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Archive for the ‘Bacterial Resistance’ Category

Proteins, Imaging and Therapeutics

Larry H Bernstein, MD, FCAP, Curator

LPBI

 

Dissecting the Structure of Membrane Proteins
http://www.genengnews.com/gen-articles/dissecting-the-structure-of-membrane-proteins/5583/

Kathy Liszewski

  • EM for Structural Analysis

Electron microscopy (EM) not only provides a straightforward approach to scrutinize the ultrastructure of cells and tissues, but it is also gaining momentum as a means to derive structural information on membrane proteins.

According to Bridget Carragher, Ph.D., co-director, Simons Electron Microscopy Center, New York Structural Biology Center, “EM is a widely applied technique to study the structure of proteins and membranes, but it is still less common than X-ray diffraction of prepared crystals. However, crystallization of membrane proteins has been particularly challenging. Since EM does not require obtaining crystals, it is becoming an increasingly used tool for performing structural analysis of membrane proteins and their complexes.”

As an example, Dr. Carragher described the use of single particle EM to directly visualize the conformational spectra of two homologous ATP-binding cassette (ABC) exporters. Single particle EM determines structure from multiple images of individual particles and uses methods like multivariate statistical analysis to separate heterogeneous particles into homogeneous classes.

“ABC transporters constitute a large family of membrane proteins that use the energy of ATP hydrolysis to translocate (either export or import) substances such as nutrients, lipids, and ions across the lipid bilayers,” said Dr. Carragher. “They are medically important because they also transport drugs and contribute to antibiotic or antifungal resistance.

“In a collaborative study, we utilized an unbiased approach employing newly developed amphiphiles in complex with lipids to create a membrane-mimicking environment for stabilizing membrane proteins. Visualization of the complexes using single particle EM analysis revealed striking conformational differences between the two transporters with respect to the effect of binding nucleotides and substrates. Overall, these studies provided a comprehensive view of the conformational flexibility of these two ABC exporters.”

As improvements continue to be made in the technology, resolution is nearing the 3 to 5 angstrom range, at least for some proteins and protein complexes.

“EM is becoming competitive with X-ray diffraction for solving some protein structures. It is not likely to replace other techniques, but rather will be complementary to them,” she added.

  • Bacterial Membrane Dynamics

reengineered nanopore

 

Structural model of a re-engineered nanopore
[Lukas Tamm, Ph.D., University of Virginia]
 

 The outer membranes of gram negative bacteria, such as Pseudomonas and E. coli, consist of multiple proteins and densely packed lipopolysaccharides (LPS or endotoxin). This structure provides a formidable barrier to antibiotics, most of which are targeted to intracellular processes.

  • “Understanding outer membrane structure and how molecules are recognized and transported across the bacterial membrane are critical to creating more effective antibiotics,” noted Lukas K. Tamm, Ph.D., professor molecular physiology and biological physics, University of Virginia.
  • The Tamm laboratory studies the dynamics of membrane proteins especially via solution NMR spectroscopy. His laboratory provided the first structure of the outer membrane ion channel of E. coli, OmpA. The group also studies OmpG, an outer membrane protein whose single polypeptide chain forms a membrane nanopore.
  • “Engineered protein nanopores have attracted interest to detect rare metal ions and neurotransmitters in solution, to sequence DNA and RNA, and to measure folding and unfolding kinetics of single proteins,” he explained. “We developed a new approach to loop immobilization that revealed cross-talk patterns between different loops of the OmpG nanopore. This will be useful to engineer new functions into OmpG and for analyzing other membrane nanopores.”
  • Dr. Tamm also studies the outer membrane protein H (OprH) from Pseudomonas aeruginosa, a multidrug resistant pathogen that is the most common cause of pneumonia and mortality in cystic fibrosis patients. It is the major cause of hospital-acquired infections.
  • “The impermeability of this pathogen’s outer membrane contributes substantially to its notorious antibiotic resistance. We utilized in vivo and in vitro assays that demonstrated the importance of the interaction of OprH with LPS in the outer membrane. Additionally, beyond determining the structure of OprH, our studies revealed that solution NMR can be a powerful tool for investigating interaction of integral membrane proteins with specific lipids. This cannot be easily done by crystallography.”
  • Dr. Tamm explained that there are many challenges remaining before antibiotic resistance can be overcome.
  • “The substrate is unknown for many of the outer membrane proteins. To develop better targeted antibiotics, it will be important to define specific substrates. Also, determining the structure of outer membrane proteins will likely also provide new insights for understanding how protein-lipid interactions contribute to antibiotic resistance. We aren’t there yet, but we are close to getting better answers.”
  • Membrane proteins, such as receptors, ion channels, and transporters, comprise nearly 30% of all proteins in eukaryotic cells. They also constitute more than 50% of all drug targets.

Yet, membrane proteins continue to present considerable challenges to the field of structural biology. Their surface is relatively hydrophobic, usually requiring potentially harmful detergent solubilization. Conformational flexibility and instability also may create roadblocks for the expression and purification required for structural analysis.

The recent Argonne National Laboratory Conference on Membrane Protein Structures highlighted advances in the field such as use of smaller and more intense beams for X-ray micro-crystallography, novel protein engineering of fusion proteins for structure determination, nanodiscs that mimic native cell environments, visualization strategies employing single particle electron microscopy, and bacterial nanopore studies that may help surmount antibiotic resistance.

  • X-Ray Micro-Crystallography

membrane proteins structure

 

Schematic view of the planned upgrade of the GM/CA beamline 23-ID-D at the Advanced Photon Source (APS) at Argonne National Laboratory. Top panel: cartoon of the X-ray optics to focus the beam. Bottom panel: elevation view of the endstation focusing optics, sample goniometry, and detector. The beam line upgrade will reduce the minimum beam size from 5 µm to 1 µm in the near future. The proposed APS-MBA upgrade will allow the beam to be focused to <500 nm with a 100-fold increase in intensity. The small, high intensity X-ray beam will enable structure determination for some of the most challenging problems in structural biology.

 

  • Many physiological processes are controlled and regulated by conformational changes in GPCRs and other integral membrane proteins. “We are studying at the atomic level how allosteric changes in such proteins regulate cell signaling,” explained Daniel M. Rosenbaum, Ph.D., assistant professor, biophysics, biochemistry, University of Texas Southwestern Medical Center.X-ray crystallography has been a workhorse technology for structural biologists for many years. Scientists generate a minute crystal by carefully optimizing conditions, shoot a high-powered X-ray beam at it, measure the angle and intensity of the diffracted beams, and derive a complete or partial structure by analyzing the results with sophisticated analytical programs.
  • “Membrane proteins are notoriously difficult to crystallize, and often yield very small, weakly diffracting, radiation-sensitive crystals that are intractable to large-beam crystallography. However, high-resolution structures can be obtained by using a micro-beam,” noted Robert F. Fischetti, Ph.D., associate division director and group leader, X-ray Science Division, Argonne National Laboratory.
  • Dr. Fischetti said the Advanced Photon Source (APS), a DOE user facility at Argonne, leads the field in deriving membrane protein structures.
  • “G-Protein Coupled Receptors (GPCRs) are one very important class of membrane proteins. There are more than 800 GPCRs, and over 40% of all drugs target them. Of the 30 known protein structures, 21 were solved at the APS.”
  • According to Dr. Fischetti, a number of key improvements and innovative approaches are needed.
  • “Stability of the beam intensity and the relative alignment of the beam and crystal are paramount in micro-crystallography. One problem is that X-ray beams cause both primary and secondary (diffusional) structural damage to the crystal. To overcome that issue smaller, hotter beams and more rapid detectors are being used in the race against radiation damage.”
  • Dr. Fischetti said the field is also seeing the emergence of breakthrough techniques, including novel sample delivery systems such as the acoustic drop and microfluidic technologies. Further, throughput is advancing.
  • “We’re approaching the ability to perform data collection on many thousands of microcrystals complexed to a variety of compounds. This is enabling pharmaceutical applications.”
  • One of the most exciting changes at APS and throughout the scientific community is the development of a new storage ring magnet lattice design, the multibend achromat (MBA). The technology promises a revolutionary increase in brightness that could reach two to three orders of magnitude beyond the current capability.
  • According to Dr. Fischetti, “This fourth generation storage ring will be nearly diffraction-limited and provide key improvements such as focusing X-rays down to the nanometer level with much higher intensity than is currently available. We expect the proposed MBA to be available in the 2020s. With this and other advances, it is clear that we are entering a new frontier in X-ray science.”
  • Disease-Related Receptors

In particular, Dr. Rosenbaum and his laboratory use protein engineering, X-ray crystallography, and NMR spectroscopy to study the structure and dynamics of molecules involved in hormone signaling and lipid homeostasis.

“GPCRs and other membrane proteins are not easily amenable to structural studies,” he said. “This limitation can often be overcome by protein engineering methods such as creating fusion proteins or thermostable mutants and using lipid-mediated crystallization methods.”

For example, Dr. Rosenbaum and colleagues studied the human β2 adrenergic receptor (β2AR) that binds epinephrine and is involved in the fight or flight response. Using the inactive structure of β2AR as guide, the team designed a β2AR agonist that could be covalently attached to a specific site on the receptor. “With this approach, we were able to crystallize a covalent agonist-bound β2AR fusion protein in lipid bilayers and determine its structure at 3.5 angstroms resolution.”

Another example of using fusion proteins to overcome membrane protein crystallization limitations is that of the human orexin receptor, OX2R. The orexin system modulates behaviors in mammals such as sleep, arousal, and feeding. Dysfunctions can lead to narcolepsy and cataplexy. The FDA recently approved the first-in-class drug, suvorexant, which became available in early 2015.

Dr. Rosenbaum and colleagues used lipid-mediated crystallization and protein engineering with a novel fusion chimera to solve the structure of the OX2R, bound to suvorexant at 2.5 angstom resolution.

“Elucidation of the molecular architecture of the human OX2R enhances our knowledge of how it recognizes ligands. Such studies provide powerful tools for designing improved therapeutics that can activate or inactivate orexin signaling.”

These studies have an overarching significance as well. “Looking at the bigger picture, these methods may lead to the design of new classes of small molecules that modulate key signaling pathways by controlling protein conformational changes within cellular membranes,” Dr. Rosenbaum concluded.

  • Nanodisc Technology

Although membrane proteins can be purified following cell lysis and detergent solubilization or after expression in heterologous systems, their true structure and function can be significantly compromised or lost entirely in the process. Ideally one would like membrane proteins to remain in a solubilized state for easier purification, functional assays, and structure determination. However, the native membrane environment is often necessary for full functionality. Detergents pose many technical obstacles including being hazardous for protein stability and interfering in many assay techniques.

Enter Nanodisc technology, a new approach for providing accessibility to the world of membrane proteins.

“We’ve always had a dream of engineering a process that would not only incorporate any membrane protein into a soluble bilayer structure, but also one that would employ a self-assembly process that would be applicable to all individual membrane proteins regardless of their structure and topology,” explained Stephen G. Sligar, Ph.D., director of the School of Molecular and Cellular Biology, University of Illinois, Urbana Champaign.

“Recently, that dream became realized by the creation of Nanodisc technology. Nanodiscs are self-assembling nanoscale phospholipid bilayers that are stabilized using engineered membrane scaffold proteins. The Nanodiscs allow membrane proteins to remain soluble and thus closely mimics native environment.”

There are many uses for the new technology according to Dr. Sligar. “Technological applications can take advantage of Nanodisc properties such as its small size, reduced light scattering, faster diffusion, enhanced stability, access to both sides of the bilayer and for surface attachment (e.g., surface plasmon resonance studies).”

Dr. Sligar and colleagues even demonstrated how to utilize the new technology for high throughput screening (HTS) assays.

“We wanted to identify antagonists that would interfere with the binding of membrane proteins to Alzheimer’s-associated amyloid β oligomers (AβOs), which are the neurotoxic ligands that instigate Alzheimer’s dementia. In collaboration with Professor William Klein and co-workers at Northwestern University, we created a solubilized membrane protein library (SMPL). This consisted of a complete set of membrane proteomes derived from biological tissue containing a heterogeneous mixture of individual proteins.

“Screening an extensive library of drug-like compounds and natural products identified yielded several ‘hits’, thus providing proof of concept for using SMPLs in HTS applications. An initial publication appeared recently in PLOS ONE.”

The results need to be confirmed in animal studies, Dr. Sligar noted. Overall, he is enthusiastic about the Nanodisc platform for uses that range from determination of structure/function to HTS applications.

“The unique properties of Nanodiscs make them ideal candidates to address important functional and structural questions involving membrane proteins in a more native environment.”

 

Twists and Turns in Protein Expression

In Early Drug Discovery it’s Often Unclear Which Recombinant Proteins Will Be Affected by Changing the Host Cell

http://www.genengnews.com/gen-articles/twists-and-turns-in-protein-expression/5589/

  • When drug developers use different cell lines for manufacturing and preclinical research, they risk generating inconsistent results, proteins with various structures and functions. Then, confounded by variability, drug developers may lavish attention on irrelevant candidates and overlook promising candidates.

To avoid misleading themselves, drug developers must find ways to avoid or account for protein variants, which include post-translational modifications, particularly alternative glycosylations. Such variants occur all too frequently among different host cell lines, an extensive body of literature documents.

“Variability is most evident when comparisons are made between mammalian and nonmammalian cells,” says James Brady, Ph.D., vice president of technical applications and customer support at MaxCyte. “But depending on the protein that is being produced, even different mammalian cell lines, such as HEK and CHO, will exhibit substantial differences in post-translational modifications.” Differences can lead to altered protein stability, activity, or in vivo half-life.

It is often unclear during the early drug discovery process which recombinant proteins will be affected by changing the host cell. However, misleading early-stage data are associated with significant costs and extended timelines. It therefore makes sense to adopt a single host cell for all stages of the development pipeline. That is the rationale behind MaxCyte’s flow electroporation transfection platform.

  • Large-Scale Electroporation

Chemical transfection based on lipids or polymers are the most common alternatives to electroporation for large-scale transient transfection. However, reagent costs, lot-to-lot reagent variability, scale-up difficulties, and low transfection efficiency with certain cell types often are significant challenges of chemical transfection, particularly in biomanufacturing-relevant cells such as CHO.

Viral transfection vectors are another possibility. “While viral vectors may be more effective than chemical methods for introducing genes into certain difficult-to-transfect cell types, producing viral vectors often requires the development of packaging or producer cell lines,” Dr. Brady explains. “There are also biosafety concerns associated with some viral vectors.”

Unlike stable transfection, transient gene expression does not involve integration of the transgene into the host chromosome. Therefore, influences of the integration site on protein expression levels or other protein attributes are not evident. Rather the host cell’s genetic background, media/feed formulation, and culture conditions are the most significant factors influencing product quality, regardless of whether the protein is produced by stable or transient expression.

While high-end titers for stably transfected cells are now advancing into the low double-digit grams per liter, average titers are still in the lower single digits. Thus, the titers of 2–3 g/L that have recently been reported for transient expression via flow electroporation in nonengineered CHO cells are beginning to rival those of stable cell lines.

“So far, upper limits to titer by stable or transient expression have not been reached,” Dr. Brady tells GEN. “It is likely that innovations in vector design, advances in cell-line engineering, and improvements to cell-culture processes will lead to continued advances in both stable and transient titers.”

  • Monitoring Expression
  • Analytical methods are crucial for quantifying not only protein expression but also quality. A group at Fujifilm Diosynth Biotechnologies led by Greg Adams, Ph.D., the company’s director of analytical development, is promoting analytical techniques applicable throughout a molecule’s life cycle.

A scientist at Fujifilm Diosynth Biotechnologies operating an ambr250 mini-bioreactor system from Sartorius Stedim Biotech business unit TAP Biosystems.

 

  • Depending on the expression system, the Fujifilm Diosynth team focuses mostly on aggregation, glycosylation, and heterogeneity. The team employs a mix of rapid and conventional analyses, for example, mass spectrometry, ultra-performance liquid chromatography (UPLC), glycan analysis with rapid 2-aminobenzamide (2-AB) labeling and normal-phase UPLC, and capillary electrophoresis (CE) techniques such as imaged CE (iCE) and the CE-sodium dodecyl sulfate (CE-SDS) method. “Our objective,” declares Dr. Adams, “is same-day quality attribute analysis for understanding what’s happening in a bioreactor while designing the upstream process.”
  • Note that all the aforementioned techniques are standard analysis methods. The novelty is the context in which Fujifilm Diosynth uses them. Another distinction is the company’s high-throughput approach. The company uses liquid-handling workstations with pre-loaded tips for culture purification over protein A. The 30–60-minute preparation provides purified, active, concentrated antibody that may be analyzed in a number of ways. “We are able to analyze multiple ambr™ minireactor or 2 L bioreactor samples in hours versus days,” asserts Dr. Adams.
  • When it is applied to cell-line development, the rapid analysis philosophy holds that the same methods should be used from early development through GMP manufacturing. In practice, this is easier with antibodies because molecules of this class lend themselves to affinity purification and rapid method optimization through design of experiment (DOE), potentially beginning with transfectant pool material.
  • “Hopefully, we can have a method that we don’t have to change for the lifetime of the program,” Dr. Adams says. “It certainly helps to be able to trace data back through clinical phases and not have to worry about chromatographic profile and column changes. This has been very successful in several programs using the newer techniques, where the development phase is assisted by the speed by which you can run each method.”
  • The next challenge is to transfer this methodology to products expressed in microbial fermentation, which Dr. Adams refers to as the “next generation” of this approach to analytics.
  • Improving Solubility

Escherichia coli became the workhorse of recombinant protein expression because of its simple genetics, ease of culturing, scalability, rapid expression, and prodigious productivity. Negatives include a lack of eukaryotic post-translational machinery, codon usage bias, and difficulty with high-molecular-weight proteins.

Pros and cons must be weighed in terms of the target protein’s intended use. Quality and purity requirements for research-only proteins vary significantly, and may be worlds apart from therapeutic proteins. “The end application dictates to a large degree the choice of expression host, purity requirements, how you design the construct, and which tags to use,” says Keshav Vasanthavada, marketing specialist at GenScript.

A disadvantage in E. coli on par with low expression is insoluble expression, which results in aggregates (inclusion bodies). Researchers can deal with this phenomenon at the process level or molecular level. But before they embark on an improvement project, they should, Vasanthavada advises, check the literature to see if other researchers have produced the target protein in adequate yield and at acceptable quality. If so, it would be worthwhile to look at the other researchers’ methods and see if they can be reproduced.

Process-level strategies, which do not require target reengineering, include changing expression conditions, in vitro protein refolding, switching E. coli strains, adjusting media and buffers, or incorporating chaperone co-expression. Molecular-level approaches involve eliminating undesirable elements through truncations or mutations.

“The easiest approach is adoption of a fusion partner-based strategy,” Vasanthavada tells GEN. “It involves the use of a solubilizing partner upstream of the target protein to enhance target protein solubility.”

While this approach is generally beneficial, it has its drawbacks. For example, while a fusion partner will solubilize the target protein, there is no guarantee that the target protein will remain in solution once the tag is cleaved off. “Sometimes, you cannot ‘cleave off’ the fusion partner. The proteolytic enzyme won’t reach the cleavage site because of interference from itself,” Vasanthavada explains. “On other occasions, your fusion partner will start sticking to your target protein post-cleavage.”

 

Riboswitch Flip Kills Bacteria

Scientists discover a novel antibacterial molecule that targets a vital RNA regulatory element.

By Ruth Williams | September 30, 2015

http://www.the-scientist.com//?articles.view/articleNo/44129/title/Riboswitch-Flip-Kills-Bacteria/

 

Part of a riboswitch

http://www.the-scientist.com/images/News/September2015/Riboswitch.jpg

Researchers at the pharmaceutical company Merck have identified a new bacteria-killing compound with an unusual target—an RNA regulatory structure called a riboswitch. The team used its drug, described in Nature today (September 30), to successfully reduce an experimental bacterial infection in mice, suggesting that the molecule could lead to the creation of a new antibiotic. Moreover, the results indicate that riboswitches—and other RNA elements—might be hitherto unappreciated targets for antibiotics and other drugs.

“Finding an antibiotic with a new target . . . has always been one of the holy grails of antibiotics discovery,” said RNA biochemist Thomas Hermann of the University of California, San Diego, who was not involved in the work. “It looks like that’s what the Merck group has now accomplished.”

The team’s research began with the idea of finding a compound that blocks the bacterial riboflavin synthesis pathway. Riboflavin is an essential nutrient for humans and bacteria alike, but while humans must consume it as part of their diet, bacteria can either scavenge riboflavin from the environment or, if supplies are lacking, make their own. “We targeted the riboflavin pathway because it is specific to bacteria so you have a built in safety margin,” said John Howe of the Merck research laboratories in Kenilworth, New Jersey, who led the research.

The team devised a simple but “very smart phenotypic screen,” said Hermann. The researchers tested roughly 57,000 antibacterial synthetic small molecules on cultures of E. coli bacteria looking for ones whose killing ability was neutralized by the presence of riboflavin. “If the effect of that antibacterial was suppressed by riboflavin,” said Howe, “then we had a good chance that the small molecule . . . was targeting the riboflavin pathway.”

The team found one molecule that fit the criteria and called it ribocil. To investigate the molecule’s mechanism of action, they applied it to cultures of E. coli cells until colonies emerged that were resistant to its effect. The researchers then sequenced the whole genomes of each of the resistant bacterial strains to find which genes were mutated.

The majority of drugs target proteins, explained Howe, “so we assumed that the mutations would be in one of the enzymes in the riboflavin synthesis pathway.” But as it turned out, while all of the 19 resistant strains did have mutations in a gene called RibB (which produces one of the riboflavin synthesis enzymes), the mutations did not affect the protein itself. They altered a non-coding part of the messenger RNA transcript: the riboswitch.

Riboswitches are regulatory elements at the beginning of messenger RNA transcripts. They bind molecules—normally metabolites—that typically suppress the transcript’s expression. “So instead of regulating the enzyme itself, [ribocil] is regulating the production of the enzyme,” Howe said.

Indeed, through reporter assays and crystallization experiments, the team confirmed that ribocil directly interacted with the RibB riboswitch, preventing expression of the protein.

“Ninety-nine-point-nine percent of drug targets are proteins,” said Hermann, “but they were prepared for the 0.1 percent outcome, and I think that’s what I really liked about this work.”

The team went on to tweak ribocil’s chemical structure, improving its killing efficiency and prolonging its effectiveness inside the body. The researchers then showed that this enhanced version of ribocil could effectively reduce bacterial burden in mice infected with a weakened E. coli strain; the bacteria are unable to efficiently expel drugs.

Weakened E. coli were used because wild-type E. coli are adept at ejecting ribocil and other compounds before they can take effect. Finding a way to keep ribocil in the bacteria and making other improvements will be necessary before it can be used as an actual antibiotic, explained Howe.

“I’ve [got] no idea if ribocil will end up being a drug candidate,” biochemist Gerry Wright of McMaster University in Ontario, Canada, wrote in an email to The Scientist, “but the work is a proof of principle, which is very important, and it makes us look to new areas of biology as targets for antibiotics.”

J.A. Howe et al., “Selective small-molecule inhibition of an RNA structural element,” Nature,doi: 10.1038/nature15542, 2015.

Tags

riboswitchnoncoding RNAdrug developmentdisease/medicinecell & molecular biology and antibiotics

 

Assay Drug Dev Technol. 2015 Sep;13(7):402-14. doi: 10.1089/adt.2015.655.

High-Content Assays for Characterizing the Viability and Morphology of 3D Cancer Spheroid Cultures.

Sirenko O1Mitlo T1Hesley J1Luke S1Owens W1Cromwell EF2.

Author information

Abstract

There is an increasing interest in using three-dimensional (3D) spheroids for modeling cancer and tissue biology to accelerate translation research. Development of higher throughput assays to quantify phenotypic changes in spheroids is an active area of investigation. The goal of this study was to develop higher throughput high-content imaging and analysis methods to characterize phenotypic changes in human cancer spheroids in response to compound treatment. We optimized spheroid cell culture protocols using low adhesion U-bottom 96- and 384-well plates for three common cancer cell lines and improved the workflow with a one-step staining procedure that reduces assay time and minimizes variability. We streamlined imaging acquisition by using a maximum projection algorithm that combines cellular information from multiple slices through a 3D object into a single image, enabling efficient comparison of different spheroid phenotypes. A custom image analysis method was implemented to provide multiparametric characterization of single-cell and spheroid phenotypes. We report a number of readouts, including quantification of marker-specific cell numbers, measurement of cell viability and apoptosis, and characterization of spheroid size and shape. Assay performance was assessed using established anticancer cytostatic and cytotoxic drugs. We demonstrated concentration-response effects for different readouts and measured IC50 values, comparing 3D spheroid results to two-dimensional cell cultures. Finally, a library of 119 approved anticancer drugs was screened across a wide range of concentrations using HCT116 colon cancer spheroids. The proposed methods can increase performance and throughput of high-content assays for compound screening and evaluation of anticancer drugs with 3D cell models.

 

Molecules Hold the Mirror Up to Cancer

Imaging Technologies are Critical Tools for Basic Research and Translational and Clinical Applications

http://www.genengnews.com/gen-articles/molecules-hold-the-mirror-up-to-cancer/5582/

The Center for Biomedical Imaging in Oncology (CBIO) at the Dana-Farber Cancer Institute in Boston is a centralized cancer imaging research enterprise that was established to enable translational cancer research and drug development through the integration of preclinical and clinical imaging, access to preclinical/clinical multidisciplinary and multimodality imaging expertise, as well as drug/imaging probe development.

cancr imaging_DanaFarber_CBIO_OraganizatonalChart6613014019

 

http://www.genengnews.com/Media/images/Article/thumb_DanaFarber_CBIO_OraganizatonalChart6613014019.jpg

  • The molecular processes behind cancer were once seen as through a glass, darkly. But now they are being reflected more clearly, thanks to advances in probe synthesis, preclinical cancer modeling, and multimodal imaging. These advances have positioned imaging as a key tool for basic research, as well as for translational and clinical applications.

To bring cancer visualization trends to light, CHI recently held a conference, Translational Imaging in Cancer Drug Development, as part of the World Preclinical Congress in Boston. This conference attracted leading imaging experts from industry and academia, including scientists and clinicians who use their expertise to accelerate cancer research. Many of the experts described how, with a little creativity, imaging modalities can be used to translate scientific discoveries into clinical applications.

Several examples of creative imaging from the conference are discussed in this article. To start, this article will highlight one investigator’s new take on a familiar technique, positron emission tomography (PET).

“Along with the scientific challenge posed by President Obama’s Precision Medicine Initiative, molecular imaging probes have substantially improved and expanded to include the noninvasive characterization of tumors and tumor microenvironments,” said Quang-Dé Nguyen, Ph.D., director of the Lurie Family Imaging Center (LFIC) at the Dana Farber Cancer Institute. “PET is becoming a method of choice for studying tumor biology in real time.”

LFIC is fully equipped to meet the creative demands of translational molecular imaging. It is an integral part of the Center for Biomedical Imaging in Oncology (CBIO), which also includes a clinical imaging research group. In addition to LFIC and CBIO, the Dana Farber Cancer Institute includes medicinal chemistry capabilities and expertise, and has recently established the Molecular Cancer Imaging Facility housing the only PET cyclotron in the state dedicated entirely to the development of novel radiotracers for cancer research.

“A unique attribute of our Cancer Center is the fully developed Mouse Hospital, mirroring every aspect of human cancer diagnostics and care,” noted Dr. Nguyen. The center uses genetically engineered mouse models that can be matched to the specific genotype of a given individual patient. Alternatively, the Center can rapidly generate xenograft mice and orthotopic murine tumor models using human tumor cells obtained from biopsies. In either case, the resulting mouse model is a faithful genetic mirror of the patient’s tumor.

Dr. Nguyen’s team deploys PET imaging to inform patient treatment in co-clinical trials. Once a patient’s genotype is identified, an appropriate mouse model is selected, sometimes in combination with additional mutations. The mouse is treated with a desired therapy, and functional and molecular outcomes can be rapidly detected by PET imaging. Mouse-derived data can then inform the design of the clinical trial and be fully integrated with clinical data.

In a seminal study, lung tumors carrying several combinations of cancer mutations were simultaneously tested in genetically engineered mouse models and in patients with lung cancer enrolled in a clinical trial to assess response to a combination therapy with a novel drug compared to standard of care. The radiolabeled glucose analog was used to visualize the lung tumors by PET in both mice and patients.

Remarkably, within 24 hours after therapy initiation, preclinical PET imaging demonstrated treatment response to the combined regimen for some but not all the mutations. This information helped identify the resistant mutation in patients being considered for enrollment in the clinical trial and allowed enrichment of the patient population by selecting patients carrying those mutations that had showed metabolic response in the preclinical setting.

more…

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Confluence of Chemistry, Physics, and Biology

Curator: Larry H. Bernstein, MD, FCAP

 

  1. How Nanotechnology Works by Kevin Bonsor and Jonathan Strickland

nanotechnology-4

Image Source:
http://s.hswstatic.com/gif/nanotechnology-4.gif

There’s an unprecedented multidisciplinary convergence of scientists dedicated to the study of a world so small, we can’t see it — even with a light microscope. That world is the field of nanotechnology, the realm ofatoms and nanostructures.Nanotechnology i­s so new, no one is really sure what will come of it. Even so, predictions range from the ability to reproduce things like diamonds and food to the world being devoured by self-replicating nanorobots.In order to understand the unusual world of nanotechnology, we need to get an idea of the units of measure involved. A centimeter is one-hundredth of a meter, a millimeter is one-thousandth of a meter, and a micrometer is one-millionth of a meter, but all of these are still huge compared to the nanoscale. A nanometer (nm) is one-billionth of a meter, smaller than the wavelength of visible light and a hundred-thousandth the width of a human hair

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As small as a nanometer is, it’s still large compared to the atomic scale. An atom has a diameter of about 0.1 nm. An atom’s nucleus is much smaller — about 0.00001 nm. Atoms are the building blocks for all matter in our universe. You and everything around you are made of atoms. Nature has perfected the science of manufacturing matter molecularly. For instance, our bodies are assembled in a specific manner from millions of living cells. Cells are nature’s nanomachines. At the atomic scale, elements are at their most basic level. On the nanoscale, we can potentially put these atoms together to make almost anything.

In a lecture called “Small Wonders:The World of Nanoscience,” Nobel Prize winner Dr. Horst Störmer said that the nanoscale is more interesting than the atomic scale because the nanoscale is the first point where we can assemble something — it’s not until we start putting atoms together that we can make anything useful.

In this article, we’ll learn about what nanotechnology means today and what the future of nanotechnology may hold. We’ll also look at the potential risks that come with working at the nanoscale.

In the next section, we’ll learn more about our world on the nanoscale.

The World of Nanotechnology

Experts sometimes disagree about what constitutes the nanoscale, but in general, you can think ofnanotechnology dealing with anything measuring between 1 and 100 nm. Larger than that is the microscale, and smaller than that is the atomic scale.

Nanotechnology is rapidly becoming an interdisciplinary field. Biologists, chemists, physicists and engineers are all involved in the study of substances at the nanoscale. Dr. Störmer hopes that the different disciplines develop a common language and communicate with one another

nanotechnology-5

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Only then, he says, can we effectively teach nanoscience since you can't understand the world of nanotechnology without a solid background in multiple sciences.

One of the exciting and challenging aspects of the nanoscale is the role that quantum mechanics plays in it. The rules of quantum mechanics are very different from classical physics, ­which means that the behavior of substances at the nanoscale can sometimes contradict common sense by behaving erratically. You can’t walk up to a wall and immediately teleport to the other side of it, but at the nanoscale an electron can — it’s called electron tunneling. Substances that are insulators, meaning they can’t carry an electric charge, in bulk form might become semiconductors when reduced to the nanoscale. Melting points can change due to an increase in surface area. Much of nanoscience requires that you forget what you know and start learning all over again.

So what does this all mean? Right now, it means that scientists are experimenting with substances at the nanoscale to learn about their properties and how we might be able to take advantage of them in various applications. Engineers are trying to use nano-size wires to create smaller, more powerful microprocessors. Doctors are searching for ways to use nanoparticles in medical applications. Still, we’ve got a long way to go before nanotechnology dominates the technology and medical markets.

In the next section, we’ll look at two important nanotechnology structures: nanowires and carbon nanotubes.

IT’S A SMALL WORLD AFTER ALL

At the nanoscale, objects are so small that we can’t see them — even with a light microscope. Nanoscientists have to use tools like scanning tunneling microscopes or atomic force microscopes to observe anything at the nanoscale. Scanning tunneling microscopes use a weak electric current to probe the scanned material. Atomic force microscopes scan surfaces with an incredibly fine tip. Both microscopes send data to a computer, which can assemble the information and project it graphically onto a monitor

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nanotechnology-6

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Nanowires and Carbon Nanotubes

Currently, scientists find two nano-size structures of particular interest: nanowires and carbon nanotubes. Nanowires are wires with a very small diameter, sometimes as small as 1 nanometer. Scientists hope to use them to build tiny transistors for computer chips and other electronic devices. In the last couple of years, carbon nanotubes have overshadowed nanowires. We’re still learning about these structures, but what we’ve learned so far is very exciting.

A carbon nanotube is a nano-size cylinder of carbon atoms. Imagine a sheet of carbon atoms, which would look like a sheet of hexagons. If you roll that sheet into a tube, you’d have a carbon nanotube. Carbon nanotube properties depend on how you roll the sheet. In other words, even though all carbon nanotubes are made of carbon, they can be very different from one another based on how you align the individual atoms.

With the right arrangement of atoms, you can create a carbon nanotube that’s hundreds of times stronger than steel, but six times lighter

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Engineers plan to make building material out of carbon nanotubes, particularly for things like cars and airplanes. Lighter vehicles would mean better fuel efficiency, and the added strength translates to increased passenger safety.

Carbon nanotubes can also be effective semiconductors with the right arrangement of atoms. Scientists are still working on finding ways to make carbon nanotubes a realistic option for transistors in microprocessors and other electronics.

In the next section, we’ll look at products that are taking advantage of nanotechnology.

GRAPHITE VS. DIAMONDS

What’s the difference between graphite and diamonds? Both materials are made of carbon, but both have vastly different properties. Graphite is soft; diamonds are hard. Graphite conducts electricity, but diamonds are insulators and can’t conduct electricity. Graphite is opaque; diamonds are usually transparent. Graphite and diamonds have these properties because of the way the carbon atoms bond together at the nanoscale.

Products with Nanotechnology

You might be surprised to find out how many products on the market are already benefiting from nanotechnology.

Bridgestone engineers developed this Quick Response Liquid Powder Display, a flexible digital screen, using nanotechnology.

Yoshikazu Tsuno/AFP/Getty Images

  • Sunscreen – Many sunscreens contain nanoparticles of zinc oxide or titanium oxide. Older sunscreen formulas use larger particles, which is what gives most sunscreens their whitish color. Smaller particles are less visible, meaning that when you rub the sunscreen into your skin, it doesn’t give you a whitish tinge.
  • Self-cleaning glass – A company called Pilkington offers a product they call Activ Glass, which uses nanoparticles to make the glassphotocatalytic and hydrophilic. The photocatalytic effect means that when UV radiation from light hits the glass, nanoparticles become energized and begin to break down and loosen organic molecules on the glass (in other words, dirt). Hydrophilic means that when water makes contact with the glass, it spreads across the glass evenly, which helps wash the glass clean.
  • Clothing – Scientists are using nanoparticles to enhance your clothing. By coating fabrics with a thin layer of zinc oxide nanoparticles, manufacturers can create clothes that give better protection from UV radiation. Some clothes have nanoparticles in the form of little hairs or whiskers that help repel water and other materials, making the clothing stain-resistant.
  • Scratch-resistant coatings – Engineers discovered that adding aluminum silicate nanoparticles to scratch-resistant polymer coatings made the coatings more effective, increasing resistance to chipping and scratching. Scratch-resistant coatings are common on everything from cars to eyeglass lenses.
  • Antimicrobial bandages – Scientist Robert Burrell created a process to manufacture antibacterial bandages using nanoparticles of silver. Silver ions block microbes’ cellular respiration

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    . In other words, silver smothers harmful cells, killing them.

New products incorporating nanotechnology are coming out every day. Wrinkle-resistant fabrics, deep-penetrating cosmetics, liquid crystal displays (LCD) and other conveniences using nanotechnology are on the market. Before long, we’ll see dozens of other products that take advantage of nanotechnology ranging from Intel microprocessors to bio-nanobatteriescapacitors only a few nanometers thick. While this is exciting, it’s only the tip of the iceberg as far as how nanotechnology may impact us in the future.

In the next section, we’ll look at some of the incredible things that nanotechnology may hold for us.­

TENNIS, ANYONE?

Nanotechnology is making a big impact on the tennis world. In 2002, the tennis racket company Babolat introduced the VS Nanotube Power racket. They made the racket out of carbon nanotube-infused graphite, meaning the racket was very light, yet many times stronger than steel. Meanwhile, tennis ball manufacturer Wilson introduced the Double Core tennis ball. These balls have a coating of clay nanoparticles on the inner core. The clay acts as a sealant, making it very difficult for air to escape the ball.

Accelerate Your Time to Print Using ANSYS™ SpaceClaim 2015

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ANSYS™ SpaceClaim 2015 provides new features to the STL Prep module, including:

  1. A one-click tool for adding a desired thickness to a part for printing
  2. Automatic facet smoothing for building precision into 3D parts
  3. A minimum thickness detection feature to check for areas falling below a tolerance limit
  4. An unsupported material warning with an overhangs button to add support material where it is needed

http://www.spaceclaim.com/en/Mkting/ppc_SpaceClaim2015_FacetedModels_Video_ThankYou.aspx

The Future of Nanotechnology

In the world of “Star Trek,” machines called replicators can produce practically any physical object, from weapons to a steaming cup of Earl Grey tea. Long considered to be exclusively the product of science fiction, today some people believe replicators are a very real possibility. They call it molecular manufacturing, and if it ever does become a reality, it could drastically change the world.

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Atoms and molecules stick together because they have complementary shapes that lock together, or charges that attract. Just like with magnets, a positively charged atom will stick to a negatively charged atom. As millions of these atoms are pieced together by nanomachines, a specific product will begin to take shape. The goal of molecular manufacturing is to manipulate atoms individually and place them in a pattern to produce a desired structure.

The first step would be to develop nanoscopic machines, called assemblers, that scientists can program to manipulate atoms and molecules at will. Rice University Professor Richard Smalley points out that it would take a single nanoscopic machine millions of years to assemble a meaningful amount of material. In order for molecular manufacturing to be practical, you would need trillions of assemblers working together simultaneously. Eric Drexler believes that assemblers could first replicate themselves, building other assemblers. Each generation would build another, resulting in exponential growth until there are enough assemblers to produce objects

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Assemblers might have moving parts like the nanogears in this concept drawing.

Trillions of assemblers and replicators could fill an area smaller than a cubic millimeter, and could still be too small for us to see with the naked eye. Assemblers and replicators could work together to automatically construct products, and could eventually replace all traditional labor methods. This could vastly decrease manufacturing costs, thereby making consumer goods plentiful, cheaper and stronger. Eventually, we could be able to replicate anything, including diamonds, water and food. Famine could be eradicated by machines that fabricate foods to feed the hungry.

Nanotechnology may have its biggest impact on the medical industry. Patients will drink fluids containing nanorobots programmed to attack and reconstruct the molecular structure of cancer cells and viruses. There’s even speculation that nanorobots could slow or reverse the aging process, and life expectancy could increase significantly. Nanorobots could also be programmed to perform delicate surgeries — suchnanosurgeons could work at a level a thousand times more precise than the sharpest scalpel

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By working on such a small scale, a nanorobot could operate without leaving the scars that conventional surgery does. Additionally, nanorobots could change your physical appearance. They could be programmed to perform cosmetic surgery, rearranging your atoms to change your ears, nose, eye color or any other physical feature you wish to alter.

Nanotechnology has the potential to have a positive effect on the environment. For instance, scientists could program airborne nanorobots to rebuild the thinning ozone layer. Nanorobots could remove contaminants from water sources and clean up oil spills. Manufacturing materials using the bottom-upmethod of nanotechnology also creates less pollution than conventional manufacturing processes. Our dependence on non-renewable resources would diminish with nanotechnology. Cutting down trees, mining coal or drilling for oil may no longer be necessary — nanomachines could produce those resources.

Many nanotechnology experts feel that these applications are well outside the realm of possibility, at least for the foreseeable future. They caution that the more exotic applications are only theoretical. Some worry that nanotechnology will end up like virtual reality — in other words, the hype surrounding nanotechnology will continue to build until the limitations of the field become public knowledge, and then interest (and funding) will quickly dissipate.

In the next section, we’ll look at some of the challenges and risks of nanotechnology.

HOW NEW IS NANOTECHNOLOGY?

In 1959, physicist and future Nobel prize winner Richard Feynman gave a lecture to the American Physical Society called “There’s Plenty of Room at the Bottom.” The focus of his speech was about the field of miniaturization and how he believed man would create increasingly smaller, powerful devices.

In 1986, K. Eric Drexler wrote “Engines of Creation” and introduced the term nanotechnology. Scientific research really expanded over the last decade. Inventors and corporations aren’t far behind — today, more than 13,000 patents registered with the U.S. Patent Office have the word “nano” in them

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Nanotechnology Challenges, Risks and Ethics

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The most immediate challenge in nanotechnology is that we need to learn more about materials and their properties at the nanoscale. Universities and corporations across the world are rigorously studying how atoms fit together to form larger structures. We’re still learning about how quantum mechanics impact substances at the nanoscale.

Because elements at the nanoscale behave differently than they do in their bulk form, there’s a concern that some nanoparticles could be toxic. Some doctors worry that the nanoparticles are so small, that they could easily cross the blood-brain barrier, a membrane that protects the brain from harmful chemicals in the bloodstream. If we plan on using nanoparticles to coat everything from our clothing to our highways, we need to be sure that they won’t poison us.

Closely related to the knowledge barrier is the technical barrier. In order for the incredible predictions regarding nanotechnology to come true, we have to find ways to mass produce nano-size products like transistors and nanowires. While we can use nanoparticles to build things like tennis rackets and make wrinkle-free fabrics, we can’t make really complex microprocessor chips with nanowires yet.

There are some hefty social concerns about nanotechnology too. Nanotechnology may also allow us to create more powerful weapons, both lethal and non-lethal. Some organizations are concerned that we’ll only get around to examining the ethical implications of nanotechnology in weaponry after these devices are built. They urge scientists and politicians to examine carefully all the possibilities of nanotechnology before designing increasingly powerful weapons.

If nanotechnology in medicine makes it possible for us to enhance ourselves physically, is that ethical? In theory, medical nanotechnology could make us smarter, stronger and give us other abilities ranging from rapid healing to night vision. Should we pursue such goals? Could we continue to call ourselves human, or would we become transhuman — the next step on man’s evolutionary path? Since almost every technology starts off as very expensive, would this mean we’d create two races of people — a wealthy race of modified humans and a poorer population of unaltered people? We don’t have answers to these questions, but several organizations are urging nanoscientists to consider these implications now, before it becomes too late.

Not all questions involve altering the human body — some deal with the world of finance and economics. If molecular manufacturing becomes a reality, how will that impact the world’s economy? Assuming we can build anything we need with the click of a button, what happens to all the manufacturing jobs? If you can create anything using a replicator, what happens to currency? Would we move to a completely electronic economy? Would we even need money?

Whether we’ll actually need to answer all of these questions is a matter of debate. Many experts think that concerns like grey goo and transhumans are at best premature, and probably unnecessary. Even so, nanotechnology will definitely continue to impact us as we learn more about the enormous potential of the nanoscale.

APOCALYPTIC GOO

Eric Drexler, the man who introduced the word nanotechnology, presented a frightening apocalyptic vision — self-replicating nanorobots malfunctioning, duplicating themselves a trillion times over, rapidly consuming the entire world as they pull carbon from the environment to build more of themselves. It’s called the “grey goo” scenario, where a synthetic nano-size device replaces all organic material. Another scenario involves nanodevices made of organic material wiping out the Earth — the “green goo” scenario.

The Technion’s Russell Berrie Nanotechnology Institute is a world-leader in nanotechnology research having made seminal discoveries in the field.

Breakthroughs in Nanotechnology

  • Prof. Ester Segal and a team of Israeli and American researchers find that silicon nanomaterials used for the localized delivery of chemotherapy drugs behave differently in cancerous tumors than they do in healthy tissues. The findings could help scientists better design such materials to facilitate the controlled and targeted release of the chemotherapy drugs to tumors.
  • Associate Professor Alex Leshansky of the Faculty of Chemical Engineering is part of an international team that has created a tiny screw-shaped propeller that can move in a gel-like fluid, mimicking the environment in a living organism. The breakthrough brings closer the day robots that are only nanometers – billionths of a meter – in length, can maneuver and perform medicine inside the human body and possibly inside human cells.
  • Prof. Amit Miller and a team of researchers at the Technion and Boston University have discovered a simple way to control the passage of DNA molecules through nanopore sensors. The breakthrough could lead to low-cost, ultra-fast DNA sequencing that would revolutionize healthcare and biomedical research, and spark major advances in drug development, preventative medicine and personalized medicine.

– Israeli Prime Minister Benjamin Netanyahu presents U.S. President Barack Obama with nano-sized inscribed replicas of the Declarations of Independence of the United States and the State of Israel. The replicas were created by scientists at the Technion’s Russell Berrie Nanotechnology Institute (RBNI). (03/13)

– Prof. Nir Tessler has found a way to generate an electrical field inside solar cells that use inorganic nanocrystals or “quantum dots,” making them more suitable for building an energy-efficient nanocrystal solar cell. (11/11)

– Researchers led by Prof. Wayne Kaplan discover the nature of nanometer-thick layers between different materials and find that they have both solid and liquid properties. The results could enable scientists to improve the resilience of the bond between ceramic materials and metals, two types of materials that “do not like” to come into contact. Applications include cutting tools for metal-working; composites for brake pads; the joins between metal conducting wires and chips in computers; and the application of protective ceramic coatings on jet engine blades. (05/11)

– Israeli President Shimon Peres presents Pope Benedict XVI with a “Nano-Bible” smaller than a pinhead. Created by researchers at the Technion-Israel Institute of Technology, the complete punctuated and vowelized version of the Old Testament takes up just 0.5 square millimeters. The idea to write the Bible on such a tiny surface was conceived by Professor Uri Sivan, the first head of the university’s Russell Berrie Nanotechnology Institute (RBNI). (05/09)

Nanotechnology and medicine

Expert Opinion on Biological Therapy  2003; Volume 3Issue 4, 655-663
Dwaine F Emerich & Christopher G Thanos   http://dx.doi.org:/10.1517/14712598.3.4.655

Nanotechnology, or systems/device manufacture at the molecular level, is a multidisciplinary scientific field undergoing explosive development. The genesis of nanotechnology can be traced to the promise of revolutionary advances across medicine, communications, genomics and robotics. On the surface, miniaturisation provides cost effective and more rapidly functioning mechanical, chemical and biological components. Less obvious though is the fact that nanometre sized objects also possess remarkable self-ordering and assembly behaviours under the control of forces quite different from macro objects. These unique behaviours are what make nanotechnology possible, and by increasing our understanding of these processes, new approaches to enhancing the quality of human life will surely be developed. A complete list of the potential applications of nanotechnology is too vast and diverse to discuss in detail, but without doubt one of the greatest values of nanotechnology will be in the development of new and effective medical treatments (i.e., nanomedicine). This review focuses on the potential of nanotechnology in medicine, including the development of nanoparticles for diagnostic and screening purposes, artificial receptors, DNA sequencing using nanopores, manufacture of unique drug delivery systems, gene therapy applications and the enablement of tissue engineering.

Nanotechnology in Medicine – Nanomedicine

The use of nanotechnology in medicine offers some exciting possibilities. Some techniques are only imagined, while others are at various stages of testing, or actually being used today.

Nanotechnology in medicine involves applications of nanoparticles currently under development, as well as longer range research that involves the use of manufactured nano-robots to make repairs at the cellular level (sometimes referred to as nanomedicine).

Whatever you call it, the use of nanotechnology in the field of medicine could revolutionize the way we detect and treat damage to the human body and disease in the future, and many techniques only imagined a few years ago are making remarkable progress towards becoming realities.

Nanotechnology in Medicine Application: Drug Delivery

One application of nanotechnology in medicine currently being developed involves employing nanoparticles to deliver drugs, heat, light or other substances to specific types of cells (such as cancer cells). Particles are engineered so that they are attracted to diseased cells, which allows direct treatment of those cells. This technique reduces damage to healthy cells in the body and allows for earlier detection of disease.

For example, nanoparticles that deliver chemotherapy drugs directly to cancer cells are under development. Tests are in progress for targeted delivery of chemotherapy drugs and their final approval for their use with cancer patients is pending. One company, CytImmune has published the results of a Phase 1 Clinical Trial of their first targeted chemotherapy drug and another company, BIND Biosciences, has published preliminary results of a Phase 1 Clinical Trial for their first targeted chemotherapy drug and is proceeding with a Phase 2 Clinical Trial.

Researchers at the University of Illinois have demonstated that gelatin nanoparticles can be used to deliver drugs to damaged brain tissue.

Researchers at MIT using nanoparticles to deliver vaccine. The nanoparticles protect the vaccine, allowing the vaccine time to trigger a stronger immune response.

Reserchers are developing a method to release insulin that uses a sponge-like matrix that contains insulin as well as nanocapsules containing an enzyme. When the glucose level rises the nanocapsules release hydrogen ions, which bind to the fibers making up the matrix. The hydrogen ions make the fibers positively charged, repelling each other and creating openings in the matrix through which insulin is released.

Researchers are developing a nanoparticle that can be taken orally and pass through the lining of the intestines into the bloodsteam. This should allow drugs that must now be delivered with a shot to be taken in pill form.

Researchers are also developing a nanoparticle to defeat viruses. The nanoparticle does not actually destroy viruses molecules, but delivers an enzyme that prevents the reproduction of viruses molecules in the patients bloodstream.

Read more about nanomedicine in drug delivery

Nanotechnology in Medicine Application: Therapy Techniques

Researchers have developed “nanosponges” that absorb toxins and remove them from the bloodstream. The nanosponges are polymer nanoparticles coated with a red blood cell membrane. The red blood cell membrane allows the nanosponges to travel freely in the bloodstream and attract the toxins.

Researchers have demonstrated a method to generate sound waves that are powerful, but also tightly focused, that may eventually be used for noninvasive surgery. They use a lens coated with carbon nanotubes to convert light from a laser to focused sound waves. The intent is to develop a method that could blast tumors or other diseased areas without damaging healthy tissue.

Researchers are investigating the use of bismuth nanoparticles to concentrate radiation used in radiation therapy to treat cancer tumors. Initial results indicate that the bismuth nanoparticles would increase the radiation dose to the tumor by 90 percent.

Nanoparticles composed of polyethylene glycol-hydrophilic carbon clusters (PEG-HCC) have been shown to absorb free radicals at a much higher rate than the proteins out body uses for this function. This ability to absorb free radicals may reduce the harm that is caused by the release of free radicals after a brain injury.

Targeted heat therapy is being developed to destroy breast cancer tumors. In this method antibodies that are strongly attracted to proteins produced in one type of breast cancer cell are attached to nanotubes, causing the nanotubes to accumulate at the tumor. Infrared light from a laser is absorbed by the nanotubes and produces heat that incinerates the tumor.

Read more about nanomedicine therapy techniques

Nanotechnology in Medicine Application: Diagnostic Techniques

Reseachers at MIT have developed a sensor using carbon nanotubes embedded in a gel; that can be injected under the skin to monitor the level of nitric oxide in the bloodstream. The level of nitric oxide is important because it indicates inflamation, allowing easy monitoring of imflammatory diseases. In tests with laboratory mice the sensor remained functional for over a year.

Researchers at the University of Michigan are developing a sensor that can detect a very low level of cancer cells, as low as 3 to 5 cancer cells in a one milliliter in a blood sample. They grow sheets of graphene oxide, on which they attach molecules containing an antibody that attaches to the cancer cells. They then tag the cancer cells with fluorescent molecules to make the cancer cells stand out in a microscope.

Researchers have demonstrated a way to use nanoparticles for early diagnosis of infectious disease. The nanoparticles attach to molecules in the blood stream indicating the start of an infection. When the sample is scanned for Raman scattering the nanoparticles enhance the Raman signal, allowing detection of the molecules indicating an infectious disease at a very early stage.

A test for early detection of kidney damage is being developed. The method uses gold nanorodsfunctionalized to attach to the type of protein generated by damaged kidneys. When protein accumulates on the nanorod the color of the nanorod shifts. The test is designed to be done quickly and inexpensively for early detection of a problem.

Read more about nanomedicine diagnostic techniques

Nanotechnology in Medicine Application: Anti-Microbial Techniques

One of the earliest nanomedicine applications was the use of nanocrystalline silver which is  as an antimicrobial agent for the treatment of wounds, as discussed on the Nucryst Pharmaceuticals Corporation website.

A nanoparticle cream has been shown to fight staph infections. The nanoparticles contain nitric oxide gas, which is known to kill bacteria. Studies on mice have shown that using the nanoparticle cream to release nitric oxide gas at the site of staph abscesses significantly reduced the infection.

Burn dressing that is coated with nanocapsules containing antibotics. If a infection starts the harmful bacteria in the wound causes the nanocapsules to break open, releasing the antibotics. This allows much quicker treatment of an infection and reduces the number of times a dressing has to be changed.

A welcome idea in the early study stages is the elimination of bacterial infections in a patient within minutes, instead of delivering treatment with antibiotics over a period of weeks. You can read about design analysis for the antimicrobial nanorobot used in such treatments in the following article: Microbivores: Artifical Mechanical Phagocytes using Digest and Discharge Protocol.

Nanotechnology in Medicine Application: Cell Repair

Nanorobots could actually be programmed to repair specific diseased cells, functioning in a similar way to antibodies in our natural healing processes.  Read about design analysis for one such cell repair nanorobot in this article: The Ideal Gene Delivery Vector: Chromallocytes, Cell Repair Nanorobots for Chromosome Repair Therapy

Nanotechnology in Medicine: Company Directory

Company Product
CytImmune Gold nanoparticles for targeted delivery of drugs to tumors
NanoBio Nanoemulsions for nasal delivery to fight viruses (such as the flu and colds) or through the skin to fight bacteria

More nanomedicine companies

Nanotechnology in Medicine: Resources

National Cancer Institute Alliance for Nanotechnology in Cancer; This alliance includes aNanotechnology Characterization Lab as well as eight Centers of  Cancer Nanotechnology Excellence.

Alliance for NanoHealth; This alliance includes eight research institutions performing collaborative research.

European Nanomedicine platform

The National Institute of Health (NIH) is funding research at eight Nanomedicine Development Centers.

Page 2: Nanomedicine based upon nano-robots

Compiled by Earl Boysen of Hawk’s Perch Technical Writing, LLC and UnderstandingNano.com.

Future impact of nanotechnology on medicine and dentistry

Mallanagouda Patil,1 Dhoom Singh Mehta,2 and Sowjanya Guvva3

J Indian Soc Periodontol. 2008 May-Aug; 12(2): 34–40.

doi:  10.4103/0972-124X.44088  PMCID: PMC2813556

The human characteristics of curiosity, wonder, and ingenuity are as old as mankind. People around the world have been harnessing their curiosity into inquiry and the process of scientific methodology. Recent years have witnessed an unprecedented growth in research in the area of nanoscience. There is increasing optimism that nanotechnology applied to medicine and dentistry will bring significant advances in the diagnosis, treatment, and prevention of disease. Growing interest in the future medical applications of nanotechnology is leading to the emergence of a new field called nanomedicine. Nanomedicine needs to overcome the challenges for its application, to improve the understanding of pathophysiologic basis of disease, bring more sophisticated diagnostic opportunities, and yield more effective therapies and preventive properties. When doctors gain access to medical robots, they will be able to quickly cure most known diseases that hobble and kill people today, to rapidly repair most physical injuries our bodies can suffer, and to vastly extend the human health span. Molecular technology is destined to become the core technology underlying all of 21st century medicine and dentistry. In this article, we have made an attempt to have an early glimpse on future impact of nanotechnology in medicine and dentistry.

Keywords: Nanodentistry, nanomedicine, nanoscience, nanotechnology

INTRODUCTION

The world began without man, and it will complete itself without him. …Cloude Levi Strauss. Winfred Phillips, DSc, said, “You have to be able to fabricate things, you have to be able to analyze things, you have to be able to handle things smaller than ever imagined in ways not done before”.[1] Many researchers believed that in future, scientific devices that are dwarfed by dust mites may one day be capable of grand biomedical miracles.

The vision of nanotechnology introduced in 1959 by late Nobel Physicist Richard P Faynman in dinner talk said, “There is plenty of room at the bottom,”[2] proposed employing machine tools to make smaller machine tools, these are to be used in turn to make still smaller machine tools, and so on all the way down to the atomic level, noting that this is “a development which I think cannot be avoided”. He suggested nanomachines, nanorobots, and nanodevices ultimately could be used to develop a wide range of automically precise microscopic instrumentation and manufacturing tools, could be applied to produce a vast quantities of ultrasmall computers and various nanoscale microscale robots.

Feynman’s idea remained largely undiscussed until the mid-1980s, when the MIT educated engineer K Eric Drexler published “Engines of Creation”, a book to popularize the potential of molecular nanotechnology.[3]

Nano comes from the Greek word for dwarf, usually nanotechnology is defined as the research and development of materials, devices, and systems exhibiting physical, chemical, and biological properties that are different from those found on a larger scale (matter smaller than scale of things like molecules and viruses).[4]

Old rules don’t apply, small things behave differently. Researchers in nanoland are also making really, really small things with astonishing properties like the carbon nanotube. Chris Papadopoulos, a nanotechnology researcher says, “The carbon nanotube is the poster boy for nanotechnology”. It’s is a very thin sheet of graphite that’s formed into a tube, its strength can be harnessed by embedding them in constructive materials, among other applications, nanotubes may be part of future improvements for high-performance air craft.

In nanoland, tiny differences in size can add up to huge differences in function. Ted Sergent, author of The dance of Molecules, says matter is tunable at nanoscale. For example, change the length of a guitar string and you change the sound it makes; change the size of semiconductors called quantum dots, and you change their rainbow of colors from a single material. Sergent made a three-nanometric dot that ‘glows’ blue, and four nanometer dot that glows red and a five nanometer dot that emits infrared rays or heat.

Nanotechnology will affect everything, says William Atkinson, author of Nanoscom. Nanotechnology and the big changes coming from the inconceivably small. It’ll be like a blizzard; snowflakes whose weight you can’t detect can bring a city to a standstill. Nanotechnology is going to be like that.

The unique quantum phenomena that happen at the nanoscale, draw researchers from many different disciplines to the field, including medicine, chemistry, physics, engineering, and others (dentistry).

The scientists in the field of regenerative medicine and tissue engineering are continually looking for new ways to apply the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that will restore and maintain normal function in diseased and injured tissue. Development of more refined means of delivering medications at therapeutic levels to specific sites is an important clinical issue, for applications of such technology in medicine, and dentistry.[5]

Nanomedicine

The field of “Nanomedicine” is the science and technology of diagnosing, treating, and preventing disease and traumatic injury, of relieving pain, and of preserving and improving human health, using nanoscale structured materials, biotechnology, and genetic engineering, and eventually complex machine systems and nonorobots.[5] It was perceived as embracing five main subdisciplines that in many ways are overlapping by common technical issues [Figure 1].

Figure 1

Dimensions in Nanomedicine

Nanodiagnostics

It is the use of nanodevices for the early disease identification or predisposition at cellular and molecular level. In in-vitro diagnostics, nanomedicine could increase the efficiency and reliability of the diagnostics using human fluids or tissues samples by using selective nanodevices, to make multiple analyses at subcellular scale, etc. In in vivo diagnostics, nanomedicine could develop devices able to work inside the human body in order to identify the early presence of a disease, to identify and quantify toxic molecules, tumor cells.

Regenerative medicine

It is an emerging multidisciplinary field to look for the reparation, improvement, and maintenance of cells, tissues, and organs by applying cell therapy and tissue engineering methods. With the help of nanotechnology it is possible to interact with cell components, to manipulate the cell proliferation and differentiation, and the production and organization of extracellular matrices.

Present day nanomedicine exploits carefully structured nanoparticles such as dendrimers, carbon fullerenes (buckyballs), and nanoshells to target specific tissues and organs. These nanoparticles may serve as diagnostic and therapeutic antiviral, antitumor, or anticancer agents. Years ahead, complex nanodevices and even nanorobots will be fabricated, first of biological materials but later using more durable materials such as diamond to achieve the most powerful results.[6]

The human body is comprised of molecules, hence the availablity of molecular nanotechnology will permit dramatic progress to address medical problems and will use molecular knowledge to maintain and improve human health at the molecular scale.

Applications in medicine

Within 10–20 years it should become possible to construct machines on the micrometer scale made up of parts on the nanometer scale. Subassemblies of such devices may include such as useful robotic components as 100 nm manipulater arms, 10 nm sorting rotors for molecule by molecule reagent purification, and smooth super hard surfaces made of automically flawless diamond.

Nanocomputers would assume the important task of activating, controlling, and deactivating such nanomechanical devices. Nanocomputers would store and execute mission plans, receive and process external signals and stimuli, communicate with other nanocomputers or external control and monitoring devices, and possess contextual knowledge to ensure safe functioning of the nanomechanical devices. Such technology has enormous medical and dental implications.

Programmable nanorobotic devices would allow physicians to perform precise interventions at the cellular and molecular level. Medical nanorobots have been proposed for genotological[7] applicatons in pharmaceuticals research,[8] clinical diagnosis, and in dentistry,[9] and also mechanically reversing atherosclerosis, improving respiratory capacity, enabling near-instantaneous homeostasis, supplementing immune system, rewriting or replacing DNA sequences in cells, repairing brain damage, and resolving gross cellular insults whether caused by irreversible process or by cryogenic storage of biological tissues.

Feynman offered the first known proposal for a nanorobotic surgical procedure to cure heart disease,[2] “A friend of mine (Albert R. Hibbs) suggests a very interesting possibility for relatively small machines. He says that, although it is a very wild idea, it would be interesting in surgery if you could swallow the surgeon. You put the mechanical surgeon inside the blood vessel and it goes into the heart and looks around. It finds out which valve is the faulty and takes a little knife and slices it out, that we can manufacture an object that maneuvers at that level, other small machines might be permanently incorporated in the body to assist some inadequately functioning organs”.[2]

Many disease causing culprits such as bacteria and viruses are nanosize. So, it only makes sense that nanotechnology would offer us ways of fighting back. The ancient greeks used silver to promote healing and prevent infection, but the treatment took backseat when antibiotics came on the scene. Nycryst pharmaceuticals (Canada) revived and improved an old cure by coating a burn and wound bandage with nanosize silver particles that are more reactive than the bulk form of metal. They penetrate into skin and work steadily. As a result, burn victims can have their dressings changed just once a week.

Genomics and protomics research is already rapidly elucidating the molecular basis of many diseases. This has brought new opportunities to develop powerful diagnostic tools able to identify genetic predisposition to diseases. In the future, point of care diagnosis will be routinely used to identify those patients requiring preventive medication to select the most appropriate medication for individual patients, and to monitor response to treatment. Nanotechnology has a vital role to play in realizing cost-effective diagnostic tools.

Chris Backous developing Lab–on-Chip to give doctor immediate results from medical tests for cancer and viruses, it gets its information by analyzing the genetic material in individual cells. Advances in gene sequencing mean this can now be done quickly and sequencing with tiny samples of body fluids or tissues such as blood, bone marrow, or tumors. The device can also detect the BK virus, a sign of trouble in patients who have had kidney transplants. Ultimately (Pilarski thinks,) chip technology will be able to detect what kind of flu a person has, or, even if they have SARS or HIV.

Nanotechnology has the potential to offer invaluable advances such as use of nanocoatings to slow the release of asthma medication in the lungs, allowing people with asthma to experience longer periods of relief from symptoms after using inhalants. Thus, what nanotechnology tries to do is essentially make drug particles in such a way, that they don’t dissolve that fast, done this with.

Nanosensors developed for military use in recognizing airborne rogue agents and chemical weapons to detect drugs and other substances in exhaled breath.[1] Basically, you can detect many drugs in breath, but the amount you detect in breath is going to be related to the amount that you take and also to whether it partitions well between the blood and the breath. Drug abuse like marijuna (and things like), concentration of alcohol, testing of athletes for banned substances, and individual’s drug treatment programs are two areas long overdue for breath detection technologies. We see this in future totally replacing urine testing.

Currently, most legal and illegal drug overdoses have no specific way to be effectively neutralized, using nanoparticles as absorbents of toxic drugs, is another area of medical nanoscience that is rapidly gaining momentum. Goal is design nanostructures that effectively bind molecular entities, which currently don’t have effective treatments. We are putting nanosponges into the blood stream and they are soaking up toxic drug molecules to reduce the free amount in the blood, in turn, causes a resolution of the toxicity that was there before you put the nanosponges into the blood.

French and Italian researchers have come up with a completely new approach to render anticancer and antiviral nucleoside analoges significantly more potent. By linking the nucleoside analoges to sequalene, a biochemical precursor to the whole family of steroids, the researchers observed the self-organization of amphiphilic molecules in water. These nanoassemblies exhibited superior anticancer activity in vitro in human cancer cells.

Laurie B Gower, PhD, has been researching bone formation and structure at the nanoscale level. She is examining biomimetic methods of constructing a synthetic bone graft substitute with a nanostructured architecture that matches natural bone so that it would be accepted by the body and guide the cells toward the mending of damaged bones. Biomineralization refers to minerals that are formed biologically, which have very different properties than geological minerals or lab-formed crystals. The crystal properties found in bone are manipulated at nanoscale and are imbedded within collagen fibers to create an interpenetrating organic–inorganic composite with unique mechanical properties. She foresees numerous implications of the material in the future of osteology.

Hichan Fenniri, a chemistry professor, tried to make artificial joints act more like natural ones. Fenniri has made a nanotube coating for titanium hip or knee, is very good mimic of collagen, as a result of coating attracts and attaches more bone cells, osteoblasts, which help in bone growth quickly than uncoated hip or knee.

There is ongoing attempts to build ‘medical microrobots’ for in vivo medical use.[10] In 2002, Ishiyama et al,[11] at Tohku University developed tiny magnetically driven spinning screws intended to swim along veins and carry drugs to infected tissues or even to burrow into tumors and kill them with heat. In 2005, Brad Nelson’s[12] team reported the fabrication of a microscopic robot, small enough (approximately 200 µm) to be injected into the body through a syringe. They hope that this device or its descendants might someday be used to deliver drugs or perform minimally invasive eye surgery. Gorden’s[9,13] group at the University of Manitoba has also proposed magnetically controlled ‘cytobots’ and ‘karyobots’ for performing wireless intracellular and intranuclear surgery.

‘Respirocytes’, the first theoreotical design study of a complete medical nanorobot ever published in peer-reviewed journal described a hypothetical artificial mechanical red blood cell or ‘respirocyte’ made of 18 billion precisely arranged structural atoms.[10,14] The respirocyte is a bloodborne spherical 1 µm diamondedoid 1000 atmosphere pressure vessel with reversible molecule selective surface pumps powered by endogenous serum glucose. This nanorobot would deliver 236 times more oxygen to body tissues per unit volume than natural red cells and would manage carbonic acidity, controlled by gas concentration sensors and an onboard nanocomputer.

Nanorobotic microbivores

Artificial phagocytes called microbivores could patrol the bloodstream, seeking out and digesting unwanted pathogens including bacteria, viruses, or fungi.[10,15] Microbivores would achieve complete clearance of even the most severe septicemic infections in hours or less. The nanorobots do not increase the risk of sepsis or septic shock because the pathogens are completely digested into harmless sugars, amino acids, and the like, which are the only effluents from the nanorobot.

Surgical nanorobotics

A surgical nanorobot, programmed or guided by a human surgeon, could act as a semiautonomous on site surgeon inside the human body, when introduced into the body through vascular system or cavities. Such a device could perform various functions such as searching for pathology and then diagnosing and correcting lesions by nanomanipulation, coordinated by an onboard computer while maintaining contact with the supervising surgeon via coded ultrasound signals.[10]

The earliest forms of cellular nanosurgery are already being explored today. For example, rapidly vibrating (100 Hz) micropipette with a <1 µm tip diameter has been used to completely cut dentrites from single neurons without damaging cell viability.[16] Axotomy of roundworm neurons was performed by femtosecond laser surgery, after which the axons functionally regenerated.[17] Femtolaser acts like a pair of nanoscissors by vaporizing tissue locally while leaving adjacent tissue unharmed. Femtolaser surgery has performed the individual chromosomes.[18]

Nanogenerators’

They could make new class of self-powered implantable medical devices, sensors, and portable electronics, by converting mechanical energy from body movement, muscle stretching, or water flow into electricity.

Nanogenerators produce electric current by bending and then releasing zinc oxide nanowires, which are both piezoelectric and semiconducting. Nanowires can be grown on polymer-based films, use of flexible polymer substrates could one day allow portable devices to be powered by movement of their users.

“Our bodies are good at converting chemical energy from glucose into the mechanical energy of our muscles,” Wang (faculty at Peking University and National Center for Nanoscience and Technology of China) explained “these nanogenerators can take mechanical energy and convert it to electrical energy for powering devices inside the body. This could open up tremendous possibilities for self-powered implantable medical devices.”

Nanodentistry

Nanodentistry will make possible the maintenance of comprehensive oral health by employing nanomaterials, biotechnology, including tissue engineering, and ultimately, dental nanorobotics. New potential treatment opportunities in dentistry may include, local anesthesia, dentition renaturalization, permanent hypersensitivity cure, complete orthodontic realignments during a single office visit, covalently bonded diamondised enamel, and continuous oral health maintenance using mechanical dentifrobots.

When the first micro-size dental nanorobots can be constructed, dental nanorobots might use specific motility mechanisms to crawl or swim through human tissue with navigational precision, acquire energy, sense, and manipulate their surroundings, achieve safe cytopenetration and use any of the multitude techniques to monitor, interrupt, or alter nerve impulse traffic in individual nerve cells in real time.

These nanorobot functions may be controlled by an onboard nanocomputer that executes preprogrammed instructions in response to local sensor stimuli. Alternatively, the dentist may issue strategic instructions by transmitting orders directly to in vivo nanorobots via acoustic signals or other means.

Inducing anesthesia

One of the most common procedure in dental practice, to make oral anesthesia, dental professionals will instill a colloidal suspension containing millions of active analgesic micron-sized dental nanorobot ‘particles’ on the patient’s gingivae. After contacting the surface of the crown or mucosa, the ambulating nanorobots reach the dentin by migrating into the gingival sulcus and passing painlessly through the lamina propria or the 1–3-micron thick layer of loose tissue at the cementodentinal junction. On reaching dentin, the nanorobots enter dentinal tubules holes that are 1–4 microns in diameter and proceed toward the pulp, guided by a combination of chemical gradients, temperature differentials, and even positional navigation, all under the control of the onboard nanocomputer as directed by the dentist.[9]

There are many pathways to choose from, near to CEJ, midway between junction and pulp, and near to pulp. Tubules diameter increases as it nears the pulp, which may facilitate nanorobot movement, although circumpulpal tubule openings vary in numbers and size (tubules number density 22,000 mm DEJ, 37,000 mm square midway, ans 48000 mm square near to pulp). Tubules branching patterns, between primary and irregular secondary dentin, regular secondary dentin in young and old teeth (sclerosing) may present a significant challenge to navigation.

The presence of natural cells that are constantly in motion around and inside the teeth including human gingival and pulpal fibroblasts, cementoblasts of the CDJ, bacteria inside dentinal tubules, odontoblasts near the pulp dentin border, and lymphocytes within the pulp or lamina propria suggested that such journey should be feasible by cell-sized nanorobots of similar mobility.

Once installed in the pulp and having established control over nerve impulse traffic, the analgesic dental nanorobots may be commanded by the dentist to shut down all sensitivity in any particular tooth that requires treatment. When on the hand-held controller display, the selected tooth immediately becomes numb. After the oral procedures completed, the dentist orders the nanorobots to restore all sensation, to relinguish control of nerve traffic and to engress, followed by aspiration. Nanorobotic analgesics offer greater patient comfort and reduced anxiety, no needles, greater selectivity, and controllability of the analgesic effect, fast and completely reversible switchable action and avoidance of most side effects and complications.

Tooth repair

Nanorobotic manufacture and installation of a biologically autologous whole replacement tooth that includes both mineral and cellular components, that is, ‘complete dentition replacement therapy’ should become feasible within the time and economic constraints of a typical office visit through the use of an affordable desktop manufacturing facility, which would fabricate the new tooth in the dentist’s office.

Chen et al[19] took advantage of these latest developments in the area of nanotechnology to simulate the natural biomineralization process to create the hardest tissue in the human body, dental enamel, by using highly organized microarchitectural units of nanorod-like calcium hydroxyapatite crystals arranged roughly parallel to each other.

Dentin hypersensitivity

Natural hypersensitive teeth have eight times higher surface density of dentinal tubules and diameter with twice as large than nonsensitive teeth. Reconstructive dental nanorobots, using native biological materials, could selectively and precisely occlude specific tubules within minutes, offering patients a quick and permanent cure.[9]

Tooth repositioning

Orthodontic nanorobots could directly manipulate the periodontal tissues, allowing rapid and painless tooth straightening, rotating and vertical repositioning within minutes to hours.

Tooth renaturalization

This procedure may become popular, providing perfect treatment methods for esthetic dentistry. This trend may begin with patients who desire to have their (1) old dental amalgams excavated and their teeth remanufactured with native biological materials, and (2) full coronal renaturalization procedures in which all fillings, crowns, and other 20th century modifications to the visible dentition are removed with the affected teeth remanufactured to become indistinguishable from original teeth.

Dental durability and cosmetics

Durability and appearance of tooth may be improved by replacing upper enamel layers with covalently bonded artificial materials such as sapphire or diamond,[20] which have 20–100 times the hardness and failure strength of natural enamel or contemporary ceramic veneers and good biocompatibility. Pure sapphire and diamond are brittle and prone to fracture, can be made more fracture resistant as part of a nanostructured composite material that possibly includes embedded carbon nanotubes.

Nanorobotic dentifrice (dentifrobots) delivered by mouthwash or toothpaste could patrol all supragingival and subgingival surfaces at least once a day metabolizing trapped organic mater into harmless and odorless vapors and performing continous calculus debridement.

Properly configured dentifrobots could identify and destroy pathogenic bacteria residing in the plaque and elsewhere, while allowing the 500 species of harmless oral microflora to flourish in a healthy ecosystem. Dentifrobots also would provide a continous barriers to halitosis, since bacterial putrification is the central metabolic process involved in oral malodor. With this kind of daily dental care available from an early age, conventional tooth decay and gingival deseases will disappear into the annals of medical history.

Potential benefits of nanotechnology are its ability to exploit the atomic or molecular properties of materials and the development of newer materials with better properties. Nanoproducts can be made by: building-up particles by combining atomic elements and using equipments to create mechanical nanoscale objects.

Nanotechnology has improved the properties of various kinds of fibers.[21] Polymer nanofibers with diameters in the nanometer range, possess a larger surface area per unit mass and permit an easier addition of surface functionalities compared to polymer microfibers.[21,22] Polymer nanofiber materials have been studied as drug delivery systems, scaffolds for tissue engineering and filters. Carbon fibers with nanometer diamensions showed a selective increase in osteoblast adhesion necessary for successful orthopedic/dental implant applications due to a high degree of nanometer surface roughness.[23]

Nonagglomerated discrete nanoparticles are homogenously manufactured in resins or coatings to produce nanocomposites. The nanofiller used include an aluminosilicate powder having a mean particles size of about 80 nm and 1:4 M ratio of alumina to silica. Advantages – superior hardness, flexible strength, modulus of elasticity, translucency and esthetic appeal, excellent color density, high polish, and polish retention, and excellent handling properties.[24] (Filtek O supreme Univrasl Restorative Pure Nano O).

Heliometer, microfilled composite resin, a close examination of this composite suggests that a form of nanotechnology was in use years ago, yet never recognized.

Nanosolutions produce unique and dispersible nanoparticles that can be added to various solvents, paints, and polymers in which they are dispersed homogenously. Nanotechnology in bonding agents ensures homogeneity and so the operator can now be totally confident that the adhesive is perfectly mixed every time.

Nanofillers are integrated in the vinylsiloxanes, producing a unique addition siloxane impression material. Better flow, improved hydrophilic properties, hence fewer voids at margin and better model pouring, enhanced detail precision.[25]

DISCUSSION

Nanotechnology is part of a predicted future in which dentistry and periodontal practice may become more high-tech and more effective looking to manage individual dental health on a microscopic level by enabling us to battle decay where it begins with bacteria. Construction of a comprehensive research facility is crucial to meet the rigorous requirements for the development of nanotechnologies.

Researchers are looking at ways to use microscopic entities to perform tasks that are now done by hand or with equipment. This concept is known as nanotechnology. Tiny machines, known as nanoassemblers, could be controlled by computer to perform specialized jobs. The nanoassemblers could be smaller than a cell nucleus so that they could fit into places that are hard to reach by hand or with other technology. Used to destroy bacteria in the mouth that cause dental caries or even repair spots on the teeth where decay has set in, by use of computer to direct these tiny workers in their tasks.

Nanotechnology has tremendous potential, but social issues of public acceptance, ethics, regulation, and human safety must be addressed before molecular nanotechnology can be seen as the possibility of providing high quality dental care to the 80% of the world’s population that currently receives no significant dental care.

Role of periodontitis will continue to evolve along the lines of currently visible trends. For example, simple self-care neglect will become fewer, while cases involving cosmetic procedures, acute trauma, or rare disease conditions will become relatively more commonplace.

Trends in oral health and disease also may change the focus on specific diagnostic and treatment modalities. Increasingly preventive approaches will reduce the need for cure prevention a viable approach for the most of them.

Diagnosis and treatment will be customized to match the preferences and genetics of each patient. Treatment options will become more numerous and exciting. All this will demand, even more so than today, the best technical abilities, professional skills that are the hallmark of the contemporary dentist and periodontist. Developments are expected to accelerate significantly.

Nanometers and nanotubes, technologies could be used to administer drugs more precisely. Technology should be able to target specific cells in a patient suffering from cancer or other life-threatening conditions. Toxic drugs used to fight these illnessess would become much more direct and consequently less harmful to the body.

CONCLUSION

The visions described in this article may sound unlikely, implausible, or even heretic. Yet, the theoretical and applied research to turn them into reality is progressing rapidly. Nanotechnology will change dentistry, healthcare, and human life more profoundly than many developments of the past. As with all technologies, nanotechnology carries a significant potential for misuse and abuse on a scale and scope never seen before. However, they also have potential to bring about significant benefits, such as improved health, better use of natural resources, and reduced environmental pollution. These truly are the days of miracle and wonder.

Current work is focused on the recent developments, particularly of nanoparticles and nanotubes for periodontal management, the materials developed from such as the hollow nanospheres, core shell structures, nanocomposites, nanoporous materials, and nanomembranes will play a growing role in materials development for the dental industry.

Once nanomechanics are available, the ultimate dream of every healer, medicine man and physician throughout recorded history will, at last become a reality. Programmable and controllable microscale robots comprised of nanoscale parts fabricated to nanometer precision will allow medical doctors to execute curative and reconstructive procedures in the human body at the cellular and molecular levels. Nanomedical physicians of the 21st century will still make good use of the body’s natural healing powers and homeostatic mechanisms, because all else equal, those interventions are best that intervene least.

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813556/?report=reader

The MIT-Harvard Center for Cancer Nanotechnology Excellence is a collaborative effort among MIT, Harvard University, Harvard Medical School, Massachusetts General Hospital, and Brigham and Women’s Hospital. It is one of eight Centers of Cancer Nanotechnology Excellence awarded by The National Cancer Institute (NCI), part of the National Institutes of Health (NIH). It focuses on developing a diversified portfolio of nanoscale devices for targeted delivery of cancer therapies, diagnostics, non-invasive imaging, and molecular sensing. In addition to general oncology applications, the Consortium focuses on prostate, brain, lung, ovarian, and colon cancer.

Examples of projects that the Consortium is undertaking include the development of:

  • Targeted nanoparticles for treating prostate cancer
  • Polymer nanoparticles and quantum dots for siRNA delivery
  • Next-generation magnetic nanoparticles for multimodal, non-invasive tumor imaging
  • Implantable, biodegradable microelectromechanical systems (MEMS), also known as lab-on-a-chip devices, for in vivo molecular sensing of tumor-associated biomolecules
  • Low-toxicity nanocrystal quantum dots for biomedical sensing

In addition to drawing on the scientific and technological expertise of its investigators, the Consortium uses available facilities for toxicology testing and the extensive mouse models of cancer collection at the collaborating institutions.

  1.  Nanotechnology and CancerNanotechnology is one of the most popular areas of scientific research, especially with regard to medical applications. We’ve already discussed some of the new detection methods that should bring about cheaper, faster and less invasive cancer diagnoses. But once the diagnosis occurs, there’s still the prospect of surgery, chemotherapy or radiation treatment to destroy the cancer. Unfortunately, these treatments can carry serious side effects. Chemotherapy can cause a variety of ailments, including hair loss, digestive problems, nausea, lack of energy and mouth ulcers.But nanotechnologists think they have an answer for treatment as well, and it comes in the form o ftargeted drug therapies. If scientists can load their cancer-detecting gold nanoparticles with anticancer drugs, they could attack the cancer exactly where it lives. Such a treatment means fewer side effects and less medication used. Nanoparticles also carry the potential for targeted and time-release drugs. A potent dose of drugs could be delivered to a specific area but engineered to release over a planned period to ensure maximum effectiveness and the patient’s safety.These treatments aim to take advantage of the power of nanotechnology and the voracious tendencies of cancer cells, which feast on everything in sight, including drug-laden nanoparticles. One experiment of this type used modified bacteria cells that were 20 percent the size of normal cells. These cells were equipped with antibodies that latched onto cancer cells before releasing the anticancer drugs they contained.Another used nanoparticles as a companion to other treatments. These particles were sucked up by cancer cells and the cells were then heated with a magnetic field to weaken them. The weakened cancer cells were then much more susceptible to chemotherapy.It may sound odd, but the dye in your blue jeans or your ballpoint pen has also been paired with gold nanoparticles to fight cancer. This dye, known as phthalocyanine, reacts with light. The nanoparticles take the dye directly to cancer cells while normal cells reject the dye. Once the particles are inside, scientists “activate” them with light to destroy the cancer. Similar therapies have existed to treat skin cancers with light-activated dye, but scientists are now working to use nanoparticles and dye to treat tumors deep in the body.From manufacturing to medicine to many types of scientific research, nanoparticles are now rather common, but some scientists have voiced concerns about their negative health effects. Nanoparticles’ small size allows them to infiltrate almost anywhere. That’s great for cancer treatment but potentially harmful to healthy cells and DNA. There are also questions about how to dispose of nanoparticles used in manufacturing or other processes. Special disposal techniques are needed to prevent harmful particles from ending up in the water supply or in the general environment, where they’d be impossible to track.Gold nanoparticles are a popular choice for medical research, diagnostic testing and cancer treatment, but there are numerous types of nanoparticles in use and in development. Bill Hammack, a professor of chemical engineering at the University of Illinois, warned that nanoparticles are “technologically sweet” [Source: Marketplace]. In other words, scientists are so wrapped up in what they can do, they’re not asking if they should do it. The Food and Drug Administration has a task force on nanotechnology, but as of yet, the government has exerted little oversight or regulation.
  2. The U.S. Food and Drug Administration (FDA)regulates a wide range of products, including foods, cosmetics, drugs, devices, veterinary products, and tobacco products some of which may utilize nanotechnology or contain nanomaterials. Nanotechnology allows scientists to create, explore, and manipulate materials measured in nanometers (billionths of a meter).  Such materials can have chemical, physical, and biological properties that differ from those of their larger counterparts.Guidance documents issued
    • On June 24, 2014, FDA issued three final guidance documentsrelated to the use of nanotechnology in regulated products,incuding cosmetics and food substances.
    • On August 5, 2015, FDA issued one final guidance documentrelated to the use of nanotechnology in food for animals.
      • FDA Guidance on Nanotechnology
        1. Nanotechnology Fact Sheet
        2. FDA issues three final guidances related to nanotechnology applications in regulated products, including cosmetics and food substances (June 2014)
        3. FDA issues final guidance on the use of nanotechnology in food for animals (August 2015)
        4. Nanotechnology in TherapeuticsA Focus on Nanoparticles as a Drug Delivery SystemSuwussa Bamrungsap; Zilong Zhao; Tao Chen; Lin Wang; Chunmei Li; Ting Fu; Weihong TanDisclosuresNanomedicine. 2012;7(8):1253-1271.AbstractContinuing improvement in the pharmacological and therapeutic properties of drugs is driving the revolution in novel drug delivery systems. In fact, a wide spectrum of therapeutic nanocarriers has been extensively investigated to address this emerging need. Accordingly, this article will review recent developments in the use of nanoparticles as drug delivery systems to treat a wide variety of diseases. Finally, we will introduce challenges and future nanotechnology strategies to overcome limitations in this field.IntroductionNanotechnology involves the engineering of functional systems at the molecular scale. Such systems are characterized by unique physical, optical and electronic features that are attractive for disciplines ranging from materials science to biomedicine. One of the most active research areas of nanotechnology is nanomedicine, which applies nanotechnology to highly specific medical interventions for the prevention, diagnosis and treatment of diseases.[1,2,401] The surge in nanomedicine research during the past few decades is now translating into considerable commercialization efforts around the globe, with many products on the market and a growing number in the pipeline. Currently, nanomedicine is dominated by drug delivery systems, accounting for more than 75% of total sales.[3]

          Nanomaterials fall into a size range similar to proteins and other macromolecular structures found inside living cells. As such, nanomaterials are poised to take advantage of existing cellular machinery to facilitate the delivery of drugs. Nanoparticles (NPs) containing encapsulated, dispersed, absorbed or conjugated drugs have unique characteristics that can lead to enhanced performance in a variety of dosage forms. When formulated correctly, drug particles are resistant to settling and can have higher saturation solubility, rapid dissolution and enhanced adhesion to biological surfaces, thereby providing rapid onset of therapeutic action and improved bioavailability. In addition, the vast majority of molecules in a nanostructure reside at the particle surface,[4] which maximizes the loading and delivery of cargos, such as therapeutic drugs, proteins and polynucleotides, to targeted cells and tissues. Highly efficient drug delivery, based on nanomaterials, could potentially reduce the drug dose needed to achieve therapeutic benefit, which, in turn, would lower the cost and/or reduce the side effects associated with particular drugs. Furthermore, NP size and surface characteristics can be easily manipulated to achieve both passive and active drug targeting. Site-specific targeting can be achieved by attaching targeting ligands, such as antibodies or aptamers, to the surface of particles, or by using guidance in the form of magnetic NPs. NPs can also control and sustain release of a drug during transport to, or at, the site of localization, altering drug distribution and subsequent clearance of the drug in order to improve therapeutic efficacy and reduce side effects.

          Nanotechnology could be strategically implemented in new developing drug delivery systems that can expand drug markets. Such a plan would be applied to drugs selected for full-scale development based on their safety and efficacy data, but which fail to reach clinical development because of poor biopharmacological properties, for example, poor solubility or poor permeability across the intestinal epithelium, situations that translate into poor bioavailability and undesirable pharmacokinetic properties.[5] The new drug delivery methods are expected to enable pharmaceutical companies to reformulate existing drugs on the market, thereby extending the lifetime of products and enhancing the performance of drugs by increasing effectiveness, safety and patient adherence, and ultimately reducing healthcare costs.[6–8]

          Commercialization of nanotechnology in pharmaceutical and medical science has made great progress. Taking the USA alone as an example, at least 15 new pharmaceuticals approved since 1990 have utilized nanotechnology in their design and drug delivery systems. In each case, both product development and safety data reviews were conducted on a case-by-case basis, using the best available methods and procedures, with an understanding that postmarketing vigilance for safety issues would be ongoing. Some representative examples of therapeutic nanocarriers on the market are briefly described in Table 1.

          In this review, we focus mainly on the application of nanotechnology to drug delivery and highlight several areas of opportunity where current and emerging nanotechnologies could enable novel classes of therapeutics. We look at challenges and general trends in pharmaceutical nanotechnology, and we also explore nanotechnology strategies to overcome limitations in drug delivery. However, this article can only serve to provide a glimpse into this rapidly evolving field, both now and what may be expected in the future.

          Nanocarriers & Their Applications

          Various nanoforms have been attempted as drug delivery systems, varying from biological substances, such as albumin, gelatin and phospholipids for liposomes, to chemical substances, such as various polymers and solid metal-containing NPs (Figure 1). Polymer–drug conjugates, which have high size variation, are normally not considered as NPs. However, since their size can still be controlled within 100 nm, they are also included in these nanodelivery systems. These nanodelivery systems can be designed to have drugs absorbed or conjugated onto the particle surface, encapsulated inside the polymer/lipid or dissolved within the particle matrix. As a consequence, drugs can be protected from a critical environment or their unfavorable biopharmaceutical properties can be masked and replaced with the properties of nanomaterials. In addition, nanocarriers can be accumulated preferentially at tumor, inflammatory and infectious sites by virtue of the enhanced permeability and retention (EPR) effect. The EPR effect involves site-specific characteristics, not associated with normal tissues or organs, thus resulting in increased selective targeting. Based on those properties, nanodrug delivery systems offer many advantages,[9–11] including:

          (Enlarge Image)

          Figure 1.

          Some nanotechnology-based drug delivery platforms, including a nanocrystal, liposome, polymeric micelle, protein-based nanoparticle, dendrimer, carbon nanotube and polymer–drug conjugate.
          NP: Nanoparticle.

          • Improving the stability of hydrophobic drugs, rendering them suitable for administration;
          • Improving biodistribution and pharmacokinetics, resulting in improved efficacy;
          • Reducing adverse effects as a consequence of favored accumulation at target sites;
          • Decreasing toxicity by using biocompatible nanomaterials.

          By adopting nanotechnology, fundamental changes in drug production and delivery are expected to affect approximately half of the worldwide drug production in the next decade, totaling approximately US$380 billion in revenue.[12] Next, several main nanocarriers are briefly discussed.

          Nanocrystals

          One of the most obvious and important nanotechnology tools for product development is the opportunity to convert existing drugs with poor water solubility and dissolution rate into readily water-soluble dispersions by converting them into nanosized drugs.[13,14] In other words, the drug itself may be formulated at a nanoscale such that it can function as its own ‘carrier’.[15] Many approaches have been studied, but the most practical strategy involves reducing the drug particle size to nanometer range and stabilizing the drug NP surface with a layer of nonionic surfactants or polymeric macromolecules.[16] By reducing the particle size of the active pharmaceutical ingredient, the drug’s surface area is increased considerably, thereby improving its solubility and dissolution and consequently increasing both the maximum plasma concentration and area under the curve. Once the drug is nanosized, it can be formulated into various dosage forms, such as oral, nasal and injectable. These nanocrystal drugs may have advantages over association colloids (micelle solutions) because the level of surfactant per amount of drug can be greatly minimized, using only the amount that is necessary to stabilize the solid–fluid interface.[15]

          Furthermore, recent studies have shown that external agents, such as surfactants, for nanocrystal drug delivery can be eliminated. For example, a method was recently developed for the delivery of a hydrophobic photosensitizing anticancer drug in its pure form using nanocrystals.[17] Synthesized by the reprecipitation method, the resulting drug nanocrystals were stable in aqueous dispersion, without the necessity of any additional stabilizer. These nanocrystals are uniform in size distribution with an average diameter of 110 nm. Such nanocrystals were efficiently taken up by tumor cells in vitro, and irradiation of such cells with visible light (665 nm) resulted in significant cell death. An in vivo study of the nanocrystal drug also showed significant efficacy compared with the conventional surfactant-based delivery system. These results illustrate the potential of pure drug nanocrystals for photodynamic therapy. As shown in Table 1 , a number of well-known drugs have already been commercialized using the nanocrystal approach.

          Organic Nanoplatforms

          Liposomes Liposomes are self-assembled artificial vesicles developed from amphiphilic phospholipids. These vesicles consist of a spherical bilayer structure surrounding an aqueous core domain, and their size can vary from 50 nm to several micrometers. Liposomes have attractive biological properties, including general biocompatibility, biodegradability, isolation of drugs from the surrounding environment and the ability to entrap both hydrophilic and hydrophobic drugs. Through the addition of agents to the lipid membrane, or the alteration of the surface chemistry, liposome properties, such as size, surface charge and functionality, can be easily tuned.

          Liposomes are the most clinically established nanosystems for drug delivery. Their efficacy has been demonstrated in reducing systemic effects and toxicity, as well as in attenuating drug clearance.[18,19]Modified liposomes at the nanoscale have been shown to have excellent pharmacokinetic profiles for the delivery of DNA, antisense oligonucleotide, siRNA, proteins and chemotherapeutic agents.[20]Examples of marketed liposomal drugs with higher efficacy and lower toxicity than their nonliposomal analogues are listed in Table 1 . Doxorubicin is an anticancer drug that is widely used for the treatment of various types of tumors. It is a highly toxic compound affecting not only tumor tissue, but also heart and kidney, a fact that limits its therapeutic applications. However, the development of doxorubicin enclosed in liposomes culminated in an approved nanomedical drug delivery system.[21,22] This novel liposomal formulation has resulted in reduced delivery of doxorubicin to the heart and renal system, while elevating the accumulation in tumor tissue[23,24] by the EPR effect. Furthermore, a number of liposomal drugs are currently being investigated, including anticancer agents, such as camptothecin[25]and paclitaxel (PTX),[26] as well as antibiotics, such as vancomycin[27] and amikacin.[28]

          Liposomes are also subject to some limitations, including low encapsulation efficiency, fast burst release of drugs, poor storage stability and lack of tunable triggers for drug release.[29] Furthermore, since liposomes cannot usually permeate cells, drugs are released into the extracellular fluid.[30] As such, many efforts have focused on improving their stability and increasing circulation half-life for effective targeting or sustained drug action.[19,31] Surface modification is one method of conferring stability and structural integrity against a harsh bioenvironment after oral or parenteral administration.[32] Surface modification can be achieved by attaching polyethylene glycol (PEG) units, which form a protective layer over the liposome surface (known as stealth liposomes) to slow down liposome recognition, or by attaching other polymers, such as poly(methacrylic acid-co-cholesteryl methacrylate)[33] and poly(actylic acid),[34] to improve the circulation time of liposomes in blood. To overcome the fast burst release of the chemotherapeutic drugs from liposomes, drugs such as doxorubicin may be encapsulated in the liposomal aqueous phase by an ammonium sulphate gradient.[35] This strategy enables stable drug entrapment with negligible drug leakage during circulation, even after prolonged residence in the blood stream.[36] Further efforts to improve control over the rate of release and drug bioavailability have been made by designing liposomes whose release is environmentally triggered. Accordingly, the drug release from liposome-responsive polymers, or hydrogel, is triggered by a change in pH, temperature, radiofrequency or magnetic field.[37] Liposomes have also been conjugated with active-targeting ligands, such as antibodies[38–40] or folate, for target-specific drug delivery.[41]

          Polymeric NPs Polymeric NPs are colloidal particles with a size range of 10–1000 nm, and they can be spherical, branched or core–shell structures. They have been fabricated using biodegradable synthetic polymers, such as polylactide–polyglycolide copolymers, polyacrylates and polycaprolactones, or natural polymers, such as albumin, gelatin, alginate, collagen and chitosan.[42] Various methods, such as solvent evaporation, spontaneous emulsification, solvent diffusion, salting out/emulsification-diffusion, use of supercritical CO2 and polymerization, have been used to prepare the NPs.[43]Advances in polymer science and engineering have resulted in the development of smart polymer (stimuli-sensitive polymer), which can change its physicochemical properties in response to environmental signals. Physical (temperature, ultrasound, light, electricity and mechanical stress), chemical (pH and ionic strength) and biological signals (enzymes and biomolecules) have been used as triggering stimuli. Various monomers having sensitivity to specific stimuli can be tailored to a homopolymer in response to a certain signal or copolymers answering multiple stimuli. The versatility of polymer sources and their easy combination make it possible to tune up polymer sensitivity in response to a given stimulus within a narrow range, leading to more accurate and programmable drug delivery.

          Polymeric nanocarriers can be categorized based on three drug-incorporation mechanisms. The first includes polymeric carriers that use covalent chemistry for direct drug conjugation (e.g., linear polymers). The second group includes hydrophobic interactions between drugs and nanocarriers (e.g., polymeric micelles from amphiphilic block copolymers). Polymeric nanocarriers in the third group include hydrogels, which offer a water-filled depot for hydrophilic drug encapsulation.

          Polymer–Drug Conjugates (Prodrugs) Many polymer–drug conjugates have been developed since the first combination reported in the 1970s.[44,45] Conjugation of macromolecular polymers to drugs can significantly enhance the blood circulation time of the drugs. Especially, protein or peptide drugs, which can be readily digested inside the human body, can maintain their activity by conjugation of the water-soluble polymer PEG (PEGylation). For example, it was reported that PEGylated L-asparaginase increased its plasma half-life by up to 357 h.[46] Without PEG, the half-life of natural L-asparaginase is only 20 h. In addition to PEGylation of proteins, small molecular anticancer drugs can also be PEGylated to improve their pharmacokinetics for cancer therapy. For instance, PEG-camptothecin (PROTHECAN®) has entered clinical trials for cancer therapy.[47]

          Increasing the otherwise poor solubility of some drugs is another important function of polymer–drug conjugation. Specifically, conjugating water-soluble polymers to functional groups that already exist in the drug structure can significantly enhance the water solubility of the drug. Recently, a new category of polymer–drug conjugates called brush polymer–drug conjugates were prepared by ring-opening metathesis copolymerization.[48] In this report, as PEG was employed as the brush polymer side chains, the conjugates exhibited significant water solubility. However, polymer–drug conjugates require chemical modification of the existing drugs; as a consequence, their production could cost more, and additional purification steps are needed. Moreover, polymers that are chemically conjugated with drugs are often considered new chemical entities owing to a pharmacokinetic profile distinct from that of the parent drugs. As such, additional US FDA approval is required, even though the parent drug has already been approved. Despite the variety of novel drug targets and sophisticated chemistries available, only four drugs (doxorubicin, camptothecin, PTX and platinate) and four polymers (N-[2-hydroxylpropyl]methacrylamide [HPMA] copolymer, poly-L-glutamic acid [PGA], PEG and dextran) have been used to develop polymer–drug conjugates.[49–54] In addition to the commercially available polymer drugs listed in Table 1 , PGA-PTX (Xyotax™, CT-2103; Cell Therapeutics Inc./Chugai Pharmaceutical Co. Ltd.),[55] PGA-camptothecin (CT-2106; Cell Therapeutics Inc.)[56] and HPMA–doxorubicin (PK1/FCE-28068; Pfizer Inc./Cancer Research Campaign)[57] are now in clinical trials. As an example, PK1 has been evaluated in clinical trials as an anticancer agent, and a Phase I evaluation has been completed in patients with several types of tumors resistant to prior therapy, such as chemotherapy or radiation. However, although the clinical results for HPMA–doxorubicin conjugates look promising, PEG-based conjugation remains the gold-standard in the field of polymeric drug delivery. In addition, polymer–drug conjugates are still limited by their nonbiodegradability and the fate of polymers after in vivoadministration.[58]

          Polymeric Micelles Polymeric micelles are formed when amphiphilic surfactants or polymeric molecules spontaneously associate in aqueous medium to form core–shell structures. The inner core of a micelle, which is hydrophobic, is surrounded by a shell of hydrophilic polymers, such as PEG.[59] Their hydrophobic core serves as a reservoir for poorly water-soluble and amphiphilic drugs; at the same time, their hydrophilic shell stabilizes the core, prolongs circulation time in blood and increases accumulation in tumor tissues.[41] So far, a large variety of drug molecules have been incorporated into polymeric micelles, either by physical encapsulation[60,61] or covalent attachment.[62] Genexol-PM® (Samyang, Korea), PEG-poly(D,L-lactide)-PTX, employs cremophor-free polymeric micelles loaded with PTX drugs. It was found to have a three-times higher maximum tolerated dose in nude mice and two- to threefold higher levels of biodistribution, compared with those of pristine PTX, in various tissues, including tumors. A Phase I clinical trial has been evaluated in patients, and the results showed that Genexol-PM is superior to conventional PTX for the delivery of higher doses without additional toxicity.[63] Recently, a series of novel dual targeting micellar delivery systems were developed based on the self-assembled hyaluronic acid-octadecyl (HA-C18) copolymer and folic acid-conjugated HA-C18 (FA-HA-C18). PTX was successfully encapsulated by HA-C18 and FA-HA-C18 polymeric micelles, with a high encapsulation efficiency of 97.3%. Since these copolymers are biodegradable, biocompatible and cell-specifically targetable, they become promising nanostructure carriers for hydrophobic anticancer drugs.[64] In addition, stimuli-responsive drug-loaded micelles[65–69] and multifunctional polymeric micelles containing imaging as well as therapeutic agents[70–72] are now under active investigation with the potential to be the mainstream of the polymeric drug development in the near future. Furthermore, using computer simulation, the experimental preparation of drug-loaded polymeric micelles could be more efficiently guided, by providing insight into the mechanism of mesoscopic structures and serving as a complement to experiments.[73]

          Hydrogel NPs In recent years, hydrogel NPs have gained considerable attention as one of the most promising nanoparticulate drug delivery systems owing to their unique properties. Hydrogels are cross-linked networks of hydrophilic polymers that can absorb and retain more than 20% of their weight in water, while at the same time, maintaining the distinct 3D structure of the polymer network. Swelling properties, network structure, permeability or mechanical stability of hydrogels can be controlled by external stimuli or physiological parameters.[74–78] Hydrogels have been extensively studied for controlled release of therapeutics, stimuli-responsive release and applications in biological implants.[75,79–81] However, the hydration response to changes in stimuli in most hydrogel systems is too slow for therapeutic applications. To overcome this limitation, further development of hydrogel structures at the micro- and nano-scale is needed.[82] Recent reports showed some progress in micro- and nanogels of poly-N-isopropylacrylamide with ultrafast responses and attractive rheological properties.[83,84] Ding et al. demonstrated that cisplatin-loaded polyacrylic acid hydrogel NPs could be implanted and plastered on tumor tissue.[85] This hydrogel system exhibited superior efficacy in impeding tumor growth and prolonging lifespan in mice. The in vivo biodistribution assay also demonstrated that the hydrogel implant results in high concentration and retention of the drug. A multifunctional hybrid hydrogel was developed by combining the magnetic properties of NPs and the typical characteristics of the hydrogel. These hybrid hydrogels could be used to load a large number of drugs and transport them to the target site by the application of an external magnetic field.[86] To improve the specificity of the hydrogel drug delivery systems, core–shell nanogels were developed, which utilize aptamers as the recognition element and near-infrared light as a triggering stimulus for drug delivery. In this system, gold (Au)–silver nanorods, which possess intense absorption bands in the near-infrared range, were coated with DNA cross-linked polymeric shells, so that drugs can be rapidly and controllably released upon the near-infrared irradiation.[87] As the fate of hydrogel NPs after in vivo administration may be a concern for clinical applications, biodegradable hydrogel NPs with diameters of approximately 200 nm have been synthesized via inverse miniemulsion reversible addition–fragmentation chain-transfer polymerization of 2-(dimethylamino)ethyl methacrylate. A disulfide cross-linker was used to cross-link the NPs, so that the polymer network could be degraded to its constituent primary chains by exposure to a reductive environment. It is indicated that these biodegradable hydrogel NPs are currently being investigated for encapsulation and controlled release of siRNA.[88] Although hydrogel NPs-based drugs are not commercially available, they have high possibility to be further developed for drug delivery systems in the future, owing to their highly biocompatible and effective drug-loading properties.

          Protein-based NPs Hydrophobic drugs, such as taxanes, are highly active and widely used in a variety of solid tumor therapies. Both PTX and docetaxel, which are the commercially available taxanes for clinical treatments, are hydrophobic. Because of their solubility problems, they have been formulated as suspensions with nonionic surfactants, such as Cremophor EL® (BASF Corp.) for PTX and Tween-80 (ICI Americas, Inc.) for docetaxel. However, these surfactants are associated with hypersensitivity reaction and toxic side effects to tissues. To decrease toxicity, albumin conjugated with PTX has been formulated, yielding NPs approximately 130 nm in size and approved by the FDA for breast cancer treatment.[89–91] In addition to reduced toxicity, albumin–PTX has been found to bind with the albumin receptor (gp60) on endothelial cells, with further extravascular transport,[92–94] resulting in an increase in drug concentration at tumor sites without hypersensitivity reactions. The albumin–PTX complex is approved in 38 countries for the treatment of metastatic breast cancer. Furthermore, Abraxane® is currently in various stages of investigation for the treatment of other cancers, such as metastatic breast cancer, non-small-cell lung cancer, malignant melanoma, pancreatic and gastric cancer.

          Dendrimers Dendrimers are synthetic, branched macromolecules that form a tree-like structure. Unlike most linear polymers, the chemical composition and molecular weight of dendrimers can be precisely controlled; hence, it is relatively easy to predict their biocompatibility and pharmacokinetics.[95]Dendrimers are very uniform with extremely low polydispersities, and they are commonly created with dimensions incrementally grown in approximate nanometer steps from 1 to over 10 nm. Their globular structures and the presence of internal cavities enable drugs to be encapsulated within the macromolecule interior and are used to provide controlled release from the inner core.[96] Although the small size (up to 10 nm) of dendrimers limits extensive drug incorporation, their dendritic nature and branching allows drug loading onto the outside surface of the structure[97] via covalent binding or electrostatic interactions. Dendrimers can be synthesized by either divergent or convergent approaches. In the divergent approach, dendrimers are synthesized from the core and further built to other layers called generations. However, this method provides a low yield because the reactions that occur must be conducted on a single molecule processing a large number of equivalent reaction sites.[98] In addition, a large amount of reagents is required for the latter stages of synthesis, resulting in complication of purification. For the convergent method, synthesis begins at the periphery of the dendrimer molecules and stops at the core. In this approach, each synthesized generation can be subsequently purified.[98]

          Drug molecules associated with dendrimers can be utilized for cancer treatment,[99] the enhancement of drug solubility and permeability (dendrimer–drug conjugates)[100] and intracellular delivery.[101] Some drugs can be physically encapsulated inside the dendrimer network or form linkages (either covalently or noncovalently) on the dendrimer surface.[102] Furthermore, functionalization of the dendrimer surface with specific ligands can enhance potential targeting. For example, Myc et al. reported a polyamidoamine dendrimer conjugate containing FA as the targeting agent and methotroxate as the therapeutic agent.[103] Cytotoxicity and specificity were tested with both FA receptor-expressing and nonexpressing cells. Both in vitro and in vivo results showed that the dendrimer conjugate was preferentially cytotoxic to the target cells. The polyamido amine dendrimer conjugated with an anti-prostate specific membrane antigen antibody was also demonstrated.[104] The antibody–dendrimer conjugate specifically bound to anti-prostate specific membrane antigen-positive, but not negative, cell lines. However, dendrimer toxicity and immunogenicity are the main concerns when they are applied for drug delivery. Since the clinical experience with dendrimers has so far been limited, it is hard to tell whether the dendrimers are intrinsically ‘safe’ or ‘toxic’.

          Inorganic Platforms

          Au NPs Noble metal NPs, such as Au NPs, have emerged as a promising scaffold for drug and gene delivery in that they provide a useful complement to more traditional delivery vehicles. The combination of inertness and low toxicity,[105] easy synthesis, very large surface area, well-established surface functionalization (generally through thiol linkages) and tunable stability provide Au NPs with unique attributes to enable new delivery strategies. Moreover, excess loading of pharmaceuticals on NPs allows ‘drug reservoirs’ to accumulate for controlled and sustained release, thereby maintaining the drug level within the therapeutic window. An Au NP with 2-nm core diameter could, in principle, be conjugated with 100 molecules to available ligands (n = 108) in the monolayer.[106] Zubarev et al. have recently succeeded in coupling 70 PTX molecules, a chemotherapeutic drug, to an Au NP with a 2-nm core diameter.[107] Efficient release of these therapeutic agents could be triggered by internal (e.g., glutathione[108] or pH[109]) or external (e.g., light[110,111]) stimuli. In addition to serving as the carrier for drug delivery, Au NPs can also be imaged using contrast imaging techniques. Once the Au NPs are targeted to the diseased site, such as a tumor, hyperthermia treatment can be used for tumor destruction. For example, a recent study demonstrated that PEGylated Au NPs were employed for highly efficient drug delivery and in vivo photodynamic therapy of cancer.[112] Compared with conventional photodynamic therapy drug delivery in vivo, PEGylated Au NPs accelerated the silicon phthalocyanine 4 administration by approximately two orders of magnitude without side effects in treated mice. The key issue that needs to be addressed with Au NPs is the engineering of the particle surface for optimized properties, such as bioavailability and nonimmunogenicity.

          Superparamagnetic NPs Magnetic NPs have been proposed as drug carriers with a push towards clinical trials.[113] The superparamagnetic properties of iron (II) oxide particles can be used to guide microcapsules in place for delivery by external magnetic fields. Another advantage of using magnetic NPs is the ability to heat the particles after internalization, which is known as the hyperthermia effect. For example, Brazel et al. developed a grafted thermosensitive polymeric system by embedding FePt NPs in poly(N-isopropylacrylamide)-based hydrogels, which can be triggered to release the loaded drug by inducing an increase in temperature based on a magnetic thermal heating event.[114] The grafted hydrogel system is also shown to exhibit a desirable positive thermal response with an increased drug diffusion coefficient for temperatures higher than physiological temperature.[115]

          Besides being utilized for targeting and raising temperature, magnetic NPs can also affect the permeability of microcapsules by applying external oscillating magnetic fields and releasing encapsulated materials.[116] For example, ferromagnetic Au-coated cobalt NPs (3 nm in diameter) were incorporated into the polymer walls of microcapsules. Subsequently, application of external alternating magnetic fields of 100–300 Hz and 1200 Oe strength disturbed the capsule wall structures and dramatically increased their permeability to macromolecules. This work supports the hypothesis that magnetic NPs embedded in polyelectrolyte capsules can be used for the controlled release of substances by applying an external magnetic field.

          The main benefits of superparamagnetic NPs over classical cancer therapies are minimal invasiveness, accessibility of hidden tumors and minimal side effects. Conventional heating of a tissue by, for example, microwaves or laser light results in the destruction of healthy tissue surrounding the tumor. However, targeted paramagnetic particles provide a powerful strategy for localized heating of cancerous cells.

          Ceramic NPs Ceramic NPs are particles fabricated from inorganic compounds with porous characteristics, such as silica, alumina and titania.[117–119] Among these, silica NPs have attracted much research attention as a result of their biocompatibility and ease of synthesis, as well as surface modification.[120–122,301] Furthermore, the well-established silane chemistry facilitates the cross-linking of drugs to silica particles.[123,124] For example, recent breakthroughs in mesoporous silica NPs (MSNs) have brought new possibilities to this burgeoning area of research. MSNs contain hundreds of empty channels (mesopores) arranged in a 2D network of a honeycomb-like porous structure. In contrast to the low biocompatibility of other amorphous silica materials, recent studies have shown that MSNs exhibit superior biocompatibility at concentrations adequate for pharmacological applications.[125,126]Once the vehicle is localized in the cytoplasm, it is desirable to have effective control over the release of drug molecules in order to reach pharmacologically effective levels. The ability to selectively functionalize the external particle and/or the interior nanochannel surface of MSNs is advantageous in achieving this goal.[127,128] Different functional groups can be added by using this methodology, including, for example, functionalization with stimuli-responsive tethers that could be further attached to NPs (Au and iron [II] oxide). These NPs could work as gatekeepers and be removed by either intracellular or external triggers, such as changes in pH, reducing environment, enzymatic activity, light, electromagnetic field or ultrasound.[128] The surface of MSNs can be engineered with cell-specific moieties, such as organic molecules, peptides, aptamers and antibodies, to achieve cell type or tissue specificity. Moreover, optical and magnetic contrast agents can be introduced to develop multipurpose drug delivery systems.

          These strategies demonstrated that the application of target-specific MSN vehicles in vitro is promising; however, the application in vivo has not yet been reported. These particles are not biodegradable; consequently, there is a concern that they may accumulate in the human body and cause harmful effects.[117] For further in vivo applications, the biocompatibility, biodistribution, retention, degradation and clearance of MSNs must be systematically investigated.

          Carbon-based Nanomaterials Carbon-based nanomaterials have attracted particular interest because they can be surface functionalized for the grafting of nucleic acids, peptides and proteins. Carbon nanotubes (CNTs), fullerene, and nanodiamonds[129] have been extensively studied for drug delivery applications.[130] The size, geometry and surface characteristics of single-wall nanotubes (SWNTs), multiwall nanotubes and C60 fullerenes make them appealing for drug carrier usage. For example, PTX-conjugated SWNTs have shown promise for in vivo cancer treatment. SWNT delivery of PTX affords markedly improved treatment efficacy over clinical Taxol (Bristol-Myers Squibb Co.), as evidenced by its ability to slow down tumor growth at a low PTX dose.[131]

          However, the primary drawback of carbon-based nanomaterials appears to be their toxicity. Experiments have shown that CNTs can lead to cell proliferation inhibition and apoptosis. Although they are less toxic than carbon fibers and NPs, the toxicity of CNTs increases significantly when carbonyl, carboxyl and/or hydroxyl functional groups are present on their surface.[132] Because of the reported toxicity of CNTs,[133–137] studies involving their application for drug delivery are still being conducted.[138–140] In order to promote the application of CNTs for drug delivery, researchers have functionalized their surface, rendering them benign.[136] Unfortunately, concerns that functionalized CNTs may revert back to a toxic state if the functional group detaches has limited the pursuit of using these modified CNTs for biomedical applications.

          The toxicity of other forms of nanocarbons has also been reported.[132,140,141] One study of human lung tumor cells showed that carbon NPs are even more toxic than multiwall nanotubes and carbon nanofibers.[132] Given the mounting evidence demonstrating the toxicity of carbon NPs, the enthusiasm to develop carbon NPs for drug delivery has decreased significantly in recent years.

          Integrated Nanocomposite Particles

          A variety of nanoplatforms have been developed for a wide spectrum of applications, and each of these applications has unique advantages and limitations. By combining the specific function of each material, new hybrid nanocomposite materials can be fabricated. For instance, liposomes and polymeric NPs are the two most widely studied drug delivery platforms, and attempts have been made to combine the advantages of both systems. A recent study reported the use of nanocells consisting of nuclear poly(lactic-co-glycolic acid) NPs within an extranuclear PEGylated phospholipid envelope for temporal targeting of tumor cells and neovasculature.[142] Moreover, liposomes are routinely coated with a hydrophilic polymer, such as PEG or poly(ethylene oxide), to improve the circulation time in vivo, which is another example of a liposome–polymer composite.[143] Similarly, liposomal locked-in dendrimers, the combination of liposomes and dendrimers in one formulation, has resulted in higher drug loading and slower drug release from the composite, as compared with pure liposomes.[144] Another LipoMag formulation, which consists of an oleic acid-coated magnetic nanocrystal core and a cationic lipid shell, was magnetically guided to deliver and silence genes in cells and tumors in mice.[145]

          Targeting Strategies

          Two basic requirements should be realized in the design of nanocarriers to achieve effective drug delivery (Figure 2). First, drugs should be able to reach the desired tumor sites after administration with minimal loss to their volume and activity in blood circulation. Second, drugs should only kill tumor cells without harmful effects to healthy tissue.[146] These requirements may be enabled using two strategies: passive and active targeting of drugs.[147]

          (Enlarge Image)

          Figure 2.

          Passive and active targeting.
          By the enhanced permeability and retention effect, nanoparticles (NPs) can be passively extravasated through leaky vascularization, allowing their accumulation at the tumor region (A). In this case, drugs may be released in the extracellular matrix and then diffuse through the tissue. Active targeting (B) can enhance the therapeutic efficacy of drugs by the increased accumulation and cellular uptake of NPs through receptor-mediated endocytosis. NPs can be engineered to incorporate ligands that bind to endothelial cell surface receptors. In this case, the enhanced permeability and retention effect does not pertain, and the presence of leaky vasculature is not required.

          Passive Targeting

          Passive targeting takes advantage of the unique pathophysiological characteristics of tumor vessels, enabling nanodrugs to accumulate in tumor tissues. Typically, tumor vessels are highly disorganized and dilated with a high number of pores, resulting in enlarged gap junctions between endothelial cells and compromised lymphatic drainage. The ‘leaky’ vascularization, which refers to the EPR effect, allows migration of macromolecules up to 400 nm in diameter into the surrounding tumor region.[147–149] One of the earliest nanoscale technologies for passive targeting of drugs was based on the use of liposomes. More advanced liposomes are coated with a synthetic polymer that protects the agents from immune destruction.[150]

          Moreover, the EPR effect, the microenvironment surrounding tumor tissue, is different from that of healthy cells, a physiological phenomenon that also supports passive targeting. Based on the high metabolic rate of fast-growing tumor cells, they require more oxygen and nutrients. Consequently, glycolysis is stimulated to obtain extra energy, resulting in an acidic environment.[151] Taking advantage of this, pH-sensitive liposomes have been designed to be stable at physiological pH 7.4, but degraded to release drug molecules at the acidic pH.[152]

          Although passive targeting approaches form the basis of clinical therapy, they suffer from several limitations. Ubiquitously targeting cells within a tumor is not always feasible because some drugs cannot diffuse efficiently, and the random nature of the approach makes it difficult to control the process. The passive strategy is further limited because certain tumors do not exhibit an EPR effect, and the permeability of vessels may not be the same throughout a single tumor.[153]

          Active Targeting

          One way to overcome the limitations of passive targeting is to attach affinity ligands (antibodies,[154]peptides,[155] aptamers[156] or small molecules[157] that only bind to specific receptors on the cell surface) to the surface of the nanocarriers by a variety of conjugation chemistries. Nanocarriers will recognize and bind to target cells through ligand–receptor interactions by the expression of receptors or epitopes on the cell surface. In order to achieve high specificity, those receptors should be highly expressed on tumor cells, but not on normal cells. Furthermore, the receptors should homogeneously express and should not be shed into the blood circulation. Internalization of targeting conjugates can also occur by receptor-mediated endocytosis after binding to target cells, facilitating drug release inside the cells. Based on the receptor-mediated endocytosis mechanism, targeting conjugates bind with their receptors first, followed by plasma membrane enclosure around the ligand–receptor complex to form an endosome. The newly formed endosome is transferred to specific organelles, and drugs could be released by acidic pH or enzymes. Although the active targeting strategy looks intriguing, nanodrugs currently approved for clinical use are relatively simple and generally lack active targeting or triggered drug release components. Moreover, nanodrugs currently under clinical development lack specific targeting. To fully explore the application of targeted drug delivery, we need to investigate whether the specific diseases are the correct application for targeting, whether the properties of the therapeutic drugs, as well as their site and mode of action, are suited for targeting and whether the delivery vehicles are optimal for product development.[158]

          Key Factors Impacting Drug Delivery

          In order to achieve effective drug delivery, nanocarriers must have suitable circulation time to prevent the elimination of drugs before reaching their target. Based on previous investigations, size, shape and surface characteristics are key factors that impact the efficiency of drug delivery systems.

          Summary

          Nanotechnology is an emerging field with the potential to revolutionize drug delivery. Advances in this area have allowed some nanomedicines in the market to achieve desirable pharmacokinetic properties, reduce toxicity and improve patient compliance, as well as clinical outcomes. Integration of nanoparticulate drug delivery technologies in preformulation work not only accelerates the development of new therapeutic moieties, but also helps in the reduction of attrition of new molecular entities caused by undesirable biopharmaceutical and pharmacokinetic properties.

          Optimizing the integration of nanomaterials into drug delivery systems will require standardized metrics for their classification, as well as protocols for their handling. This will, in turn, result in a better understanding of the interactions of nanomaterials with biological systems, which will facilitate better engineering of their properties specific to biomedical applications. The development of such drug carriers will require a greater understanding of both the surface chemistry of nanomaterials and the interaction chemistry of these nanomaterials with biological systems. This can only be achieved through collaborative efforts among scientists in different disciplines. Those who work in this emerging field should have up-to-date information on related toxicology issues, potential health and safety risks and the regulatory environment that will impact patient use. Understanding both the benefits and the risks of these new nanotechnology applications will be essential to good decision-making for drug developers, regulators and ultimately the consumers and patients who will be the beneficiaries of new drug delivery technologies.

        5. Nanoparticles wrapped inside human platelet membranes serve as new vehicles for targeted drug delivery.

http://www.technologynetworks.com/news.aspx?ID=183111

Nanoparticles disguised as human platelets could greatly enhance the healing power of drug treatments for cardiovascular disease and systemic bacterial infections. These platelet-mimicking nanoparticles, developed by engineers at the University of California, San Diego, are capable of delivering drugs to targeted sites in the body — particularly injured blood vessels, as well as organs infected by harmful bacteria. Engineers demonstrated that by delivering the drugs just to the areas where the drugs were needed, these platelet copycats greatly increased the therapeutic effects of drugs that were administered to diseased rats and mice.

“This work addresses a major challenge in the field of nanomedicine: targeted drug delivery with nanoparticles,” said Liangfang Zhang, a nanoengineering professor at UC San Diego and the senior author of the study. “Because of their targeting ability, platelet-mimicking nanoparticles can directly provide a much higher dose of medication specifically to diseased areas without saturating the entire body with drugs.”

Schematic-of-platelet-nanoparticles-150915-f.jpg

The study is an excellent example of using engineering principles and technology to achieve “precision medicine,” said Shu Chien, a professor of bioengineering and medicine, director of the Institute of Engineering in Medicine at UC San Diego, and a corresponding author on the study. “While this proof of principle study demonstrates specific delivery of therapeutic agents to treat cardiovascular disease and bacterial infections, it also has broad implications for targeted therapy for other diseases such as cancer and neurological disorders,” said Chien.

The ins and outs of the platelet copycats

On the outside, platelet-mimicking nanoparticles are cloaked with human platelet membranes, which enable the nanoparticles to circulate throughout the bloodstream without being attacked by the immune system. The platelet membrane coating has another beneficial feature: it preferentially binds to damaged blood vessels and certain pathogens such as MRSA bacteria, allowing the nanoparticles to deliver and release their drug payloads specifically to these sites in the body.

Enclosed within the platelet membranes are nanoparticle cores made of a biodegradable polymer that can be safely metabolized by the body. The nanoparticles can be packed with many small drug molecules that diffuse out of the polymer core and through the platelet membrane onto their targets.

To make the platelet-membrane-coated nanoparticles, engineers first separated platelets from whole blood samples using a centrifuge. The platelets were then processed to isolate the platelet membranes from the platelet cells. Next, the platelet membranes were broken up into much smaller pieces and fused to the surface of nanoparticle cores. The resulting platelet-membrane-coated nanoparticles are approximately 100 nanometers in diameter, which is one thousand times thinner than an average sheet of paper.

This cloaking technology is based on the strategy that Zhang’s research group had developed to cloak nanoparticles in red blood cell membranes. The researchers previously demonstrated that nanoparticles disguised as red blood cells are capable of removing dangerous pore-forming toxins produced by MRSA, poisonous snake bites and bee stings from the bloodstream.

By using the body’s own platelet membranes, the researchers were able to produce platelet mimics that contain the complete set of surface receptors, antigens and proteins naturally present on platelet membranes. This is unlike other efforts, which synthesize platelet mimics that replicate one or two surface proteins of the platelet membrane.

“Our technique takes advantage of the unique natural properties of human platelet membranes, which have a natural preference to bind to certain tissues and organisms in the body,” said Zhang. This targeting ability, which red blood cell membranes do not have, makes platelet membranes extremely useful for targeted drug delivery, researchers said.

Platelet copycats at work

In one part of this study, researchers packed platelet-mimicking nanoparticles with docetaxel, a drug used to prevent scar tissue formation in the lining of damaged blood vessels, and administered them to rats afflicted with injured arteries. Researchers observed that the docetaxel-containing nanoparticles selectively collected onto the damaged sites of arteries and healed them.

When packed with a small dose of antibiotics, platelet-mimicking nanoparticles can also greatly minimize bacterial infections that have entered the bloodstream and spread to various organs in the body. Researchers injected nanoparticles containing just one-sixth the clinical dose of the antibiotic vancomycin into one of group of mice systemically infected with MRSA bacteria. The organs of these mice ended up with bacterial counts up to one thousand times lower than mice treated with the clinical dose of vancomycin alone.

“Our platelet-mimicking nanoparticles can increase the therapeutic efficacy of antibiotics because they can focus treatment on the bacteria locally without spreading drugs to healthy tissues and organs throughout the rest of the body,” said Zhang. “We hope to develop platelet-mimicking nanoparticles into new treatments for systemic bacterial infections and cardiovascular disease.”

6.  Sponge-like nanoporous gold could be key to new devices to detect disease-causing agents in humans and plants, according to UC Davis researchers.

http://www.technologynetworks.com/news.aspx?ID=182663

A group from the UC Davis Department of Electrical and Computer Engineering have demonstrated that they could detect nucleic acids  using nanoporous gold, a novel sensor coating material, in mixtures of other biomolecules that would gum up most detectors. This method enables sensitive detection of DNA in complex biological samples, such as serum from whole blood.

“Nanoporous gold can be imagined as a porous metal sponge with pore sizes that are a thousand times smaller than the diameter of a human hair,” said Erkin Şeker, assistant professor of electrical and computer engineering at UC Davis and the senior author on the papers. “What happens is the debris in biological samples, such as proteins, is too large to go through those pores, but the fiber-like nucleic acids that we want to detect can actually fit through them. It’s almost like a natural sieve.”

CoverArt_nanoporous_gold.png

Rapid and sensitive detection of nucleic acids plays a crucial role in early identification of pathogenic microbes and disease biomarkers. Current sensor approaches usually require nucleic acid purification that relies on multiple steps and specialized laboratory equipment, which limit the sensors’ use in the field. The researchers’ method reduces the need for purification.

“So now we hope to have largely eliminated the need for extensive sample clean-up, which makes the process conducive to use in the field,” Şeker said.

The result is a faster and more efficient process that can be applied in many settings.

The researchers hope the technology can be translated into the development of miniature point-of-care diagnostic platforms for agricultural and clinical applications.

“The applications of the sensor are quite broad ranging from detection of plant pathogens to disease biomarkers,” said Şeker.

For example, in agriculture, scientists could detect whether a certain pathogen exists on a plant without seeing any symptoms. And in sepsis cases in humans, doctors might determine bacterial contamination much more quickly than at present, preventing any unnecessary treatments.

7.  Pushing the limits of lensless imaging

http://www.rdmag.com/news/2015/09/pushing-limits-lensless-imaging?

The Optical Society

To take a picture with this method, scientists fire an X-ray or extreme ultraviolet laser at a target. The light scatters off, and some of those photons interfere with one another and find their way onto a detector, creating a diffraction pattern. By analyzing that pattern, a computer then reconstructs the path those photons must have taken, which generates an image of the target material—all without the lens that’s required in conventional microscopy.

WASHINGTON — Using ultrafast beams of extreme ultraviolet light streaming at a 100,000 times a second, researchers from the Friedrich Schiller University Jena, Germany, have pushed the boundaries of a well-established imaging technique. Not only did they make the highest resolution images ever achieved with this method at a given wavelength, they also created images fast enough to be used in real time. Their new approach could be used to study everything from semiconductor chips to cancer cells.

The team will present their work at the Frontiers in Optics, The Optical Society’s annual meeting and conference in San Jose, California, USA, on October 22, 2015.

The researchers’ wanted to improve on a lensless imaging technique called coherent diffraction imaging, which has been around since the 1980s. To take a picture with this method, scientists fire an X-ray or extreme ultraviolet laser at a target. The light scatters off, and some of those photons interfere with one another and find their way onto a detector, creating a diffraction pattern. By analyzing that pattern, a computer then reconstructs the path those photons must have taken, which generates an image of the target material—all without the lens that’s required in conventional microscopy.

“The computer does the imaging part—forget about the lens,” explained Michael Zürch, Friedrich Schiller University Jena, Germany and lead researcher. “The computer emulates the lens.”

Without a lens, the quality of the images primarily depends on the radiation source. Traditionally, researchers use big, powerful X-ray beams like the one at the SLAC National Accelerator Laboratory in Menlo Park, CA, USA. Over the last 10 years, researchers have developed smaller, cheaper machines that pump out coherent, laser-like beams in the laboratory setting. While those machines are convenient from the cost perspective, they have drawbacks when reporting results.

The table-top machines are unable to produce as many photons as the big expensive ones which limits their resolution. To achieve higher resolutions, the detector must be placed close to the target material—similar to placing a specimen close to a microscope to boost the magnification. Given the geometry of such short distances, hardly any photons will bounce off the target at large enough angles to reach the detector. Without enough photons, the image quality is reduced.

Zürch and a team of researchers from Jena University used a special, custom-built ultrafast laser that fires extreme ultraviolet photons a hundred times faster than conventional table-top machines. With more photons, at a wavelength of 33 nanometers, the researchers were able to make an image with a resolution of 26 nanometers — almost the theoretical limit. “Nobody has achieved such a high resolution with respect to the wavelength in the extreme ultraviolet before,” Zürch said.

The ultrafast laser also overcame another drawback of conventional table-top light sources: long exposure times. If researchers have to wait for images, they can’t get real-time feedback on the systems they study. Thanks to the new high-speed light source, Zürch and his colleagues have reduced the exposure time to only about a second — fast enough for real-time imaging. When taking snapshots every second, the researchers reached a resolution below 80 nanometers.

The prospect of high-resolution and real-time imaging using such a relatively small setup could lead to all kinds of applications, Zürch said. Engineers can use this to hunt for tiny defects in semiconductor chips. Biologists can zoom in on the organelles that make up a cell. Eventually, he said, the researchers might be able to cut down on the exposure times even more and reach even higher resolution levels.

About FiO/LS

Frontiers in Optics (FiO) 2015 is The Optical Society’s (OSA) 99th Annual Meeting and is being held together with Laser Science, the 31th annual meeting of the American Physical Society (APS) Division of Laser Science (DLS). The two meetings unite the OSA and APS communities for five days of quality, cutting-edge presentations, in-demand invited speakers and a variety of special events spanning a broad range of topics in optics and photonics—the science of light—across the disciplines of physics, biology and chemistry. The exhibit floor will feature leading optics companies, technology products and programs.

About The Optical Society

Founded in 1916, The Optical Society (OSA) is a leading professional organization for scientists, engineers, students and entrepreneurs who fuel discoveries, shape real-life applications and accelerate achievements in the science of light. Through world-renowned publications, meetings and membership initiatives, OSA provides quality research, inspired interactions and dedicated resources for its extensive global network of optics and photonics experts. OSA is a founding partner of the National Photonics Initiative and the 2015 International Year of Light.

SOURCE: The Optical Society

8.  Physicists determine three-dimensional positions of individual atoms for the first time
http://www.rdmag.com/news/2015/09/physicists-determine-three-dimensional-positions-individual-atoms-first-time?

Katherine Kornei, UCLA
The scientists were able to plot the exact coordinates of nine layers of atoms with a precision of 19 trillionths of a meter. Courtesy of Mary Scott and Jianwei (John) Miao/UCLAAtoms are the building blocks of all matter on Earth, and the patterns in which they are arranged dictate how strong, conductive or flexible a material will be. Now, scientists at UCLA have used a powerful microscope to image the three-dimensional positions of individual atoms to a precision of 19 trillionths of a meter, which is several times smaller than a hydrogen atom.

Their observations make it possible, for the first time, to infer the macroscopic properties of materials based on their structural arrangements of atoms, which will guide how scientists and engineers build aircraft components, for example. The research, led by Jianwei (John) Miao, a UCLA professor of physics and astronomy and a member of UCLA’s California NanoSystems Institute, is published September 21 in the online edition of the journal Nature Materials.

For more than 100 years, researchers have inferred how atoms are arranged in three-dimensional space using a technique called X-ray crystallography, which involves measuring how light waves scatter off of a crystal. However, X-ray crystallography only yields information about the average positions of many billions of atoms in the crystal, and not about individual atoms’ precise coordinates.

“It’s like taking an average of people on Earth,” Miao said. “Most people have a head, two eyes, a nose and two ears. But an image of the average person will still look different from you and me.”

Because X-ray crystallography doesn’t reveal the structure of a material on a per-atom basis, the technique can’t identify tiny imperfections in materials, such as the absence of a single atom. These imperfections, known as point defects, can weaken materials, which can be dangerous when the materials are components of machines like jet engines.

“Point defects are very important to modern science and technology,” Miao said.

Miao and his team used a technique known as scanning transmission electron microscopy, in which a beam of electrons smaller than the size of a hydrogen atom is scanned over a sample and measures how many electrons interact with the atoms at each scan position. The method reveals the atomic structure of materials because different arrangements of atoms cause electrons to interact in different ways.

However, scanning transmission electron microscopes only produce two-dimensional images. So, creating a 3-D picture requires scientists to scan the sample once, tilt it by a few degrees and re-scan it—repeating the process until the desired spatial resolution is achieved—before combining the data from each scan using a computer algorithm. The downside of this technique is that the repeated electron beam radiation can progressively damage the sample.

Using a scanning transmission electron microscope at the Lawrence Berkeley National Laboratory’s Molecular Foundry, Miao and his colleagues analyzed a small piece of tungsten, an element used in incandescent light bulbs. As the sample was tilted 62 times, the researchers were able to slowly assemble a 3-D model of 3,769 atoms in the tip of the tungsten sample.

The experiment was time consuming because the researchers had to wait several minutes after each tilt for the setup to stabilize.

“Our measurements are so precise, and any vibrations—like a person walking by—can affect what we measure,” said Peter Ercius, a staff scientist at Lawrence Berkeley National Laboratory and an author of the paper.

The researchers compared the images from the first and last scans to verify that the tungsten had not been damaged by the radiation, thanks to the electron beam energy being kept below the radiation damage threshold of tungsten.

Miao and his team showed that the atoms in the tip of the tungsten sample were arranged in nine layers, the sixth of which contained a point defect. The researchers believe the defect was either a hole in an otherwise filled layer of atoms or one or more interloping atoms of a lighter element such as carbon.

Regardless of the nature of the point defect, the researchers’ ability to detect its presence is significant, demonstrating for the first time that the coordinates of individual atoms and point defects can be recorded in three dimensions.

“We made a big breakthrough,” Miao said.

Miao and his team plan to build on their results by studying how atoms are arranged in materials that possess magnetism or energy storage functions, which will help inform our understanding of the properties of these important materials at the most fundamental scale.

“I think this work will create a paradigm shift in how materials are characterized in the 21st century,” he said. “Point defects strongly influence a material’s properties and are discussed in many physics and materials science textbooks. Our results are the first experimental determination of a point defect inside a material in three dimensions.”

The study’s co-authors include Rui Xu, Chien-Chun Chen, Li Wu, Mary Scott, Matthias Bartels, Yongsoo Yang and Michael Sawaya, all of UCLA; as well as Colin Ophus of Lawrence Berkeley National Laboratory; Wolfgang Theis of the University of Birmingham; Hadi Ramezani-Dakhel and Hendrik Heinz of the University of Akron; and Laurence Marks of Northwestern University.

This work was primarily supported by the U.S. Department of Energy’s Office of Basic Energy Sciences (grant DE-FG02-13ER46943 and contract DE-AC02—05CH11231).

9.  An SDSU chemist has developed a technique to identify potential cancer drugs that are less likely to produce side effects.

http://www.technologynetworks.com/medchem/news.aspx?ID=183124

A class of therapeutic drugs known as protein kinase inhibitors has in the past decade become a powerful weapon in the fight against various life-threatening diseases, including certain types of leukemia, lung cancer, kidney cancer and squamous cell cancer of the head and neck. One problem with these drugs, however, is that they often inhibit many different targets, which can lead to side effects and complications in therapeutic use. A recent study by San Diego State University chemist Jeffrey Gustafson has identified a new technique for improving the selectivity of these drugs and possibly decreasing unwanted side effects in the future.

Why are protein kinase–inhibiting drugs so unpredictable? The answer lies in their molecular makeup.

Many of these drug candidates possess examples of a phenomenon known as atropisomerism. To understand what this is, it’s helpful to understand a bit of the chemistry at work. Molecules can come in different forms that have exactly the same chemical formula and even the same bonds, just arranged differently. The different arrangements are mirror images of each other, with a left-handed and a right-handed arrangement. The molecules’ “handedness” is referred to as chirality. Atropisomerism is a form of chirality that arises when the spatial arrangement has a rotatable bond called an axis of chirality. Picture two non-identical paper snowflakes tethered together by a rigid stick.

Some axes of chirality are rigid, while others can freely spin about their axis. In the latter case, this means that at any given time, you could have one of two different “versions” of the same molecule.

Watershed treatment

As the name suggests, kinase inhibitors interrupt the function of kinases—a particular type of enzyme—and effectively shut down the activity of proteins that contribute to cancer.

“Kinase inhibition has been a watershed for cancer treatment,” said Gustafson, who attended SDSU as an undergraduate before earning his Ph.D. in organic chemistry from Yale University, then working there as a National Institutes of Health poctdoctoral fellow in chemical biology.

“However, it’s really hard to inhibit a single kinase,” he explained. “The majority of compounds identified inhibit not just one but many kinases, and that can lead to a number of side effects.”

Many kinase inhibitors possess axes of chirality that are freely spinning. The problem is that because you can’t control which “arrangement” of the molecule is present at a given time, the unwanted version could have unintended consequences.

In practice, this means that when medicinal chemists discover a promising kinase inhibitor that exists as two interchanging arrangements, they actually have two different inhibitors. Each one can have quite different biological effects, and it’s difficult to know which version of the molecule actually targets the right protein.

“I think this has really been under-recognized in the field,” Gustafson said. “The field needs strategies to weed out these side effects.”

Applying the brakes

So that’s what Gustafson did in a recently published study. He and his colleagues synthesized atropisomeric compounds known to target a particular family of kinases known as tyrosine kinases. To some of these compounds, the researchers added a single chlorine atom which effectively served as a brake to keep the atropisomer from spinning around, locking the molecule into either a right-handed or a left-handed version.

When the researchers screened both the modified and unmodified versions against their target kinases, they found major differences in which kinases the different versions inhibited. The unmodified compound was like a shotgun blast, inhibiting a broad range of kinases. But the locked-in right-handed and left-handed versions were choosier.

“Just by locking them into one or another atropisomeric configuration, not only were they more selective, but they inhibited different kinases,” Gustafson explained.

If drug makers incorporated this technique into their early drug discovery process, he said, it would help identify which version of an atropisomeric compound actually targets the kinase they want to target, cutting the potential for side effects and helping to usher drugs past strict regulatory hurdles and into the hands of waiting patients.

11.  ‘Nanocubes’ Make PSA Test Over 100 Times More Sensitive

http://www.mdtmag.com/news/2015/09/nanocubes-make-psa-test-over-100-times-more-sensitive?

A new catalyst that improves the sensitivity of the standard PSA test more than 100-fold, pictured above, is made of palladium nanocubes coated with iridium. (Credit: Xiaohu Xia, Michigan Technological University)

Say you’ve been diagnosed with prostate cancer, the second-leading cause of cancer death in men. You opt for surgery to remove your prostate. Three months later, a prostate surface antigen (PSA) test shows no prostate cells in your body. Everyone rejoices.

Until 18 months later, when another PSA test reveals that now prostate cells have reappeared. What happened?

The first PSA test yielded what’s known as a false negative result. It did not detect the handful of cells that remained after surgery and later multiplied. Now a chemist at Michigan Technological University has made a discovery that could, among other things, slash the numbers of false negatives in PSA tests.

Xiaohu Xia and his team, including researchers from Louisiana State University and the University of Texas at Dallas, have developed a new catalyst that could make lab tests like the PSA much more sensitive. And it may even speed up reactions that neutralize toxic industrial chemicals before they enter lakes and streams.

A paper on the research, “Pd-Ir Core-Shell Nanocubes: A Type of Highly Efficient and Versatile Peroxidase Mimic,” was published online Sept. 3 in ACS Nano. In addition to Xia, the coauthors are graduate students Jingtuo Zhang, Jiabin Liu and Haihang Ye and undergraduate Erin McKenzie of Michigan Tech; Moon J. Kim and Ning Lu of the University of Texas at Dallas; and Ye Xu and Kushal Ghale of Louisiana State University. The LSU team conducted theoretical calculations, and the UT Dallas team contributed high-resolution electron microscopy images.

Their new catalyst mimics the action of similar biochemicals found in nature, called peroxidases. “In animals and plants, these peroxidases are important– for example, they get rid of hydrogen peroxide, which is harmful to the organism,” said Xia, an assistant professor of chemistry at Michigan Tech. In medicine, peroxidases have become powerful tools for accelerating chemical reactions in diagnostic tests; a peroxidase found in the horseradish root is commonly used in the standard PSA test.

However, these natural peroxidases have drawbacks. They can be difficult to extract and purify. “And, they are made of protein, which isn’t very stable,” Xia explained. “At high temperatures, they cook, like meat.”

“Moreover, their efficiency is just fair,” he added. “We wanted to develop a mimic peroxidase that was substantially more efficient than the natural peroxidase, which would lead to a more-sensitive PSA test.”

Their new catalyst, made from nanoscale cubes of palladium coated with a few layers of iridium atoms, does just that. PSA tests Xia’s team conducted using the palladium-iridium catalyst were 110 times more sensitive than tests completed with the conventional peroxidase.

“After surgery, it’s vital to detect a tiny amount of prostate antigen, because otherwise you can get a false negative and perhaps delay treatment for cancer,” said Xia. “Our ultimate goal is to further refine our system for use in clinical diagnostic laboratories.”

Xia hopes that his mimic peroxidase will someday save lives through earlier detection of cancer and other maladies. He also plans to explore other applications, including how it compares with horseradish peroxidase in other catalytic reactions: breaking down toxic industrial-waste products like phenols into harmless substances.

Finally, the team wants to better understand why its palladium-iridium catalyst works so well. “We know the iridium coating is the key,” Xia said. “We think it makes the surface sticky, so the chemical reagents bind to it better.”

12.  Using Proteomics To Understand How Genetic Mutations Rewire Cancer Cells

http://www.laboratorynetwork.com/doc/using-proteomics-to-understand-genetic-mutations-rewire-cancer-cells-0001?

SAN JOSE, Calif.–(BUSINESS WIRE)–Thermo Fisher Scientific and the Biotech Research and Innovation Center (BRIC) at the University of Copenhagen (UCPH) have shared results from two important scientific papers that advance understanding of how gene mutations drive cancer progression. The two landmark studies, published this week in the journal ; CELL, are some of the early results of the strategic collaboration between Thermo Fisher Scientific and the Linding Lab at BRIC, UCPH.

Using advanced Thermo Scientific Orbitrap Fusion mass spectrometry and next-generation sequencing technologies, researchers from the Universities of Copenhagen, Yale, Zurich, Rome and Tottori describe how specific cancer mutations target and damage the protein signaling networks within human cells on a global scale.

By developing advanced algorithms to integrate data from quantitative mass-spectrometry and next generation sequencing of tumor samples, the researchers have been able to uncover cancer-related changes to phosphorylation signaling networks. This new breakthrough allows researchers to identify the effects of mutations on the function of protein pathways in cancer for individual patients, even if those mutations are very rare.

Lead BRIC researcher Dr. Rune Linding said: “The identification of distinct changes within our tissues that could have the potential to help predict and treat cancer is a major step forward and we are confident that it can aid in the development of novel therapies and screening techniques.”

Since the human genome was decoded more than a decade ago, large scale cancer genome studies have successfully identified gene mutations in individual patients and tumors. However to develop improved cancer therapies, researchers need to explain and relate this genomic data to proteins, the targets of most pharmaceutical drugs. Creating this linkage provides powerful new insights into cancer biology and potential therapeutic approaches.

“The studies highlight the importance of integrating proteomics with genomics in future cancer studies and underscores the value of the broad technological expertise within Thermo Fisher,” said Ken Miller, vice president of research product marketing, life sciences mass spectrometry at Thermo Fisher. “It is becoming increasingly apparent that the genetic basis for each patient’s cancer is subtly, but importantly, different. This realization will inevitably lead to a need for tools to acquire and assess patient-specific information to develop highly personalized therapies with the potential for much greater efficacy. It is hoped that the novel approaches described in these studies, together with best-in-class enabling technologies such as the Orbitrap and Ion Torrent systems, will continue to improve our knowledge of cancer biology.”

The Biotech Research & Innovation Centre (BRIC) was established in 2003 by the Danish Ministry of Science, Technology and Innovation to form an elite centre in biomedical research.

The two studies will be available in advance online and printed in the 24th September issue of CELL, a premier journal in life and biological sciences. More information about the studies and links to media content can be found on http://www.lindinglab.science and http://www.bric.ku.dk. The work was supported by the European Research Council (ERC), the Lundbeck Foundation and Human Frontier Science Program.

13.  Multi-Ancestry GWAS Uncovers a Dozen New Loci Linked to Blood Pressure

Sep 21, 2015

https://www.genomeweb.com/cardiovascular-disease/multi-ancestry-gwas-uncovers-dozen-new-loci-linked-blood-pressure?

NEW YORK (GenomeWeb) – In Nature Genetics, an international team described a dozen new loci influencing blood pressure patterns across individuals from multiple populations — a set that overlaps with variants implicated in epigenetic features of blood and other tissues.

Through a multi-stage genome-wide association study that relied on genotyping information for as many as 320,251 individuals of East Asian, South Asian, and European descent, the researchers focused in on SNPs at 12 blood pressure-associated sites in the genome, including loci previously linked to cardiac or metabolic functions.

In particular, the team saw blood pressure-linked variants in and around genes contributing to vascular smooth muscle and renal function. And a large proportion of the associated SNPs — or variants in linkage disequilibrium with them — turned up at sites already implicated in control of DNA methylation.

“We note an effect of genome-wide-associated sentinel SNPs on DNA methylation for traits in addition to blood pressure, suggesting that DNA methylation might have a wider role in linking common genetic variation to multiple phenotypes,” the study’s authors wrote.

More than a billion people around the world are affected by high blood pressure, the team explained, a condition that elevates the risk of heart disease, heart attack, stroke, and chronic kidney disease.

Because it occurs at especially high rates in East Asian and South Asian populations, the investigators reasoned that it might be possible to find both ancestry-specific and trans-ancestral genetic associations with high blood pressure.

The team started by analyzing imputed and directly genotyped SNPs in 31,516 individuals of East Asian ancestry, 35,352 individuals with European ancestry, and 33,126 individuals of South Asian descent, searching for variants associated with systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure, and hypertension.

Through analyses on each population individually and in a meta-analysis of individuals from all three populations, the researchers initially identified 630 loci with suspected ties to at least one of the five blood pressure traits considered.

They then compared the top SNP at each site against data on as many as 87,205 individuals tested for various blood pressure traits for the International Consortium on Blood Pressure GWAS, narrowing in on 19 loci with potential ties to blood pressure that were not described in the past.

The team confirmed blood pressure associations for SNPs at 12 of the new loci through testing on another 48,268 East Asians, 68,456 Europeans, and 16,328 South Asians.

The analysis also verified almost two-dozen loci linked to blood pressure in the past and pointed to 17 sites in the genome with weaker ties to the traits of interest.

Variants at the 12 new loci seemed to have similar effects on the five traits in question, regardless of the population considered, while variants that first appeared to show population-specific effects in East Asians and Europeans did not pan out in replication testing.

By folding in linkage disequilibrium patterns for SNPs at the new blood pressure-associated sites, the researchers got a look at genes that fall near these linked SNPs — a collection that includes genes such as PDE3A, KCNK3, and PRDM6.

They also used these linkage patterns to look for overlap with DNA methylation-related SNPs, demonstrating that 28 of 35 SNPs at these loci seem to be linked to altered DNA methylation levels and related expression shifts in samples from thousands of Europeans or East Asians.

And the team saw similar effects in hundreds of cord blood samples subjected to methylation profiling, suggesting the effect is not simply a consequence of high blood pressure itself.

“The presence of these associations at an early stage of life, before substantial environmental exposure, lends support to the view that the sequence variants have a direct effect on DNA methylation and argues against reverse causation,” the study authors wrote.

14.  Elabela, A New Human Embryonic Stem Cell Growth Factor

September 20, 2015 by mburatov

When embryonic stem cell lines are made, they are traditionally grown on a layer of “feeder cells” that secrete growth factors that keep the embryonic stem cells (ESCs) from differentiating and drive them to grow. These feeder cells are usually irradiated mouse fibroblasts that coat the culture dish, but do not divide. Mouse ESCs can be grown without feeder cells if the growth factor LIF is provided in the medium. LIF, however, is not the growth factor required by human ESCs, and therefore, designing culture media for human ESCs to help them grow without feeder cells has proven more difficult.

Having said that, several laboratories have designed media that can be used to derive human embryonic stem cells without feeder cells. Such a procedure is very important if such cells are to be used for therapeutic purposes, since animal cells can harbor difficult to detect viruses and unusual sugars on their cell surfaces that can also be transferred to human ESCs in culture. These unusual sugars can elicit a strong immune response against them, and for this reason, ESCs must be cultivated or derived under cell-free conditions. However, to design good cell-free culture media, we must know more about the growth factors required by ESCs.

To that end, Bruno Reversade from The Institute of Molecular and Cell Biology in Singapore and others have identified a new growth factor that human ESCs secrete themselves. This protein, ELABELA (ELA), was first identified as a signal for heart development. However, Reversade’s laboratory has discovered that ELA is also abundantly secreted by human ESCs and is required for human ESCs to maintain their ability to self-renew.

Reversade and others deleted the ELA gene with the CRISPR/Cas9 system, and they also knocked the expression of this gene down in other cells with small interfering RNAs. Alternatively, they also incubated human ESCs with antibodies against ELA, which neutralized ELA and prevented it from binding to the cell surface. However Ela was inhibited, the results were the same; reduced ESC growth, increased amounts of cell death, and loss of pluripotency.

How does ELA signal to cells to grow? Global signaling studies of growing human ESCs showed that ELA activates the PI3K/AKT/mTORC1 signaling pathway, which has been show in other work to be required for cell survival. By activating this pathway, ELA drives human ESCs through the cell-cycle progression, activates protein synthesis, and inhibits stress-induced apoptosis.

Interestingly, INSULIN and ELA have partially overlapping functions in human ESC culture medium, but only ELA seems to prime human ESCs toward the endoderm lineage. In the heart, ELA binds to the Apelin receptor APLNR. This receptor, however, is not expressed in human ESCs, which suggests that another receptor, whose identity remains unknown at the moment, binds ELA in human ESCs.

Thus ELA seems to act through an alternate cell-surface receptor, is an endogenous secreted growth factor in human

This paper was published in the journal Cell Stem Cell.

15.  Multiwavelength TIRF Microscopy Enables Insight into Actin Filaments

http://www.photonics.com/Article.aspx?PID=1&AID=57707

Researchers at the University of California, San Francisco (UCSF) are combining multiple laser excitation wavelengths in total internal reflection fluorescence (TIRF) microscopy to investigate the binding dynamics of individual actin filaments.

DAN CALLEN, COHERENT INC.

TIRF microscopy provides a unique method of imaging isolated molecules and complexes in vitro. Additionally, the use of sensitive, low-noise cameras enables researchers to study this behavior in real time. A new plug-and-play method of combining several fiber-delivered, digitally modulated lasers into a single instrument, such as a TIRF microscope, now enables multiple labeled proteins to be imaged pseudosimultaneously at high frame rates. This article explores how multiwavelength excitation is being combined with TIRF microscopy in the laboratory of Dr. Dyche Mullins, a professor at UCSF, and how it’s being used to gain new insights into complex biochemical interactions that control the stability and function of actin filaments.

TIRF microscopy in single-filament studies

The Mullins Lab, located at UCSF’s Mission Bay campus, is widely recognized as a leading authority on the study of actin filaments. The protein filaments are fundamental to many processes in virtually every eukaryotic cell — they act as structural elements that enable movement of internal cargoes, amoeboid cell migration, cell division, etc. With these filaments playing so many different roles, it is not surprising that their combination of growth, branching, aggregation and movement involves many subtle control options, which are mediated by a range of different proteins. Sam Lord, the Mullins Lab’s microscope specialist, said, “One area of our research is studying how various proteins bind to actin filaments to enable aggregation, branching and other actions, and more specifically, how yet another set of proteins modulates these binding processes. Obviously, we do bulk studies in a cuvette that reveal overall kinetic data about these binding processes but we also want to image these processes in real time to study the structural biochemistry.” In order to do so, the lab uses TIRF microscopy to observe single actin filaments.

This process involves excitation light that is introduced into the sample region through either a glass slide or a cover slip. The microscope’s optics are configured so that the light hits the glass/sample interface beyond the critical angle, meaning that all of the light will undergo total internal reflection (TIR). However, even with TIR, some of the light’s electric field, called the evanescent wave, penetrates into the sample by an incredibly short distance — typically around 100 nm — beyond the interface. This means that TIRF microscopy can be used to selectively excite fluorescence in molecules and complexes that are adhered to the interface. However, because the light does not penetrate into the bulk (i.e., background) sample region, this methodology will not excite fluorescence from the huge backdrop of molecules freely floating within this medium.

TIRF microscopy is thus a 3D-resolved imaging technique. Its X-Y resolution is limited only by diffraction and/or the camera resolution, but the Z-axis sampling depth is much smaller than the diffraction limit. If there is sufficient signal for fast frame acquisition speeds, the important fourth dimension — time — enables dynamic processes, such as actin filament-protein binding, to be observed on a single filament or on a network of filaments, in real time.

In principle, both laser and nonlaser light sources may be used for fluorescence excitation in such TIRF-based applications. However, for experiments with naturally low signal levels, such as single-molecule monitoring, a laser beam’s extreme brightness is a critical advantage. In particular, a laser’s unique spatial brightness means that it is relatively simple to collimate and subsequently focus the beam into the sample with a narrow range of incidence angles, avoiding excitation of the bulk sample.

Through-objective TIRF microscopy

All TIRF microscope setups are based on one of two basic approaches: through-objective lens geometry or the prism-based method. In the former approach, light is directed in an off-axis geometry through an oil-immersion microscope objective so that the angle of incidence at the coverslip/sample interface is greater than the critical angle, as is shown schematically in Figure 1.


Figure 1.
 In TIRF microscopy, excitation light beyond the critical light is completely reflected. The evanescence of the light field at the refractive interface penetrates into the sample by about 100 nm, causing selective excitation of molecules and complexes adhered to this interface. TIRF microscopes are available with a choice of either through-objective excitation or prism excitation options.
In the prism-based method, the orientation of the sample is reversed with respect to the imaging objective. A light beam is introduced to the sample through a prism attached to the cover slip; the geometry of the prism ensures that the incidence angle at the sample is greater than the critical angle.

Depending on the type of experiment being performed, there are both advantages and disadvantages to each of the above methods. For example, the prism method limits physical access to the sample. As Lord explained, the Mullins Lab uses a Nikon microscope in the through-objective configuration with a very high numerical aperture (NA = 1.49) for several reasons. “For single-molecule studies, fluorescence signal strength is always a major challenge, particularly since we are following processes that need fast frame rates. So, we need a high-NA objective with a small working distance to maximize light collection efficiency. These objectives require a coverglass of precise thickness and the sample near the top of the coverslip to minimize aberrations.” Lord also stated that caution must be taken so the team does not introduce scattering and other losses due to viewing fluorescence through the bulk of the sample.

Multiple, simultaneous laser wavelengths

As has been noted, the mechanisms controlling the binding of regulatory proteins to actin filaments are quite complex. To better understand these processes, the Mullins Lab increasingly has been using sophisticated, multiwavelength TIRF-based experiments. In order to image multiple fluorophores, Lord explained, “We can use either multiple sequenced lasers or a scope equipped with multiple cameras — we have setups for both arrangements.” He continued, “Multiple excitation wavelengths that sequence at high rates enable us to selectively image multiple, differently labeled targets using a microscope equipped with a single high-sensitivity camera, and ensures near-perfect image registration.”

When using multiple lasers, the two technical challenges are to perfectly coalign the lasers into the microscope objective and then to be able to switch between different wavelengths. In order to follow fast binding processes in real time, researchers typically must switch wavelengths between alternate camera frames to build up pseudosimultaneous (i.e., interleaved) videos at two or sometimes three laser wavelengths. This switching must be performed with no undesirable dead time (i.e., shifts in the beam path) and without using mechanical shutters or a complex and costly approach, such as an acousto-optic tunable filter.

Lord notes, “As recently as five years ago, we simply didn’t have low-cost options to conduct single molecule studies using multiple laser wavelengths pseudosimultaneously at the requisite frame rates (30 fps) in order to follow critical binding processes.” He added, “Digitally controllable diode or solid-state lasers, hardware sequencing electronics and quad-band optical filters make it possible to achieve nearly simultaneous multicolor imaging with a single camera.”

In 2014, the lab acquired several digitally modulatable smart lasers to enable multiwavelength TIRF microscopy. These lasers included Coherent’s fiber-pigtailed OBIS FP modules that operate at 488, 561 and 640 nm. The lab also acquired the OBIS Galaxy, which enables simple plug-and-play combining of up to eight fiber-coupled lasers into one, single-mode output fiber. As was detailed by Coherent’s Dan Callen and Matthias Schulze in BioPhotonics’ November 2014 issue (“Laser Combiner Enables Scanning Fluorescence Endoscopy,” www.photonics.com/A56915), this passive module enables lasers to be added or subtracted (i.e., hot-swapped) to any fiber-coupled instrument or setup in a few minutes or less via standard fiber connectors, such as FC/UFC and FC/APC connectors.

Figure 2. The OBIS Galaxy (shown with the top cover removed) allows plug-and-play combining of up to eight separate fiber coupled lasers into a single output fiber. Courtesy of Sam Lord.
The timing hardware setup at the Mullins Lab is very simple in design due to the fact that these smart lasers support direct digital modulation. In each experiment, the frame rate is set by the microscope’s high-sensitivity camera, which is an Andor DU897. The camera’s TTL output trigger pulses are processed in either a programmable Arduino board or an ESio controller, which then directs TTL pulses to fire one of the three lasers without any hardware or software delays. Alternating wavelengths typically are used in most experiments, although any sequence of wavelength frames easily can be programed using the Arduino and Micro-Manager software.1

According to Lord, the flexibility of this arrangement supports future experimental setups that have even greater levels of complexity. In particular, he added, “We may well add a 405-nm laser option in the near future. If/when this arrives, we can simply plug it in and we are ready to go.”

Investigating modulation of actin binding processes

In the team’s work on the binding of actin filaments, this flexible TIRF setup enables the Mullins Lab to conduct experiments with several different approaches. For example, in typical two-wavelength experiments, the actin filament is labeled with one fluorophore, and the protein of interest is labeled with another fluorophore. The protein fluorophore only appears in the TIRF-produced images if/when it binds to the actin sitting on the cover slip. One use of the third wavelength is to image a second protein, which is labeled with a different fluorophore. The image sequences then may reveal, for example, whether the proteins are interspersed at different sites on the filament, or whether the second protein promotes filament growth or branching from a new site. Or, it may reveal that the second protein competitively displaces the first.

In a recently published study,2 Mullins Lab researchers used their multilaser TIRF setup to investigate the details of control mechanisms associated with the binding of tropomyosins to actin filaments. Tropomyosins are coiled-coil proteins whose known functions are to bind actin filaments and thereby regulate multiple cytoskeletal functions — including actin network dynamics near the leading edge of motile cells.

Mullins explained, “The binding of tropomyosins to actin filaments is known to be fundamentally important in actin dynamics. But, we do not yet fully understand how this binding is regulated, especially near the leading edge of migrating cells. Why, for example, are filaments in the lamellum coated with tropomyosin while filaments in the adjacent lamellipod are not?” (Lamellum and lamellipod are distinct, actin-based substructures involved in cell migration.) He went on to state that, prior to his team’s latest studies, previous research demonstrated that tropomyosins inhibit actin nucleation by the Arp2/3 protein complex and that this, in turn, prevented filament severing by the protein cofilin.3,4 “So, we have recently used TIRF and other methods to investigate if and how the Arp2/3 complex and cofilin in turn modulate the binding of tropomyosins to actin filaments,” he said.


Figure 3.
 TIRF images showing Tm1A binding preferentially to the pointed end of single actin filaments. The red signal is from Cy5 labeled Tm1A fluorescence excited at 640 nm, and the green signal is due to Alexa 488 labeled actin excited at 488 nm. Courtesy of J.Y. Hsiao, L.M. Goins, N.A. Petek, R.D. Mullins.
The team members studied these interactions in the specific case of nonmuscle Drosophila tropomyosin protein, Tm1A. They also compared some of these interactions in Tm1A to the same interactions in rabbit skeletal muscle tropomyosin, as other researchers previously have found that mammalian skeletal muscle tropomyosin is the least-effective Arp2/3 inhibitor.2

Data from dual-wavelength excitation produced by TIRF microscopy methodology when applied to single filaments is shown in Figure 3. This information shows that Tm1A preferentially binds near the pointed end of actin filaments. By comparing similar data that resulted from different experimental conditions, the researchers showed that pointed-end binding is dependent on the nucleotide state of the actin and the Tm1A concentration.

Although a complete evaluation of all of the research’s results, conclusions and wider implications falls outside the scope of this article, Mullins does summarize some of the key points. “Binding of cyto-skeletal tropomyosin to actin filaments turns out to be more complicated than previously appreciated. Both nucleation and spreading of tropomyosin are strongly influenced by the conformation of the actin filament and the presence of other regulatory proteins.” Mullins added that, based on TIRF-produced images and other collected data, “We have been able to propose a model where the cooperation of the severing activity of cofilin and tropomyosin binding helps establish the border between the lamellipod and lamellum.” The role of cofilin in the model referenced by Mullin is shown in Figure 4.


Figure 4.
 These images summarize the role of cofilin in the model proposed by Hsaio et al. [ref]. The branched actin network on the left shows the situation in the absence of cofilin, where tropomyosin binding is blocked by Arp2/3 branches. The branched actin network on the right illustrates that in the presence of cofilin, new pointed ends are created, which allows tropomyosin to bind. Once tropomyosin is bound, it protects the actin filaments from further cofilin severing, possibly resulting in the transition from the lamellipod to the lamellum. Courtesy of J.Y. Hsiao, L.M. Goins, N.A. Petek, R.D. Mullins.
In summation, TIRF microscopy is a well-established technique for imaging single molecular structures and protein complexes. This method also enables their respective dynamics to be observed in real time. By providing a method to rapidly switch between two or more excitation wavelengths, the latest lasers and laser-combining technologies are now enabling researchers to perform TIRF microscopy experiments with a greater number of separate labels. This capability is delivering unique insights into important and multifaceted processes in the study of cell biology.

Meet the author

Dan Callen is a product manager at Coherent Inc. in Santa Clara, Calif.; email: daniel.callen@coherent.com.

References

1. A.D. Edelstein et al. (2014). Advanced methods of microscope control using μManager software. J Biol Methods, Vol. 1, No. 2, e10.

2. J.Y. Hsiao et al. (2015). Arp2/3 complex and cofilin modulate binding of tropomyosin to branched actin networks. Curr Biol, pp. 1-10.

3. L. Blanchoin et al. (2001). Inhibition of the Arp2/3 complex-nucleated actin polymerization and branch formation by tropomyosin. Curr Biol, Vol. 11, No. 16, pp. 1300-1304.

4. J.H. Iwasa and R.D. Mullins (2007). Spatial and temporal relationships between actin-filament nucleation, capping and disassembly. Curr Biol, Vol. 17, No. 5, pp. 395-406.

18.  Using QCLs for MIR-Based Spectral Imaging — Applications in Tissue Pathology

http://www.photonics.com/Article.aspx?PID=1&AID=57708

A quantum cascade laser (QCL) microscope allows for fast data acquisition, real-time chemical imaging and the ability to collect only spectral frequencies of interest. Due to their high-quality, highly tunable illumination characteristics and excellent signal-to-noise performance, QCLs are paving the way for the next generation of mid-infrared (MIR) imaging methodologies.

MICHAEL WALSH, UNIVERSITY OF ILLINOIS AT CHICAGO; MATTHEW BARRE & BENJAMIN BIRD, DAYLIGHT SOLUTIONS

H. Sreedhar*1, V. Varma*2, A. Graham3, Z. Richards1, F. Gambacorata4, A. Bhatt1,
P. Nguyen1, K. Meinke1, L. Nonn1, G. Guzman1, E. Fotheringham5, M. Weida5,
D. Arnone5, B. Mohar5, J. Rowlette5
Real-time, MIR chemical imaging microscopes could soon become powerful frontline screening tools for practicing pathologists. The ability to see differences in the biochemical makeup across a tissue sample greatly enhances a practioner’s ability to detect early stages of disease or disease variants. Today, this is accomplished much as it was 100 years ago — through the use of specially formulated stains and dyes in combination with white light microscopy. A new MIR, QCL-based microscope from Daylight Solutions enables real-time, nondestructive biochemical imaging of tissues without the need to perturb the sample with chemical or heat treatments, thus preserving the sample for follow-on fluorescence tagging, histochemical staining or other “omics” testing within the workflow.
MIR chemical imaging is a well-established absorbance spectroscopy technique; it senses the relative amount of light that molecules absorb due to their unique vibrational resonances falling within the MIR portion of the electromagnetic spectrum (i.e., wavelengths from approximately 2 to 15 µm). This absorption can be detected with a variety of MIR detector types and can provide detailed information about the sample’s chemical composition.

The most common instrument for this type of measurement is known as a Fourier transform infrared (FTIR) spectrometer. FTIR systems use a broadband MIR light source, known as a globar, to illuminate a sample; the absorption spectrum is generated by the use of interferometry. Throughout the past decade, FTIR systems have incorporated linear arrays and 2D focal plane arrays (FPAs) in a microscope configuration to enable a technique known as chemical imaging.

19.  Inner Ear Undertakers

Support cells in the inner ear respond differently to two drugs that kill hair cells.

By Kerry Grens | September 1, 2015

http://www.the-scientist.com//?articles.view/articleNo/43824/title/Inner-Ear-Undertakers/

The paper
E.L. Monzack et al., “Live imaging the phagocytic activity of inner ear supporting cells in response to hair cell death,” Cell Death Differ, doi:10.1038/cdd.2015.48, 2015.

Killer drugs
A number of commonly used medications can cause hearing loss by killing off cochlear hair cells, which translate sound waves into neural activity. To understand how they die, Lisa Cunningham and Elyssa Monzack of the National Institute on Deafness and Other Communication Disorders and colleagues turned to the utricle, a vestibular inner-ear structure involved with balance whose hair cells are very similar to those in the cochlea, which are notoriously resistant to culturing when mature.

Body bags
The team developed a method to watch hair cells of whole mouse utricles die in real time after exposure to the chemotherapy drug cisplatin or the antibiotic neomycin. In response to the latter, supporting cells, glia-like neighbors of hair cells, appeared to form a phagosome around the corpses and engulf them. “You can see two, three, sometimes four supporting cells advancing simultaneously on that hair cell corpse,” says Cunningham—which suggests that the dying cell is giving off a specific and local signal.

Spilled guts
In contrast, cisplatin-induced hair cell death provoked hardly any phagocytic reaction from supporting cells, about half of which themselves succumbed. Cunningham says this could have clinical implications if dead hair cells then spill their cytoplasmic contents into the tissue, which can result in an immune response that can cause even further damage.

Distress call
Mark Warchol of Washington University in St. Louis says it will be important to identify the signal supporting cells are responding to after neomycin treatment. “There’s some molecular signal by which the hair cell causes [supporting cells] to execute this process. And with cisplatin, they’re just not capable of doing it.”

Tags

utriclesensory biologyphagocytosishearinghair cellearcell death and cell & molecular biology

20.  Inner Ear Cartography

Scientists map the position of cells within the organ of Corti.

By Ruth Williams | September 1, 2015

http://www.the-scientist.com//?articles.view/articleNo/43804/title/Inner-Ear-Cartography/

Age-related hearing loss caused by damage to the sensory hair cells within the cochlea is extremely common, but studying the inner ear is tough. “It’s in the densest bone in the body, so you don’t have access,” says John Brigande of Oregon Health and Science University in Portland. Even if you can extract cells, he says, “there are so darn few of them.”

Despite these technical difficulties, researchers have gleaned gene-expression information about different cell types within the organ of Corti—home to the sensory cells within the cochlea. But “it’s not only important to know what a cell expresses,” says Robert Durruthy-Durruthy, a postdoc in the Stanford University lab of Stefan Heller. “It’s also important to know where it can be found within a tissue.”

To this end, Durruthy-Durruthy, Heller, and postdoc Jörg Waldhaus have derived a 2-D map of organ of Corti cells from neonatal mice. First, the team sorted all cell types across the medial-to-lateral axis (or width) of the organ based on marker gene expression. The approximately 900 sorted cells, representing nine cell types, were then each quantitatively analyzed for the expression of 192 selected genes. Computational analysis of these expression data then enabled reconstruction of the cells’ positions along the organ’s apical-to-basal (length) and medial-to-lateral axes. In principle, the technique, which harnesses gene-expression information to determine cells’ spatial organization, could be applied to generate 2-D maps of any complex tissue, says Durruthy-Durruthy.

Within the mammalian cochlea, apical cells retain regenerative capacity for a few weeks after birth, but basal cells do not. “Spatial mapping allows us to get at the differences [between these cells],” says Brigande, and that could ultimately highlight possible ways to reinstate regeneration in the adult ear. (Cell Reports, 11:1385-99, 2015)

  FROM ORGAN TO SINGLE CELLS: To build a map of cells within the organ of Corti—where sound is translated to neural activity—scientists divide the cochlea in two. Each half of the organ of Corti is then broken up into its constituent cells, which comprise nine cell types (represented by the nine colors) spanning the organ’s edial-to-lateral axis.

http://www.the-scientist.com/images/August2015/MO_11.jpg

21.  Resveratrol Stabilizes Amyloid in Alzheimer’s

Pauline Anderson

September 17, 2015

http://www.medscape.com/viewarticle/851172?

High doses of purified resveratrol, a polyphenol found in some foods, appear to stabilize levels of amyloid beta (Aβ) in cerebrovascular fluid (CSF) and in plasma in patients with mild to moderate Alzheimer disease (AD) and are safe and well tolerated, a new phase 2 study has shown.

Although it is too soon to start recommending resveratrol supplements to patients, the research indicates that this compound is safe and is promising, lead author R. Scott Turner, MD, PhD, professor, Neurology, and director of the Memory Disorders Program, Georgetown University Medical Center, Washington, DC, one of 21 medical centers across the United States participating in the study.

“It seems to have some interesting effects, enough to justify further research into this strategy,” he told Medscape Medical News.

The study was published online September 11 as an Open Access article in Neurology.

Natural Compound

Resveratrol is a naturally occurring compound found in red grapes, red wine, dark chocolate, and some other foods, and is widely available as a supplement.

It is believed that resveratrol promotes resilience to stress, as levels increase in plants exposed to severe cold or to fungus, said Dr Turner. Animal research suggests that resveratrol may affect sirtuins, which are proteins that are activated with calorie restriction, which is a form of mild stress.

The study included 119 patients randomly assigned to either high doses of pure synthetic pharmaceutical grade resveratrol that is not available commercially (n = 64) or placebo (n = 55). The resveratrol used in the study was introduced at a dose of 500 mg a day and was increased every 3 months, so that by the end of the 1-year study, subjects were taking 2000 mg a day.

Results showed that at 1 year, the treated group’s levels of Aβ40 in CSF declined from 6574 to 6513 ng/mL, but in the placebo group, these levels went from 6560 to 5622 ng/mL, for a statistical difference at week 52 (P = .002).

This difference was also found in secondary analyses of study completers, in the mild dementia subgroup, and in APOE4 carriers and noncarriers.

The treated group’s Aβ40 levels in plasma declined from 163 to 153 ng/mL, and in the placebo group, these levels went from 165 to 132 ng/mL (for a statistical difference; P = .024).

“We can’t prove efficacy from this trial, but we’re looking for some movement in biomarkers, and we actually found that,” which is promising, said Dr Turner. “The major movement we found was in amyloid proteins in blood and CSF that were stabilized by resveratrol treatment compared to placebo, where it trended downhill, which is what happens with Alzheimer’s disease.”

This downhill trend could signal more amyloid being deposited into the brain. In contrast, that resveratrol seemed to stabilize Aβ40 in the CSF and plasma suggests the drug was able to penetrate the blood–brain barrier.

Unfortunately, said Dr Turner, the study could not fund amyloid positron emission tomography scans, which might have shed more light on the Aβ status of subjects.

Although there were no significant effects of the treatment on other amyloid biomarkers, including CSF and plasma Aβ42, trends were similar to the findings with Aβ40.

There was no difference in CSF tau. There was a trend toward an increase in CSF phospho-tau 181 with treatment (P = .08) and in secondary analysis of mild dementia (P = .047).

As for brain volume determined through magnetic resonance imaging (MRI), results showed that volumes declined more in the treatment group (going from 866 to 839 mL) than in the placebo group (going from 850 to 840 mL). This result was “mysterious” and “unexpected,” said Dr Turner.

However, he noted that the same effect has been reported in other AD trials, including those investigating immunotherapy. “The working hypothesis is that by treating AD, we are also decreasing the amount of inflammation and swelling in the brain.”

The study showed no significant effects on the mini mental state exam or on other clinical scales, but the researchers note that the phase 2 trial was not powered to detect differences in clinical outcomes.

However, they did find that the activities of daily living scale declined less in the resveratrol group than in the placebo group. “That’s also promising, because even with this phase 2, we are seeing what we think might be a clinical benefit,” said Dr Turner

A total of 657 adverse events were reported (355 in the treatment and 302 in the placebo groups), most of which were mild. The most common adverse events were gastrointestinal-related and included nausea and diarrhea.

Weight Loss

The placebo group gained about 1 pound of body weight, whereas the treated group lost almost 2 pounds. At the end of the study, the mean body mass index in the placebo group was 26.1, and in the treated group, it was 25.4.

“The weight loss is concerning, because Alzheimer disease itself causes weight loss, and we don’t want people to continue to lose weight,” said Dr Turner.

It is not clear whether the weight loss was a result of the adverse effects of diarrhea, nausea, and so on, or because of some metabolic effect.

Interestingly, six of the seven new neoplasms seen in study participants occurred in those taking placebo. This is of great interest to cancer researchers, said Dr Turner, adding that resveratrol and similar compounds are being tested in many age-related disorders, including diabetes and neurodegenerative disorders, as well as AD and cancer.

None of the 36 serious adverse events (19 on the drug and 17 on placebo), including three deaths, were deemed to be related to treatment.

Commenting on this study for Medscape Medical News, James Hendrix, PhD, director, Global Science Initiatives, Alzheimer’s Association, said that although the finding that resveratrol might stabilize Aβ40 is encouraging, the study needs to be followed up with a larger and longer phase 3 trial.

“The main focus of this study, and the main question it addressed, was whether a dose at such a high level is safe, and with the exception of some [gastrointestinal] discomfort for some people, it appears to be mostly safe.”

Dr Hendrix noted that the high dose used in the study is equivalent to 1000 bottles of red wine.

He pointed out that the study was relatively small, with 56 subjects completing the study in the treatment group, and only 48 in the placebo group.

The research was supported by a grant from the National Institute on Aging. Dr Turner reports no personal financial interests related to the study. Dr Hendrix is an employee of the Alzheimer’s Association, which has funded resveratrol grants in the past, but did not fund this study.

Neurology. Published online September 11, 2015. Full text

http://www.neurology.org/content/early/2015/09/11/WNL.0000000000002035.full.pdf

A randomized, double-blind, placebo-controlled trial of resveratrol for Alzheimer disease ABSTRACT Objective: A randomized, placebo-controlled, double-blind, multicenter 52-week phase 2 trial of resveratrol in individuals with mild to moderate Alzheimer disease (AD) examined its safety and tolerability and effects on biomarker (plasma Ab40 and Ab42, CSF Ab40, Ab42, tau, and phospho-tau 181) and volumetric MRI outcomes (primary outcomes) and clinical outcomes (secondary outcomes). Methods: Participants (n 5 119) were randomized to placebo or resveratrol 500 mg orally once daily (with dose escalation by 500-mg increments every 13 weeks, ending with 1,000 mg twice daily). Brain MRI and CSF collection were performed at baseline and after completion of treatment. Detailed pharmacokinetics were performed on a subset (n 5 15) at baseline and weeks 13, 26, 39, and 52. Results: Resveratrol and its major metabolites were measurable in plasma and CSF. The most common adverse events were nausea, diarrhea, and weight loss. CSF Ab40 and plasma Ab40 levels declined more in the placebo group than the resveratrol-treated group, resulting in a significant difference at week 52. Brain volume loss was increased by resveratrol treatment compared to placebo. Conclusions: Resveratrol was safe and well-tolerated. Resveratrol and its major metabolites penetrated the blood–brain barrier to have CNS effects. Further studies are required to interpret the biomarker changes associated with resveratrol treatment. Classification of evidence: This study provides Class II evidence that for patients with AD resveratrol is safe, well-tolerated, and alters some AD biomarker trajectories. The study is rated Class II because more than 2 primary outcomes were designated. Neurology® 2015;85:1–9

Caloric restriction prevents aging-dependent phenotypes1 and activates sirtuins (including SIRT1), a highly conserved family of deacetylases that are regulated by NAD1/NADH and thus link energy metabolism to gene expression.2 SIRT1 substrates include FOXO and PGC- 1a. 3 A screen of SIRT1 activators identified resveratrol (trans-3,49,5-trihydroxystilbene) as a potent compound.4 Similar to caloric restriction,5,6 resveratrol decreases aging-dependent cognitive decline and pathology in Alzheimer disease (AD) animal models.7,8

Resveratrol is under investigation to prevent age-related disorders including cancer, diabetes mellitus, and neurodegeneration.4,9–12 Due to its low bioavailability but high bioactivity,13,14 we increased the dose to the maximal amount considered safe and well-tolerated for this study.15 We conducted a randomized, placebocontrolled, double-blind, multicenter 52- week phase 2 trial of resveratrol in individuals with mild to moderate AD. The primary objectives were to (1) assess the safety and tolerability of resveratrol; (2) assess effect on plasma and CSF Ab42 and Ab40, CSF tau and phospho-tau 181, and volumetric MRI; and (3) examine pharmacokinetics. The secondary objectives were to (1) explore the effects of resveratrol on cognitive, functional, and behavioral outcomes; (2) examine the influence of APOE genotype; and (3) determine whether resveratrol affects insulin and glucose metabolism. We hypothesized that resveratrol would alter AD biomarker trajectories.

RESULTS A total of 179 participants were screened, of whom 60 were not randomized (50 screen-failed and 10 withdrew consent). Participants (119) were randomized as shown (figure 1). A total of 104 completed the study (12.6% dropout), and 77 completed 2 CSF collections (34% dropout). Eighteen participants discontinued treatment early and 15 discontinued the study. The population was English-speaking, 57% female, and 91% Caucasian.

Safety and tolerability. No differences between the resveratrol and placebo-treated groups were found on vital signs, physical examinations, or neurologic examinations. Routine laboratory tests were normal. A total of 657 AEs (490 mild, 139 moderate, 28 severe) were reported (355 on drug, 302 on placebo) (table 2). A total of 113 out of 119 (95%) participants reported at least 1 AE. The most common AEs were nausea and diarrhea (in 42% of individuals with drug vs 33% with placebo, p 5 0.35). Few participants reported nausea and diarrhea—the most likely drug-related AE—that led to treatment discontinuation, a treatment plateau at a lower dosage, or study discontinuation (figure 1). The placebo group gained 0.54 6 3.2 kg body weight, while the treated group lost 0.92 6 4.9 kg (mean 6 SD, p 5 0.038) resulting in a difference in body mass index (BMI). The treated group’s BMI was 25.4 6 4.0 vs the placebo group’s 26.1 6 4.1 at week 52 (mean 6 SD, p 5 0.047). Thirty-six serious AEs (SAEs) were reported (19 on drug, 17 on placebo) including 27 hospitalizations (14 on drug, 13 on placebo) and 3 deaths (1 on drug, 2 on placebo)—none study drug-related. There were no differences in participants who experienced at least one SAE (20.3% on drug, 18.2% on placebo), at least one hospitalization (18.8% drug, 16.4% placebo), or died (1.6% drug, 3.6% placebo). Seven new neoplasms were reported (1 on drug, 6 on placebo, p , 0.048) (table 2). Retrospective review of the brain MRIs of a placebo-enrolled participant with malignant glioma, which resulted in death, revealed that the tumor was present at screening. Two participant deaths were due to lung melanoma (placebo group) and drowning (drug group).

AD duration (from year of symptom onset), y, mean (SD)      Resv 3.9 (2.3)        Placebo 5.5 (2.6)     <0.001

Outcomes. At week 52, the treated group’s CSF Ab40 declined from 6,574 6 2,346 to 6,513 6 2,279 ng/mL and from 6,560 6 2,190 to 5,622 6 1,736 ng/mL with placebo, resulting in a difference at week 52 (mean 6 SD, p 5 0.002) (figure 2A). This difference was also found in secondary analyses of study completers (p 5 0.002), in the mild dementia subgroup (p 5 0.01), and in APOE4 carriers (p 5 0.05) and noncarriers (p 5 0.01) (table e-2). During the study, the treated group’s plasma Ab40 (figure 2B) declined from 163 6 58 to 153 6 54 ng/mL and from 165 6 55 to 132 6 54 ng/mL with placebo (mean 6 SD, p 5 0.024). Secondary analyses by APOE4 genotype revealed an effect of treatment on plasma Ab40 in APOE4 carriers (p 5 0.04) but not noncarriers (table e-2). There were no effects on CSF Ab42 or plasma Ab42 (figure 2, C and D), although trends were similar to Ab40. There was no difference in CSF tau and a trend toward an increase in CSF phospho-tau 181 with treatment (p 5 0.08), and in a secondary analysis of mild dementia (p 5 0.047) (data not shown). Volumetric MRIs revealed that brain volume (excluding CSF, brainstem, and cerebellum) declined more in the treatment group (p 5 0.025) with an increase in ventricular volume (p 5 0.05) at week 52 (figure 3, A and B). In the treatment group, brain volume decreased from 866 6 84 to 839 6 85 mL and ventricular volume increased from 55 6 24 to 81 6 24 mL (mean 6 SD). With placebo, brain volume decreased from 850 6 99 to 840 6 93 mL and ventricular volume increased from 56 6 19 to 76 6 25 mL (mean 6 SD). Secondary analyses revealed that brain volume declined with treatment in APOE4 carriers (p 5 0.02) but not noncarriers (table e-2). Similar results were found with ventricular volume, which increased with treatment in APOE4 carriers (p 5 0.05) but not noncarriers. This phase 2 trial (underpowered to detect differences in clinical outcomes) found no significant effects on CDR-SOB, ADAS-cog, MMSE, or NPI. The drugtreated group’s ADCS-ADL declined from 63.7 6 10.8 to 57.4 6 12.3 and from 60.5 6 10.7 to 51.3 6 14.5 in the placebo group (mean 6 SD, p 5 0.03), indicating less decline with treatment. No drug effects were found with plasma glucose or insulin metabolism (data not shown). We also analyzed (post hoc) the subset of individuals with CSF Ab42 ,600 ng/mL at baseline as a proxy of AD amyloid pathology. At week 52, differences between treatment groups persisted for CSF Ab40 (p 5 0.001, total n 5 70) and plasma Ab40 (p 5 0.02, n 5 83). In this analysis, we also found a treatment effect on CSF Ab42 (p 5 0.02, n 5 70) but lost significance in brain volume loss (p 5 0.06, n 5 83) and ADCSADL (p 5 0.055, n 5 88).

DISCUSSION High-dose oral resveratrol is safe and well-tolerated. The most common AEs were nausea and diarrhea, but results were similar to placebo. Weight and fat loss with resveratrol are reported in some preclinical studies,4 but human studies are scarce and of shorter duration. A decrease in body fat and a trend toward weight loss were reported in a 26- week trial with 200 mg/day resveratrol in healthy older participants.33 Weight and fat loss may be related to enhanced mitochondrial biogenesis mediated by SIRT1 activation of PCG-1a. 4,10,11 Ab levels declined as dementia advanced. The altered CSF Ab40 trajectory suggests that the drug penetrated the blood–brain barrier to have central effects. At week 52, the mean CSF levels of resveratrol, 3G-RES, 4G-RES, and S-RES were 3.3%, 0.4%, 0.4%, and 0.3%, respectively, of plasma levels at the same study visit. At the highest dosage, low mM levels of resveratrol and its metabolites were measured in plasma, with corresponding low nM levels found in CSF. Resveratrol has many targets, with some engaged at uM concentrations.4 These findings suggest that a central molecular target may be engaged at nM concentrations. In addition to anti-inflammatory, antioxidant, and anti-Ab aggregation, putative targets include sirtuin activation with enhanced a-cleavage of amyloid precursor protein34 and promotion of autophagy.35 Further studies of banked CSF, plasma, pellets, DNA, and blood mononuclear cells from participants will examine mechanisms.

Resveratrol treatment increased brain volume loss. This finding persisted when participants with weight loss (table 2) were excluded (data not shown). The etiology and interpretation of brain volume loss observed here and in other studies are unclear, but they are not associated with cognitive or functional decline. In the first human active Ab immunization trial, antibody responders had greater brain volume loss, and greater volumetric changes were associated with higher antibody titers.36 In the phase 2 bapineuzumab trial, treatment resulted in greater ventricular enlargement, but only in APOE4 carriers.37 In the phase 3 bapineuzumab APOE4 carrier trial and the high-dose noncarrier study, treatment resulted in a trend toward greater brain atrophy.38 Since this phase 2 study lacks consistent changes in clinical outcomes, interpretation of the effects on trajectories for plasma and CSF Ab40, and brain and ventricular volume, remain uncertain.

Resveratrol altered levels of CSF Ab40 (A) and plasma Ab40 (B) (ng/mL, mean 6 SE). Similar but nonsignificant trends were found for CSF Ab42 (C) and plasma Ab42 (D) (ng/mL, mean 6 SE). Note difference in scales. Sample sizes are indicated.

Resveratrol increased brain volume loss (A, C) (mL, mean 6 SE) with a corresponding increase in ventricular volume (B, D) (mL, mean 6 SE). Sample sizes are indicated.

This phase 2 study has limitations. It was designed to determine the safety and tolerability of resveratrol and to examine pharmacokinetics. Although some biomarker trajectories were altered, we found no effects of drug treatment on plasma Ab42, CSF Ab42, CSF tau, CSF phospho-tau 181, hippocampal volume, entorhinal cortex thickness, MMSE, CDR, ADAS-cog, NPI, or glucose or insulin metabolism. The altered biomarker trajectories must be interpreted with caution. Although they suggest CNS effects, they do not indicate benefit.

22.  Miniature VHS Solenoid Valves Play Significant Role in the Viability of 3D Bio-Printing of Human Cells  

The rapid development of viable inkjet technology for highly specialised applications, such as printing human cells, continues to generate significant interest. If successful, the realisation of this technology for specialised biological applications, generally known as ‘biofabrication’, has the potential to replace the long established (and often controversial) process of using animals for testing new drugs. However, there are many challenges to overcome to enable the successful production of a valve-based cell printer for the formation of human embryonic stem cell spheroid aggregates. For example, printing techniques need to be developed which are both controllable and less harmful to the process of preserving human cell tissue viability and functions.

One particular cell printing project at an advanced stage and which has benefitted from the features and benefits of Lee Products miniature VHS solenoid valves and nozzles, is the result of pioneering activities at Edinburgh’s Heriot-Watt University. Dr Will Shu at the University’s Biomedical micro-engineering Group and his colleagues, including Alan Faulkner-Jones a bioengineering PhD student have successfully developed a bio-printer which has been demonstrated at the 3D Print show in London. Also involved in the development of the bio-printer are specialists at Roslin Cellab in Midlothian, a leading stem cell technology company.

The valve based bio-printer has been validated to print highly viable cells in programmable patterns from two different bio-inks with independent control of the volume of each droplet (with a lower limit of 2nL or fewer than five cells per droplet). Human ESC’s (Embryonic Stem Cells) were used to make spheroids by overprinting two opposing gradients of bio-ink; one of hESC’s in medium and the other of medium alone.
The resulting array of uniform sized droplets with a gradient of cell concentrations was inverted to allow cells to aggregate and form spheroids via gravity.
The resulting aggregates have controllable and repeatable sizes and consequently they can be made to order for specific applications. Spheroids with between 5 and 140 dissociated cells resulted in spheroids of 0.25-0.6 mm diameter. The success of the bio-printer demonstrates that a valve based printing process is gentle enough to maintain stem cell viability, accurate enough to produce spheroids of uniform size and that printed cells maintain their pluripotency.
Looking closer at the design of the bio-printer platform reveals two dispensing systems, each comprising a Lee VHS Nanolitre solenoid dispensing valve with a Teflon coated 101.6 µm internal diameter Lee Minstac nozzle controlled by a Arduino microcontroller. Each dispensing system is attached to a static pressure reservoir for the bio-ink solution to be dispensed via flexible tubing. The dispensing system and bio-ink reservoirs are mounted within a custom-built enclosure on the tool head of a micrometer-resolution 3-axis 3d printing platform (High-Z S-400, CNC Step) and controlled by a customized CNC controller (based on G540, Geokodrives).

A relatively larger nozzle diameter (compared to the size of the cells that are printed) was selected to reduce the amount of shear stress that could be experienced by the cells during the dispensing process. The bio-ink reservoirs were kept as close as possible to the valves in order to minimise the amount of time it would take to charge the system with bio-ink and to purge it at the end of the experiment. A USB microscope is also included to enable visual inspection of the target substrate during the printing process. Due to the type of deposition system used, a direct line of sight view through the nozzle is not possible and therefore the USB microscope is mounted at an offset angle from the cell deposition system assemblies.
Commenting on the development of the bio-printer and the vital role played by Lee Product’s VHS solenoid valves, Dr Will Shu at Heriot-Watt University said: “Printing living cells is extremely challenging and to the best of our knowledge, this is the first time that these cells have been 3D printed. The technique will allow us to create more accurate human tissue models which are essential to in-vitro drug development and toxicity testing and since the majority of drug discovery is targeting human disease, it makes sense to use human tissues.
”The development of the bio-printer has taken many years of effort and we are very pleased with the performance of Lee’s VHS solenoid valves, they are a vital component within the bio-printer printhead and we recommend them to our colleagues working on similar projects.”
Dr Shu added, “We also acknowledge the support and interaction from our contacts at Lee Products which has helped us to overcome the challenges of this project.”
This highly specialised application is an excellent example of the performance of Lee’s range of VHS Micro-Dispense Solenoid Valves which provide precise, repeatable, non-contact dispensing of fluids in the nanolitre to microlitre range. The valves feature a number of port configurations to facilitate quick and convenient connections to Lee’s 062 MINSTAC fittings and press-on tubing. The 062 MINSTAC outlet port can be used with Lee 062 MINSTAC tubing or atomising nozzles. Custom configurations and voltages are also available to suit specific applications.

https://www.labmate-online.com/articles/laboratory-products/3/dr_will_shu_and_alan_faulkner-jones/miniature_vhs_solenoid_valves_play_significant_role_in_the_viability_of_3d_bio-printing_of_human_cells_/1833/#sthash.IbWGZ7fU.Maild7vy.dpuf

23. NEW MITOCHONDRIA-BASED INSULIN AMPLIFIER PATHWAY IDENTIFIED IN T2 DIABETES.

http://health-innovations.org/2015/09/23/new-mitochondria-based-insulin-amplifier-pathway-identified-in-t2-diabetes/

Posted on September 23, 2015 by Healthinnovations

Ten million Canadians are living with diabetes or pre-diabetes. The Canadian Diabetes Association reports that more than 20 Canadians are newly diagnosed with the disease every hour of every day. It is also the seventh leading cause of death in Canada, with associated health-care costs estimated at nearly $9 billion a year. Type 2 diabetes accounts for 90 per cent of all cases, increasing the risk of blindness, nerve damage, stroke, heart disease and several other serious health conditions.

Insulin secretion from β cells of the pancreatic islets of Langerhans is impaired in type 2 diabetes (T2D).  Evidence suggests that this metabolic amplification of insulin secretion occurs distally in the secretory pathway, possibly at the calcium dependent exocytotic site.  Therefore the regulation or amplification of insulin is an important target for researchers around the world

Now, researchers from the University of Alberta have identified a new molecular pathway that manages the amount of insulin produced by the pancreatic cells, essentially a ‘dimmer’ switch that adjusts how much or how little insulin is secreted when blood sugar increases.  The team state that the dimmer appears to be lost in Type 2 diabetes, however, it can be restored and ‘turned back on’, reviving proper control of insulin secretion from islet cells of people with Type 2 diabetes.  The opensource study is published in the Journal of Clinical Investigation.

Previous studies show that the canonical mechanism of glucose-stimulated insulin secretion involving increases in metabolism-derived ATP, inhibition of KATP channels, and activation of VDCCs was first introduced more than 30 years ago and remains as a cornerstone mechanism for the triggering of insulin secretion’.  The KATP channel mechanism does not define the entire secretory response with multiple metabolic coupling intermediates proposed as factors that amplify the secretory response to a Ca2+exocytosis-based signal, with the net export of mitochondrial substrates being of great interest.

The current study examined pancreatic islet cells from 99 human organ donors.  Results show that the glucose-dependent amplification of exocytosis in human β cells, which is disrupted in type 2 diabetes, requires isocitrate flux through mitochondrial export which generates cytosolic NADPH and GSH. These then act through SENP1 to amplify the exocytosis of insulin, thereby controlling glucose homeostasis.  The lab then validated these data findings in a transgenic animal model.

The researchers state that the discovery is a potential game-changer in Type 2 diabetes research, leading to a new way of thinking about the disease and its future treatment.  The go on to add that understanding the islet cells in the pancreas that make insulin, how they work, and how they can fail, could lead to new ways to treat the disease, delaying or even preventing diabetes.

The team surmise that although the ability to restore and fix the dimmer switch in islet cells may have been proven on a molecular level, finding a way to translate those findings into clinical use could yet take decades. Despite this the group conclude that the findings show an important new way forward.

Source: University of Alberta

https://michellepetersen76.files.wordpress.com/2015/09/identifying-the-dimmer-switch-of-diabetes-healthinnovations.jpg?w=860

Pancreatic islet–specific knockout of Senp1 blunts insulin secretion due to an impaired amplification of exocytosis. Proposed pathway linking mitochondrial export of (iso)citrate, glutathione biosynthesis (blue), and glutathione reduction (orange) pathways to the amplification of insulin exocytosis (yellow). Isocitrate-to-SENP1 signaling amplifies insulin secretion and rescues dysfunctional β cells. MacDonald et al 2015.

24.  Nanotechnology
http://www.nano.gov/nanotech-101/what/definition

Nanotechnology is science, engineering, and technology conducted at the nanoscale, which is about 1 to 100 nanometers.

Physicist Richard Feynman, the father of nanotechnology.

Nanoscience and nanotechnology are the study and application of extremely small things and can be used across all the other science fields, such as chemistry, biology, physics, materials science, and engineering.

The ideas and concepts behind nanoscience and nanotechnology started with a talk entitled “There’s Plenty of Room at the Bottom” by physicist Richard Feynman at an American Physical Society meeting at the California Institute of Technology (CalTech) on December 29, 1959, long before the term nanotechnology was used. In his talk, Feynman described a process in which scientists would be able to manipulate and control individual atoms and molecules. Over a decade later, in his explorations of ultraprecision machining, Professor Norio Taniguchi coined the term nanotechnology. It wasn’t until 1981, with the development of the scanning tunneling microscope that could “see” individual atoms, that modern nanotechnology began.

Medieval stained glass windows are an example of  how nanotechnology was used in the pre-modern era. (Courtesy: NanoBioNet)

It’s hard to imagine just how small nanotechnology is. One nanometer is a billionth of a meter, or 10-9 of a meter. Here are a few illustrative examples:

  • There are 25,400,000 nanometers in an inch
  • A sheet of newspaper is about 100,000 nanometers thick
  • On a comparative scale, if a marble were a nanometer, then one meter would be the size of the Earth

Nanoscience and nanotechnology involve the ability to see and to control individual atoms and molecules. Everything on Earth is made up of atoms—the food we eat, the clothes we wear, the buildings and houses we live in, and our own bodies.

But something as small as an atom is impossible to see with the naked eye. In fact, it’s impossible to see with the microscopes typically used in a high school science classes. The microscopes needed to see things at the nanoscale were invented relatively recently—about 30 years ago.

Once scientists had the right tools, such as the scanning tunneling microscope (STM) and the atomic force microscope (AFM), the age of nanotechnology was born.

Although modern nanoscience and nanotechnology are quite new, nanoscale materials were used for centuries. Alternate-sized gold and silver particles created colors in the stained glass windows of medieval churches hundreds of years ago. The artists back then just didn’t know that the process they used to create these beautiful works of art actually led to changes in the composition of the materials they were working with.

Today’s scientists and engineers are finding a wide variety of ways to deliberately make materials at the nanoscale to take advantage of their enhanced properties such as higher strength, lighter weight, increased control of light spectrum, and greater chemical reactivity than their larger-scale counterparts.

http://www.nano.gov/node/1415

Education and workforce development are critical to the advancement of nanotechnology and are encompassed within one of the four goals of the National Nanotechnology Initiative (NNI): “Develop and sustain educational resources, a skilled workforce, and a dynamic infrastructure and toolset to advance nanotechnology.” As new knowledge is created through exploratory research and development, it is a challenge to translate this understanding into the educational system and to the broader public. Over the past fifteen years of the NNI, there have been several activities that have made significant contributions in this area: public outreach and informal education by the NSF Nanoscale Informal Science Education  Network (NISE Net) through programs such as NanoDays; technician and workforce training through programs such as the NSF Advanced Technological Education Centers including the Nanotechnology Applications and Career Knowledge (NACK) Network; countless university courses and degree programs; and the emerging incorporation of nanoscience into the K-12 science education standards in states such as Virginia. To build upon this strong foundation, several announcements were made last week at the White House Forum on Small Business Challenges to Commercializing Nanotechnology including the establishment of a Nano and Emerging Technologies Student Leaders conference, a webinar series focused on providing information for teachers, and a web portal of nanoscale science and engineering educational resources.  – See more at: http://www.nano.gov/node/1415#sthash.fw1tMPiU.dpuf

25.  Antimicrobial film for future implants

http://www.nanowerk.com/news2/biotech/newsid=41408.php

(Nanowerk News) The implantation of medical devices is not without risks. Bacterial or fungal infections can occur and the body’s strong immune response may lead to the rejection of the implant. Researchers at Unit 1121 “Biomaterials and Bio-engineering” (Inserm/Strasbourg university) have succeeded in creating a biofilm with antimicrobial, antifungal and anti-inflammatory properties. It may be used to cover titanium implants (orthopaedic prostheses, pacemakers…) prevent or control post-operative infections. Other frequently used medical devices that cause numerous infectious problems, such as catheters, may also benefit.
These results are published in the journal Advanced Healthcare Materials (“Harnessing the Multifunctionality in Nature: A Bioactive Agent Release System with Self-Antimicrobial and Immunomodulatory Properties”).

26.  Characterizing the forces that hold everything together: UMass Amherst physicists offer new open source calculations for molecular interactions

http://www.nanotech-now.com/news.cgi?story_id=52274

UMass Amherst physicists, with others, provide a new software tool and database to help materials designers with the difficult calculations needed to predict the magnitude of van der Waals interactions between anisotropic or directionally dependent bodies such as those illustrated, with long-range torques. Though small, these forces are dominant on the nanoscale.

CREDIT: UMass Amherst

Abstract:
As electronic, medical and molecular-level biological devices grow smaller and smaller, approaching the nanometer scale, the chemical engineers and materials scientists devising them often struggle to predict the magnitude of molecular interactions on that scale and whether new combinations of materials will assemble and function as designed.

Characterizing the forces that hold everything together: UMass Amherst physicists offer new open source calculations for molecular interactions

Amherst. MA | Posted on September 23rd, 2015

This is because the physics of interactions at these scales is difficult, say physicists at the University of Massachusetts Amherst, who with colleagues elsewhere this week unveil a project known as Gecko Hamaker, a new computational and modeling software tool plus an open science database to aid those who design nano-scale materials.

In the cover story in today’s issue of Langmuir, Adrian Parsegian, Gluckstern Chair in physics, physics doctoral student Jaime Hopkins and adjunct professor Rudolf Podgornik on the UMass Amherst team report calculations of van der Waals interactions between DNA, carbon nanotubes, proteins and various inorganic materials, with colleagues at Case Western Reserve University and the University of Missouri who make up the Gecko-Hamaker project team.

To oversimplify, van der Waals forces are the intermolecular attractions between atoms, molecules, surfaces, that control interactions at the molecular level. The Gecko Hamaker project makes available to its online users a large variety of calculations for nanometer-level interactions that help to predict molecular organization and evaluate whether new combinations of materials will actually stick together and work.

In this work supported by the U.S. Department of Energy, Parsegian and colleagues say their open-science software opens a whole range of insights into nano-scale interactions that materials scientists haven’t been able to access before.

Parsegian explains, “Van der Waals forces are small, but dominant on the nanoscale. We have created a bridge between deep physics and the world of new materials. All miniaturization, all micro- and nano-designs are governed by these forces and interactions, as is behavior of biological macromolecules such as proteins and lipid membranes. These relationships define the stability of materials.”

He adds, “People can try putting all kinds of new materials together. This new database and our calculations are going to be important to many different kinds of scientists interested in colloids, biomolecular engineering, those assembling molecular aggregates and working with virus-like nanoparticles, and to people working with membrane stability and stacking. It will be helpful in a broad range of other applications.”

Podgornik adds, “They need to know whether different molecules will stick together or not. It’s a complicated problem, so they try various tricks and different approaches.” One important contribution of Gecko Hamaker is that it includes experimental observations seemingly unrelated to the problem of interactions that help to evaluate the magnitude of van der Waals forces.

Podgornik explains, “Our work is fundamentally different from other approaches, as we don’t talk only about forces but also about torques. Our methodology allows us to address orientation, which is more difficult than simply describing van der Waals forces, because you have to add a lot more details to the calculations. It takes much more effort on the fundamental level to add in the orientational degrees of freedom.”

He points out that their methods also allow Gecko Hamaker to address non-isotropic, or non-spherical and other complex molecular shapes. “Many molecules don’t look like spheres, they look like rods. Certainly in that case, knowing only the forces isn’t enough. You must calculate how torque works on orientation. We bring the deeper theory and microscopic understanding to the problem. Van der Waals interactions are known in simple cases, but we’ve taken on the most difficult ones.”

Hopkins, the doctoral student, notes that as an open-science product, Gecko Hamaker’s calculations and data are transparent to users, and user feedback improves its quality and ease of use, while also verifying the reproducibility of the science.

####

For more information, please click here

Contacts:
Janet Lathrop
jlathrop@admin.umass.edu
413-545-0444

27.  Researchers have succeeded in creating a biofilm with antimicrobial, antifungal and anti-inflammatory properties. (Image: Inserm / E.Falett)
Implantable medical devices (prosthesis/pacemakers) are an ideal interface for micro-organisms, which can easily colonize their surface. As such, bacterial infection may occur and lead to an inflammatory reaction. This may cause the implant to be rejected. These infections are mainly caused by bacteria such as Staphylococcus aureus, originating in the body, and Pseudomonas aeruginosa. These infections may also be fungal or caused by yeasts. The challenge presented by implanting medical devices in the body is preventing the occurrence of these infections, which lead to an immune response that compromises the success of the implant. Antibiotics are currently used during surgery or to coat certain implants. However, the emergence of multi-resistant bacteria now restricts their effectiveness.
A biofilm invisible to the naked eye…
It is within this context that researchers at the “Bioengineering and Biomaterials” Unit 1121 (Inserm/Strasbourg University) with four laboratories1 have developed a biofilm with antimicrobial and anti-inflammatory properties. Researchers have used a combination of two substances: polyarginine (PAR) and hyaluronic acid (HA), to develop and create a film invisible to the naked eye (between 400 and 600 nm thick) that is made of several layers. As arginine is metabolised by immune cells to fight pathogens, it has been used to communicate with the immune system to obtain the desired anti-inflammatory effect. Hyaluronic acid, a natural component of the body, was also chosen for its biocompatibility and inhibiting effect on bacterial growth.
…with embedded antimicrobial peptides,
The film is also unique due to the fact that it embeds natural antimicrobial peptides, in particular catestatin, to prevent possible infection around the implant. This is an alternative to the antibiotics that are currently used. As well as having a significant antimicrobial role, these peptides are not toxic to the body that they are secreted into. They are capable of killing bacteria by creating holes in their cellular wall and preventing any counter-attack on their side.
…on a thin silver coating,
In this study researchers show that poly(arginine), associated with hyaluronic acid, possesses microbial activity against Staphylococcus aureus (S. aureus) for over 24 hours. “In order to prolong this activity, we have placed a silver-coated precursor before applying the film. Silver is an anti-infectious material currently used on catheters and dressings. This strategy allows us to extend antimicrobial activity in the long term” explains Philippe Lavalle, Research Director at Inserm.
…effectively reducing inflammation, preventing and controlling infection
The results from numerous tests performed on this new film shows that it reduces inflammation and prevents the most common bacterial and fungal infections.
On the one hand, researchers demonstrate, through contact with human blood, that the presence of the film on the implant suppresses the activation of inflammatory markers normally produced by immune cells in response to the implant. Moreover, “the film inhibits the growth and long-term proliferation of staphylococcal bacteria (Staphylococcus aureus), yeast strains (Candida albicans) or fungi (Aspegillus fumigatus) that frequently cause implant-related infection” emphasises Philippe Lavalle.
Researchers conclude that this film may be used in vivo on implants or medical devices within a few years to control the complex microenvironment surrounding implants and to protect the body from infection.
Source: INSERM (Institut national de la santé et de la recherche médicale)

28.  Quantum dots light up under strain

http://www.nanotech-now.com/news.cgi?story_id=52274

Semiconductor nanocrystals, or quantum dots, are tiny, nanometer-sized particles with the ability to absorb light and re-emit it with well-defined colors. With low-cost fabrication, long-term stability and a wide palette of colors, they have become a building blocks of the display technology, improving the image quality of TV-sets, tablets, and mobile phones. Exciting quantum dot applications are also emerging in the fields of green energy, optical sensing, and bio-imaging.

Prospects have become even more appealing after a publication, entitled “Band structure engineering via piezoelectric fields in strained anisotropic CdSe/CdS nanocrystals,” was published in the journal Nature Communications last July. An international team, formed by scientists at the Italian Institute of Technology (Italy), the University Jaume I (Spain), the IBM research lab Zurich (Switzerland) and the University of Milano-Bicocca (Italy) demonstrated a radically new approach to manipulate the light emission of quantum dots.

The traditional operating principle of quantum dots is based on the so-called quantum confinement effect, where the particle size determines the color of the emitted light. The new strategy relies on a completely different physical mechanism; a strain induced electrical field inside the quantum dots. It is created by growing a thick shell around the dots. This way, researchers were able to compress the inner core, creating the intense internal electric field. This field now becomes the dominating factor in determining the emission properties.

The result is a new generation of quantum dots whose properties are beyond those enabled by quantum confinement alone. This not only broadens the application scope of the well-known CdSe/CdS material set but also of other materials. “Our findings add an important new degree of freedom to the development of quantum dot-based technological devices,” the researchers say. “For example, the elapsed time between light absorption and emission can be extended to be more than 100 times longer compared to conventional quantum dots, which opens the way towards optical memories and smart pixel new devices. The new material could also lead to optical sensors that are highly sensitive to the electrical field in the environment on the nanometer scale.”

Explore further: Resonant energy transfer from quantum dots to graphene

More information: “Band structure engineering via piezoelectric fields in strained anisotropic CdSe/CdS nanocrystals” Nat Commun. 2015 Jul 29; 6:7905. DOI: 10.1038/ncomms8905

Journal reference: Nature Communications

Read more at: http://phys.org/news/2015-09-quantum-dots-strain.html#jCp

29. Turing Reaction-diffusion Model Confirmed

http://www.scientificcomputing.com/news/2015/09/turing-reaction-diffusion-model-confirmed?

http://www.scientificcomputing.com/sites/scientificcomputing.com/files/Turing_Reaction-diffusion_Model_Confirmed_ml.jpg

In 1952, the legendary British mathematician and cryptographer Alan Turing proposed a model, which assumes formation of complex patterns through chemical interaction of two diffusing reagents. Russian scientists managed to prove that the corneal surface nanopatterns in 23 insect orders completely fit into this model.

Their work is published in the Proceedings of the National Academy of Sciences.

The work was done by a team working in the Institute of Protein Research of the Russian Academy of Sciences, (Pushchino, Russia) and the Department of Entomology at the Faculty of Biology of the Lomonosov Moscow State University. It was supervised by Professor Vladimir Katanaev, who also leads a lab in the University of Lausanne, Switzerland. Artem Blagodatskiy and Mikhail Kryuchkov performed the choice and preparation of insect corneal samples and analyzed the data. Yulia Lopatina from the Lomonosov Moscow State University played the role of expert entomologist, while Anton Sergeev performed the atomic force microscopy.

The initial goal of the study was to characterize the antireflective three-dimensional nanopatterns covering insect eye cornea, with respect to the taxonomy of studied insects and to get insight into their possible evolution path.

The result was surprising as the pattern morphology did not correlate with insect position on the evolutionary tree. Instead, Russian scientists have characterized four main morphological corneal nanopatterns as well as transition forms between them, omnipresent among the insect class. Another finding was that all the possible forms of the patterns directly matched to the array of patterns predicted by the famous Turing reaction-diffusion model published in 1952, what Russian scientists confirmed not by mere observation, but by mathematical modeling as well. The model assumes formation of complex patterns through chemical interaction of two diffusing reagents.

The analysis of corneal surface nanopatterns in 23 insect orders has been performed by means of atomic force microscopy with resolution up to single nanometers.

“This method allowed us to drastically expand the previously available data, acquired through scanning electron microscopy; it also made possible to characterize surface patterns directly, not based upon analysis of metal replicas. When possible, we always examined corneae belonging to distinct families of one order to get insight into intra-order pattern diversity,” Blagodatskiy said.

The main implication of the work is the understanding of the mechanisms underlying the formation of biological three-dimensional nano-patterns, demonstrating the first example of Turing reaction-diffusion model acting in the bio-nanoworld.

Interestingly, the Turing nanopatterning mechanism is common not only for the insect class, but also for spiders, scorpions and centipedes in other words — universal for arthropods. Due to the antireflective properties of insect corneal nanocoatings, the revealed mechanisms are paving the way for design of artificial antireflective nanosurfaces.

“A promising future development of the project is planned to be a genetic analysis of corneal nanopattern formation on platform of a well-studied Drosophila melanogaster (fruitfly) model. The wild-type fruitflies possess a nipple array type nanocoating on their eyes,” Blagodatskiy summarized.

Different combinations of overexpressed and underexpressed proteins known to be responsible for corneal development in Drosophila may alter the nipple pattern to another pattern type and thus shed the light on chemical nature of compounds, forming the Turing-type structures upon insect eyes. Revealing of proteins and\or other agents responsible for nanopattern formation will be a direct clue to artificial design of nanocoatings with desired properties. Another direction of project development will be the comparison

Citation: Artem Blagodatski, Anton Sergeev, Mikhail Kryuchkov, Yuliya Lopatina, Vladimir L. Katanaev. Diverse set of Turing nanopatterns coat corneae across insect lineages.Proceedings of the National Academy of Sciences, 2015; 112 (34): 10750 DOI:10.1073/pnas.1505748112

30.  Germ-free mice gain weight when transplanted with gut microbes from obese humans, in a diet-dependent manner.

By Ed Yong | September 5, 2013

Escherichia coliWIKIPEDIAPhysical traits like obesity and leanness can be “transmitted” to mice, by inoculating the rodents with human gut microbes. A team of scientists led byJeffrey Gordon from the Washington University School of Medicine in St. Louis found that germ-free mice put on weight when they were transplanted with gut microbes from an obese person, but not those from a lean person.

The team also showed that a “lean” microbial community could infiltrate and displace an “obese” one, preventing mice from gaining weight so long as they were on a healthy diet. The results were published today (September 5) in Science.

Gordon emphasized that there are many causes of obesity beyond microbes. Still, he said that studies like these “provide a proof-of-principle for ameliorating diseases.” By understanding how microbes and food interact to influence human health, researchers may be able to design effective probiotics that can prevent obesity by manipulating the microbiome.

The human gut is home to tens of trillions of microbes, which play crucial roles in breaking down food and influencing health. Gordon’s group and others have now shown that obese and lean people differ in their microbial communities. Just last week, the MetaHIT consortium showed that a quarter of Danish people studied had a very low number of bacterial genes in their gut—an impoverished state that correlated with higher risks of both obesity and metabolic diseases.

However, descriptive studies like these cannot tell scientists whether such microbial differences are the cause of obesity or a consequence of it. “A lot of correlations are being made between microbe community configurations and disease states, but we don’t know if these are casual or causal,” said Gordon. By using germ-free mice as living laboratories, Gordon and his colleagues aim to start moving “beyond careful description to direct tests of function,” he added.

“It’s extremely exciting and powerful to go from descriptive studies in humans to mechanistic studies in mice,” said Oluf Pedersen, an endocrinologist who was involved in the MetaHIT studies. “That’s beautifully illustrated in this paper.”

Gordon lab graduate student Vanessa Ridaura inoculated the germ-free mice with gut microbes from four pairs of female twins, each in which one person was obese and the other had a healthy weight. Mice that received the obese humans’ microbes gained more body fat, put on more weight, and showed stronger molecular signs of metabolic problems.

Once the transplanted microbes had taken hold in their guts, but before their bodies had started to change, Ridaura housed the two groups of mice together. Mice regularly eat one another’s feces, so these cage-mates inadvertently introduced their neighbors’ microbes to their own gut communities. Gordon called this the “Battle of the Microbiota.”

These co-housing experiments prevented the mice with “obese” microbes from putting on weight or developing metabolic problems, while those with the “lean” microbes remained at a healthy weight.

Gordon explains that the obese microbe communities, being less diverse than the lean ones, leave many “job openings” within the gut—niches that can be filled by the diverse lean microbes when they invade. “And obviously, those job openings aren’t there in the richer, lean gut community,” he said. “That’s why the invasion is one-directional.”

“But if invasion is so robust, why then isn’t there an epidemic of leanness?” asked Gordon. “The answer appears to be, in part, diet.”

In her initial experiments, Ridaura fed the mice standard chow, which is high in fiber and plant matter. She also blended up two new recipes, designed to reflect extremes of saturated fat versus fruit and vegetable consumption associated with Western diets.

If the mice were fed food low in fat and high in fruit and vegetables, Ridaura found the same results as before—the lean microbes could cancel out the effect of the obese ones. But when the mice were fed food low in fruit and vegetables and high in saturated fat, those with obese gut microbes still gained weight, no matter who their neighbors were.

This may be because the best colonizers among the lean communities were the Bacteroidetes—a group of bacteria that are excellent at breaking down the complex carbohydrates found in plant foods. When the mice ate plant-rich diets, the Bacteroidetes could fulfill a metabolic role that was vacant in the obese gut communities. When the mice ate unhealthy, plant-poor diets, “these vacancies weren’t there and the organisms couldn’t establish themselves,” said Gordon.

“We’re now trying to identify particular sets of organisms that can do what the complete community does,” Gordon added. The ultimate goal is to create a set of specific bacteria that could be safely administered as a probiotic that, along with a defined diet, could help these beneficial microbes to establish themselves and might effectively prevent weight gain.

“This study is an inspiration for us at MetaHIT,” said Pedersen. “It would be very interesting to take stools or cultures from extreme cases within our samples—people who have very rich or very poor gut microbiomes—and inoculate them into germ-free mice. . . . Now that we have a proof-of-concept, it’s obvious for us to follow up our findings through these studies.”

V.K. Ridaura et al., “Gut microbiota from twins discordant for obesity modulate metabolism in mice,” Science, doi: 10.1126/science.1241214, 2013.

31. Gut Microbes Treat Illness

Oral administration of a cocktail of bacteria derived from the human gut reduces colitis and allergy-invoked diarrhea in mice.

By Chris Palmer | July 10, 2013

Micrograph of germ-free mice colon colonized with 17 strains of human-derived Clostridia. Kenya Honda

An astounding array of microorganisms colonizes the human gut; our large intestines alone are home to 1014 bacteria from more than 1,000 species. Though scientists have long attempted to manipulate these microbial populations to affect health, probiotics have failed to reliably treat disease. However, a new study published today in Nature reports that a blend of specially selected strains of Clostridium bacteria derived from humans can significantly reduce symptoms of certain immune disorders in mice.

“[This work] shows that microbes can influence the balance and architecture of the immune system of their host,” said Sarkis Mazmanian, an immunologist at the California Institute of Technology who did not participate in the research. “I think it has tremendous potential for ameliorating human disease.”

Mammalian gut microbiota—the community of microorganisms that inhabit the gastrointestinal tract—have a long, intimate, and mostly symbiotic history with their hosts. The ubiquitous bugs are integral to some of the most basic of physiological functions, including metabolism and immune system development and function. However, specific gut microbes have also been linked to autoimmune disorders, obesity, inflammatory bowel disease, and possibly even neurological disorders. “It’s clear that gut microbes can affect many, many aspects of our physiology,” said Mazmanian.

Senior author Kenya Honda and his team previously reported that colonization of germ-free mice—mice that lack a microbiota—with a cocktail of a few dozen strains of Clostridium bacteria derived from wild-type mice promoted the activity of regulatory T cells (Treg) in the colon. Treg cells produce important anti-inflammatory immune molecules, including interleukin-10 and inducible T-cell co-stimulator, to prevent an overreaction of the immune system, and disruption of Treg cells is known to play a role in autoimmune disorders such as colitis, Crohn’s disease, food allergies, and type II diabetes. Indeed, mice treated with theClostridium cocktail appeared more resistant to allergies and intestinal inflammation.

Clostridia bacteria include the well-known tetanus and botulism toxins. “Clostridia are very diverse bacteria, and include some pathogens,” said Alexander Rudensky, an immunologist at the Memorial Sloan-Kettering Cancer Center in New York and a cofounder,  of Vedanta Biosciences, which he launched with the paper authors in 2010. “So, their role [in disease] may be surprising to immunologists and public, but not to microbiologists.”

To extend the clinical relevance of the previous results, Honda’s group repeated their experiment usingClostridium derived from a sample of human feces. As in the previous study, germ-free mice treated with specially selected strains of human-derived Clostridia displayed a significant increase in Treg cells. The treated mice also displayed reduced symptoms of colitis and allergy-induced diarrhea.

“This is a terrific advance to their previous studies where they showed that mouse microbiota can induce regulatory T cells,” said Mazmanian. “In this paper they’ve extended that to bacteria that come from humans, which they have tested in mice.”

The researchers used RNA sequencing of gut tissue samples of mice treated with human microbes to identify 17 specific non-virulent strains of Clostridium responsible for the increased production of Treg cells. They then sequenced the metagenomes of human ulcerative colitis patient guts, and found that they tended to carry lower levels of the 17 strains, with 5 out of the 17 showing a statistically significant reduction. “This work lays out the first instance of a rationally designed drug candidate isolated from human microbiota, which can be given to animals to treat autoimmune disease,” said study coauthor Bernat Olle, the chief operating officer of Vedanta Biosciences, which is developing therapies based on the new research.

Investigations into the mechanisms underlying Treg-cell induction pointed to small chain fatty acids and bacterial antigens that are cooperatively produced by the 17 strains of Clostridium. The small chain fatty acids and antigens in turn activate a transforming growth factor (TGF-beta) response that drives Treg cell differentiation and expansion.

“It’s very valuable to see studies like this one, where detailed analysis of microbial compositions is linked to biology,” said Rudensky.

Atarashi et al., “Treg induction by a rationally selected mixture of Clostridia strains from the human microbiota,” Nature, doi:10.1038/nature12331, 2013.

 

32.  Foxp3 targets revealed

The first comprehensive — but preliminary — list of Foxp3 targets in mice could provide clues to how the protein helps regulate the immune system

By Chandra Shekhar | January 22, 2007

The first comprehensive catalogue of mouse genes targeted by the transcriptional factor Foxp3 appears intwo papers published in this week’s Nature. The lists from both studies don’t always match, but the combined findings represent a key step in understanding how the protein helps regulatory T-cells maintain immune system tolerance and prevent autoimmune diseases. “The papers provide the first look at relating the transcriptional DNA-binding activity of Foxp3 with specific target genes,” said Fred Ramsdell of ZymoGenetics in Seattle, who was not involved in either study. “This is something the field has beenlooking to do for the past five years.” Expressed primarily in regulatory T-cells, Foxp3 is essential to both their development and normal function. Loss-of-function Foxp3 mutations in mice and humans result in fatal autoimmune diseases. A research team led by Alexander Rudensky of the University of Washington in Seattle, with Ye Zheng as first author, used ex vivo T-cells from mice with Foxp3 knocked out or tagged with GFP. Using a chromatin immunoprecipitation (ChIP) protocol, the team located nearly 1,300 Foxp3 binding sites on the mouse genome, from which it identified 702 Foxp3-bound genes. “Unlike other transcription factors, Foxp3 binds to only a few sites in the genome,” observed Rudensky. “But its binding results in very efficient changes in gene expression.” Another study, led by Richard Young of the Whitehead Institute in Cambridge, Mass. and Harald von Boehmer of the Dana-Farber Cancer Institute in Boston, also used ChIP to identify Foxp3 binding sites. Out of more than 1,500 binding sites, they identified 1,119 genes bound by Foxp3. Instead of ex vivo T-cells, however, the researchers used T-cell hybridomas transfected with Foxp3. This made it easier to observe the effects of T-cell receptor stimulation, explained study’s first author, Alexander Marson. “Foxp3 exerts a much stronger influence on its target genes in stimulated cells than in unstimulated cells,” he noted. Ethan Shevach of the National Institutes of Health in Bethesda, Md., who was not involved in either study, said he preferred the use of normal T-cells — as in the Zheng et al. study — to hybridomas. “There is no evidence that the cell [Marson et al] transfect with Foxp3 is a regulatory T-cell,” Shevach said. Some of the direct targets of Foxp3 identified in the two studies — such as members of the irf family — are transcription factors in their own right, indicating a second layer of regulation mediated by Foxp3. The target lists also include a number of genes for cell surface molecules, such as CD28, and signal transduction, such as Cdc42. “Some of these targets are red herrings,” cautioned Shevach. “Foxp3 may bind to them, but they may have nothing to do with regulatory cell function.” The results from the two studies differ significantly. For instance, Zheng et al. noted that ctla4 — an important T-cell inhibitor — was bound and strongly upregulated by Foxp3, but Marson et al. did not observe this. Conversely, while both studies found that Foxp3 bound to the receptor for IL2, a key player in immune response, only Marson et al. found IL2 itself to be a target. Further, while Zheng et al. determined that Foxp3 activated more genes than it suppressed, Marson et al. came to the opposite conclusion. “What I found most striking was the amount of non-overlap between the two datasets,” said Steve Ziegler of the Benaroya Research Institute in Seattle. “This may reflect the fact that they used two different systems for their chip-on-chip analysis.” Despite the discrepancies, experts said the studies would be a major help in research into immune tolerance. “Foxp3 is located in the nucleus and is hard to get at,” said Ziegler. “Downstream targets of it may be more accessible and give us more tractable surrogate markers of regulatory T-cells.” Chandra Shekhar cshekhar@the-scientist.com Links within this article Two papers: Y. Zheng, et al., “Genome-wide analysis of Foxp3 target genes in developing and mature regulatory T cells,” Nature, Jan 2007. A. Marson, et al., “Foxp3 occupancy and regulation of key target genes during T-cell stimulation,” Nature, Jan 2007. http://www.nature.com T.P. Toma, “Self-tolerance gene?” The Scientist, January 9, 2003 http://www.the-scientist.com/article/display/20994 M. Greener, “Hot on tolerance’s trail: The hunt for human Foxp3,” The Scientist, May 23, 2005http://www.the-scientist.com/article/display/15478 F. Ramsdell, “Foxp3 and natural regulatory T cells: Key to a cell lineage?” Immunity, August 2003. ‘http://www.immunity.com/content/article/abstract?uid=PIIS1074761303002073 Alexander Rudenskyhttp://depts.washington.edu/immunweb/faculty/profiles/rudensky.html Richard Younghttp://jura.wi.mit.edu/young_public/index.html Harald von Boehmer http://www.dana-farber.org/res/physician/detail.asp?personID=232&RD=True&group=%28Researcher%29 Ethan Shevachhttp://www3.niaid.nih.gov/labs/aboutlabs/li/cellularImmunologySection Steve Zieglerhttp://www.benaroyaresearch.org/investigators/ziegler_steven

32.  Lasker Winners Announced

This year’s prizes honor pioneering work on the unfolded protein response, deep-brain stimulation, and the discovery of cancer-related genes.

By Tracy Vence | September 8, 2014

Kazutoshi Mori (left), Peter Walter (right) ALBERT AND MARY LASKER FOUNDATION Kazutoshi Mori of Kyoto University in Japan and Peter Walter of the University of California, San Francisco, have won the 2014 Lasker Award for basic medical research. Mori and Walter are being honored by the Albert and Mary Lasker Foundation for their work related to the unfolded protein response—a cellular stress response that has been implicated in several protein-folding diseases.

In its announcement, the foundation said that “Mori and Walter’s work has led to a better understanding of inherited diseases such as cystic fibrosis, retinitis pigmentosa, and certain elevated cholesterol conditions in which unfolded proteins overwhelm the unfolded protein response.”

Three years ago, the Lasker Foundation honored Franz-Ulrich Hartl and Arthur Horwich for their protein-folding work with its 2011 basic research award.

Meanwhile, Alim Louis Benabid of Joseph Fourier University in Grenoble, France, and Mahlon DeLong of the Emory University School of Medicine in Atlanta, Georgia, have won the this year’s Lasker-DeBakey Clinical Medical Research Award for their deep-brain stimulation work that has been used to help restore and motor function in patients with advanced Parkinson’s disease.

And the University of Washington’s Mary-Claire King has won the 2014 Lasker-Koshland Special Achievement Award in Medical Science for “bold, imaginative, and diverse contributions to medical science and human rights” related to her work to reunite missing persons or their remains with their families, as well as her discovery of the cancer-related BRCA1 gene locus. In a commentary published in JAMA today (September 8), King and her colleagues advocated for population-based screening for cancer-related genetic variants. “Population-wide screening will require significant efforts to educate the public and to develop new counseling strategies, but this investment will both save women’s lives and provide a model for other public health programs in genomic medicine,” they wrote.

This year’s recipients will receive a $250,000 honorarium per category. The awards will be presented on Friday, September 19, in New York City.

33.  Protein Binding

Edited by: Thomas W. Durso S.D. Rosen, C.R. Bertozzi, “The selectins and their ligands,” Current Opinion in Cell Biology, 6:663-73, 1994. (Cited in more than 60 publications through April 1996) Comments by Steven D. Rosen, University of California, San Francisco The selectins are a trio of related proteins involved in leukocyte-endothelium interactions, affecting the ability of leukocytes-that is, white blood cells-to interact with blood vessel walls. THREEPEAT: The selectins are a threesome

By Carolyn Bertozzi | October 28, 1996

Edited by: Thomas W. Durso
S.D. Rosen, C.R. Bertozzi, “The selectins and their ligands,” Current Opinion in Cell Biology6:663-73, 1994. (Cited in more than 60 publications through April 1996) Comments by Steven D. Rosen, University of California, San Francisco

The selectins are a trio of related proteins involved in leukocyte-endothelium interactions, affecting the ability of leukocytes-that is, white blood cells-to interact with blood vessel walls.

THREEPEAT: The selectins are a threesome of related proteins, says UC-San Francisco’s Steven Rosen.

“One of the novel aspects of the selectins is that they function as carbohydrate-binding receptor molecules-that is, they recognize specific carbohydrate structures as their ligands, or counter-receptors,” Rosen says. “This means that in principle, it’s possible to interrupt the function of selectins by determining what carbohydrates they bind to and providing mimics for those carbohydrates in the form of soluble small molecules, thereby arriving at a new class or classes of anti-inflammatory substances.”The paper summarizes the three selectins and their physiological functions in leukocyte-endothelium interactions, and describes how they function.First identified at the molecular level in 1989 (L.M. Stoolman, Cell,56:907-10, 1989), selectins are the topic of this review paper by Steven D. Rosen, a professor in the department of anatomy and program in immunology at the University of California, San Francisco, and Carolyn R. Bertozzi, a former postdoc in Rosen’s lab and now an assistant professor of chemistry at the University of California, Berkeley.

Rosen explains that with leukocytes moving from the blood into tissues, the leukocyte-endothelium interaction is critical to inflammatory reactions.

ONE PLACE: UC-Berkeley’s Carolyn Bertozzi, Rosen’s former postdoc, was coauthor of the review paper.

“Leukocytes in tissue sites are protecting the individual from bacterial invasions and foreign substances that the individual wants to eliminate, but leukocytes can have an arsenal of destructive capabilities which can be turned on the individual’s own tissues. So inflammatory reactions have a down side. There are a lot of inflammatory diseases, such as rheumatoid arthritis, multiple sclerosis, lupus, and other autoimmune diseases.””In many cases, inflammatory reactions lead to pathological problems,” he points out. “It’s a defense mechanism the body has, but leukocytes being in tissue sites can cause problems as well as be of value to the individual.

He concludes: “The interest in the selectins was: Here’s a family of proteins that has involvement in leukocyte-endothelium interactions, therefore here’s a potential set of targets to prevent leukocyte entry into tissues and prevent inflammatory problems.”

Asked for his opinion on why this paper has been cited so much, Rosen replies: “There’s a huge amount of interest in the selectins, because there’s basic cell biology and biochemistry that everybody’s interested in here. . . . There’s a real convergence of the basic science with direct clinical applications. What you do in the lab can have immediate ramifications on the design of anti-inflammatory compounds. There’s tremendous biotech and pharmaceutical company interest in the selectins and their ligands.

“This has been a tremendously hot topic since 1989, and it will be for years to come. Our article put everything down in one place, from the basic cell biology to the clinical connections, and updated the carbohydrate information and ligand identification information in a very accessible way.”

In addition to reviewing the selectins, Rosen states, “the paper deals with what is known about the carbohydrates that the selectins recognize, and what is known about the macromolecules-the ligands-that carry these carbohydrates. What might make the carbohydrates that one selectin recognizes different from the carbohydrates that another selectin molecule might recognize-that is, what is the selectivity of carbohydrate binding among the three selectins?”

The paper also lists the animal models of inflammatory diseases in which selectins have been shown to play an important role, “where antagonism of the selectin leads to beneficial effects, in terms of decreasing damage,” Rosen notes.

Since the publication of this paper, he and Bertozzi have written a second review, updating ligand characterizations (S.D. Rosen, C.R. Bertozzi, Current Biology6:261-4, 1996).

“It has a lot more on carbohydrate specificity, and it’s got some new information on how one of the selectins recognizes its ligands,” Rosen notes. “Sulfation is important. At the time of the first review, sulfation was known to be important for the binding of one selectin to its ligands. . . . This review points to the importance of sulfation for the ligand of another selectin. The nature of the sulfation modifications of the ligands are very different for the two selectins.”

Additional LPBI articles:

MIT’s Promise for the MI Patient: A new cardiac patch uses Gold Nanowires to enhance Electrical Signaling between heart cells

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Nanotechnology and Heart Disease

Author and Curator:  Tilda Barliya PhD

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Robert S. Langer, Massachusetts Institute of Technology

Challenges and Opportunities at the Confluence of Biotechnology and Nanomaterials

Introduction to Tissue Engineering; Nanotechnology applications

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Read Full Post »

Demet Sag, PhD, CRA, GCP

 

Gene engineering and editing specifically are becoming more attractive. There are many applications derived from microbial origins to correct genomes in many organisms including human to find solutions in health.

There are four customizable DNA specific binding protein applications to edit the gene expression in translational genomics. The targeted DNA double-strand breaks (DSBs) could greatly stimulate genome editing through HR-mediated recombination events.  We can mainly name these site-specific DNA DSBs:

 

  1. meganucleases derived from microbial mobile genetic elements (Smith et al., 2006),
  2. zinc finger (ZF) nucleases based on eukaryotic transcription factors (Urnov et al., 2005;Miller et al., 2007),
  3. transcription activator-like effectors (TALEs) from Xanthomonasbacteria (Christian et al., 2010Miller et al., 2011Boch et al., 2009; Moscou and Bogdanove, 2009), and
  4. most recently the RNA-guided DNA endonuclease Cas9 from the type II bacterial adaptive immune system CRISPR (Cong et al., 2013;Mali et al., 2013a).

There is a new ground breaking study published in Science by Valentino Gantz and Ethan Bier of the University of California, San Diego, described an approach called mutagenic chain reaction (MCR).

This group developed a new technology for editing genes that can be transferable change to the next generation by combining microbial immune defense mechanism, CRISPR/Cas9 that is the latest ground breaking technology for translational genomics with gene therapy-like approach.

  • In short, this so-called “mutagenic chain reaction” (MCR) introduces a recessive mutation defined by CRISPR/Cas9 that lead into a high rate of transferable information to the next generation. They reported that when they crossed the female MCR offspring to wild type flies, the yellow phenotype observed more than 95 percent efficiency.

 

Development and Applications of CRISPR-Cas9 for Genome Engineeri

Structural and Metagenomic Diversity of Cas9 Orthologs

(A) Crystal structure of Streptococcus pyogenes Cas9 in complex with guide RNA and target DNA.

(B) Canonical CRISPR locus organization from type II CRISPR systems, which can be classified into IIA-IIC based on their cas gene clusters. Whereas type IIC CRISPR loci contain the minimal set of cas9, cas1, andcas2, IIA and IIB retain their signature csn2 and cas4 genes, respectively.

(C) Histogram displaying length distribution of known Cas9 orthologs as described in UniProt, HAMAP protein family profile MF_01480.

(D) Phylogenetic tree displaying the microbial origin of Cas9 nucleases from the type II CRISPR immune system. Taxonomic information was derived from greengenes 16S rRNA gene sequence alignment, and the tree was visualized using the Interactive Tree of Life tool (iTol).

(E) Four Cas9 orthologs from families IIA, IIB, and IIC were aligned by ClustalW (BLOSUM). Domain alignment is based on the Streptococcus pyogenes Cas9, whereas residues highlighted in red indicate highly conserved catalytic residues within the RuvC I and HNH nuclease domains.

(Cell. Author manuscript; available in PMC 2015 Feb 27.Published in final edited form as:

Cell. 2014 Jun 5; 157(6): 1262–1278.doi:  10.1016/j.cell.2014.05.010)

 

The uniqueness of this study comes from:

 

  • There is a big difference between the new type of mutation and traditional mutation is expressivity of the character since previously mutations were passive and non-transferable at 100% rate. However,  in classical Mendelian Genetics, only one fourth f the recessive traits can be presented in new generation. Yet, in this case this can be achieve about 97% plus transferred to new generation.

 

  • MCR alterations is active that is they convert matching sequences at the same target site so mutated sites took over the wild type character without degenerating by wild type alleles segregating independently during the breeding process

 

  • Therefore, the altered sequences routinely replace the wild type (original) sequences at that site. The data demonstrated that among 92 flies, only one female became wild type but remaining 41 females had yellow eyes yet all 50 males showed wild type eye coloring at the second generation.

 

  • The genetic engineering of the genome occurred in a single generation with high efficiency.

 

Their technique developed by Gantz and Bier had three basic parts:

 

  1. Both somatic and germline cells expressed a Cas9 gene,

 

  1. A guide RNA (gRNA) targeted to a genomic sequence of interest,

 

  1. The Cas9/gRNA cassettes have the flanking homolog arms that matches the two genomic sequences immediately adjacent to either side of the target cut site

 

There are many applications in translational genomics that requires multiple steps to make it perfect for complicated organisms, such as plants, mosquitoes and human diseases.

Short Walk from Past to the Future of CRISPR/Cas9

Development and Applications of CRISPR-Cas9 for Genome Engineeri

The RNA-guided Cas9 nuclease from the microbial clustered regularly interspaced short palindromic repeats (CRISPR) adaptive immune system can be used to facilitate efficient genome engineering in eukaryotic cells by simply specifying a 20-nt targeting sequence within its guide RNA.

CRISPR/Cas systems are part of the adaptive immune system of bacteria and archaea, protecting them against invading nucleic acids such as viruses by cleaving the foreign DNA in a sequence-dependent manner.

The latest ground-breaking technology for genome editing is based on RNA-guided engineered nucleases, which already hold great promise due to their:

  • simplicity,
  • efficiency and
  • versality

Although CRISPR arrays were first identified in the Escherichia coli genome in 1987 (Ishino et al., 1987),

their biological function was not understood until 2005, when it was shown that the spacers were homologous to viral and plasmid sequences suggesting a role in adaptive immunity (Bolotin et al., 2005; Mojica et al., 2005; Pourcel et al., 2005).

Two years later, CRISPR arrays were confirmed to provide protection against invading viruses when combined with Cas genes (Barrangou et al., 2007).

The mechanism of this immune system based on RNA-mediated DNA targeting was demonstrated shortly thereafter (Brouns et al., 2008; Deltcheva et al., 2011; Garneau et al., 2010; Marraffini and Sontheimer, 2008).

 

The most widely used system is the type II clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 (CRISPR-associated) system from Streptococcus pyogenes (Jinek et al., 2012).

Then, five independent groups demonstrated that the two-component system was functional in eukaryotes (human, mouse and zebrafish), indicating that the other functions of the CRISPR locus genes were supported by endogenous eukaryotic enzymes (Cho et al., 2013Cong et al., 2013Hwang et al., 2013Jinek et al., 2013 and Mali et al., 2013).

Beginning with target design, gene modifications can be achieved within as little as 1-2 weeks, and modified colonial cell lines can be derived within 2-3 weeks

 

Development and Applications of CRISPR-Cas9 for Genome Engineeri

Genome editing with site-specific nucleases.

Double-strand breaks induced by a nuclease at a specific site can be repaired either by non-homologous end joining (NHEJ) or homologous recombination (HR).  In most cases, NHEJ causes random insertions or deletions (indels), which can result in frameshift mutations if they occur in the coding region of a gene, effectively creating a gene knockout.

Alternatively, when the DSB generates overhangs, NHEJ can mediate the targeted introduction of a double-stranded DNA template with compatible overhangs

Even though the generation of breaks in both DNA strands induces recombination at specific genomic loci, NHEJ is by far the most common DSB repair mechanism in most organisms, including higher plants, and the frequency of targeted integration by HR remains much lower than random integration.

  • Unlike its predecessors, the CRISPR/Cas9 system does not require any protein engineering steps, making it much more straightforward to test multiple gRNAs for each target gene

 

  • Unlike ZFNs and TALENs, the CRISPR/Cas9 system can cleave methylated DNA in human cells (Hsu et al., 2013), allowing genomic modifications that are beyond the reach of the other nucleases (Ding et al., 2013).

 

  • The main practical advantage of CRISPR/Cas9 compared to ZFNs and TALENs is the ease of multiplexing. The simultaneous introduction of DSBs at multiple sites can be used to edit several genes at the same time (Li et al., 2013; Mao et al., 2013) and can be particularly useful to knock out redundant genes or parallel pathways.

 

  • Finally, the open access policy of the CRISPR research community has promoted the widespread uptake and use of this technology in contrast, for example, to the proprietary nature of the ZFN platform.

The community provides access to plasmids (e.g., via the non-profit repository Addgene), web tools for selecting gRNA sequences and predicting specificity:

Downside:

One area that will likely need to be addressed when moving to more complex genomes, for instance, is off-target CRISPR/Cas9 activity since fruit fly has only four chromosomes and less likely to have off-target effects. However, this study provided proof of principle.

  • Yet, this critics is not new since one of the few criticisms of the CRISPR/Cas9 technology is the relatively high frequency of off-target mutations reported in some of the earlier studies (Cong et al., 2013; Fu et al., 2013; Hsu et al., 2013; Jiang et al., 2013a; Mali et al., 2013; Pattanayak et al., 2013).

 

Several strategies have been developed to reduce off-target genome editing, the most important of which is the considered design of the gRNA.

 

  • fusions of catalytically inactive Cas9 and FokI nuclease have been generated, and these show comparable efficiency to the nickases but substantially higher (N140-fold) specificity than the wild-type enzyme (Guilinger et al., 2014; Tsai et al., 2014)

 

  • Altering the length of the gRNA can also minimize non-target modifications. Guide RNAs with two additional guanidine residues at the 5′ end were able to avoid off-target sites more efficiently than normal gRNAs but were also slightly less active at on-target sites (Cho et al., 2014)

Development and Applications of CRISPR-Cas9 for Genome Engineeri

What more:

The CRISPR/Cas9 system can be used for several purposes in addition to genome editing:

  • The ectopic regulation of gene expression, which can provide useful information about gene functions and can also be used to engineer novel genetic regulatory circuits for synthetic biology applications.

 

  • The external control of gene expression typically relies on the use of inducible or repressible promoters, requiring the introduction of a new promoter and a particular treatment (physical or chemical) for promoter activation or repression.

 

  • Disabled nucleases can be used to regulate gene expression because they can still bind to their target DNA sequence. This is the case with the catalytically inactive version of Cas9 which is known as dead Cas9 (dCas9).

 

  • Preparing the host for an immunotherapy is possible if it is combined with TLR mechanism:

On the other hand, the host mechanism needs to be review carefully for the design of an effective outcome.

The mechanism of microbial response and infectious tolerance are complex.

 

During microbial responses, Toll-like receptors (TLRs) play a role to differentiate and determine the microbial structures as a ligand to initiate production of cytokines and pro-inflammatory agents to activate specific T helper cells.

 

Uniqueness of TLR comes from four major characteristics of each individual TLR :

 

  1. ligand specificity,
  2. signal transduction pathways,
  3. expression profiles and
  4. cellular localization.

 

Thus, TLRs are important part of the immune response signaling mechanism to initiate and design adoptive responses from innate (naïve) immune system to defend the host.

 

TLRs are expressed cell type specific patterns and present themselves on APCs (DCs, MQs, monocytes) with a rich expression  levels Specific TLR stimulat ion links innate and acquired responses through simple recognition of pathogen-associated molecular patterns (PAMPs) or co-stimulation of PAMPs with other TLR or non-TLR receptors, or even better with proinflammatory cytokines.

 

Some examples of ligand – TLR specificity shown in Table1, which are bacterial lipopeptides, Pam3Cys through TLR2, double stranded (ds) RNAs through TLR3, lipopolysaccharide (LPS) through TLR4, bacterial flagellin through TLR5, single stranded RNAs through TLR7/8, synthetic anti-viral compounds imiquinod through TLR 7 and resiquimod through TLR8, unmethylated CpG DNA motifs through TLR9.

 

The specificity is established by correct pairing of a TLR with its proinflammatory cytokine(s), so that these permutations influence creation and maintenance of cell differentiat ion.

Development and Applications of CRISPR-Cas9 for Genome Engineeri

 

  • Immunotherapy: The immune cells can be used as a sensor to scavenger the circulating malformed cells in vivo diagnostics or attack and remember them, for instance, relapse of cancer, re-infection with a same or similar agent (bacteria or virus) etc.

Not only using unique microbial and other model organism properties but also using the human host defense mechanism during innate immune responses may bring a new combat to create a new method of precision medicine. This can be a new type of immunotherapy, immune cell mediated gene therapy or vaccine even a step for an in vivo diagnostics.

 

Molecular Genetics took a long road from discovery of restriction enzymes, developing PCR assays, cloning were the beginning. Now, having technology to sequence and compare the sequences between organisms also help to design more sophisticated methods.

Generating mutant lines in Drosophila with the classical genetics methods relies on P elements, a type of transposon and balancers after crossing selected flies with specific markers. This fly pushing is a very tedious work but powerful to identify primary pathways, mechanisms and gene interactions in system and translational  genomics.

 Thus, Microbial Immunomodulation is an important factor not only using the microorganisms or their mechanisms but also modulating the immune cells based on the host interaction may generate new types of diagnostics and targeted therapy tools.

 

Microbial immunomodulation. Microbes from the environment, and from the various microbiota, modulate the immune system. Some of this is due to direct effects of defined microbial products on elements of the immune system. But modulation of the immune system also secondarily alters the host–microbiota relationship and leads to changes in the composition of the microbiota, and so to further changes in immunoregulation (shown as indirect pathways). At the end of the day balance is the key for survival.

microbial immunomodulationGrahamnihms199923f2 A. W. Rook,*,1 Christopher A. Lowry,2 and Charles L. Raison3  Microbial ‘Old Friends’, immunoregulation and stress resilience  Evol Med Public Health. 2013; 2013(1): 46–64. Published online 2013 Apr 9. doi:  10.1093/emph/eot004 PMCID: PMC3868387

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881665/bin/nihms199923f2.jpg

 

CRISPR-Cas9 mediated NHEJ in transient transfection experiments.

Table 1.
Species Transformation method Cas9 codon optimization Promoters (Cas9,  gRNA) Target Mutation frequency Detection method Off-target (no. of sites analyzed) Detection method Multiplex (deletion) Reference
Arabidopsis thaliana PEG-protoplast transfection Arabidopsis (with intron) CaMV35SPDK, AtU6 PDS3<comma> FLS2 1.1–5.6% PCR + sequencing Li et al. (2013)
A. thaliana Leaf agroinfiltration Arabidopsis (with intron) CaMV35SPDK, AtU6 PDS3 2.70% PCR + sequencing Yes (48 bp) Li et al. (2013)
A. thaliana PEG-protoplast transfection Arabidopsis (with intron) CaMV35SPDK,  AtU6 RACK1b<comma> RACK1c 2.5–2.7% PCR + sequencing No (1 site) PCR + sequencing Li et al. (2013)
A. thaliana Leaf agroinfiltration C. reinhardtii CaMV35S, AtU6 Co-transfected GFP n.a. Pre-digested PCR + RE Jiang et al. 2013a and Jiang et al. 2013b
Nicotiana benthamiana PEG-protoplast transfection Arabidopsis (with intron) CaMV35SPDK, AtU6 PDS3 37.7–38.5% PCR + sequencing Li et al. (2013)
N. benthamiana Leaf agroinfiltration Arabidopsis (with intron) CaMV35SPDK,  AtU6 PDS3 4.80% PCR + sequencing Li et al. (2013)
N. benthamiana Leaf agroinfiltration Human CaMV35S,  AtU6 PDS 1.8–2.4% PCR + RE No (18 sites) PCR + RE Nekrasov et al. (2013)
N. benthamiana Leaf agroinfiltration C. reinhardtii CaMV35S, AtU6 Co-transfected GFP n.a. pre-digested PCR + RE Jiang et al. 2013a and Jiang et al. 2013b
N. benthamiana Leaf agroinfiltration Human CaMV35S, CaMV35S PDS 12.7–13.8% Upadhyay et al. (2013)
Nicotiana tabacum PEG-protoplast transfection Tobacco 2xCaMV35S, AtU6 PDS<comma> PDR6 16.27–20.3% PCR + RE Yes (1.8 kb) Gao et al. (2014)
Oryza sativa PEG-protoplast transfection Rice 2xCaMV35S, OsU3 PDS<comma> BADH2<comma> MPK2<comma> Os02g23823 14.5–38.0% PCR + RE Noa (3 sites) PCR + RE Shan et al. (2013)
O. sativa PEG-protoplast transfection Human CaMV35S,  OsU3 or OsU6 MPK5 3–8% RE + qPCR and T7E1 assay No (2 sites) Yes (1 site with a mismatch at position 12) RE + PCR Xie and Yang (2013)
O. sativa PEG-protoplast transfection Rice CaMV35S,  OsU6 SWEET14 n.a. pre-digested PCR + RE Jiang et al. 2013a and Jiang et al. 2013b
O. sativa PEG-protoplast transfection Rice ZmUbi,  OsU6 KO1 KOL5; CPS4 CYP99A2; CYP76M5 CYP76M6 n.a. PCR + sequencing Yes (115<comma> 170<comma> 245 kb) Zhou et al. (2014)
Triticum aestivum PEG-protoplast transfection Rice 2xCaMV35S, TaU6 MLO 28.50% PCR + RE Shan et al. (2013)
T. aestivum PEG-protoplast transfection Plant ZmUbi, TaU6 MLO-A1 36% T7E1 Wang et al. 2014a and Wang et al. 2014b
T. aestivum Agrotransfection of cells from immature embryos Human CaMV35S,  CaMV35S PDS<comma> INOX 18–22% PCR + sequencing Upadhyay et al. (2013)
T. aestivum Agrotransfection of cells from immature embryos Human CaMV35S,  CaMV35S INOX PCR + sequencing No* PCR + RE Yes (53 bp) Upadhyay et al. (2013)
Zea mays PEG-protoplast transfection Rice 2xCaMV35S,  ZmU3 IPK 16.4–19.1% PCR + RE Liang et al. (2014)
Citrus sinensis Leaf agroinfiltration Human CaMv35S,  CaMV35S PDS 3.2–3.9% PCR + RE No (8 sites) PCR + RE Jia et al. (2014)

 

 

 

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A brief overview of CRISPR-mediated immunity and explain how the emerging new properties of this defense system are being repurposed for genome engineering in bacteria, yeast, human cells, insects, fish, worms, plants, frogs, pigs, and rodents.

Also look at F1000Prime Rep. 2014; 6: 3. For the list of microorganisms use in CRISPR applications.

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About the author:

Dr Sag has a Bachelor’s degree in Basic and Industrial Microbiology as a Sum cum Laude among 450 graduating class of Science faculty,  an MSc in Microbial Engineering and Biotechnology (Bioprocessing improvement) and PhD in Molecular and Developmental Genetics (Functional Genome and Stem Cell Biology).

She is an translational functional genomic scientist to develop diagnostics and targeted therapies by non-invasive methods for personalized medicine from bench to bedside and engineering tools through clinical trials and regulatory affairs.

You may contact with her at 858-729-4942 or by demet.sag@gmail.com if you have questions.

 

 

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Diarrheas – Bacterial and Nonbacterial

Writer and Curator: Larry H. Bernstein, MD, FCAP 

 

Introduction

Diarrheas are one of the common problems of societies worldwide. However, the prevalence of cause of the diarrhea may be different depending on location, water quality, food source, age, and psychological stress factors.

Microbial and Parasitic Diseases

A Systematic Review on Neglected Important Protozoan Zoonoses

Yibeltal Muhie Mekonen and Simenew Keskes Melaku
Int. J. Adv. Res. Biol.Sci. 2(1): (2015): 53–65

Infectious protozoan parasites are transmitted to humans through several routes, including contaminated food and water, inadequately treated sewage/sewage products, and livestock and domestic pet handling. Several enteric protozoa cause severe morbidity and mortality in both humans and animals worldwide. In developed settings, enteric protozoa are often ignored as a cause of diarrheal illness due to better hygiene conditions, and as such, very little effort is used toward laboratory diagnosis. Although these protozoa contribute to the high burden of infectious diseases, estimates of their true prevalence are sometimes affected by the lack of sensitive diagnostic techniques to detect them in clinical and environmental specimens. Despite recent advances in the epidemiology, molecular biology, and treatment of protozoan illnesses, gaps in knowledge still exist, requiring further research. There is evidence that climate-related changes will contribute to their burden due to displacement of ecosystems and human and animal populations, increases in atmospheric temperature, flooding and other environmental conditions suitable for transmission, and the need for the reuse of alternative water sources to meet growing population needs. This review discusses the common enteric protozoa from a public health perspective, highlighting their epidemiology, modes of transmission, prevention and control and epidemiological pictures in Ethiopia. It also discusses the potential impact of climate changes on their epidemiology and the issues surrounding waterborne transmission and suggests a multidisciplinary approach to their prevention and control.

Approximately 60 percent of all human pathogens are zoonoses of microbes that are naturally transmitted between animals and humans. Neglect of their control persists because of a lack of information and awareness about their distribution, a lack of suitable tools and managerial capacity for their diagnosis, and a lack of appropriate and sustainable strategies for their prevention and control. Furthermore, many of the most affected countries have poor or non-existent veterinary public health infrastructures. This situation has marginalized control of zoonoses to the gap between veterinary responsibilities and medical needs, generating a false perception that their burden and impact on society are low. As a result, neither the human and animal health resources nor the research needed for their control are available spawning a category of non zoonotic diseases (Choffnes and Relman, 2011).

The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 500 million people living in sub-Saharan Africa (SSA), and together produce a burden of disease that may be equivalent to up to one-half of SSA’s malaria disease burden and more than double that caused by tuberculosis (Hotez and Kamath, 2009).Starting with an initial set of 13-15 diseases, there are now over 40 helminth, protozoal, bacterial, viral, fungal and ectoparasitic infections covered under the brand-name of the neglected tropical diseases. Gaps in our understanding of the epidemiology and control of many of the neglected tropical diseases remain, which calls for additional funding for innovative research (Jürg et al, 2012).

The health and socioeconomic impacts of zoonotic parasitic and related food-borne diseases are growing continuously and increasingly being felt most particularly by developing countries. Apart from causing human morbidity and mortality, they hamper agricultural production, decrease availability of food, and create barriers to international trade (Solaymani-Mohammadi and Petri, 2006). The problem of zoonoses has spread from predominantly restricted rural areas into regional and, in some cases, worldwide epidemics. This is due to the great changes of the previous decades, especially the increasing urbanization, most of which is inadequate planned. In addition, large movements of populations, opening up of badly needed new areas for food production, the increasing trade in meat, milk and other products of animal origin, the increasing number and speed of vehicles, and even tourism have contributed to expanding the impact of zoonotic diseases. The challenges of food-borne, waterborne, and zoonotic protozoan diseases associated with climate change are expected to increase, with a need for active surveillance systems, some of which have already been initiated by several developed countries. However, very little effects are attempting in the developing world which actually are the main victims.

The prevalence rates are generally higher in immunodeficient compared to immune-competent patients. However, most studies on prevalence have been carried out in developed countries where the laboratory and clinical infrastructure are more easily available. Protozoan pathogens and HIV interact in their host, modifying the immunopathology of disease and complicating therapeutic intervention. Disease prevalence and distribution and population movements impact greatly on HIV/protozoan parasite co-infections (Andeani et al, 2012).

In Ethiopia there are little reports regarding protozoan zoonoses. However, there are still reports from clinics and hospitals where these diseases are becoming major issues of concern. This review will examine published data on the neglected protozoan pathogens in Ethiopia and analyses their current importance to public health.

Important but Neglected Protozoan Zoonoses Dealt in this Critical Review

  • Amebiasis

This disease is caused by a single cell protozoan parasite called Entamoeba  spp. (E. histolytica, E. polecki). Invasive amebiasis is one of the world most prevalent and fatal infectious diseases. Around 500 million people are infected worldwide while 75,000 die of the disease annually. Behind malaria and schistosomiasis, amebiasis ranks third on the list of parasitic causes of death worldwide. The infection is common in developing countries and predominantly affects individuals with poor socioeconomic conditions, non hygienic practices, and malnutrition (Stanley, 2003).

A number of survey and routine diagnosis in Ethiopia indicate that amebiasis is one of the most widely distributed diseases. In a countrywide survey of amebiasis in 97 communities, the overall prevalence of Entamoeba histolytica infections, as measured by rate of cyst-passers, in schoolchildren and non-school communities were 15.0% and 3.5%, respectively (Erko et al, 1995). A study conducted on the prevalence of Entamoeba histolytica/dispar among children in Legedini, Adada and Legebira, Dire-Dawa administrative region was 33.7% (Dawit, 2006 Unpublished MSc Thesis).

  • Giardiasis

Giardiasis is caused by Giardia lamblia (also known as Giardia duodenalis or G. intestinalis) is a unicellular, flagellated intestinal protozoan parasite of humans isolated worldwide and is ranked among the top 10 parasites of man (Farthing and Kelly, 2005). Its occurrence is worldwide (Figure 1) and prevalence very high in areas with poor sanitation and in institutions. Human infections usually originate from other humans but may result from contact with dogs, cats, rodents, beavers, or nonhuman primates. The prevalence of the disease varies from 2% to 5% in developed to 20% to 30% in developing countries. The variation in prevalence might be attributed to factors such as the geographical area, the urban or rural setting of the society, the age group composition and the socio-economical conditions of the study subject.

Risk of disease caused by Giarda species

Risk of disease caused by Giarda species

Risk of disease caused by Giarda species with different degrees Source: Esch and Petersen (2013)

According to Birrie and Erko (1995) based on a countrywide survey of giardiasis, the overall prevalence among school children and residents were 8.9% and 3.1%, respectively and that of the non-school children were 4.4%. Recent report indicates that the prevalence of Giardia lamblia among diarrhea patients referred to EHNRI (Ethiopian Health and Nutrition Research Institute) was 8.6%. In a study conducted in South Western Ethiopia, the prevalence of Giardiasis was 13.7%. A study conducted for the determination of Prevalence of Giardiasis and Cryptosporidiosis among children in relation to water sources in selected Village of Pawi Special District in Benishangul-Gumuz Region, Northwestern Ethiopia showed that out of the 384 children examined, 102 for giardiasis.

  • Leishmaniasis

Leishmaniasis is an ancient disease caused by protozoans from the Leishmania genus and transmitted by the bite of a sand fly. It has four subtypes of varying severity, which include cutaneous and visceral infections. Cutaneous infection results in the formation of disfiguring lesions which frequently occur on the face, arms and legs. Lesions may last anywhere from a few weeks to over a year; secondary lesions may also occur years after the initial lesion has healed. Visceral cases can result in anemia, fever, debility and death if left untreated.

About 20 species of Leishmania infect mammals and many of them can cause human leishmaniasis. Motile infective forms of the parasite (metacyclic promastigotes with a long free flagellum) develop in the guts of competent sand fly vectors, which inoculate them into mammalian skin. Infections can spread, often via the lymphatic system, to cause secondary dermal lesions with forms and tissue tropisms in humans that show some parasite species specificity. Leishmaniasis can visceralize (for example Leishmania (Leishmania) tropica, which normally causes Oriental sore), but only two species of the subgenus Leishmania routinely do so, and these are the causative agents of most human visceral leishmaniasis (VL) worldwide.

Global burden of Leishmania

Global burden of Leishmania

Global burden of Leishmania as adapted from the “Leshimaniases and Leishmania HIV co-infection” WHO fact sheet No. 116, May 2000

The New World visceral leishmaniasis is in Latin America and southern United States. Of course the visceral form also is common in Asia, Africa, Europe and Latin America. Both VL and CL are important endemic vector‐borne diseases in Ethiopia. The Federal Ministry of Health (FMoH) estimates the annual burden of VL to be between 4,500 and 5,000 cases (FMoH Ethiopia, 2006 unpublished). Known VL endemic foci are in the arid southwest, and the Humera and Metema lowlands in the north‐west. About 2-12% of all visceral leishmaniasis cases involve HIV coinfections underlines the synergic aspect of both diseases; such proportions may reach 40%, as in Humera, northwest Ethiopia (WHO, 2007), where coinfections have increased two-fold in the last decade (Andreani et al, 2012).

  • Cryptosporidiosis

The causes of this disease are Cryptosporidium spp. (C. parvum, possibly others). In humans, abdominal pain, nausea, watery diarrhea lasting 3-4 days. In immune-deficient or immune-suppressed people, the disease is severe, with persistent diarrhea (6-25 evacuations per day) and malabsorption of nutrients. In normal persons the disease is self-limiting. In immune-compromised individuals, disease is severe and case fatality rate may be high. In animals normally a clinical disease can be seen only among young neonates. In ruminants, gastroenteritis and diarrhea are common.

  • Toxoplasmosis

Toxoplasmosis is among the global major zoonotic diseases and the third leading cause of food-related deaths in the USA. It is caused by Toxoplasma gondii, an Apicomplexa protozoan parasite, with cats as the definitive host. Cats are considered the key in the transmission of Toxoplasma gondii to humans because they are the only hosts that can excrete the environmentally resistant oocysts in their feces.

Human seroprevalece of Toxoplasma gondii

Human seroprevalece of Toxoplasma gondii

Human seroprevalece of Toxoplasma gondii.  Esch and Petersen (2013)

The clinical impact of zoonotic enteric protozoan infections is greatest in the developing world where inadequate sanitation, poor hygiene and proximity to zoonotic reservoirs, particularly companion animals and livestock are greatest. In such circumstances, it is not surprising that infections with more than one species of enteric protozoan are common, and in fact single infections are rare.

Impact of animal disease on human health

Impact of animal disease on human health

Impact of animal disease on human health

The protozoan zoonoses circulating in Ethiopia are major burden on public health and wellbeing. The magnitude and scope of this burden varies for each of the protozoan parasites discussed in this manuscript. Apart from causing human morbidity and mortality, they hamper agricultural production, decrease availability of food, and create barriers to international trade. It is generally believed that although these parasitic infections are distributed worldwide, their prevalence is higher in developing compared to developed countries. However, the relative importance of zoonotic infections especially in developing countries has not been studied in detail including. These protozoan zoonoses are the most neglected but very important in terms of human health and veterinary concerns. The main share belongs to cryptosporidiosis; giardiasis, toxoplasmosis, leishmaniasis and amebiasis are some of the major protozoan zoonoses.

Clinical Microbiology: Past, Present, and Future

Henry D. Isenberg
J Clin Microbiol, Mar. 2003; 41(3):917–918
http://dx.doi.org:/10.1128/JCM.41.3.917–918.2003

During the last two decades of the 19th century, a plethora of bacteria were isolated and designated etiological agents of human infectious diseases. As with many instances at the interface between cause and effective therapy, the further characterization of these alleged pathogens remained in the hands of a few devoted investigators until drugs with therapeutic potential became available. This vague period before the advent of proper cures for infections explains the shadowy origin of clinical or diagnostic microbiology. But, as R. Porter has stated, “history should be rooted in detail and as messy as life itself”; this is an undeniable description of the history of clinical microbiology, long the stepchild, frequently denied legitimacy, among the many siblings that constitute the science of microbiology. Yet the practice of clinical microbiology is the application of knowledge gained to the betterment of the human condition, the goal of clinical microbiologists.

The advances in the grouping and typing of streptococci, salmonellae, and shigellae, the separation of Staphylococcus aureus on the basis of the coagulase reaction, and the growing awareness of the need for safe water and uncontaminated food items established the need for laboratories to assume these responsibilities. It was only logical that microbiology should join endeavors such as chemistry, hematology, and serology under the rubric of clinical pathology. Differential media especially designed to sequester species increased dramatically during Word War II; military hospitals developed clinical microbiology sections devoted not only to recognizing agents endangering the health of troops in camps, in battle, and in foreign environments but also to assessing the responses of certain of the microorganisms isolated to several sulfonamides and that hitherto unknown agent, penicillin. The subsequent explosion of antimicrobial agents—streptomycin, chloramphenicol, tetracyclines, and erythromycin—suggested to the reigning powers of medical facilities that clinical microbiologists could be phased out, since infectious disease would disappear before the onslaught of agents discovered through human ingenuity.

In the interim, cotton plugs gave way to Bakelite, polypropylene, glass, metal, and plastic closures; in-house medium preparation was relieved in part by the beginnings of commercially manufactured ready-to-use media especially for mycobacteria and antimicrobial susceptibility testing. Alcohol, Bunsen, and Tyril burners were replaced by microincinerators, eventually followed by disposable loops and transfer needles. The prescient wisdom of hospital boards soon was shattered by the genetic versatility of the microbial world, dramatically demonstrated by the pandemic of S. aureus 80/81 in the late 1950s and early 1960s and the emergence of gram-negative rods that demonstrated the superiority of the bacterial physiology over the commercially prepared secondary microbial metabolites that initially appeared so promising. To be sure, the tug of war between antimicrobial agents—natural and synthetic—and the microorganisms continues unabated, with signs that the evolutionary potential of the microbial world will succeed in the long run.

Since the 1960s, numerous ingenious innovations have been introduced. Molecular biology techniques promise to revolutionize the diagnosis of infectious disease—to date a promise still in its infancy.  Systems approaches began to replace the single test tube with but one substrate. Perhaps the first was double sugar iron agar for the recognition of so-called enteric pathogens, followed by triple sugar iron agar and the next tentative shortcut, the r/b tube. Rollender and Beckford, the inventors of the r/b tube, must be credited with initiating manufacturers’ efforts to teach laboratory staffs the vagaries and problems of new system approaches. Shortly thereafter, the API system was introduced in the United States, bringing a novel numerical approach first to the identification of Enterobacteriaceae (enteric – gut bacteria) and then to that of several other categories of microorganisms. Similarly, the Roche Enterotube used fewer reaction substrates to decrease the time needed to identify isolates to the species level; initially it was used for members of the Enterobacteriaceae and eventually for other microbial representatives. All systems eventually addressed yeasts and nutritionally demanding bacteria, obviating the multiple-tube approaches in use.

Clinical microbiologists are acutely aware of the constantly emerging intruders into the intimate human biosphere. These agents appear as the traditional scourges of humanity are brought under control. But the application of antimicrobial agents to the food chain, cosmetics, and over-the-counter medications, and the advances in medical science, sparing individuals afflicted with a variety of diseases but accompanied by impaired immunity—all these factors have combined to increase nosocomial infections, placing the medical facility at the very apex of the selective-pressure pyramid. The selection results in colonization by microbiota with a minority of antimicrobial-tolerant or -resistant constituents; administration of antimicrobial therapy converts these organisms to a majority. These selected prokaryotes and eukaryotes,
along with the emerging viruses, coccidia, yeasts, and molds, pose a dynamic challenge to the clinical microbiologist and promise a continued need for her or his services. But these challenges must be met by the expansion of technical skills brought to bear on the changing nature of the challenging microbiota and the willingness of clinical microbiologists
to adopt and practice evolving technologies, to gain knowledge in addition to information, and to remain in the forefront of innovation and invention.

Gut microbiota: next frontier in understanding human health and development of biotherapeutics

Satya Prakash, L Rodes, M Coussa-Charley, C Tomaro-Duchesneau
Biologics: Targets and Therapy 2011:5 71–86
http://dx.doi.org/10.2147/BTT.S19099

The human gastrointestinal tract houses a huge microbial ecosystem, the gut microbiota. This intestinal ecosystem is partially responsible for maintaining human health. However, particular changes in the ecosystem might contribute to the development of certain diseases. With this in mind, there is a need for an exhaustive review on the functions of the gut microbiota, occurrence of gut dysbiosis (alteration of the microbiota), mechanisms by which intestinal bacteria can trigger development of disease, how this ecosystem can be exploited for understanding human health, development of biotherapeutics, expert opinion on current biotherapeutics, and future perspectives. This review presents a descriptive and comprehensive analysis on “the good, the bad, and the ugly” of the gut microbiota, and methods to study these and their modulation of human health.

The gut microbiota is a remarkable asset for human health. As a key element in the development and prevention of specific diseases, its study has yielded a new field of promising biotherapeutics. This review provides comprehensive and updated knowledge of the human gut microbiota, its implications in health and disease, and the potentials and limitations of its modification by currently available biotherapeutics to treat, prevent and/ or restore human health, and future directions. Homeostasis of the gut microbiota maintains various functions which are vital to the maintenance of human health. Disruption of the intestinal ecosystem equilibrium (gut dysbiosis) is associated with a plethora of human diseases, including autoimmune and allergic diseases, colorectal cancer, metabolic diseases,

and bacterial infections. Relevant underlying mechanisms by which specific intestinal bacteria populations might trigger the development of disease in susceptible hosts are being explored across the globe. Beneficial modulation of the gut microbiota using biotherapeutics, such as prebiotics, probiotics, and antibiotics, may favor health-promoting populations of bacteria and can be exploited in development of biotherapeutics. Other technologies, such as development of human gut models, bacterial screening, and delivery formulations e.g., microencapsulated probiotics, may contribute significantly in the near future. Therefore, the human gut microbiota is a legitimate therapeutic target to treat and/or prevent various diseases. Development of a clear understanding of the technologies needed to exploit the gut microbiota is urgently required.

Seven bacterial divisions constitute the gut microbiota, i.e., Firmicutes, Bacteroides, Proteobacteria, Fusobacteria, Verrucomicrobia, Cyanobacteria, and Actinobacteria, with Firmicutes and Bacteroides being the most abundant species. Bacterial communities exhibit quantitative and qualitative variations along the length of the gastrointestinal tract due to host factors (e.g., pH, transit time, bile acids, digestive enzymes, and mucus), nonhost factors (eg, nutrients, medication, and environmental factors), and bacterial factors (e.g., adhesion capacity, enzymes, and metabolic capacity).

Until recently, the analysis of bacterial ecosystems was performed by growth on defined media, which has some limitations because this method is labor-intensive and, more importantly, only 80% of stool bacteria can be cultivated. As a consequence, new molecular techniques have been developed. In terms of qualitative measurements of the microbiota, techniques such as fingerprinting (denaturing gradient gel electrophoresis), terminal restriction fragment length polymorphism, ribosomal intergenic spacer analysis, and 16S ribosomal RNA sequencing are widely used. Specifically, genome sequencing has provided tremendous information in the microbial world, spearheading technologies such as microarrays. New automated parallel sequencing technologies, based on the 16S ribosomal RNA gene present in all prokaryotes, can offer a cost-effective solution for rapid sequencing and identification of bacterial species of the gut.

Essential metabolic functions

Metabolic functions of the gut microbiota include production of vitamin, amino acid synthesis, and bile acid biotransformation. Bile acid biotransformations, performed by microbial enzymes, have implications for cholesterol and glucose metabolism. Importantly, the microbiome provides biochemical pathways required for the fermentation of nondigestible substrates and endogenous mucus. Through fermentation, bacterial growth is stimulated, producing short-chain fatty acids and gases. The major short-chain fatty acids produced are acetate, butyrate, and propionate. Other bacterial end products include lactate, ethanol, succinate, formate, valerate, caproate, isobutyrate, 2-methyl-butyrate,
and isovalerate. Bacterial fermentation is present in the cecum and colon, where the short-chain fatty acids are absorbed, stimulating the absorption of salts and water.

Ensures protection

Pathogen displacement or “colonization resistance” is an accepted function of the gut microbiota. Commensal organisms prevent pathogenic colonization by competing for attachment sites and nutrients, and also through the production and secretion of antimicrobials. Those mechanisms are relevant for reducing the level of lipopolysaccharides, peptidoglycans, bacterial CpG-DNA motifs, and superantigens, which can all be detrimental to the host. The indigenous microbiota is also essential for development of the immune system. Short-chain fatty acids, such as butyrate, may exert potent immunomodulatory effects by suppressing nuclear factor-kB activation and/or by acting on G-coupled receptors, as demonstrated with acetate. These concepts illustrate a dynamic relationship between the immune system and the microbiota. The intestinal mucosa averts threats by signaling to the innate immune system through pattern recognition receptors, such as toll-like receptors. Pattern recognition receptors recognize and bind to specific microbial macromolecules, referred to as microbial-associated molecular patterns. These include lipopolysaccharide, flagellin, peptidoglycan, and N-formylated peptides.

Structural and histological function

The microbiota ensures intestinal structure and function. Firstly, the mucus layer, which reflects the balance between mucus secretion and bacterial degradation, constitutes an obstacle to the uptake of antigens and proinflammatory molecules. Secondly, some bacterial communities may strengthen the barrier at the level of the tight junctions, ie, protein clusters that form a barrier between the lumen and the lamina propria. Moreover, the gut microbiota is involved in cell and tissue development. Butyrate regulates cell growth and differentiation, inhibiting transformed cell growth while encouraging reversion of cells from a neoplastic to a non-neoplastic phenotype. Most of the structural and morphological development of the gut contributes to and manages the gut bacterial system.

Dysbiosis is a state in which the microbiota becomes altered as a consequence of an alteration in the composition of the microbiota, a change in bacterial metabolic activity, and/or a shift in local distribution of communities. Many factors can alter the gastrointestinal ecosystem, including antibiotics, psychological and physical stresses, radiation, altered peristalsis, and dietary changes. At present, the focus is on the description of dysbiosis in a plethora of human disorders.

  • Autoimmune disease

Autoimmune diseases occur when the body’s immune system attacks and destroys healthy cells and tissues, as is the case in type 1 diabetes mellitus, celiac disease, inflammatory bowel diseases, and allergic asthma. Most often, the immune response is initiated by unknown factors. Alteration of the gut microbiota as a result of modern lifestyles is an attractive hypothesis to explain the rise in prevalence of celiac disease, type 1 diabetes mellitus, and inflammatory bowel diseases.

Celiac disease is an inflammatory disease of the small intestine that is triggered and maintained by the storage proteins of wheat, barley, and rye. Studies have investigated the composition of the microbiota in patients with celiac disease. Fecal samples from patients with celiac disease had reduced the proportions of Bifidobacterium, Clostridium histolyticum, Clostridium lituseburense, Faecalibacterium prausnitzii, and increased proportions of Bacteroides/Prevotella.

Type 1 diabetes mellitus, characterized by insulin deficiency resulting from immune-mediated destruction of pancreatic β cells, is thought to be triggered by environmental factors in genetically susceptible individuals. Given that antibiotics prevented type 1 diabetes mellitus in biobreeding diabetes-prone rats and in nonobese diabetic mice, alteration of the microbiota has been associated with progression of type 1 diabetes mellitus. Evidence shows that bacterial communities from biobreeding diabetes-prone and diabetes-resistant rats differ, marked by a higher abundance of Lactobacillus and Bifidobacterium in diabetes-resistant rats.

Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease. Crohn’s disease is characterized by patchy and transmural inflammation that may affect any part of the gastrointestinal tract, while ulcerative colitis is a chronic episodic inflammatory condition that involves only the large bowel. There is evidence that species belonging to the normal gut microbiota are involved in the etiology and/or maintenance of inflammatory processes. Reduced microbial diversity, increased Bacteroidetes and Enterobacteriaceae, and decreased Firmicutes were all observed in patients with inflammatory bowel diseases.

  • Irritable bowel syndrome

Irritable bowel syndrome is characterized by abdominal pain, bloating, and changes in bowel habit, in the absence of any overt mucosal abnormality. Observations have directed attention towards the gut microbiota, identifying a postinfectious variant of the syndrome, ie, evidence that antibiotics induced a reduction in the microbiota which may be a risk factor, and the proposal that some patients may have bacterial overgrowth in the small bowel.49 Studies have demonstrated that patients with irritable bowel syndrome have fewer intestinal Bifidobacteria, Collinsella aerofaciens, Coprococcus eutactus, and Clostridium cocleatum, and an increase in Veillonella and Enterobacteriaeae.

  • Bacterial infection

It is well established that a disruption in the commensal microbiota increases susceptibility to enteric infections. Antibiotic-treated mice are particularly useful for studying colitis induced by Salmonella spp, Shigella spp, and E. coli infections. In addition, in murine Citrobacter rodentium infections, pathogen colonization is associated with a reduced total density and a relative increase in γ-Proteobacteria. Furthermore, elderly patients with C. difficile-associated diarrhea demonstrate reduced numbers of Bacteroides, Prevotella, and Bifidobacteria, and a greater diversity of facultative species, ie, Lactobacilli and Clostridia. The evidence suggests an association between disruption of the gut microbiota and bacterial infections, further accentuating the dysbiosis.

Altered composition of the human gastrointestinal ecosystem can lead to physiological changes in the intestinal environment, disrupting the functions of the microbiota and having serious consequences for human health.

  1. Altered gut microbiota may trigger serious immune deregulation
  2. Specific gut dysbiosis can engender metabolic endotoxemia
  3. Bacterial infection might be promoted by gut dysbiosis
  4. Abnormal bacterial metabolite levels may trigger cancer

An altered microbial balance in the gut can lead to A) an increase in immune mediated disorders and B) chronic low-grade inflammation.

A mechanism based on the triggering of the host’s immune defenses was elucidated using models of C. rodentium (mimicking diarrheal pathogen associated inflammation), Campylobacter jejuni infection, and chemically and genetically induced models of intestinal inflammation are used for altered microbiota investigations. An overgrowth of Enterobacteriaceae was observed in all models, indicating that inflammation induced microbiota changes support colonization by aerotolerant bacteria.

Many etiological bacterial mechanisms have been hypothesized to promote carcinogenesis. Amongst those, hydrogen sulfide, a product of bacterial sulfate reduction, appears to be linked to the incidence of chronic disorders, such as ulcerative colitis and colorectal cancer. Because DNA strand breaks are associated with mutation and promotion of carcinogenesis, bacterial hydrogen sulfide may be responsible for the induction of mutations in the development of sporadic colorectal cancer.

  • Gut microbiota alters energy and lipid metabolism

Reared mice have more body and gonadal fat than germ-free mice, despite reduced chow consumption. The increase in fat was accompanied with increased fasting glucose and insulin levels and an insulin-resistant state.

– Prebiotics

Prebiotics are “nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or the activity of one or a limited number of bacteria in the colon, and thus improves host health”. A prebiotic should not be hydrolyzed by human intestinal enzymes, but selectively fermented by bacteria, benefiting the host.

The relationship between health and the gastrointestinal system is established. Due to the inherent plasticity of microbiota, one can consider exploiting it to develop biotherapeutics.

Gut Microbiota Regulates Bile Acid Metabolism by Reducing the Levels of Tauro-beta-muricholic Acid, a Naturally Occurring FXR Antagonist

Sama I. Sayin, Annika Wahlstrom, Jenny Felin, Sirkku Jantti, et al.
Cell Metabolism  Feb 5, 2013; 17, 225–235
http://dx.doi.org/10.1016/j.cmet.2013.01.003

Bile acids are synthesized from cholesterol in the liver and further metabolized by the gut microbiota into secondary bile acids. Bile acid synthesis is under negative feedback control through activation of the nuclear receptor farnesoid X receptor (FXR) in the ileum and liver. Here we profiled the bile acid composition throughout the enterohepatic system in germfree (GF) and conventionally raised (CONV-R) mice.

We confirmed a dramatic reduction in muricholic acid, but not cholic acid, levels in CONV-R mice. Rederivation of Fxr-deficient mice as GF demonstrated that the gut microbiota regulated expression of fibroblast growth factor 15 in the ileum and cholesterol 7α-hydroxylase (CYP7A1) in the liver by FXR-dependent mechanisms. Importantly, we identified tauroconjugated β- and α-muricholic acids as FXR antagonists. These studies suggest that the gut microbiota not only regulates secondary bile acid metabolism but also inhibits bile acid synthesis in the liver by alleviating FXR inhibition in the ileum.

 

Diet rapidly and reproducibly alters the human gut microbiome.

Lawrence A David, Corinne F Maurice, Rachel N Carmody, et al.
Nature 12/2013; http://dx.doi.org:/10.1038/nature12820

Long-term dietary intake influences the structure and activity of the trillions of microorganisms residing in the human gut, but it remains unclear how rapidly and reproducibly the human gut microbiome responds to short-term macronutrient change. Here we show that the short-term consumption of diets composed entirely of animal or plant products alters microbial community structure and overwhelms inter-individual differences in microbial gene expression. The animal-based diet increased the abundance of bile-tolerant microorganisms (Alistipes, Bilophila and Bacteroides) and decreased the levels of Firmicutes that metabolize dietary plant polysaccharides (Roseburia, Eubacterium rectale and Ruminococcus bromii). Microbial activity mirrored differences between herbivorous and carnivorous mammals, reflecting trade-offs between carbohydrate and protein fermentation. Foodborne microbes from both diets transiently colonized the gut, including bacteria, fungi and even viruses. Finally, increases in the abundance and activity of Bilophila wadsworthia on the animal-based diet support a link between dietary fat, bile acids and the outgrowth of microorganisms capable of triggering inflammatory bowel disease. In concert, these results demonstrate that the gut microbiome can rapidly respond to altered diet, potentially facilitating the diversity of human dietary lifestyles

Honing in on enteric fever

Lyle R Mckinnon And Quarraisha Abdool Karim
eLife 2014;3:e03545. http://dx.doi.org:/10.7554/eLife.03545

Enteric fever, also known as typhoid, is a disease that affects about 22 million people and causes about 200,000 deaths every year, according to conservative estimates. Enteric fever is spread by bacteria belonging to the Salmonella genus, with two sub-species—Salmonella Typhi and Salmonella Paratyphi A—being responsible for most cases of the disease. And although the number of cases of enteric fever has fallen significantly over recent decades, there is a clear need for a diagnostic test for Salmonella that is rapid, affordable and accurate. Moreover, it is important to be able to distinguish between enteric fever caused by Salmonella Typhi and enteric fever caused by Salmonella Paratyphi A in order to ensure that the correct drugs are prescribed and to combat the development of antibiotic resistance.

The application of metabolomics is relatively new in infectious diseases research compared to the application of genomics and proteomics. Despite this, screening the metabolome in blood plasma has identified useful prognostic profiles of several diseases, including sepsis.  Using a combination of gas chromatography and mass spectrometry, Näsström et al. identified 695 distinct peaks that were associated with different metabolites: from these they selected six peaks that had significantly different heights in the three groups of patients. This meant that they were able to tell if the patient had S. Typhi, S. Paratyphi A, or neither. That this mass spectrometric analysis was able to distinguish two Salmonella groups that share many similarities is remarkable. Moreover, in addition to its diagnostic potential, this new approach might also provide insights into the antigenic and physiological differences between the two strains.

http://emedicine.medscape.com/article/186458-overview

Clostridium difficile colitis results from a disturbance of the normal bacterial flora of the colon, colonization by C difficile, and the release of toxins that cause mucosal inflammation and damage. Antibiotic therapy is the key factor that alters the colonic flora. C difficile infection (CDI) occurs primarily in hospitalized patients.

Essential update: CDC promotes improving inpatient antibiotic prescribing to reduce drug resistance and increase patient safety In a CDC analysis of data regarding antibiotic prescribing in hospitalized patients, Fridkin and colleagues estimated that a 30% reduction in use of broad-spectrum antibiotics would result in a 26% reduction in C difficile infections (CDIs).[1, 2] In addition, improvement in physician antibiotic prescribing habits from overuse and incorrect use would also help to reduce antibiotic resistance.

The authors recommend the following[2] :

Promptly initiate antibiotics for a presumed infection, but first obtain any recommended cultures.

Document and specify the drug’s indication, dose, and expected duration of use in the patient’s medical chart.

Reassess the patient within 48 hours based on test results and patient examination; adjust the antibiotic regimen (dose, duration) and/or the agent, or end the antibiotic treatment, as needed.

Signs and symptoms

Symptoms of C difficile colitis often include the following:

Mild to moderate watery diarrhea that is rarely bloody

Cramping abdominal pain

Anorexia

Malaise

Physical examination may reveal the following in patients with the disorder:

Fever: Especially in more severe cases

Dehydration

Lower abdominal tenderness

Rebound tenderness: Raises the possibility of colonic perforation and peritonitis

Regulatory T-cells in autoimmune diseases: Challenges, controversies and—yet—unanswered questions

Charlotte R. Grant, Rodrigo Liberal, Giorgina Mieli-Vergani, et al.
Autoimmunity Reviews 14 (2015) 105–116
http://dx.doi.org/10.1016/j.autrev.2014.10.012

Regulatory T cells (Tregs) are central to the maintenance of self-tolerance and tissue homeostasis. Markers commonly used to define human Tregs in the research setting include high expression of CD25, FOXP3 positivity and low expression/negativity for CD127. Many other markers have been proposed, but none unequivocally identifies bona fide Tregs. Tregs are equipped with an array of mechanisms of suppression, including the modulation of antigen presenting cell maturation and function, the killing of target cells, the disruption of metabolic pathways and the production of anti-inflammatory cytokines. Treg impairment has been reported in a number of human autoimmune conditions and includes Treg numerical and functional defects and conversion into effector cells in response to inflammation. In addition to intrinsic Treg impairment, resistance of effector T cells to Treg control has been described. Discrepancies in the literature are common, reflecting differences in the choice of study participants and the technical challenges associated with investigating this cell population. Studies differ in terms of the methodology used to define and isolate putative regulatory cells and to assess their suppressive function. In this review we outline studies describing Treg frequency and suppressive function in systemic and organ specific autoimmune diseases, with a specific focus on the challenges faced when investigating Tregs in these conditions.
Role of dendritic cells in the initiation, progress and modulation of systemic autoimmune diseases

Juan Pablo Mackern-Oberti, Carolina Llanos, Fabián Vega, et al.
Autoimmunity Reviews 14 (2015) 127–139
http://dx.doi.org/10.1016/j.autrev.2014.10.010

Dendritic cells (DCs) play a key role in the activation of the immune response against pathogens, as well as in the modulation of peripheral tolerance to self-antigens (Ags). Furthermore, an imbalance in the activating/inhibitory receptors expressed on the surface of DCs has been linked to increased susceptibility to develop autoimmune diseases underscoring their immunogenicity potential. It has been described that modulation of activating or inhibitory molecules expressed by DCs, such as CD86, TLRs, PDL-1 and FcγRs, can define the immunogenic phenotype. On the other hand, T cell tolerance can be achieved by tolerogenic DCs, which have the capacity of blocking undesired autoimmune responses in several experimental models, mainly by inducing T cell anergy, expansion of regulatory T cells and limiting B cell responses. Due to the lack of specific therapies to treat autoimmune disorders and the tolerogenic capacity of DCs shown in experimental autoimmune disease models, autologous tol-DCs are a potential therapeutic strategy for fine-tuning the immune system and reestablishing tolerance in human autoimmune diseases. New advances in the role of DCs in systemic lupus erythematosus (SLE) pathogenesis and the identification of pathogenic self-Ags may favor the development of novel tol-DC based therapies with amajor clinical impact. In this review, we discuss recent data relative to the role of DCs in systemic autoimmune pathogenesis and their use as a therapy to restore tolerance.

T cell subsets and their signature cytokines in autoimmune and inflammatory diseases

Itay Raphael, Saisha Nalawade, Todd N. Eagar, Thomas G. Forsthuber
Cytokine xxx (2014) xxx–xxx
http://dx.doi.org/10.1016/j.cyto.2014.09.011

CD4+ T helper (Th) cells are critical for proper immune cell homeostasis and host defense, but are also major contributors to pathology of autoimmune and inflammatory diseases. Since the discovery of the Th1/Th2 dichotomy, many additional Th subsets were discovered, each with a unique cytokine profile, functional properties, and presumed role in autoimmune tissue pathology. This includes Th1, Th2, Th17, Th22, Th9, and Treg cells which are characterized by specific cytokine profiles. Cytokines produced by these Th subsets play a critical role in immune cell differentiation, effector subset commitment, and in directing the effector response. Cytokines are often categorized into proinflammatory and anti-inflammatory cytokines and linked to Th subsets expressing them. This article reviews the different Th subsets in terms of cytokine profiles, how these cytokines influence and shape the immune response, and their relative roles in promoting pathology in autoimmune and inflammatory diseases. Furthermore, we will discuss whether Th cell pathogenicity can be defined solely based on their cytokine profiles and whether rigid definition of a Th cell subset by its cytokine profile is helpful.

Irritable Bowel Syndrome and Gluten Sensitivity Without Celiac Disease: Separating the Wheat from the Chaff

Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo controlled trial. Am J Gastroenterol 2011;106:508–514.

Courtney C. Ferch, William D. Chey
Gastroenterology 2012; 142:664–673

Over the past several years, there has been increasing discussion concerning the topic of gluten sensitivity as a cause of irritable bowel syndrome (IBS) symptoms in patients for whom celiac disease has been excluded. Biesiekierski et al performed a double-blind, placebo-controlled, dietary rechallenge trial to better understand the role of gluten ingestion in the development of gastrointestinal (GI) and non-GI symptoms in patients diagnosed with IBS. This study included a sample of 34 patients diagnosed with IBS by the Rome III criteria who had experienced symptom improvement with a gluten-free diet for 6 weeks before study enrollment. Celiac disease had been excluded in all study participants by either a negative HLADQ2/HLA-DQ8 haplotype or a normal duodenal biopsy. Patients with potentially important confounders such as cirrhosis, inflammatory bowel disease, nonsteroidal anti-inflammatory drug ingestion, or excessive alcohol use were excluded from the study.

Upon completion of the study period, it was found that a significantly greater proportion of patients in the gluten group compared with the gluten-free group answered “no” to the primary outcome question (68% vs 40%; P < .001). Compared with the gluten group, those who remained gluten free also reported significant improvements in pain (P < .016), bloating (P < .031), satisfaction with stool consistency (P <.024), and tiredness (P < .001), but showed no significant differences in wind (P < .053) or nausea (P < .69). The results of celiac antibodies at baseline and after the dietary intervention were similar. Intestinal permeability as measured by urine lactulose-to-rhamnose ratio was also unchanged by the dietary intervention. Fecal lactoferrin levels were persistently undetectable in all but 1 patient during the treatment period. High-sensitivity C-reactive protein levels remained normal before and after the dietary intervention. There were no differences in the likelihood of symptomatic response in those with and without HLA-DQ2 and HLA-DQ8 alleles, arguing against undiagnosed celiac disease as a cause for symptom response to a gluten-free diet.

The authors felt that these data support the existence of non–celiac-associated gluten sensitivity. They concluded that gluten is indeed associated with overall IBS symptoms, bloating, dissatisfaction with stool consistency, abdominal pain, and fatigue in a subset of patients.

A recent meta-analyses of studies from around the world found that patients with IBS symptoms were significantly more likely to have celiac disease than controls. (Arch Intern Med 2009;169:65165– 65168). As such, the American College of Gastroenterology Task Force has recommended that routine serologic screening for celiac sprue be pursued in patients with diarrhea-predominant IBS and IBS with a mixed bowel pattern (grade 1B recommendation; Am J Gastroenterol 2009;104[Suppl 1]:S1–S35). Although much of the recent discussion around the potential role of food in IBS symptoms has focused on celiac disease, it is important to note that data from the available US studies have not shown a significantly greater risk for celiac disease among patients with IBS symptoms and no warning signs (Am J Gastroenterol 2008;103[Suppl 1]:S472; Gastroenterology 2011;141:1187–1193). A recent prospective study from the United States reported a 0.4% prevalence of biopsy-proven celiac disease in 492 patients with IBS symptoms and 458 asymptomatic persons undergoing colonoscopy for colorectal cancer screening or surveillance (Gastroenterology 2011;141:1187–1193). Although not significantly different, it is interesting that 7.3% of the IBS group and 4.8% of controls had 1 abnormal celiac serology test result (adjusted odds ratio, 1.49; 95% confidence interval, 0.76 – 0.90; P =.25). Thus, this study suggests that the likelihood of an abnormal immunologic response to gluten is orders of magnitude more common than biopsy-proven celiac disease in IBS patients and controls from the United States. It has been suggested that ~20% of the general population reports symptoms in association with the ingestion of gluten. Such patients have been said to suffer from “gluten sensitivity.”

It is also interesting to consider the potential effects of food on gut immune function beyond celiac disease. There is emerging evidence to suggest that immune activation and/or low-grade inflammation may play a role in the pathogenesis of IBS (GI Clin North Am 2011;40:65–85). The data are currently conflicting, but alternations in the number of mast cells in close proximity to afferent neurons, mucosal lymphocytes, and certain pro-inflammatory or anti-inflammatory cytokines have been identified in a subset of patients with IBS. It is not difficult to envision that alterations in the gut immune system could occur as a consequence of an acute GI infection in a genetically susceptible individual. However, it is interesting to speculate that other environmental factors, such as an altered gut microbiota, physical or emotional abuse, stress, or food, might result in abnormal gut immune function translating clinically into IBS symptoms.

A better understanding of how differences in gut immune function, the microbiome, and fermentation might influence the development of IBS symptoms in association with the ingestion of gluten are all deserving of further investigation. The study by Biesiekierski et al is the first randomized, controlled trial to suggest that nonceliac IBS patients might benefit from a gluten-free diet. Although these results are certainly intriguing and hypothesis generating, they require validation in larger, randomized, controlled trials in other parts of the world. What is clear and important for providers to understand is that gluten sensitivity is here to stay and significantly more likely for them to encounter in day-to-day practice than celiac disease.

No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates

Jessica R. Biesiekierski, Simone L. Peters, Evan D. Newnham, et al.
Gastroenterology 2013;145:320–328
http://dx.doi.org/10.1053/j.gastro.2013.04.051

Background & Aims: Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease but their symptoms improve when they are placed on gluten-free diets. We investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in subjects believed to have NCGS. Methods: We performed a double-blind crossover trial of 37 subjects (aged 2461 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease. Participants were randomly assigned to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks. We assessed serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue. Twenty-two participants then crossed over to groups given gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days. Symptoms were evaluated by visual analogue scales. Results: In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. Gluten-specific effects were observed in only 8% of participants. There were no diet-specific changes in any biomarker. During the 3-day rechallenge, participants’ symptoms increased by similar levels among groups. Gluten-specific gastrointestinal effects were not reproduced. An order effect was observed. Conclusions: In a placebo controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs. www.anzctr.org.au.ACTRN12610000524099

Infection, inflammation, and the irritable bowel syndrome

Spiller, K. Garsed
Digestive and Liver Disease 41 (2009) 844–849
http://dx.doi.org:/10.1016/j.dld.2009.07.007

Infectious diarrhea is one of the commonest afflictions of mankind. Worldwide most of the burden, about 1 billion cases a year, is seen in children <5 years old, the vast majority in the developing world in communities where access to clean water and adequate sanitation is restricted. Here a child can expect to have 6–7 episodes per year compared to 1–2 in the developed world. Following recovery from an episode of gastroenteritis (GE) the vast majority of healthy adults and children develop some degree of immunity to the organism responsible and return to normal functioning. However 7–31% develop post-infectious irritable bowel syndrome (PI-IBS). The proportion of unselected IBS that is post-infectious varies from 6 to 17% in the USA and Europe but whether this differs in the developing world is unknown, though previous enteric infection is a known risk factor for IBS in Southern China.

This review will compare the epidemiology of infectious diarrhea in the developing and developed world and the link between mucosal inflammation and the development of IBS symptoms. The available evidence suggests that the acquisition of immunity in early childhood reduces the severity of subsequent gastroenteritis in adulthood. Since these are known risk factor for developing PI-IBS we hypothesize that this may underlie some of the regional differences in the incidence of both infection and IBS.

Gastrointestinal infection is ubiquitous worldwide though the pattern of infection varies widely. Poor hygiene and lack of piped water is associated with a high incidence of childhood infection, both viral and bacterial. However in developed countries bacterial infection is commoner in young adults. Studies of bacterial infections in developed countries suggest 75% of adults fully recover, however around 25% have long lasting changes in bowel habit and a smaller number develop the irritable bowel syndrome (IBS). Whether the incidence is similar in developing countries is unknown. Post-infective IBS (PI-IBS) shares many features with unselected IBS but by having a defined onset allows better definition of risk factors. These are in order of importance: severity of initial illness, smoking, female gender and adverse psychological factors. Symptoms may last many years for reasons which are unclear. They are likely to include genetic factors controlling the immune response, alterations in serotonin signaling, low grade mucosal inflammation maintained by psychological stressors and alterations in gut microbiota. As yet there are no proven specific treatments, though 5HT3 receptor antagonists, anti-inflammatory agents and probiotics are all logical treatments which should be examined in large well-designed randomized placebo controlled trials.

There are three key questions. Firstly is the incidence of IBS less in the developing world, secondly is the incidence increasing with the adoption of a western urban life style and finally is the disease itself different? The answer to all three is probably yes though interpretation of cross-cultural surveys is fraught with problems relating to the imprecise translation of questions into different cultures. Initial reports from small uncontrolled studies suggested that IBS was very uncommon and predominantly affected a subpopulation who pursued a “western life style”. More recent and robust work gives a range of values for prevalence from very low in Iran and India with just 5.8 and 4.2% respectively, to values in developed Asian countries that are generally lower but not dissimilar to those seen in the west. The key factors associated with rapid westernization that underlie this increase in numbers is unclear but could include the effect of improved hygiene, increased overcrowding, stress and changes in diet. The best evidence comes from studies in which the same populations have been studied over a number of years as has been done in Singapore where after a decade of steady industrial growth the prevalence of IBS has risen from 2.3% to 8.6%.

This raises is a most important question – why should these differences occur? It is clear that major differences in the epidemiology of gut infection exist between the west and the developing world. This is illustrated by Campylobacter jejuni enteritis, which causes a shorter, less severe illness in childhood than in adulthood, which is when most Europeans and North Americans are infected. The greater degree of inflammation which adults experience may increase the risk of developing subsequent PI-IBS which might partly account for the higher prevalence of IBS in the westernized nations.

Worldwide the average number of episodes of infection annually per person is 3. A poorly nourished child living in cramped conditions without access to sewerage and running water will have 8 or more infections in the first year of life, most frequently with enteric bacteria and parasites whereas a child in better sanitary conditions would have less infections and these would be more likely to be viral in origin. Even in England an estimated 1 in 5 people per year have an episode of diarrhea in the community adding up to 9.4 million cases in total a year, largely unreported since only 1 in 30 present to their doctor. It seems here that viral infections predominate in the very young, with bacterial infection particularly Campylobacter spp. being most common in adolescence and early adulthood. PCR analysis of stool in the same study showed that Norovirus and Rotavirus were the commonest pathogens detected across all age groups. Campylobacter spp. were most commonly found in age group 30–39 (16% compared to 6.7% of those aged 1–4).

Infectious diarrhea results from either an increase in fluid and electrolyte secretion, predominantly in the small intestine, or a decrease in absorption which can involve both the small and large bowel. During a diarrheal illness these two mechanisms frequently co-exist. Enterotoxins from Vibrio cholerae or enterotoxigenic E. coli induce profuse secretion while decreased intestinal absorption can be induced by mucosal injury caused by enteroinvasive organisms (e.g., Salmonella, Shigella, and Yersinia spp.). These invasive infections injure cells and excite an immune response and activate enteric nerves and mast cells resulting in an acute inflammatory infiltrate with the release of pro-inflammatory mediators and stimulation of secretion. Clinically the patient will have an acutely inflamed mucosa with ulceration and bleeding.

Campylobacter jejuni produces a range of toxins including cytolethal distending toxin, that first produces a secretory diarrhea in the small intestine in the early part of the illness after which there is invasion of the distal ileum and colon to produce an inflammatory ileocolitis, which can extend all the way to the rectum. The disease is less severe in developing countries than in developed countries, with watery stool, fever, abdominal pain, vomiting and dehydration predominating as opposed to the severe abdominal pain, weight loss, fever and bloody stool that is seen more frequently in infections in the west. Infants usually have milder disease with less fever and pain, which in some cases is due to immunity acquired during previous infection. The reasons for these differences between the developed and developing world are unclear.

The composition of the resident intestinal microbiota is highly variable between individuals but relatively stable for each individual, though IBS patients showamore unstable microbiota. This instability may be due to antibiotic therapy or alterations in diet, both of which are commoner in IBS. Patients given antibiotics are 4 times more likely than untreated controls to report bowel symptoms 4 months later, and antibiotic use is a risk factor for developing IBS with an adjusted OR of 3.70 (1.80–7.60). Antibiotic use increases the incidence of post-infective functional diseases following both Salmonella enteritidis and travellers’ diarrhea, in whom antibiotic treatment gave a relative risk of developing PI-IBS of 4.1 (1.1–15.3) compared with those not receiving treatment.

During acute infectious diarrhea there is a decrease in anaerobes. Mice infected with Citrobacter rodentium or C. jejuni or subjected to a chemically induced colitis show significant reduction in the total numbers of microbiota, which is mainly due to activation of the host immune response and only to a much lesser degree by bacterial factors. This loss of anaerobes is associated with a depletion in short chain fatty acids and an increase in the pH of the stool allowing overgrowth of other organisms which may contribute to disturbed bowel function.

The study of patients with PI-IBS has yielded many new insights for several reasons. Firstly the patients are a more homogenous group than unselected IBS, most having diarrhea with fewer psychological problems than unselected IBS. Secondly the direction of causation is easier to ascertain as they represent a “natural experiment”, with subjects “randomized” to receive an infection, thus producing an unbiased study group. Finally onset of symptoms on a clearly defined date in a previously well patient provides an opportunity to examine the prior host and bacterial factors that predispose to developing IBS.

The severity of injury is mediated not only by factors related to the infecting organism but also by the host’s own immune response which develops in early life and declines in old age. However little is known about the incidence of PI-IBS in the pediatric population and whether it is different to the condition seen in adults. Functional bowel disorders are common in children, with IBS affecting 14% of high school and 6% of middle school patients in a US community study and are classified according to the main complaints made by parents or children rather than in an organ-specific way. This makes comparisons with the adult population difficult however a single recent study reports a very high incidence of postinfectious symptoms in 88 children with positive bacterial stool culture results presenting to a single institution. These had a 36% prevalence of functional gastrointestinal disorders compared to 11% in age- and sex-matched healthy controls. This is much higher than most adult studies with the exception of the Walkerton outbreak. Unlike adults, female gender is not a risk factor for PI-IBS in children suggesting the gender effect depends on hormonal and/or psychosocial factors rather than being genetic.

Despite uncertainty about PI-IBS in childhood we do know that age in adulthood does have an effect on the likelihood of developing PI-IBS. A meta-analysis indicates that patients who develop PI-IBS are slightly younger and one study showed increasing age was protective with age >60 years giving a relative risk of PI-IBS of 0.36 (0.1–0.09) though not all studies have shown this.

Why should this inflammation persist in some and not others? As we have already discussed adverse life events, anxiety and epression may play a part however less psychological morbidity is seen in PI-IBS than IBS indicating the presence of other factors which predispose to an exaggerated or prolonged inflammatory response.  These factors might be genetic since a larger proportion of IBS patients have the high producing heterozygous TNF-α G/A polymorphism at position-308 than controls. Some PI-IBS patients were contained in this study but too few to examine as a subgroup. This study did not confirm an earlier finding of a decrease in the presumed immunoregulatory high IL-10 producing phenotype in IBS.

Although it is likely from animal work that infection does alter the gut microbiota there is no data on this in PI-IBS. There is some indirect evidence that altered microbiota may be important in IBS since fecal serine protease activity, which may be of bacterial origin, is increased in D-IBS. This is of great interest because these proteases can increase visceral sensitivity in rats, acting via the protease activated receptor-2 (PAR-2) group of receptors found in the mucosa and enteric nerves.

A recent small randomized placebo controlled trial of Mesalazine suggested this could reduce mast cell numbers and improve symptoms, a finding which needs repeating with larger numbers. Given the increase in 5HT availability and the effectiveness of 5HT3 receptor antagonists in animal studies and in unselected IBS-D patients a trial of a 5HT3 receptor antagonist would also be logical.

Gut motility and enteroendocrine secretion

Tongzhi Wu, Christopher K Rayner, Richard L Young and Michael Horowitz
Current Opinion in Pharmacology 2013, 13:928–934
http://dx.doi.org/10.1016/j.coph.2013.09.002
The motility of the gastrointestinal (GI) tract is modulated by complex neural and hormonal networks; the latter include gut peptides released from enteroendocrine cells during both the interdigestive and postprandial periods. Conversely, it is increasingly recognised that GI motility is an important determinant of gut hormone secretion, in that the transit of luminal contents influences the degree of nutrient stimulation of enteroendocrine cells in different gut regions, as well as the overall length of gut exposed to nutrient. Of particular interest is the relationship between gallbladder emptying and enteroendocrine secretion. The inter-relationships between GI motility and enteroendocrine secretion are central to blood glucose homeostasis, where an understanding is fundamental to the development of novel strategies for the management of diabetes mellitus.

Enteroendocrine cells account for release of more than 30 known peptides, including motilin and ghrelin during the interdigestive period, and cholecystokinin (CCK), glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) after meals. The latter are key mediators of the shift from an interdigestive to a postprandial GI motor pattern. Conversely, the delivery of luminal contents to be sensed by enteroendocrine cells in various gut regions is dependent on GI motor activity.

During the interdigestive period, both the stomach and small intestine undergo a cyclical motor pattern — the ‘migrating motor complex (MMC)’ — consisting of a quiescent phase (~40 min, phase I), a phase of irregular contraction (~50 min, phase II), and a period of maximum contraction (5–10 min, phase III). The MMC migrates from the stomach (or proximal small intestine) to the terminal ileum, and acts to sweep small intestinal contents (including bile, digestive juice and indigestible debris) towards the large intestine. Phase III of the MMC is also associated with spontaneous gallbladder emptying.

The cyclical occurrence of MMC activity during the interdigestive state closely parallels the secretion of motilin, and to a lesser degree, ghrelin. Increases in plasma motilin concentrations follow immediately each episode of spontaneous gallbladder emptying, while after phase III there is a decrease in motilin. The latter might be associated with the relative absence of luminal content due to the ‘house-keeping’ effect of phase III. Patients with gallstones have defective gallbladder emptying and lack the cyclical profile of motilin concentrations and exhibit a reduced frequency of phase III activity.

GI motility has a major impact on enteroendocrine secretion; conversely, enteroendocrine hormones play a pivotal role in the regulation of interdigestive and postprandial GI motility. The significance of these interrelationships is increasingly recognized as being central to the regulation of postprandial glycemia. Slowing gastric emptying and intestinal transit, accelerating gallbladder emptying and intestinal exposure to bile acids, and stimulating postprandial enteroendocrine hormones, all represent novel therapeutic approaches for the management of type 2 diabetes.

Enteroendocrine cell types revisited

Maja S Engelstoft, Kristoffer L Egerod, Mari L Lund and Thue W Schwartz
Current Opinion in Pharmacology 2013, 13:912–921
http://dx.doi.org/10.1016/j.coph.2013.09.018

The GI-tract is profoundly involved in the control of metabolism through peptide hormones secreted from enteroendocrine cells scattered throughout the gut mucosa. A large number of recently generated transgenic reporter mice have allowed for direct characterization of biochemical and cell biological properties of these previously highly elusive enteroendocrine cells. In particular the surprisingly broad co-expression of six functionally related hormones in the intestinal enteroendocrine cells indicates that it should be possible to control not only the hormone secretion but also the type and number of enteroendocrine cells. However, this will require a more deep understanding of the factors controlling differentiation, gene expression and specification of the enteroendocrine cells during their weekly renewal from progenitor cells in the crypts of the mucosa.

Go with the flow — membrane transport in the gut

Editorial overview, David T Thwaites
Current Opinion in Pharmacology 2013, 13:843–846
http://dx.doi.org/10.1016/j.coph.2013.09.019

The primary function of the gastrointestinal tract is the assimilation of nutrients from diet. The final stages of digestion and almost all absorption take place in the small intestine and, to a lesser extent, the large intestine. The intestinal epithelium is the single layer of polarized, differentiated cells that lines the wall of the intestine. It sits at the interface between the outside world and the internal environment of the human body. It is across this epithelial barrier that all essential nutrients, vitamins, electrolytes and fluid are absorbed. Many toxins and waste products can be secreted directly across the intestinal epithelium or excreted through the biliary route. The gastrointestinal tract is of great interest to the pharmacologist, and the pharmaceutical industry beyond, because most patients, if given the opportunity, would choose to take medication orally rather than have it delivered by any other route. In addition, many drugs and metabolites are lost from the body by active secretion from the intestine and liver. Thus, the intestinal epithelium is a major target for clinical intervention to improve bioavailability and modulate gut function.

To allow net transport in either the absorptive or secretory direction, the polarised cells in the small intestine (enterocytes), large intestine (colono-cytes) and liver (hepatocytes) express a distinct set of membrane transport proteins in their apical and basolateral membrane domains. Each epithelial cell type mediates net solute and ion movement through the coordinated activity of an array of membrane transport proteins (primary active transporters or pumps, secondary active cotransporters or antiporters, and channels).

Chloride channel-targeted therapy for secretory diarrheas

Jay R Thiagarajah and AS Verkman
Current Opinion in Pharmacology 2013, 13:888–894
http://dx.doi.org/10.1016/j.coph.2013.08.005

Secretory diarrheas caused by bacterial and viral enterotoxins remain a significant cause of morbidity and mortality. Enterocyte Cl channels represent an attractive class of targets for diarrhea therapy, as they are the final, rate-limiting step in enterotoxin-induced fluid secretion in the intestine. Activation of cyclic nucleotide and/or Ca2+ signaling pathways in secretory diarrheas increases the conductance of Cl channels at the enterocyte luminal membrane, which include the cystic fibrosis transmembrane conductance regulator (CFTR) and Ca2+-activated Cl channels (CaCCs). High-throughput screens have yielded several chemical classes of small molecule CFTR and CaCC inhibitors that show efficacy in animal models of diarrheas. Natural-product diarrhea remedies with Cl channel inhibition activity have also been identified, with one product recently receiving FDA approval for HIV-associated diarrhea.

The intestinal epithelium consists of villi and crypts, with absorption occurring mainly in villi and secretion in crypts. Fluid absorption in the small intestine is driven by the luminal Na+/H+ exchanger (NHE3), Na+-glucose cotransporter (SGLT1), and Cl/HCO3 exchanger (DRA)(Figure 1, not shown). As in all epithelia the electrochemical driving force is established by a basolateral Na+K+-ATPase pump. The pro-absorptive solute transporters are constitutively active, though they can be modulated by second-messengers including cAMP and Ca2+. NHE3, SGLT1 and DRA are thus potential membrane transporter targets to increase intestinal fluid absorption. In the colon, fluid absorption is also facilitated by the epithelial Na+ channel (ENaC) and short-chain fatty acid (scfa) transporters (SMCT1).

Intestinal signal pathways controlling fluid secretion. Not shown. (a) Signaling pathways in CFTR activation by bacterial enterotoxins. Cholera toxin and heat stable enterotoxin (STa) bind to membrane receptors (GM1 —ganglioside receptor, guanylin receptor) causing increases in cyclic nucleotides (cAMP, cGMP) and neurotransmitters, resulting in CFTR activation. EC — enterochromaffin cells, 5-HT — 5-hydroxytryptamine, VIP — vasoactive intestinal peptide, ENS — enteric nervous system. (b) Signaling pathways in CaCC activation by rotavirus. Rotavirus releases NSP4 (non-structural protein 4), which causes elevation of cytoplasmic Ca2+ either: directly via binding to a membrane receptor (integrin α1β2); via neuropeptide galanin; or through activation of enteric nerves. Gal1-R — galanin 1 receptor. (c) Cross-talk between Ca2+ and cAMP pathways in intestinal epithelial cells. Epac — exchange protein directly activated by cAMP, PDE — phosphodiesterase, AC —adenylate cyclase, CaSR — calcium sensing receptor.

Natural-product ClS channel inhibitors Natural products have been identified with antidiarrheal efficacy in humans and a putative mechanism of action involving Cl channel inhibition. Crofelemer, a heterogeneous proanthocyanidin oligomer extracted from the bark latex of South American tree Croton lechleri, was approved recently for HIV-associated diarrhea following clinical trials showing efficacy in reducing the number and severity of diarrhea episodes. Whether CaCC inhibition by crofelemer can explain its efficacy in HIV-associated diarrhea is unclear.

Following a natural product screen that identified tannic acid as a general CaCC inhibitor, we found that red wines containing polyphenolic gallotannins fully inhibited intestinal CaCC without effect on CFTR. In recent follow-up work, we generated an alcohol-free red wine extract with potent CaCC inhibition activity, and showed its efficacy in a neonatal mouse model of rotaviral diarrhea (unpublished data). The wine extract inhibited intestinal Ca2+-activated Cl current and fluid secretion without affecting rotaviral infection of intestinal epithelial cells. CaCC inhibition may account for anecdotal reports of antidiarrheal action of red wines. Motivated by the possibility that known herbal antidiarrheal remedies might act by Cl channel inhibition, we recently screened a selection of diarrhea remedies from sources worldwide and identified a commonly used Thai herbal remedy that fully inhibited both CFTR and CaCC (unpublished observations). The herbal remedy showed efficacy in mouse models of cholera and rotaviral diarrhea.

Clinical relevance of drug efflux pumps in the gut

Shingen Misaka, Fabian Muller and Martin F Fromm
Current Opinion in Pharmacology 2013, 13:847–852
http://dx.doi.org/10.1016/j.coph.2013.08.010

Important export pumps expressed in the apical membrane of enterocytes are P-glycoprotein (P-gp), breast cancer resistance protein (BCRP) and multidrug resistance protein 2 (MRP2). They are believed to be a crucial part of the bodies’ defense mechanisms against potentially toxic, orally administered xenobiotics. In particular P-gp and BCRP also limit the bioavailability of drugs. Inhibition of these intestinal export pumps by concomitantly administered drugs leads to increased plasma concentrations, whereas induction can reduce absorption of the substrate drugs and decrease plasma concentrations. The role of polymorphisms in genes encoding for these transporters will also be discussed. Taken together this review will focus on the role of intestinal export pumps using selected examples from clinical studies in humans.

P-gp (gene: ABCB1) is a protein consisting of two homologous halves, each containing six transmembrane helices and one nuclear-binding domain. The protein expression of P-gp has been shown to increase from proximal to distal parts of the intestine. P-gp generally tends to transport hydrophobic, amphipathic or cationic compounds. Clinically important P-gp substrates include anticancer agents, cardiovascular drugs and immunosuppressants. It is of note that most of the listed drugs are also substrates of CYP3A4, and thus intestinal P-gp and intestinal CYP3A4 efficiently collaborate to enhance the removal of their substrates. ABCB1 mRNA expression is regulated by several nuclear receptors such as pregnane X receptor (PXR), constitutive androstane receptor (CAR), thyroid hormone receptor and vitamin D receptor (VDR).

Human intestinal P-gp limits bioavailability of drugs and induction and inhibition of intestinal P-gp are important mechanisms underlying drug–drug interactions in humans. Direct evidence for these processes in humans was largely generated using studies in healthy volunteers, who received P-gp drug substrates with negligible drug metabolism such as digoxin and talinolol. Further work is required regarding the importance of intestinal P-gp for drug disposition and drug–drug interactions for the majority of P-gp substrates, which are also metabolized, for example, by intestinal and hepatic CYP3A4, since inducers or inhibitors of P-gp frequently also affect CYP3A4 expression or function. For intestinal BCRP and intestinal MRP2, so far only a limited number of examples with specific drugs exist, which indicate their clinical importance in humans.

Gastrointestinal HCO3 S transport and epithelial protection in the gut: new techniques, transport pathways and regulatory pathways

Ursula E Seidler
Current Opinion in Pharmacology 2013, 13:900–908
http://dx.doi.org/10.1016/j.coph.2013.10.001

The concept of a protective alkaline gastric and duodenal mucus layer is a century old, yet it is amazing how much new information on HCO3 transport pathways has emerged recently, made possible by the extensive utilization of gene deleted and transgenic mice and novel techniques to study HCO3  transport. This review highlights recent findings regarding the importance of HCO3  for mucosal protection of duodenum and other gastrointestinal epithelia against luminal acid and other damaging factors. Recently, methods have been developed to visualize HCO3  transport in vivo by assessing the surface pH in the mucus layer, as well as the epithelial pH. New information about HCO3  transport pathways, and emerging concepts about the intricate regulatory network that governs duodenal HCO3 secretion are described, and new perspectives for drug therapy discussed.

The lack of HCO3 ions in the pancreatic secretions of children with cystic fibrosis was recognized in the 1960s and the significance for impaired mucus release discussed. It is now evident that CFTR expression is essential for HCO3  secretion in most gastrointestinal epithelia, such as the esophagus, the small intestine, the biliary tract, and the pancreatic ducts, as well as the reproductive tract and the airways. The low pH in the acinar-ductal unit after release of the zymogen granules needs to be quickly neutralized to prevent acinar damage. Similarly, the bile ducts need a ‘biliary HCO3 umbrella’ to keep toxic bile acids ionized and thereby membrane-impermeable, and the esophagus needs HCO3  secretion to protect the epithelial surface from acid reflux, and this is possibly mediated also by CFTR-dependent mechanisms. HCO3 is essential for the release and proper expansion of mucin molecules. CF patients and CFTR-deficient mice have impaired lipid absorption, which in mice has been experimentally linked with the duodenal HCO3 deficit. Thus the HCO3 secretory defect of cystic fibrosis patients is closely linked to many of the pathophysiological GI manifestations of CF.

Fluid and electrolyte secretion in the inflamed gut: novel targets for treatment of inflammation-induced diarrhea

Melanie G Gareau and Kim E Barrett
Current Opinion in Pharmacology 2013, 13:895–899
http://dx.doi.org/10.1016/j.coph.2013.08.014

Diarrheal disease can occur in the context of both inflammatory and infectious challenges. Inflammation can result in changes in ion transporter expression or simply mislocalization of the protein. In addition to development of diarrhea, an altered secretory state can lead to changes in mucus secretion and luminal pH. Bacterial infection can lead to subversion of host cell signaling, leading to transporter mislocalization and hyposecretion, promoting bacterial colonization. Novel therapeutic strategies are currently being developed to ameliorate transporter defects in the setting of inflammation or bacterial infection including, for example, administration of probiotics and fecal microbiota transplantation. This review will highlight recent findings in the literature detailing these aspects of ion transport in the inflamed gut.

Inflammatory diarrhea can occur in many different pathological conditions including IBD, comprising Crohn’s disease (CD) and ulcerative colitis (UC). The resulting inflammation triggers production of cytokines, including TNFα and IFNϒ, that can modulate ion transporters directly, including Na+K+ATPase and Na+H+ exchanger (NHE)-1 (SLC9A1), and decrease barrier function. Inflammation can activate several potential mechanisms that can underlie diarrheal symptoms via distinct pathways.

The presence of immune cells, such as T cells, results in the production of cytokines that can inhibit Na+ absorption, activate Cl secretion, and cause mucosal barrier dysfunction, resulting in diarrhea. In the IL-10 deficient mouse model of colitis, inflammation is characterized by T cells and macrophages, and high levels of pro-inflammatory cytokines, including TNFα. This was accompanied by dysfunctional NHE3 (SLC9A3) transport activity in the absence of overall changes in gene expression and protein localization. A decrease in expression of PDZ adaptor proteins (NHERF2 and PDZK1 scaffolding proteins), which modulate NHE3 activity by regulating transporter interactions and signal transduction, was also observed.

Ion transporters and their regulatory mechanisms represent potential therapeutic targets for the treatment of inflammatory diarrhea. Probiotics, live microorganisms provided in adequate amounts to confer a benefit on the host beyond their inherent nutrition, have been demonstrated to provide a beneficial effect in various GI diseases, including diarrhea. Acute administration of Lactobacillus acidophilus to Caco-2 cells in vitro and to mice in vivo increased DRA expression. Administration of Bifidobacterium breve, but not Lactobacillus rhamnosus or Eubacterium rectale, to HT29 cells down-regulated both Ca2+ (carbachol [CCh]) and cAMP (FSK) mediated Cl secretion. This effect by B. breve was not seen at the expense of monolayer integrity or tight junction dysfunction, occurred downstream of Ca2+ mobilization and was hypothesized to occur via CFTR based on the observation that a CFTR inhibitor could block the effects of CCh. In contrast, administration of the probiotic strain Enterococcus faecium was able to improve intestinal barrier function in piglets, as measured by mannitol flux rates, whereas prostaglandin E2-induced short circuit current was increased, suggesting an increased secretory state.

Differing degrees of susceptibility to infection with C. rodentium within different strains of mice have been well established and characterized; however the precise mechanisms involved are not well defined. A decrease in DRA was found in C3H and FVB mice, which succumb to C. rodentium infection, compared to resistant C57BL/6 mice. It was recently demonstrated that gavaging C3H mice with the colonic microbiota of C57BL/6 mice, following antibiotic administration, could transfer the protection against death following infection with C. rodentium in C3H mice. Survival was accompanied with restoration of DRA gene expression and other transporters that are known to be involved in protection from diarrhea. While this is extremely preliminary, fecal microbiota transplant may serve as an alternative in a subset of cases of infectious diarrhea, separate from the well-established data on C. difficile.

Phospholipids are increasingly being recognized for their signaling roles in addition to their traditional roles in cell structure. Lysophosphatidic acid (LPA) is a naturally occurring glycerophospholipid that can serve as a signaling molecule via binding to its G-protein coupled receptors LPA1, LPA2, and LPA3. In colonic Caco-2 cells, administration of LPA for 24 hours induced DRA expression via LPA2, increasing its Cl/HCO3exchange activity via a PI3 kinase pathway. The ability of LPA to increase ion transporter activity in the setting of inflammation or infection needs to be tested directly, but the findings at least potentially suggest that LPA may serve as a useful anti-diarrheal agent. Studies in bronchial epithelial cells suggest that LPA can also ameliorate lipopoly-saccharide-induced barrier dysfunction, suggesting a similar effect may be present in the intestinal tract. The ability of LPA to increase migration and proliferation of intestinal epithelial cells, however, would warrant some concerns with long-term administration and would need to be carefully assessed.

Intestinal ion transporters represent a valid physiological target for limiting inflammatory and infectious diarrhea. Their ability to regulate both water secretion and absorption allows bidirectional mechanisms to be exploited, creating a wide range of possible therapeutic targets.

Discovery and Development of Antisecretory Drugs for Treating Diarrheal Diseases

Jay R. Thiagarajah, Eun–A Ko, L Tradtrantip, M Donowitz, and A. S. Verkman
Clinical Gastroenterology and Hepatology 2014;12:204–209
http://dx.doi.org/10.1016/j.cgh.2013.12.001

Diarrheal diseases constitute a significant global health burden and are a major cause of childhood mortality and morbidity. Treatment of diarrheal disease has centered on the replacement of fluid and electrolyte losses using oral rehydration solutions. Although oral rehydration solutions have been highly successful, significant mortality and morbidity due to diarrheal disease remains. Secretory diarrheas, such as those caused by bacterial and viral enterotoxins, result from activation of cyclic nucleotide and/or Ca2+ signaling pathways in intestinal epithelial cells, enterocytes, which increase the permeability of Cl channels at the lumen-facing membrane. Additionally, there is often a parallel reduction in intestinal Na+ absorption. Inhibition of enterocyte Cl channels, including the cystic fibrosis transmembrane conductance regulator and Ca2-activated Cl channels, represents an attractive strategy for antisecretory drug therapy. High-throughput screening of synthetic small-molecule collections has identified several classes of Cl channel inhibitors that show efficacy in animal models of diarrhea but remain to be tested clinically. In addition, several natural product extracts with Cl channel inhibition activity have shown efficacy in diarrhea models. However, a number of challenges remain to translate the promising bench science into clinically useful therapeutics, including efficiently targeting orally administered drugs to enterocytes during diarrhea, funding development costs, and carrying out informative clinical trials. Nonetheless, Cl channel inhibitors may prove to be effective adjunctive therapy in a broad spectrum of clinical diarrheas, including acute infectious and drug-related diarrheas, short bowel syndrome, and congenital enteropathies.

Cl- channels as targets for therapy of secretory diarrheas

Cl- channels as targets for therapy of secretory diarrheas

Cl channels as targets for therapy of secretory diarrheas. This diagram of fluid secretory mechanism in enterocytes lining intestinal crypts and villi illustrates active Cl transport from the blood or submucosa to the intestinal lumen facilitated by luminal membrane CFTR and CaCC channels.

Natural products represent a potentially attractive source of antidiarrheal therapeutics, because they are generally inexpensive and have the potential for rapid translation to the clinic. In addition, there is a long history of anecdotal evidence of efficacy of various antidiarrheal remedies in many parts of the world.

A number of hurdles remain in the translation of antidiarrheal drug candidates to widely used therapy. Although a number of compounds have been advanced through preclinical testing in murine models, new high throughput model systems of enterocyte fluid secretion, such as human intestinal enteroids, or genetically tractable systems, such as zebrafish, warrant development to identify novel compounds and antidiarrheal drug targets. A major translational roadblock, however, is the difficulty in designing and funding informative clinical trials.

Barriers to diarrheal drug development in developing countries include the need for very low manufacture cost, high stability in hot and humid environments, and obtaining funding to support commercial development of new chemical entities with relatively low profit potential.

For drugs targeting the enterocyte extracellular surface, an additional challenge is convective washout in which secreted fluid in intestinal crypts washes away inhibitor drugs. A mathematical model of intestinal convection-diffusion concluded that in severe secretory diarrheas, such as cholera, the antisecretory efficacy of an orally administered, surface-targeted inhibitor requires high inhibitor affinity to its target (low nanomolar Kd) to obtain sufficiently high luminal inhibitor concentration (>100-fold Kd), and sustained high luminal inhibitor concentration or slow inhibitor dissociation. Washout is a significant concern for small-molecule CFTR glycine hydrazides, such as iOWH032, and potentially for several of the natural product agents.

Current and emerging therapies in irritable bowel syndrome: from pathophysiology to treatment

Joseph Y. Chang and Nicholas J. Talley
Trends in Pharmacological Sciences 31 (2010) 326–334
http://dx.doi.org:/10.1016/j.tips.2010.04.008

Irritable bowel syndrome is a common functional gastrointestinal disorder with characteristic symptoms of abdominal pain/discomfort with a concurrent disturbance in defecation. It accounts for a significant healthcare burden, and symptoms may be debilitating for some patients. Traditional symptom-based therapies have been found to be ineffective in the treatment of the entire syndrome complex, and do not modify the natural history of the disorder. Although the exact etiopathogenesis of IBS is incompletely understood, recent advances in the elucidation of the pathophysiology and molecular mechanisms of IBS have resulted in the development of novel therapies, as well as potential future therapeutic targets. This article reviews current and emerging therapies in IBS based upon: IBS as a serotonergic disorder; stimulating intestinal chloride channels; modulation of visceral hypersensitivity; altering low-grade intestinal inflammation; and modulation of the gut microbiota.

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by abdominal pain or discomfort that is associated with disturbances in defecation; bloating is common, and the symptoms are not estimates for North America being 10–15%. Only a minority seek care for their symptoms, but IBS has a dramatic impact on patients and utilization of healthcare resources. It is estimated that IBS accounts for 3.5 million physician visits annually in the USA, and is associated with annual direct costs of $1.6 billion and indirect costs of $19.2 billion; patients with IBS consistently report lower health-related quality of life (HRQOL).

Serotonin, or 5-hydroxytryptamine (5-HT), is a neurotransmitter which is largely stored in the enterochromaffin cells of the gut and plays a critical part in the motility, sensation, and secretion of the GI tract. There is growing evidence that a serotonergic mechanism may be involved in the pathophysiology of IBS. Some of the notable findings include: increased postprandial levels of circulating 5-HT in subjects with diarrhea-predominant IBS (D-IBS); D-IBS subjects were observed to have elevated platelet-depleted plasma 5-HT levels in fasting and fed states; the mucosal 5-Hydroxyindoleacetic acid (5-HIAA)/5-HT ratio was decreased in subjects with constipation-predominant IBS (C-IBS); and a lack of increase in plasma 5-HT levels after meal ingestion in those with C-IBS. These findings suggested that a subset of IBS may be a disorder centered on the serotonin disequilibrium, with 5-HT excess responsible for symptoms of D-IBS and insufficient release of 5-HT in the circulation being responsible for the features of C-IBS. However, not all studies support this disease model.

Given the possible role of serotonin in IBS, several 5-HT receptor-modulating agents have been developed as disease-specific therapeutic agents. The 5-HT3 antagonist alosetron has been shown in multiple randomized clinical trials as well as meta-analyses to be an effective agent in the treatment of D-IBS with improvements in global IBS symptoms, relief of abdominal pain, improvement of the consistency and frequency of bowel movements, and reduced fecal urgency. Furthermore, alosetron has been reported to inhibit intestinal secretion, delay colonic transit time, increase colonic compliance in response to distention, and have central effects that result in its beneficial effects on sensation in IBS.

Current and emerging therapies in irritable bowel syndrome

Serotonergic mechanisms·       Alosetron

·       Tegaserod

·       Prucalopride

Chloride channelsActivators

·       Lubiprostone

·       Linaclotide

Inhibitors

·       Crofelemer

Visceral hypersensitivityTricyclic antidepressants (TCAs)

·       Selective serotonin reuptake inhibitors (SSRIs)

·       ϒ-Aminobutyric acid analog (pregabalin)

K-opioid receptor agonists

·       Asimadoline

Corticotropin-releasing factor (CRF) receptor antag

Modulation of immune activation and inflammation·       5-aminosalicylic acid

·       Corticosteroids ?

Modulating intestinal floraProbiotics

·       Bifidobacteria

Prebiotics

Antibiotics

·       Rifaximin

Fiber supplementation·       Psyllium
Antispasmodics·       Hyoscine

·       Cimetropium

·       Pinaverium

·       Peppermint oil

Alternative therapiesDietary factors and modification

·       Food elimination diet (based on IgG antibodies)

·       Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet

·       Gluten-free diet

Agonists to 5-HT4 receptors have been found to be effective in the treatment of C-IBS. 5-HT4 receptor agonists accelerate intestinal transit in the small intestine and colon. Tegaserod is an aminoguanidine indole and selective partial agonist of the 5-HT4 receptor that has been shown to provide improvements in global IBS symptoms and improve constipation in female C-IBS patients. Reports have supported the efficacy of tegaserod in CIBS in terms of global symptom improvement as well as improvement of constipation.

The GI tract contains numerous chloride channels that have an integral role in the transport and secretion of fluids. Type-2 chloride channels (ClC-2) have been investigated with respect to their role in C-IBS and constipation. The ClC-2 channel is an a-helical transmembrane protein located on the apical cell membrane of the intestines, is highly selective for chloride ions, and is involved in the transport and secretion of fluids as well as maintaining cellular membrane potential.  Activation of ClC-2 channels through second messenger induced phosphorylation causes an efflux of chloride ions into the lumen of the GI tract, which results in a subsequent efflux of sodium ions due to isoelectric balance. It is the efflux of sodium that results in the efflux of water into the lumen due to the maintenance of isotonic neutrality through the paracellular pathway. This resulting increase in intestinal secretion and fluid volume has been of interest in the development of chloride channel-directed therapies for C-IBS and constipation.

TCAs and SSRIs have been of interest in the treatment of IBS for their modulation of hyperalgesia and not for their psychotropic effects. TCAs have been demonstrated to be effective in the treatment of neuropathic pain, whereas SSRIs have been suggested to enhance the effectiveness of endogenous pain inhibition systems, and both have been effective the in treatment of various chronic pain disorders. Despite the analgesic effects of these agents, some authors have cited the lack of evidence based on well designed large clinical trials of these agents in IBS as reason for caution.

Gammaa Aminobutyric acid (GABA) analog: pregabalin

Pregabalin is a novel second-generation α2δ ligand that is structurally related to ϒ-aminobutyric acid (GABA). It has been shown to be effective in the treatment of inflammatory and neuropathic pain. Its precise mechanism of action is incompletely understood because it does not appear to have GABA-related functional activity or metabolites; it is believed to decrease depolarization-induced calcium influx at nerve terminals, and thereby inhibit release of excitatory neurotransmitters by acting on the α2δ auxiliary proteins associated with voltage-gated calcium channels. Its potential role in IBS is based upon a recent study demonstrating normalization of rectal distension sensory thresholds in IBS patients with rectal hypersensitivity. Placebo-controlled trials of pregabalin for IBS are currently ongoing.

Potential advances in the visceral modulation of IBS have been seen through studies of the role of opiate receptors in visceral pain. Specifically, peripheral K-opioid receptor agonists are of great interest because they are involved in the inhibition of noxious stimuli from the gut and are devoid of many of the adverse side effects (e.g. constipation, opioid dependence) seen in other opioid agonists that bind to µ receptors; K receptors are found most abundantly in the stomach and colon and in the brain. Asimadoline, a novel selective K-opioid receptor agonist, may be promising in the treatment of IBS. Its low blood–brain barrier permeability and low distribution in the central nervous system (CNS) suggest that its analgesic effects are mediated by reduction of excitability of nociceptors on peripheral nerve endings. Human pharmacodynamics studies of asimadoline demonstrated attenuation of visceral sensation without affecting gut motor function, a decrease in satiation and postprandial fullness independent of effects on gastric volume, and attenuation of pain intensity to colonic distension in IBS subjects. These findings led to the investigation of the possible role of asimadoline in IBS.

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The Challenge of Antimicrobial Resistance

Writer and Curator: Larry H. Bernstein, MD, FCAP

 

Antibiotic resistance has become a major challenge of our time.  Common microorganisms that inhabit the skin, mouth and nares, and fecal organisms are transmitted in the hospital setting. Handwashing procedures have had limited benefit. Operating rooms are ventilated and environmentally engineered to minimize transmission intraoperatively. The patient may be immune-compromized. The organisms that are encountered have genetically adapted to the most effective antibiotics at our disposal. even with some risk of secondary toxicity in some cases.

What is Drug Resistance?

Antimicrobial resistance is the ability of microbes, such as bacteria, viruses,
parasites, or fungi, to grow in the presence of a chemical (drug) that would
normally kill it or limit its growth.

Diagram showing the difference between non-resistant bacteria and drug
resistant bacteria.

Drug Resistance difference between non-resistant bacteria and drug resistant bacteria

Drug Resistance difference between non-resistant bacteria and drug resistant bacteria

Credit: NIAID

http://www.niaid.nih.gov/SiteCollectionImages/topics/
antimicrobialresistance/1whatIsDrugResistance.gif

Diagram showing the difference between non-resistant bacteria and drug
resistant bacteria. Non-resistant bacteria multiply, and upon drug treatment,
the bacteria die. Drug resistant bacteria multiply as well, but upon drug
treatment, the bacteria continue to spread.

Many infectious diseases are increasingly difficult to treat because of
antimicrobial-resistant organisms, including HIV infection, staphylococcal
infection, tuberculosis, influenza, gonorrhea, candida infection, and malaria.

Between 5 and 10 percent of all hospital patients develop an infection. About
90,000 of these patients die each year as a result of their infection, up from
13,300 patient deaths in 1992.

According to the Centers for Disease Control and Prevention (April 2011),
antibiotic resistance in the United States costs an estimated $20 billion a year
in excess health care costs, $35 million in other societal costs and more than 8
million additional days that people spend in the hospital.

World Health Organization – 2014 Report
WHO/HSE/PED/AIP/2014.2
http://www.who.int.org/

Antimicrobial resistance (AMR) is an increasingly serious threat to
global public health. AMR develops when a microorganism (bacteria,
fungus, virus or parasite) no longer responds to a drug to which it
was originally sensitive. This means that standard treatments no
longer work; infections are harder or impossible to control; the risk
of the spread of infection to others is increased; illness and hospital
stays are prolonged, with added economic and social costs; and the
risk of death is greater—in some cases, twice that of patients who
have infections caused by non-resistant bacteria. The problem is so
serious that it threatens the achievements of modern medicine. A
post-antibiotic era—in which common infections and minor
injuries can kill—is a very real possibility for the 21st century.

WHO is developing a global action plan for AMR that
will include:
• development of tools and standards for harmonized
surveillance of ABR in humans, and for integrated
surveillance in food-producing animals and the
food chain;
• elaboration of strategies for population-based
surveillance of AMR and its health and economic
impact; and
• collaboration between AMR surveillance networks
and centres to create or strengthen coordinated
regional and global surveillance.
AMR is a global health security threat that requires
action across government sectors and society as a
whole. Surveillance that generates reliable data is the
essential foundation of global strategies and public
health actions to contain AMR.

Resistance to Antibiotics: Are We in the Post-Antibiotic Era?
Alfonso J. Alanis
Archives of Medical Research 36 (2005) 697–705
http://dx.doi.org:/10.1016/j.arcmed.2005.06.009

Serious infections caused by bacteria that have become resistant
to commonly used antibiotics have become a major global healthcare
problem in the 21st century. They not only are more severe and
require longer and more complex treatments, but they are also
significantly more expensive to diagnose and to treat. Antibiotic
resistance, initially a problem of the hospital setting associated
with an increased number of hospital acquired infections usually
in critically ill and immunosuppressed patients, has now extended
into the community causing severe infections difficult to diagnose
and treat. The molecular mechanisms by which bacteria have
become resistant to antibiotics are diverse and complex. Bacteria
have developed resistance to all different classes of antibiotics
discovered to date. The most frequent type of resistance is
acquired and transmitted horizontally via the conjugation
of a plasmid. In recent times new mechanisms of resistance
have resulted in the simultaneous development of resistance
to several antibiotic classes creating very dangerous multidrug
-resistant (MDR) bacterial strains, some also known as
‘‘superbugs’’. The indiscriminate and inappropriate use of
antibiotics in outpatient clinics, hospitalized patients and
in the food industry is the single largest factor leading to
antibiotic resistance. In recent years, the number of new
antibiotics licensed for human use in different parts of the
world has been lower than in the recent past. In addition,
there has been less innovation in the field of antimicrobial
discovery research and development. The pharmaceutical
industry, large academic institutions or the government are
not investing the necessary resources to produce the next
generation of newer safe and effective antimicrobial drugs.
In many cases, large pharmaceutical companies have terminated
their anti-infective research programs altogether due to economic
reasons. The potential negative consequences of all these events
are relevant because they put society at risk for the spread of
potentially serious MDR bacterial infections.

Structural and biological studies on bacterial nitric oxide synthase
inhibitors
JK Holden,  H Li, Q Jing, S Kang, J Richo, RB Silverman, TL Poulos

Significance: Nitric oxide (NO) produced by bacterial nitric oxide
synthase has recently been shown to protect the Gram-positive
pathogens Bacillus anthracis and Staphylococcus aureus from
antibiotics and oxidative stress. Using Bacillus subtilis as a model
system, we identified two NOS inhibitors that work in conjunction
with an antibiotic to kill B. subtilis. Moreover, comparison of inhibitor-bound crystal structures between the bacterial NOS and mammalian
NOS revealed an unprecedented mode of binding to the bacterial NOS
that can be further exploited for future structure-based drug design.
Overall, this work is an important advance in developing inhibitors
against gram-positive pathogens.

Summary: Nitric oxide (NO) produced by bacterial NOS functions as a
cytoprotective agent against oxidative stress in Staphylococcus aureus,
Bacillus anthracis, and Bacillus subtilis. The screening of several NOS-selective inhibitors uncovered two inhibitors with potential antimicrobial
properties. These two compounds impede the growth of B. subtilis under
oxidative stress, and crystal structures show that each compound exhibits
a unique binding mode. Both compounds serve as excellent leads for the
future development of antimicrobials against bacterial NOS-containing
bacteria.  http://dx.doi.org/10.1073/pnas.1314080110

Speciation of clinically significant coagulase negative Staphylococci
and their antibiotic resistant patterns in a tertiary care hospital
PR Vysakh, S Kandasamy and RM Prabhavathi
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 704-709
http://www.ijcmas.com

Human skin and mucus membrane has Coagulase Negative Staphylococci
(CoNS) as the indigenous flora. CoNS had become an important agent for
nosocomial infections accounting for about 9%. These infections are
difficult to treat because of the risk factors and the multiple drug resistance
nature of these organisms. The study was undertaken to identify the
prevalence of clinical isolates of CoNS, their speciation and to determine
the antibiotic sensitivity/resistant patterns of CoNS. A total of 490 isolates
were collected from different samples and subjected to biochemical
characterization and antimicrobial screening using conventional
microbiological methods. 165 isolates were identified as CoNS. 23% of
CoNS were isolated from blood, 30% from post-operative wound infections,
23% from pus, 18% from urine, 3% from body fluids (CSF, ascitic fluid etc)
and 3% from CVP tips. The antibiotic sensitivity revealed 81% resistance
to Penicillin,32% resistance to Cefoxitin, 27% resistance to Cefazolin,
55% resistance to Erythromycin, 22% to Clindamycin and 35% to
Cotrimoxazole and with no resistance to Vancomycin, Linezolid and
Ciprofloxacin. The increased recognition of CoNS and emergence of
drug resistance among them demonstrates the need to consider them
as a potent pathogen and to devise laboratory procedure to identify
and to determine the prevalence and antibiotic resistant patterns of CoNS.

Resistance to rifampicin: a review
Beth P Goldstein
The Journal of Antibiotics (2014) 67, 625–630
http:://dx.doi.org:/10.1038/ja.2014.107

Resistance to rifampicin (RIF) is a broad subject covering not just the
mechanism of clinical resistance, nearly always due to a genetic change
in the b subunit of bacterial RNA polymerase (RNAP), but also how
studies of resistant polymerases have helped us understand the structure
of the enzyme, the intricacies of the transcription process and its role
in complex physiological pathways. This review can only scratch the
surface of these phenomena. The identification, in strains of
Escherichia coli, of the positions within b of the mutations determining
resistance is discussed in some detail, as are mutations in organisms
that are therapeutic targets of RIF, in particular Mycobacterium
tuberculosis. Interestingly, changes in the same three codons of
the consensus sequence occur repeatedly in unrelated RIF-resistant
(RIFr) clinical isolates of several different single mutation
predominates in mycobacteria. The utilization of our knowledge of
these mutations to develop rapid screening tests for detecting resistance
is briefly discussed. Cross-resistance among rifamycins has been a topic
of controversy; current thinking is that there is no difference in the
susceptibility of RNAP mutants to RIF, rifapentine and rifabutin.
Also summarized are intrinsic RIF resistance and other resistance
mechanisms.

Multi-drug resistance, inappropriate initial antibiotic therapy and
mortality in Gram negative severe sepsis and septic shock: A
retrospective cohort study
MD Zilberberg, AF Shorr, ST Micek, C Vazquez-Guillamet, MH Kollef
Critical Care 2014, 18:596 http://dx.doi.org:/10.1186/s13054-014-0596-8
http://ccforum.com/content/18/6/596

Introduction
The impact of in vitro resistance on initially appropriate antibiotic therapy
(IAAT) remains unclear. We elucidated the relationship between non-IAAT
and mortality, and between IAAT and multi-drug resistance (MDR) in
sepsis due to Gram-negative bacteremia (GNS).
Methods
We conducted a single-center retrospective cohort study of adult intensive
care unit patients with bacteremia and severe sepsis/septic shock caused by
a gram-negative (GN) organism. We identified the following MDR pathogens:
MDR P. aeruginosa, extended spectrum beta lactamase and carbapenemase-
producing organisms. IAAT was defined as exposure within 24 hours of
infection onset to antibiotics active against identified pathogens based on
in vitro susceptibility testing. We derived logistic regression models to
examine a) predictors of hospital mortality and b) impact of MDR on
non-IAAT. Proportions are presented for categorical variables, and
median values with interquartile ranges (IQR) for continuous
variables.

Results
Out of 1,064 patients with GNS, 351 (29.2%) did not survive
hospitalization. Non-survivors were older (66.5 (55, 73.5)
versus 63 (53, 72) years, P =0.036), sicker (Acute Physiology and
Chronic Health Evaluation II (19 (15, 25) versus 16 (12, 19),
P <0.001), and more likely to be on pressors (odds ratio (OR) 2.79,
95% confidence interval (CI) 2.12 to 3.68), mechanically ventilated
(OR 3.06, 95% CI 2.29 to 4.10) have MDR (10.0% versus 4.0%,
P <0.001) and receive non-IAAT (43.4% versus 14.6%, P <0.001).
In a logistic regression model, non-IAAT was an independent
predictor of hospital mortality (adjusted OR 3.87, 95% CI 2.77 to
5.41). In a separate model, MDR was strongly associated with
the receipt of non-IAAT (adjusted OR 13.05, 95% CI 7.00 to 24.31).
Conclusions
MDR, an important determinant of non-IAAT, is associated with
a three-fold increase in the risk of hospital mortality. Given the
paucity of therapies to cover GN MDRs, prevention and
development of new agents are critical.

Phenotypic and molecular characteristics of methicillin-resistant
Staphylococcus aureus isolates from Ekiti State, Nigeria
OA Olowe, OO Kukoyi, SS Taiwo, O Ojurongbe, OO Opaleye, et al.
Infection and Drug Resistance 2013:6 87–92
http://dx.doi.org/10.2147/IDR.S48809

Introduction: The characteristics and antimicrobial resistance profiles
of Staphylococcus aureus differs according to geographical regions and
in relation to antibiotic usage. The aim of this study was to determine
the biochemical characteristics of the prevalent S. aureus from Ekiti State,
Nigeria, and to evaluate three commonly used disk diffusion methods
(cefoxitin, oxacillin, and methicillin) for the detection of methicillin
resistance in comparison with mecA gene detection by polymerase chain
reaction.
Materials and methods: A total of 208 isolates of S. aureus recovered
from clinical specimens were included in this study. Standard
microbiological procedures were employed in isolating the strains.
Susceptibility of each isolate to methicillin (5 μg), oxacillin (1 μg),
and cefoxitin (30 μg) was carried out using the modified Kirby–Bauer/
Clinical and Laboratory Standard Institute disk diffusion technique.
They were also tested against panels of antibiotics including vancomycin.
The conventional polymerase chain reaction method was used to detect
the presence of the mecA gene.
Results: Phenotypic resistance to methicillin, oxacillin, and cefoxitin
were 32.7%, 40.3%, and 46.5%, respectively. The mecA gene was detected
in 40 isolates, giving a methicillin-resistant S. aureus (MRSA) prevalence
of 19.2%. The S. aureus isolates were resistant to penicillin (82.7%) and
tetracycline (65.4%), but largely susceptible to erythromycin (78.8%
sensitive), pefloxacin (82.7%), and gentamicin (88.5%). When compared
to the mecA gene as the gold standard for MRSA detection, methicillin,
oxacillin, and cefoxitin gave sensitivity rates of 70%, 80%, and 100%,
and specificity rates of 76.2%, 69.1%, and 78.5% respectively.
Conclusion: When compared with previous studies employing mecA
polymerase chain reaction for MRSA detection, the prevalence of 19.2%
reported in Ekiti State, Nigeria in this study is an indication of gradual rise
in the prevalence of MRSA in Nigeria. A cefoxitin (30 μg) disk diffusion test
is recommended above methicillin and oxacillin for the phenotypic detection
of MRSA in clinical laboratories.

Direct sequencing for rapid detection of multidrug resistant Mycobacterium
tuberculosis strains in Morocco
F Zakham, I Chaoui, AH Echchaoui, F Chetioui, M Driss Elmessaoudi, et al.
Infection and Drug Resistance 2013:6 207–213
http://dx.doi.org/10.2147/IDR.S47724

Background: Tuberculosis (TB) is a major public health problem with high
mortality and morbidity rates, especially in low-income countries.
Disturbingly, the emergence of multidrug resistant (MDR) and extensively
drug resistant (XDR) TB cases has worsened the situation, raising concerns
of a future epidemic of virtually untreatable TB. Indeed, the rapid diagnosis
of MDR TB is a critical issue for TB management. This study is an attempt to
establish a rapid diagnosis of MDR TB by sequencing the target fragments of
the rpoB gene which linked to resistance against rifampicin and the katG gene
and inhA promoter region, which are associated with resistance to isoniazid.
Methods: For this purpose, 133 sputum samples of TB patients from Morocco
were enrolled in this study. One hundred samples were collected from new
cases, and the remaining 33 were from previously treated patients (drug
relapse or failure, chronic cases) and did not respond to anti-TB drugs after
a sufficient duration of treatment. All samples were subjected to rpoB, katG
and pinhA mutation analysis by polymerase chain reaction and DNA sequencing.
Results: Molecular analysis showed that seven strains were isoniazid-
monoresistant and 17 were rifampicin-monoresistant. MDR TB strains were
identified in nine cases (6.8%). Among them, eight were traditionally
diagnosed as critical cases, comprising four chronic and four drug-relapse
cases. The last strain was isolated from a new case. The most recorded
mutation in the rpoB gene was the substitution TCG . TTG at codon 531
(Ser531 Leu), accounting for 46.15%. Significantly, the only mutation found
in the katG gene was at codon 315 (AGC to ACC) with a Ser315Thr amino acid
change. Only one sample harbored mutation in the inhA promoter region
and was a point mutation at the −15p position (C . T). Conclusion: The
polymerase chain reaction sequencing approach is an accurate and rapid
method for detection of drug-resistant TB in clinical specimens, and could
be of great interest in the management of TB in critical cases to adjust the
treatment regimen and limit the emergence of MDR and XDR strains.

Limiting and controlling carbapenem-resistant Klebsiella pneumoniae
L Saidel-Odes, A Borer.
Infection and Drug Resistance 2014:7 9–14
http://dx.doi.org/10.2147/IDR.S44358

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to
almost all antimicrobial agents, is associated with substantial morbidity
and mortality, and poses a serious threat to public health. The ongoing
worldwide spread of this pathogen emphasizes the need for immediate
intervention. This article reviews the global spread and risk factors for
CRKP colonization/infection, and provides an overview of the strategy
to combat CRKP dissemination.

Staphylococcus aureus – antimicrobial resistance and the immuno-
compromised child
J Chase McNeil
Infection and Drug Resistance 2014:7 117–127
http://dx.doi.org/10.2147/IDR.S39639

Children with immunocompromising conditions represent a unique
group for the acquisition of antimicrobial resistant infections due to
their frequent encounters with the health care system, need for empiric
antimicrobials, and immune dysfunction. These infections are further
complicated in that there is a relative paucity of literature on the clinical
features and management of Staphylococcus aureus infections in
immunocompromised children. The available literature on the clinical
features, antimicrobial susceptibility, and management of S. aureus
infections in immunocompromised children is reviewed. S. aureus
infections in children with human immunodeficiency virus (HIV) are
associated with higher HIV viral loads and a greater degree of CD4 T-cell
suppression. In addition, staphylococcal infections in children with HIV
often exhibit a multidrug resistant phenotype. Children with cancer have
a high rate of S. aureus bacteremia and associated complications. Increased
tolerance to antiseptics among staphylococcal isolates from pediatric
oncology patients is an emerging area of research. The incidence of S. aureus
infections among pediatric solid organ transplant recipients varies
considerably by the organ transplanted; in general however, staphylococci
figure prominently among infections in the early post-transplant period.
Staphylococcal infections are also prominent pathogens among children
with a number of immunodeficiencies, notably chronic granulomatous
disease. Significant gaps in knowledge exist regarding the epidemiology
and management of S. aureus infection in these vulnerable children.

selected Staphylococcus aureus mechanisms for immune evasion.

selected Staphylococcus aureus mechanisms for immune evasion.

Figure 1 A schematic depiction of selected Staphylococcus aureus
mechanisms for immune evasion.
Notes: Cna interacts with C1q preventing formation of the C1qrs complex.
ClfA and SdrE each promote Factor I mediated conversion of C3b to iC3b.
Protein A is depicted binding to the Fc region of IgG preventing immunoglobulin
opsonization.
Abbreviations: ClfA, staphylococcal clumping factor A; Cna, collagen adhesin;
IgG, immunoglobulin G; PVL, Panton–Valentine leukocidin; SdrE, S. aureus
surface protein.

The Future of Antibiotics and Resistance
B Spellberg, JG Bartlett, and DN Gilbert
N Engl J Med Jan 24, 2013; 368(4): 299-302
http://dx.doi.org:/ 10.1056/NEJMp1215093

In its recent annual report on global risks, the World Economic
Forum (WEF) concluded that “arguably the greatest
risk . . . to human health comes in the form of antibiotic-resistant
bacteria. We live in a bacterial world where we will never be able
to stay ahead of the mutation curve. A test of our resilience is
how far behind the curve we allow ourselves to fall.”

The WEF report underscores the facts that antibiotic resistance
and the collapse of the antibiotic research and-development
pipeline continue to worsen despite our ongoing efforts on
current fronts. If we’re to develop countermeasures that
have lasting effects, new ideas that complement traditional
approaches will be needed.

Resistance is primarily the result of bacterial adaptation to eons
of antibiotic exposure. What are the fundamental implications of
this reality? First, in addition to antibiotics’ curative power, their
use naturally selects for preexisting resistant populations of bacteria
in nature. Second, it is not just “inappropriate” antibiotic use
that selects for resistance. Rather, the speed with which resistance
spreads is driven by microbial exposure to all antibiotics, whether
appropriately prescribed or not. Thus, even if all inappropriate
antibiotic use were eliminated, antibiotic-resistant infections
would still occur (albeit at lower frequency). Third, after billions
of years of evolution, microbes have most likely invented
antibiotics against every biochemical target that can be attacked
— and, of necessity, developed resistance mechanisms
to protect all those biochemical targets.

Remarkably, resistance was found even to synthetic antibiotics
that did not exist on earth until the 20th century. These results
underscore a critical reality: antibiotic resistance already exists,
widely disseminated in nature, to drugs we have not yet invented.

Table **

Interventions to Address the Antibiotic-Resistance Crisis.*

Intervention Status                                                   Preventing infection
and resistance

“Self-cleaning” hospital rooms;                                Some commercially available
automated disinfectant application                         but require clinical validation;
through misting, vapor, radiation, etc.                    more needed

Novel drug-delivery systems to replace                  Basic science and
IV catheters; regenerative-tissue technology        conceptual stages
to replace prosthetics; superior, noninvasive
ventilation strategies

Improvement of population health and                 Implementation
health care systems to reduce admissions             research stage
to hospitals and skilled nursing facilities

Niche vaccines to prevent resistant                        Basic and clinical
bacterial infections                                                    development stage

Refilling antibiotic pipeline by aligning
economic and regulatory approaches

Models in place, expansion needed in number    Government or nonprofit grants
and scope; new nonprofit corporations                 and contracts to defray R&D costs
needed                                                                          and establish nonprofits
to develop antibiotics

Institution of novel approval pathways                 Proposed, legislative
(e.g., Limited Population Antibiotic                        and regulatory
Drug proposal)                                                            action needed

Preserving available antibiotics,
slowing resistance

Public reporting of antibiotic-use data as a         Policy action needed to
basis for benchmarking and reimbursement      develop and implement

Development of and reimbursement for            Basic and applied research
rapid diagnostic and biomarker tests to              and policy action and
enable appropriate use of antibiotics                   policy action needed

Elimination of use of antibiotics to                       Legislation proposed
promote livestock growth

New waste-treatment strategies;                       One strategy approaching
targeted chemical or biologic                              clinical trials
degradation of antibiotics in waste

Studies to define shortest effective                    Some trials completed
courses of antibiotics for infections

Developing microbe-attacking                            Preclinical, proof-of-
treatments with diminished                                principle stage
potential to drive resistance

Immune-based therapies, such
as infusion of monoclonal antibodies
and white cells that kill microbes

Antibiotics or biologic agents that
don’t kill bacteria but alter their ability
to trigger inflammation or cause disease

Developing treatments attacking host             Preclinical, proof-of-principle stage
targets rather than microbial targets to
avoid selective pressure driving resistance

Direct moderation of host inflammation
in response to infection (e.g., cytokine
agonists or antagonists, PAMP receptor
agonists)

Sequestration of host nutrients to
prevent microbial access to nutrients

Probiotics that compete with microbial
growth

* IV denotes intravenous, PAMP pathogen-associated molecular
pattern, and R&D research and development

Antibiotic-Resistant Bugs Appear to Use Universal Ribosome-Stalling Mechanism

GEN News  Jan 26, 2015
http://www.genengnews.com/gen-news-highlights/antibiotic-resistant-bugs-
appear-to-use-universal-ribosome-stalling-mechanism/81250847/

Researchers at St. Louis University say they have discovered new information
about how antibiotics like azithromycin stop staph infections, and why staph
sometimes becomes resistant to drugs. The team, led by Mee-Ngan F. Yap, Ph.D.,
believe their evidence suggests a universal, evolutionary mechanism by which
the bacteria elude this kind of drug, offering scientists a way to improve the
effectiveness of antibiotics to which bacteria have become resistant.  Their
study (“Sequence selectivity of macrolide-induced translational attenuation”)
was published in PNAS.

Staphylococcus aureus  is a strain of bacteria that frequently has become
resistant to antibiotics, a development that has been challenging for doctors
and dangerous for patients with severe infections. Dr. Yap and her research
team studied staph that had been treated with the antibiotic azithromycin and
learned two things: One, it turns out that the antibiotic isn’t as effective as was
previously thought. And two, the process that the bacteria use to evade the
antibiotic appears to be an evolutionary mechanism that the bacteria developed
in order to delay genetic replication when beneficial.

Genomic epidemiology of a protracted hospital outbreak caused by multidrug-
resistant Acinetobacter baumannii in Birmingham, England
MR Halachev, J Z-M Chan, CI Constantinidou, N Cumley, C Bradley, et al.
Genome Medicine 2014, 6:70 http://genomemedicine.com/content/6/11/70

Background: Multidrug-resistant Acinetobacter baumannii commonly causes
hospital outbreaks. However, within an outbreak, it can be difficult to identify
the routes of cross-infection rapidly and accurately enough to inform infection
control. Here, we describe a protracted hospital outbreak of multidrug-resistant
A. baumannii, in which whole-genome sequencing (WGS) was used to obtain
a high-resolution view of the relationships between isolates.
Methods: To delineate and investigate the outbreak, we attempted to genome-
sequence 114 isolates that had been assigned to the A. baumannii complex
by the Vitek2 system and obtained informative draft genome sequences from
102 of them. Genomes were mapped against an outbreak reference sequence
to identify single nucleotide variants (SNVs).
Results: We found that the pulsotype 27 outbreak strain was distinct from all
other genome-sequenced strains. Seventy-four isolates from 49 patients
could be assigned to the pulsotype 27 outbreak on the basis of genomic
similarity, while WGS allowed 18 isolates to be ruled out of the outbreak.
Among the pulsotype 27 outbreak isolates, we identified 31 SNVs and seven
major genotypic clusters. In two patients, we documented within-host diversity,
including mixtures of unrelated strains and within-strain clouds of SNV diversity.
By combining WGS and epidemiological data, we reconstructed potential
transmission events that linked all but 10 of the patients and confirmed links
between clinical and environmental isolates. Identification of a contaminated
bed and a burns theatre as sources of transmission led to enhanced
environmental decontamination procedures.
Conclusions: WGS is now poised to make an impact on hospital infection
prevention and control, delivering cost-effective identification of routes of
infection within a clinically relevant timeframe and allowing infection control
teams to track, and even prevent, the spread of drug-resistant hospital pathogens.

Discovery of β-lactam-resistant variants in diverse pneumococcal populations
Regine Hakenbeck
Genome Medicine 2014, 6:72  http://genomemedicine.com/content/6/9/72

Understanding of antibiotic resistance in Streptococcus pneumoniae has been
hindered by the low frequency of recombination events in bacteria and thus the
presence of large linked haplotype blocks, which preclude identification of
causative variants. A recent study combining a large number of genomes of
resistant phenotypes has given an insight into the evolving resistance to
β-lactams, providing the first large-scale identification of candidate variants
underlying resistance.

Additional sources:

A Simple Method for Assessment of MDR Bacteria for Over-Expressed
Efflux Pumps
M Martins, MP McCusker, M Viveiros, I Couto, S Fanning, .., L Amaral
The Open Microbiology Journal, 2013, 7, 1-5

Identification of Efflux Pump-mediated Multidrug-resistant
Bacteria by the Ethidium Bromide-agar Cartwheel Method
M MARTINS, M VIVEIROS, I COUTO,, SS COSTA, .., L AMARAL
in vivo 25: 171-178 (2011)

Efflux Pumps that Bestow Multi-Drug Resistance of Pathogenic
Gram negative Bacteria
Amaral L, Spengler G, Martins A and Molnar J
Biochem Pharmacol 2013; 2(3):119
http://dx.doi.org/10.4172/2167-0501.1000119

graphical abstract

graphical abstract

An Instrument-free Method for the Demonstration
of Efflux Pump Activity of Bacteria
M MARTINS, B SANTOS, A MARTINS, M VIVEIROS, I COUTO,
A CRUZ, THE MANAGEMENT COMMITTEE MEMBERS
OF COST B16 OF THE EUROPEAN COMMISSION/
EUROPEAN SCIENCE FOUNDATION,…, J MOLNAR, S FANNING
and LEONARD AMARAL
in vivo 20: 657-664 (2006)

Potential Therapy of Multidrug-resistant and Extremely
Drug-resistant Tuberculosis with Thioridazine
LEONARD AMARAL and JOSEPH MOLNAR
in vivo 26: 231-236 (2012)

Inhibitors of efflux pumps of Gram-negative bacteria
inhibit Quorum Sensing
Leonard Amaral, Joseph Molnar
Open Journal of Pharmacology, 2012, 2-2

An Overview of Clinical Microbiology, Classification,
and Antimicrobial Resistance
Larry H. Bernstein
http://pharmaceuticalintelligence.com/2015/01/17/an-overview-
of-clinical-microbiology-classification-and-antimicrobial-resistance/

New protein detonates bacteria from within

By Tim Sandle     in Science

Tel Aviv – By sequencing the DNA of bacteria resistant to viral toxins, scientists have identified novel proteins capable of stymieing growth in pathogenic, antibiotic-resistant bacteria.

Today’s arsenal of antibiotics is ineffective against some emerging strains of antibiotic-resistant pathogens. Novel inhibitors of bacterial growth therefore need to be found. One way is looking into the viruses that infect bacteria.

Key to the new initiative is the concept of fighting bacteria from within, rather than using an external chemical to batter through the bacterial cell wall. the basis of the new weapon is viral. In order to select an appropriate viral protein, researchers undertook a comprehensive screening exercise in order to identify proteins in viruses that are known to infect bacteria (bacteriophages). Bacteriophages occur abundantly in the biosphere, with different virions, genomes and lifestyles. The review was so comprehensive that it took almost three years to complete.

The screening was achieved through the use of high-throughput DNA sequencing. This is the process of determining the precise order of nucleotides within a DNA molecule. By using this advanced genetic method, the scientists identified mutations in bacterial genes that resisted the toxicity of growth inhibitors produced by bacterial viruses. Through this, a new, tiny protein was found. The protein is termed “growth inhibitor gene product (Gp) 0.6”.

Later testing found that the protein specifically targets and inhibits the activity of a protein essential to bacterial cells. The bacterial protein affected has the function of holding the microbe’s cell wall together. Without this protein functioning correctly, the cell bursts open from within and the bacterium dies.

For the next wave of research, the Israeli science group are looking further at bacterial viruses with the aim of finding compounds that facilitate improved treatment of antibiotic-resistant bacteria.
Read more: http://www.digitaljournal.com/science/new-protein-detonates-bacteria-from-within/article/424747#ixzz3QJN0uo1d

Revealing bacterial targets of growth inhibitors encoded by bacteriophage T7

Shahar Molshanski-Mora, Ido Yosefa, Ruth Kiroa, Rotem Edgara, Miriam Manora, Michael Gershovitsb, Mia Lasersonb, Tal Pupkob, and Udi Qimrona,1

Author Affiliations

Edited* by Sankar Adhya, National Institutes of Health, National Cancer Institute, Bethesda, MD, and approved November 24, 2014 (received for review July 13, 2014)

Significance

Antibiotic resistance of pathogens is a growing threat to human health, requiring immediate action. Identifying new gene products of bacterial viruses and their bacterial targets may provide potent tools for fighting antibiotic-resistant strains. We show that a significant number of phage proteins are inhibitory to their bacterial host. DNA sequencing was used to map the targets of these proteins. One particular target was a key cytoskeleton protein whose function is impaired following the phage protein’s expression, resulting in bacterial death. Strikingly, in over 70 y of extensive research into the tested bacteriophage, this inhibition had never been characterized. We believe that the presented approach may be broadened to identify novel, clinically relevant bacteriophage growth inhibitors and to characterize their targets.

Abstract

Today’s arsenal of antibiotics is ineffective against some emerging strains of antibiotic-resistant pathogens. Novel inhibitors of bacterial growth therefore need to be found. The target of such bacterial-growth inhibitors must be identified, and one way to achieve this is by locating mutations that suppress their inhibitory effect. Here, we identified five growth inhibitors encoded by T7 bacteriophage. High-throughput sequencing of genomic DNA of resistant bacterial mutants evolving against three of these inhibitors revealed unique mutations in three specific genes. We found that a nonessential host gene, ppiB, is required for growth inhibition by one bacteriophage inhibitor and another nonessential gene, pcnB, is required for growth inhibition by a different inhibitor. Notably, we found a previously unidentified growth inhibitor, gene product (Gp) 0.6, that interacts with the essential cytoskeleton protein MreB and inhibits its function. We further identified mutations in two distinct regions in the mreB gene that overcome this inhibition. Bacterial two-hybrid assay and accumulation of Gp0.6 only in MreB-expressing bacteria confirmed interaction of MreB and Gp0.6. Expression of Gp0.6 resulted in lemon-shaped bacteria followed by cell lysis, as previously reported for MreB inhibitors. The described approach may be extended for the identification of new growth inhibitors and their targets across bacterial species and in higher organisms.

New funding to fight antibiotic resistance SPECIAL

By Tim Sandle

This week the White House stated that it will double the amount of federal funding put aside to combat and preventing antibiotic resistance. The sum stands at greater than $1.2 billion.

Read more: http://www.digitaljournal.com/life/health/new-funding-to-fight-antibiotic-resistance/article/424745#ixzz3QJSBRxLU

U.S. Senator Sherrod Brown has been campaigning across the U.S. about the risks related to antibiotic-resistant infections for several years. Such infections affect more than two million U.S. citizens each year. The issue is not only of importance in one country for the growing menace of antibiotic resistance is, arguably, the single biggest threat faced by the world’s population. Moreover, emerging antimicrobial resistance and the growing shortage of effective antibiotic drugs is widely regarded as a crisis that jeopardizes patient safety and public health.

Senator Brown has welcomed the increased spending, although he also feels that more action is required. “To combat antibiotic resistance, it’s important that we leverage the best in medical expertise, stewardship, and technological innovation,” Brown has told Digital Journal.

He went on to add: “This unprecedented proposal underscores the importance of taking a comprehensive, wide-ranging approach to tackle this issue. I look forward to continuing to work with federal agencies, research institutions, and health care providers to combat this threat to America’s health.”

In 2014, Brown proposed the Strategies to Address Antimicrobial Resistance (STAAR) Act. The aim of this legislation was to boost the federal response to antibiotic resistance through promoting prevention and control. Other measures included: tracking drug-resistant bacteria; supporting enhanced research efforts; and improving the development, use, and stewardship of antibiotics. The Act would have provided an opportunity to bring multiple federal and non-governmental partners together to protect the public health from these drug-resistant bugs.

The Act, reported by Digital Journal, did not get through, despite the recent announcement of increased federal spending. Senator Brown argues that more preventative measures are needed. For this reason he plans to reintroduce similar legislation this year.

The STAAR Act would:

Promote prevention through public health partnerships at the U.S. Centers for Disease Control and Prevention (CDC) and local health departments;

Track resistant bacteria by making data collection better and requiring better reporting;

Improve the use of antibiotics by educating health care facilities on appropriate antibiotic use;

Enhance leadership and accountability in antibiotic resistance by reauthorizing a task force and coordinating agency efforts;

Support research by directing the National Institutes of Health (NIH) to work with other agencies and experts to create a strategic plan to address the problem.

Read more: http://www.digitaljournal.com/life/health/new-funding-to-fight-antibiotic-resistance/article/424745#ixzz3QJSliTXy

Senator takes on antibiotic resistant organisms SPECIAL

By Tim Sandle     Apr 16, 2014 in Science

Washington – With so-called “super bugs” on the rise, U.S. Sen. Sherrod Brown (D-OH) has introduced a bill aimed at slowing down the rate of antibiotic resistant microorganisms.

Read more: http://www.digitaljournal.com/science/senator-takes-on-antibiotic-resistant-organisms/article/381328#ixzz3QJT1jbOk

Senator Brown has introduced the Strategies to Address Antimicrobial Resistance (STAAR) Act. This is legislation aimed at combating antimicrobial resistance. In presenting the Act, Brown called for greater Federal attention to the growth of antibiotic-resistant infections, which affect more than two million Americans each year.

Brown is aiming for the STAAR Act to provide an opportunity to bring multiple federal and non-governmental partners together to protect the public health from these drug-resistant bugs.

Senator Brown contacted Digital Journal to explain more. In explaining the basis to the Act, Brown said: “Each year more than 23,000 Americans die from bacterial infections that are resistant to antibiotics.”

Antimicrobial resistance describes the ability of a microorganism to resist the action of antimicrobial drugs. In some instances some microorganisms are naturally resistant to particular antimicrobial agents; in other instances, the genes of non-disease-causing bacteria can be transferred to pathogenic bacteria, leading to patterns of clinically significant antibiotic resistance. Since the 1990s antibiotic resistance has been of concern for scientists and health policy makers.

Looking at the reasons for this, Brown explained that: “Antibiotics and other antimicrobial drugs have been a victim of their own success. We have used these drugs so widely and for so long that the microbes they are designed to kill have adapted to them, making the drugs less effective.”

Considering this in the context of his Act, Brown added: “We need a comprehensive strategy to address antimicrobial resistance. That is why I am introducing the STAAR Act, which would revitalize efforts to combat super bugs.”

Emerging antimicrobial resistance and the growing shortage of effective antibiotic drugs is widely regarded as a crisis that jeopardizes patient safety and public health. Once confined to hospitals, drug-resistant microbes, such as multi-drug-resistant Staphylococcus aureus (MRSA), are now striking down healthy, non-hospitalized citizens. This includes both the young and old, adults and children. These infections are painful, difficult to treat, and have become a silent epidemic in communities and hospitals across the U.S. (according to CDC).

Brown hopes that the STAAR Act will help strengthen the federal response to antimicrobial resistance by placing more of an emphasis on federal antimicrobial resistance surveillance, prevention and control, and research efforts.

In addition the Senator hopes that the Act will strengthen coordination within both Department of Health and Human Services (HHS) agencies as well as across other federal departments that are important to addressing antimicrobial resistance and enable opportunities to address this issue globally.

By providing for a more comprehensive and coordinated approach to the antimicrobial resistance crisis, it would seem that the STAAR Act represents a critical first step toward resolving what has become a major public health crisis.

Read more: http://www.digitaljournal.com/science/senator-takes-on-antibiotic-resistant-organisms/article/381328#ixzz3QJTWUxTB

H.R. 2285 (113th): Strategies to Address Antimicrobial Resistance Act

Introduced:
Jun 6, 2013 (113th Congress, 2013–2015)

Status:
Died (Referred to Committee) in a previous session of Congress

See Instead:
S. 2236 (same title)

Referred to Committee — Apr 10, 2014

  • Vaccination -how is vaccination important in preventing resistance?
  • Bioterrorism – what are the risks of resistance associated with bioterrorism
  • Antibacterials – do they cause resistance?
  • Food & Farming – why are antimicrobials used in farming?

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