin therapy were screened out as the non–insulin therapy group (NIT.; n=116). Serum Nampt and interleukin (IL)-1β were measured by enzyme-linked immunosorbent assay. The relationships among the variables were analyzed by Pearson correlation analysis and Stepwise multiple regression analysis. Results: Serum Nampt and IL-1β in the LA group were significantly higher than other groups, and they were higher in MA than in the NA group (P<0.05). Serum Nampt was positively correlated with IL-1β and urinary albumin-to-creatinine ratio (UACR) (P <0.01), and IL-1β and UACR were independent relevant factors affecting Nampt. Serum Nampt was positively correlated with insulin resistance (HOMA-IR) but negatively correlated with the quantitative insulin sensitivity check index (QUICKI) (P <0.01) in the NIT group. Conclusion: We indicated that serum Nampt and IL-1β were increased accompanied by the increased UACR and the association between Nampt and insulin resistance and β-cell function in T2DM with different UACRs.

Objectives: The underlying mechanism of atherosclerosis and visceral obesity remains unknown.The purpose of this study was to test the hypothesis that atherosclerosis and visceral obesity are caused by an immune response to native plasma lipoproteins, and the atherogenic and adipogenic effects of the antibodies to native lipoproteins stem from the androgen deficiency that is created. Methods: Wistar rats were immunized with native human (nh) low-density (LDL) or high-density lipoproteins (HDL). Visceral fat, aortic wall structure, and testosterone levels were studied. Results: Immunization with nhLDL or nhHDL induced in rats increased visceral abdominal fat and perivascular adipose tissue volume, the appearance of epicardial fat, and atherosclerosis-like changes in the aortic wall: accumulation of leucocytes, destruction of the intima, and disruption of the media structure. Immunized rats produced antibodies to native plasma lipoproteins, while there was no difference between immunized and adjuvant-injected rats with regard to the level of antibodies to oxidized LDL. The immune response to nhHDL caused testosterone disturbances, but it is not associated with visceral obesity and atherosclerosis. Conclusion: The immune response to native lipoproteins is atherogenic and adipogenic and testosterone is not involved in the atherogenic and adipogenic effects of antibodies to lipoproteins.

Background: Primary antibody deficiency (PAD) is the most common group of primary immunodeficiency disorders, resulting from different defects in the development and function of B cell lineage. Common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA) are two of the major types of PADs. Optimal growth and subsequently bone health could potentially compromise due to the interference of several factors in PAD with childhood onset. In the present study, our aim was to evaluate bone mineral density (BMD) of patients with CVID and XLA. Methods: BMD of 37 CVID and 19 XLA patients was examined. Total BMD was determined by dual-energy X-ray absorptiometry and the calculated scores were compared internally and externally with age-sex matched and ethnic-specific reference. Related factors associated with bone density including immune-related complications, serum calcium, phosphate, total alkaline phosphatase, 25(OH) vitamin D and parathyroid hormone levels were recorded. Results: The median age at the time of study was 20 years among all patients and was not statistically different between CVID and XLA groups and the mean of body mass index (BMI) was 19.4±4.6 kg/cm2. Thirty-eight (67.9%) of total patients had normal BMD and 18 (32.1%) patients had a low BMD. BMI was positively correlated with BMD at lumbar spine and femoral neck. The number of low BMD patients in CVID (40.5%) group was more than the XLA (15.8%). Conclusion: Beside nutritional, gastrointestinal and infectious complications which are shared in both groups of patients, CVID patients are more prone to alteration of BMD due to association with lymphoproliferative and endocrine diseases. Therefore routine evaluation of bone density and treatment adjustment should be considered in all PAD patients particularly in CVID patients.

Objective: Our objectives were to investigate the therapeutic effect of halofuginone (HF) in the treatment of autoimmune thyroid diseases (AITDs) and explore its underlying mechanism of action. Methods: The Graves' disease (GD) model was generated by immunizing female BALB/c mice with adenovirus expressing the TSH receptor A subunit (Ad-TSHR289). The Ad-TSHRA+HF and Ad- TSHRA+DMSO groups were injected intraperitoneally with HF or the vehicle control (DMSO), respectively. The autoimmune thyroiditis (AIT) group consisted of female NOD.H-2h4 mice that were administered NaI in the drinking water and intraperitoneally injected daily with the vehicle control (DMSO) during the study period. The AIT/HF group consisted of female NOD.H-2h4 mice that were administered NaI in the drinking water and intraperitoneally injected daily with HF. The frequencies of splenic Th17 cells, Tregs and Bregs were determined by flow cytometry. The mRNA levels of IL-17, forkhead box P3 (Foxp3), RORγt and IL-10 were determined by real-time PCR. Results: In both Ad-TSHRA+DMSO and Ad-TSHRA+HF groups, 10 out of 15 mice displayed serum T4 and TSAb levels above 3 SD beyond the mean control levels. The number of CD4+CD25+Foxp3+ T lymphocytes in the GD model was significantly increased in the HF group compared with the DMSO group (P < 0.05). The mRNA level of Foxp3 was significantly increased in the Ad-TSHRA+HF group compared with the Ad-TSHRA+DMSO group (P < 0.05). However, neither the abundance of CD4+IL-17+ T cell subpopulation nor the mRNA expression level of RORγt differed significantly between the Ad-TSHRA+HF and Ad-TSHRA+DMSO groups (P > 0.05). The serum TgAb titer was significantly reduced in the AIT/HF group compared with the AIT group (P < 0.01). The differences in the number of CD4+CD25+Foxp3+ T lymphocytes and the mRNA levels of Foxp3 between the AIT/HF and AITgroups were not significant (P > 0.05). However, the number of CD4+IL-17+ T cells and the mRNA levels of IL-17 and RORγt were significantly increased in HF-treated mice compared with the non-treated AIT-induced mice (P < 0.05). Conclusion: Treatment with HF significantly decreased the incidence of AIT by decreasing the number of CD4+IL-17+ T cells.

Objectives: The objectives of the present investigation were to prepare recombinant human insulin entrapped Eudragit-S100 microspheres containing protease inhibitors and to precisely analyze the outcome of different formulation variables on the microspheres properties using a response surface methodology to develop an optimized formulation with desirable features. Methods: A central composite design was employed to produce microspheres of therapeutic protein by w/o/w multiple emulsion solvent evaporation technique using Eudragit S-100 as coating material and polyvinyl alcohol as a stabilizer. The effect of formulation variables (independent variables) that is levels of Eudragit S-100 (X1), therapeutic protein (X2), volumes of inner aqueous phase (X3) and external aqueous phase (X4) on dependant variables, that are encapsulation efficiency (Y1), drug release at pH 1.2 after 2 h (Y2) and drug release at pH 7.4 after of 2 h (Y3) were evaluated. Results: The significant terms in the mathematical models were generated for each response parameter using multiple linear regression analysis and analysis of variance. All the formulation variables except the volume of external aqueous phase (X4) exerted a significant effect (P <0.05) on drug encapsulation efficiency (Y1) whereas first two variables, namely the levels of Eudragit S-100 (X1) and therapeutic protein (X2) materialized as the determining factors which significantly influenced drug release at pH 1.2 after 2 h (Y2) and drug release at pH 7.4 after of 2 h (Y3). The formulation was numerically optimized by framing the constraints on the dependent and independent variables using the desirability approach. The experimental values for Y1 and Y2 of optimized formulation were found to be 77.65% and 3.64%, respectively which were quite closer to results suggested by software. Conclusion: The results recorded indicate that the recombinant human insulin loaded Eudragit S-100 microspheres containing aprotinin have the benefits of higher loading efficiency, pH responsive and prolonged release characteristics, which may help to carry insulin to the optimum site of absorption.

Background: Nickel (Ni) is widely distributed in the environment and continuous exposure to this metal may lead to pathological manifestations, such as the human allergic contact dermatitis. Methods: The in vitro effects of Ni on human healthy non allergic peripheral blood mononuclear cells (PBMCs) in the absence or presence of red grape polyphenols have been evaluated. In the culture supernatants, levels of cytokines have been determined by ELISA, while nitric oxide (NO) concentration has been evaluated by a colorimetric procedure. Results: Ni per se did not affect release of interferon-γ, interleukin (IL)-4 and IL-10. Instead, this metal dramatically reduced production of IL-17 which was restored by the supplementation of polyphenols. Finally, while Ni significantly increased generation of NO, polyphenols reduced production of this compound. Conclusion: Taken together, all these data may indicate a preventative role of polyphenols against Ni exposure in non allergic to Ni individuals, also confirming the immunomodulating role of these natural products. The interaction Ni/polyphenols/lipopolysaccharides will also be discussed.