Citrulline supplementation improves organ perfusion and arginine availability under conditions with enhanced arginase activity

Enhanced arginase-induced arginine consumption is believed to play a key role in the pathogenesis of sickle cell disease-induced end organ failure. Enhancement of arginine availability with l-arginine supplementation exhibited less consistent results; however, l-citrulline, the precursor of l-arginine, may be a promising alternative. In this study, we determined the effects of l-citrulline compared to l-arginine supplementation on arginine-nitric oxide (NO) metabolism, arginine availability and microcirculation in a murine model with acutely-enhanced arginase activity. The effects were measured in six groups of mice (n = 8 each) injected intraperitoneally with sterile saline or arginase (1000 IE/mouse) with or without being separately injected with l-citrulline or l-arginine 1 h prior to assessment of the microcirculation with side stream dark-field (SDF)-imaging or in vivo NO-production with electron spin resonance (ESR) spectroscopy. Arginase injection caused a decrease in plasma and tissue arginine concentrations. l-arginine and l-citrulline supplementation both enhanced plasma and tissue arginine concentrations in arginase-injected mice. However, only the citrulline supplementation increased NO production and improved microcirculatory flow in arginase-injected mice. In conclusion, the present study provides for the first time in vivo experimental evidence that l-citrulline, and not l-arginine supplementation, improves the end organ microcirculation during conditions with acute arginase-induced arginine deficiency by increasing the NO concentration in tissues

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Phytoplankton abundance, dominance and coexistence in an eutrophic reservoir in the state of Pernambuco, Northeast Brazil

The present study reports the phytoplankton abundance, dominance and co-existence relationships in the eutrophic Carpina reservoir, Pernambuco, Brazil. Sampling was carried out at six different depths bimonthly at a single reservoir spanning two climatic periods: dry season (January, September, and November 2006) and rainy season (March, May, and July 2006). Density, abundance, dominance, specific diversity and equitability of the community were determined, along with chlorophyll a, and physical and chemical variables of the environment. Eight species were considered abundant, and their densities corresponded to more than 90% of the total phytoplankton community quantified. Cyanobacteria represented more than 80% of this density. Cylindrospermopsis raciborskii was the only dominant taxon in the dry season, and was co-dominant in the rainy season. C. raciborskii, Planktothrix agardhii and Geitlerinema amphibium had the greatest densities and lowest vertical variation coefficients. The statistical analysis indicated relationships with vertical and seasonal variations in the phytoplankton community and the following variables: total dissolved solids, water temperature, electrical conductivity and pH. The changes in the environmental variables were discrete and regulated by the establishment of precipitation however, they were able to promote vertical and seasonal instability in the structure of the phytoplankton community.<br>O presente estudo remete às relações de abundância, dominância e co-existência fitoplanctônica no reservatório eutrófico de Carpina, Pernambuco, Brasil. Foram realizadas amostragens bimensalmente, em seis profundidades, em um único ponto do reservatório, contemplando dois períodos sazonais: seco (janeiro, setembro e novembro/2006) e chuvoso (março, maio e julho/2006). A densidade, abundância, dominância, diversidade específica e equitabilidade foram determinadas, além da clorofila a e algumas variáveis físicas e químicas do ambiente. Oito táxons foram considerados abundantes e suas densidades corresponderam a mais de 90% do fitoplâncton total quantificado. As cianobactérias representaram mais de 80% desta densidade. Cylindrospermopsis raciborskii foi o único táxon dominante durante o período seco e co-dominante no chuvoso. C. raciborskii, Planktothrix agardhii e Geitlerinema amphibium destacaram-se com as maiores densidades e os menores coeficientes de variação vertical. As análises estatísticas indicaram relação entre as alterações verticais e sazonais da comunidade fitoplanctônica e seguintes variáveis: sólidos totais dissolvidos, temperatura da água, condutividade elétrica e pH. As alterações observadas para as variáveis ambientais foram discretas e reguladas pelo estabelecimento das precipitações, no entanto foram capazes de promover instabilidade vertical e sazonal na estrutura da comunidade fitoplanctônica

The Relationship between the Extent of Collaboration of General Practitioners and Pharmacists and the Implementation of Recommendations Arising from Medication Review

Geriatrics in primary car

Genetic variation in the Estonian population : pharmacogenomics study of adverse drug effects using electronic health records

Pharmacogenomics aims to tailor pharmacological treatment to each individual by considering associations between genetic polymorphisms and adverse drug effects (ADEs). With technological advances, pharmacogenomic research has evolved from candidate gene analyses to genome-wide association studies. Here, we integrate deep whole-genome sequencing (WGS) information with drug prescription and ADE data from Estonian electronic health record (EHR) databases to evaluate genome- and pharmacome-wide associations on an unprecedented scale. We leveraged WGS data of 2240 Estonian Biobank participants and imputed all single-nucleotide variants (SNVs) with allele counts over 2 for 13,986 genotyped participants. Overall, we identified 41 (10 novel) loss-of-function and 567 (134 novel) missense variants in 64 very important pharmacogenes. The majority of the detected variants were very rare with frequencies below 0.05%, and 6 of the novel lossof-function and 99 of the missense variants were only detected as single alleles (allele count = 1). We also validated documented pharmacogenetic associations and detected new independent variants in known gene-drug pairs. Specifically, we found that CTNNA3 was associated with myositis and myopathies among individuals taking nonsteroidal anti-inflammatory oxicams and replicated this finding in an extended cohort of 706 individuals. These findings illustrate that population-based WGS-coupled EHRs are a useful tool for biomarker discovery