IL-1β, Interleukin-1 Beta

  • 文章类型: Journal Article
    衰老,影响所有生物的复杂生理过程,是一个主要的研究领域,特别关注减缓其进展的干预措施。这项研究评估了达格列净(DAPA)对人工诱导衰老的小鼠模型中各种衰老相关参数的抗衰老功效。将40只雄性瑞士白化病小鼠随机分为四组,每组十只动物。对照组(I组)接受生理盐水。衰老模型组(Ⅱ组)口服D-半乳糖500mg/kg诱导衰老。在老化诱导之后,阳性对照组接受维生素C补充剂(第三组),而DAPA组(IV组)接受达格列净治疗。炎症介质(TNF-α和IL-1β)显示出相似的变化模式。在III组和IV组之间没有观察到统计学上的显著差异。与GII相比,两组的数值均明显较低,虽然与GI相比明显更高。谷胱甘肽过氧化物酶(GSH-Px)在GIII组和GIV组之间无统计学差异,但是与GII相比,GIII中的GIII更高,而与GI相比,GIII中的GIII明显更低。研究表明,达格列净对小鼠衰老的许多指标都有有益的影响。干预导致心肌细胞肥大减少,增强皮肤活力,炎症介质的存在减少,和改善抗氧化剂的功效。
    Aging, a complex physiological process affecting all living things, is a major area of research, particularly focused on interventions to slow its progression. This study assessed the antiaging efficacy of dapagliflozin (DAPA) on various aging-related parameters in a mouse model artificially induced to age. Forty male Swiss albino mice were randomly divided into four groups of ten animals each. The control group (Group I) received normal saline. The aging model group (Group II) was administered D-galactose orally at 500mg/kg to induce aging. Following the aging induction, the positive control group received Vitamin C supplementation (Group III), while the DAPA group (Group IV) was treated with dapagliflozin. The inflammatory mediators (TNF-α and IL-1β) showed similar patterns of change. No statistically significant difference was observed between groups III and IV. Both groups had significantly lower values compared to GII, while it was significantly higher compared to GI. Glutathione peroxidase (GSH-Px) showed no statistically significant difference between groups GIII and GIV, but it was higher in GIII compared to GII and significantly lower in GIII compared to GI. The study demonstrated that dapagliflozin exerts a beneficial impact on many indicators of aging in mice. The intervention resulted in a reduction in hypertrophy in cardiomyocytes, an enhancement in skin vitality, a decrease in the presence of inflammatory mediators, and an improvement in the efficacy of antioxidants.
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  • 文章类型: Journal Article
    UNASSIGNED: The immunosuppressant tacrolimus is a major cause of new-onset diabetes after transplantation. The aim of this study was to evaluate whether a low dose of the histone-deacetylase inhibitor (vorinostat) might ameliorate tacrolimus-induced new-onset diabetes.
    UNASSIGNED: Thirty 8-week-old male Wistar rats were randomly divided into five groups: a control group, tacrolimus group (1.5 mg/kg intraperitoneally for 28 days), vorinostat group (15 mg/kg orally for 28 days), a group receiving tacrolimus with vorinostat for 28 days; and a group receiving coadministration of tacrolimus for 28 days and vorinostat for 14 days. Diabetes development was assessed on the basis of serum glucose, insulin, HOMA-IR and C-peptide. To investigate the mechanism of vorinostat, we assessed inflammatory markers (tumor necrosis factor-α and interleukin-1β), an antioxidant marker (glutathione), an oxidant marker (nicotinamide adenine dinucleotide phosphate hydrogen oxidase) and an apoptosis marker (caspase-3). Kidney functions (creatinine and blood urea nitrogen) were also assessed.
    UNASSIGNED: The administration of tacrolimus for 28 days resulted in significantly increased serum glucose and decreased C-peptide and insulin levels than those in the control group. However, coadministration of vorinostat significantly decreased hyperglycemia and increased C-peptide and insulin levels. Moreover, combined treatment with tacrolimus and vorinostat, compared with tacrolimus treatment alone, resulted in significantly reduced inflammatory and oxidant markers, and increased glutathione. Additionally, vorinostat improved the kidney parameters.
    UNASSIGNED: Vorinostat at a low dose (15 mg/kg) induces anti-inflammatory and antioxidative effects that protect the pancreas and kidney against the development of new-onset diabetes due to tacrolimus in rats. This experimental study provides insights supporting further clinical trials to improve the post-kidney transplantation protocol through addition of vorinostat to the immunosuppressive regimen.
    UNASSIGNED: يعتبر مثبط المناعة (التاكروليموس) أهم مسبب للإصابة بنوع السكري الجديد ما بعد زراعة الكلى. تهدف الدراسة لتقييم فعالية الفورينوستات (مثبط الهستون-دياسيتايلاز) في التحكم بالسكري الناتج عن التاكروليموس.
    UNASSIGNED: تم تقسيم ثلاثين ذكر من جرذان ويستر البالغة 8-أسابيع عشوائيا إلى ٥ مجموعات: المجموعة الضابطة، مجموعة التاكروليموس (١.٥ مجم/كجم، داخل الصفاق لمدة ٢٨ يوم)، مجموعة الفورينوستات (١٥ مجم/كجم، عن طريق الفم لمدة ٢٨ يوم). ومجموعتان تم إعطاؤهما الدوائين معا: مجموعة التاكروليموس مع الفورينوستات لمدة ٢٨ يوم، ومجموعة التاكروليموس مع الفورينوستات لمدة ١٤ يوم قبل نهاية التجربة. تم تقييم تطور السكري بقياس نسبة الجلوكوز والأنسولين والببتيد الرابط. وللتحقق من آلية عمل الفورينوستات، تم قياس علامات الالتهاب (عامل نخر الورم-ألفا و انترلوكين١بيتا)، علامات مضادات الأكسدة (الجلوتاثيون) والأكسدة (أكسيد فوسفات ثنائي نيوكلوتيد الأدينين) ومؤشر موت الخلايا المبرمج (كاسباس-٣). أيضاً تم تقييم وظائف الكلى (اليوريا والكرياتينين).
    UNASSIGNED: أدى العلاج بالتاكروليموس لمدة 28 يوم إلى زيادة ملحوظة في مستوى السكر وانخفاض في مستويات الببتيد الرابط والأنسولين مقارنة بالمجموعة الضابطة. ومع ذلك، فإن تزامن أخذ الدوائين معا قلل بشكل ملحوظ من ارتفاع السكر وزيادة مستويات الببتيد الرابط والأنسولين. كما قلل جمع الدوائين بشكل ملحوظ مستويات علامات الالتهاب والاكسدة وكاسباس-٣ مع زيادة مستوى الجلوتاثيون مقارنة بالمجموعة المعالجة بالتاكروليموس. أيضا، حافظ الفورينوستات على مستويات عوامل الكلى ضمن المعدل الطبيعي.
    UNASSIGNED: استخدام الفورينوستات بجرعة صغيرة (15 مجم/كجم) يستحث التأثير المضاد للالتهاب والمضاد للأكسدة والتي تحمي بنكرياس وكلى الجرذان من الاصابة بالسكري الناتج عن التاكروليموس. تفتح هذه الدراسة الطريق لمزيد من التجارب السريرية لتحسين بروتوكول ما بعد زراعة الكلى عن طريق إضافة الفورينوستات في النظام العلاجي لمثبطات المناعة.
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  • 文章类型: Journal Article
    由于免疫系统和骨骼系统之间复杂的相互作用,骨整合似乎是一种异物反应平衡。骨免疫微环境在植入材料的骨整合中的异质性仍然难以捉摸。这里,进行了涉及40043个细胞的单细胞研究,从五个不同的组中鉴定出总共10个不同的细胞簇。对骨免疫微环境的初步描述揭示了多种细胞异质性和植入物特性调节的动态变化。未成熟的中性粒细胞增多,Ly6C+CCR2hi单核细胞,和S100a8hi巨噬细胞诱导侵袭性炎症反应并最终导致在不锈钢植入物周围形成纤维囊。成熟中性粒细胞的富集,FcgR1hi和钛植入物周围的分化免疫调节巨噬细胞表明在中等免疫应答下有利的骨整合。进行中性粒细胞耗竭小鼠以探索中性粒细胞在骨整合中的作用。中性粒细胞可以通过CXCL12/CXCR3信号轴增强BMSCs的募集来改善骨形成。这些发现有助于更好地了解骨免疫学,并且对于骨再生领域中的“骨免疫智能”生物材料的设计和修饰很有价值。
    Osseointegration seems to be a foreign body reaction equilibrium due to the complicated interactions between the immune and skeletal systems. The heterogeneity of the osteoimmune microenvironment in the osseointegration of implant materials remains elusive. Here, a single-cell study involving 40043 cells is conducted, and a total of 10 distinct cell clusters are identified from five different groups. A preliminary description of the osteoimmune microenvironment revealed the diverse cellular heterogeneity and dynamic changes modulated by implant properties. The increased immature neutrophils, Ly6C + CCR2hi monocytes, and S100a8hi macrophages induce an aggressive inflammatory response and eventually lead to the formation of fibrous capsule around the stainless steel implant. The enrichment of mature neutrophils, FcgR1hi and differentiated immunomodulatory macrophages around the titanium implant indicates favorable osseointegration under moderate immune response. Neutrophil-depletion mice are conducted to explore the role of neutrophils in osseointegration. Neutrophils may improve bone formation by enhancing the recruitment of BMSCs via the CXCL12/CXCR3 signal axis. These findings contribute to a better knowledge of osteoimmunology and are valuable for the design and modification of \'osteoimmune-smart\' biomaterials in the bone regeneration field.
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  • 文章类型: Journal Article
    乙二醇单甲醚(EGME)已用于许多通常由人类处理的产品,包括油墨,油漆,抛光,制动液等。因此,本研究,调查了它对肺的影响,在雄性Wistar大鼠的时程研究中。对动物口服给予50mg/kg体重的EGME,持续7、14和21天。口服暴露于EGME7天后,GPx和SOD活性显著增加,以及K-Ras的水平,c-Myc,p53、caspase-3、TNF-α和,IL-6,而NO水平和GST活性与对照组相比显着降低。在14天暴露结束时,GSH水平显著下降,而K-Ras的水平,c-Myc,p53,caspase-3,TNF-α,与对照组相比,IL-6,NO以及SOD和GPx的活性显着升高。EGME给药21天后,Bcl-2、IL-10、GSH和NO水平以及GST活性显著降低,而K-Ras的水平,c-Myc,p53,Bax,caspase-3,IL-6,IL-1β,TNF-α,以及GPx,CAT,与对照相比,SOD活性显着升高。肺组织病理学显示慢性播散性肺泡炎症,细支气管炎,严重的肺泡和支气管增生,严重的播散性炎症,血栓形成,和增厚的血管作为EGME暴露的结果。暴露于EGME可以通过抗氧化系统的解体引发肺损伤,引起炎症的上调,凋亡,和大鼠的致癌标志物。
    Ethylene glycol monomethyl ether (EGME) has been used in many products usually handled by humans including inks, paints, polishes, brake fluids and so on. This present study therefore, investigated its effect on lung, in a time-course study in male Wistar rats. Animals were orally administered 50 mg/kg body weight of EGME for a period of 7, 14, and 21 days. Following 7 days of oral exposure to EGME, activities of GPx and SOD were significantly increased, as well as levels of K-Ras, c-Myc, p53, caspase-3, TNF-α and, IL-6, while NO level and GST activity were significantly reduced compared with control. At the end of 14 days exposure, GSH level was significantly decreased, while levels of K-Ras, c-Myc, p53, caspase-3, TNF-α, IL-6, NO and the activities of SOD and GPx were significantly elevated with respect to control. After 21 days of EGME administration, levels of Bcl-2, IL-10, GSH and NO as well as GST activity were significantly decreased, while levels of K-Ras, c-Myc, p53, Bax, caspase-3, IL-6, IL-1β, TNF-α, as well as GPx, CAT, and SOD activities were significantly elevated compared with control. Lung histopathology revealed chronic disseminated alveolar inflammation, bronchiolitis, severe alveolar and bronchi hyperplasia, severe disseminated inflammation, thrombosis, and thickened vessels as a result of EGME exposures. Exposures to EGME could trigger lung damage via the disorganization of the antioxidant system, eliciting the up-regulation of inflammatory, apoptotic, and oncogenic markers in rats.
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  • 文章类型: Journal Article
    背景:目前,脊髓损伤(SCI)是一种病理事件,会引发多种神经病理学状况,通过几种促炎介质释放导致神经元损伤的开始。然而,焦亡被认为是一种新的程序性细胞死亡机制,受caspase-1和/或caspase-11/-4/-5信号通路刺激的一系列炎症反应调控。
    目的:我们当前的综述根据几种分子和病理生理机制,简要总结了在SCI中焦凋亡调节的程序性细胞死亡的潜在作用。这篇综述还强调了焦凋亡信号通路和炎性小体成分的靶向及其对SCI治疗的治疗意义。
    多个证据表明,焦亡在细胞肿胀中起着重要作用,质膜裂解,染色质碎片和细胞内促炎因子,包括IL-18和IL-1β释放。此外,焦亡是由最近发现的称为GSDMD的成孔蛋白家族直接介导的。目前的研究表明,焦凋亡调节的细胞死亡在多种神经系统疾病以及SCI的发病机理中起着至关重要的作用。我们的叙述文章表明,在不久的将来,抑制焦凋亡调节的细胞死亡和炎症小体成分可能是治疗SCI的有希望的治疗方法。
    BACKGROUND: Currently, spinal cord injury (SCI) is a pathological incident that triggers several neuropathological conditions, leading to the initiation of neuronal damage with several pro-inflammatory mediators\' release. However, pyroptosis is recognized as a new programmed cell death mechanism regulated by the stimulation of caspase-1 and/or caspase-11/-4/-5 signaling pathways with a series of inflammatory responses.
    OBJECTIVE: Our current review concisely summarizes the potential role of pyroptosis-regulated programmed cell death in SCI, according to several molecular and pathophysiological mechanisms. This review also highlights the targeting of pyroptosis signaling pathways and inflammasome components and its therapeutic implications for the treatment of SCI.
    UNASSIGNED: Multiple pieces of evidence have illustrated that pyroptosis plays significant roles in cell swelling, plasma membrane lysis, chromatin fragmentation and intracellular pro-inflammatory factors including IL-18 and IL-1β release. In addition, pyroptosis is directly mediated by the recently discovered family of pore-forming protein known as GSDMD. Current investigations have documented that pyroptosis-regulated cell death plays a critical role in the pathogenesis of multiple neurological disorders as well as SCI. Our narrative article suggests that inhibiting the pyroptosis-regulated cell death and inflammasome components could be a promising therapeutic approach for the treatment of SCI in the near future.
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  • 文章类型: Journal Article
    Ethylene glycol monomethyl ether (EGME) is a major component of paints, lacquers, inks, and automobile brake fluids. As a result, exposures to humans are inevitable. We therefore, investigated in this study, its effect on testicular cells in a time-course manner in male Wistar rats. Animals were orally administered 50 mg/kg body weight of EGME for duration of 7, 14, and 21 days. Following 7 days of the administration, levels of NO and GSH were significantly reduced, while levels of c-Myc, K-Ras, caspase-3, IL-6, TNF-α, and IL-1β were significantly increased compared with control. At the end of 14 days exposure, GPx, and SOD activities, as well as IL-10 level were significantly decreased, while levels of c-Myc, K-Ras, p53, Bax, caspase-3, IL-6, TNF-α, IL-1β, and GST activity were significantly elevated compared with control. After 21 days of EGME administration, Bcl-2, IL-10, and NO levels were significantly decreased, while levels of c-Myc, K-Ras, p53, Bax, caspase-3, IL-6, TNF-α, IL-1β, MDA and GST activity were significantly increased compared with control. After 7, 14, and 21 days of EGME administrations, testis histopathology showed severe loss of seminiferous tubules, the seminiferous epithelium revealed very few spermatocytes, spermatids, spermatogonia, spermatozoa, and Sertoli cells, while the interstitial tissue is eroded, with scanty abnormal Leydig cells, compared with the control that appeared normal. We therefore, concluded that EGME-induced testicular toxicity as a result of EGME administration could be via the disorganization of the endogenous antioxidant systems as well as up-regulation of pro-inflammatory, apoptotic and oncogenic mediators in rats.
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  • 文章类型: Journal Article
    2-甲氧基乙醇(2-ME)是一种广泛用于制造制动液的有机溶剂,油漆,树脂,清漆,指甲油,醋酸纤维素,木材着色,作为塑料制造中的增塑剂。因此,我们,调查了它对肝脏的影响,在雄性Wistar大鼠的时程研究中。将动物口服施用50mg/kg体重的2-ME,持续7、14和21天。服用2-ME7天后,Bax的水平有了显著的提高,c-Myc,K-Ras,TNF-α,IL-1β,IL-6、MDA和GPx活性,与对照组相比,Bcl-2,NO和GSH水平显着降低。在14天暴露结束时,Bcl-2和GSH水平,以及GST活动,显著下降,而Bax的水平,c-Myc,K-Ras,caspase-3,TNF-α,IL-1β,与对照组相比,IL-6,MDA和NO显着增加。2-ME给药21天后,Bcl-2、IL-10和GSH水平,以及SOD和GST活性,显著下降,而Bax的水平,c-Myc,K-Ras,caspase-3,p53,TNF-α,IL-1β,与对照组相比,IL-6,MDA和NO显着增加。最后,肝脏组织病理学证实并证实了上述生化发现.因此,我们,建议应严格避免暴露于2-ME,因为它可能会通过抗氧化系统的解体引发肝损伤,炎症的上调,凋亡,和大鼠的致癌标志物。
    2-methoxyethanol (2-ME) is an organic solvent widely used in the manufacture of brake fluids, paints, resins, varnish, nail polish, acetate cellulose, wood coloring, and as a plasticizer in plastics manufacturing. We therefore, investigated its effect on the liver, in a time-course study in male Wistar rats. Animals were orally administered 50 mg/kg body weight of 2-ME for a period of 7, 14, and 21 days. Following 7 days of administration of 2-ME, there was a significant increase in the level of Bax, c-Myc, K-Ras, TNF-α, IL-1β, IL-6, MDA and GPx activity, while the levels of Bcl-2, NO and GSH were significantly reduced compared with control. At the end of 14 days exposure, Bcl-2, and GSH levels, as well as GST activity, were significantly decreased, while levels of Bax, c-Myc, K-Ras, caspase-3, TNF-α, IL-1β, IL-6, MDA and NO were significantly increased compared with control. After 21 days of 2-ME administration, Bcl-2, IL-10, and GSH levels, as well as SOD and GST activities, were significantly decreased, while levels of Bax, c-Myc, K-Ras, caspase-3, p53, TNF-α, IL-1β, IL-6, MDA and NO were significantly increased compared with control. Lastly, liver histopathology confirmed and corroborated the biochemical findings reported above. We therefore, advised that exposures to 2-ME should be strictly avoided as it could trigger hepatic damage through the disorganization of the antioxidant system, up-regulation of inflammatory, apoptotic, and oncogenic markers in rats.
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  • 文章类型: Journal Article
    Methyl cellosolve (MC) is used in production of textile, paints, stains, inks, surface coatings, and anti-icing additive in hydraulic fluids and jet fuel. Consequently, the present study investigated its effect on renal cells, in a time-course study in male Wistar rats. Animals were orally administered 50 mg/kg body weight of MC for a period of 7, 14, and 21 days. Following 7 days of administration of MC, there was a significant increase in the levels of K-Ras, c-Myc, TNF-α, IL-6 and NO, while GSH level and SOD activity were significantly reduced compared with control. At the end of 14 days exposure, RKW, GSH, NO, and Bcl-2 levels were significantly decreased, while levels of K-Ras, c-Myc, p53, Bax, caspase-3, TNF-α, IL-1β, IL-6, MDA and GPx activity were significantly increased compared with control. After 21 days of MC administration, RKW, GSH, NO, IL-10 and Bcl-2 levels were significantly decreased, while levels of K-Ras, c-Myc, p53, Bax, caspase-3, TNF-α, IL-1β, IL-6, MDA and GST activity were significantly increased compared with control. Exposures to MC in any way should be strictly avoided as it could trigger renal damage through the disorganization of the antioxidant system, up-regulation of inflammatory, apoptotic, and oncogenic markers in rats.
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  • 文章类型: Journal Article
    目的:脂质过氧化物及其活性醛衍生物(LPP)与肥胖相关的病理有关,但是它们是否有因果作用尚不清楚。谷胱甘肽过氧化物酶4(GPx4)是一种硒酶,可以选择性地中和脂质氢过氧化物,在流行病学研究中,人类gpx4基因变异与肥胖和心血管疾病有关。这项研究检验了以下假设:LPPs是肥胖患者使用高脂肪的心脏代谢紊乱的基础,gpx4单倍体不足小鼠(GPx4(/-))和人心肌样品中的高蔗糖(HFHS)饮食。
    方法:给野生型(WT)和GPx4(+/-)小鼠喂食标准食物(CNTL)或HFHS饮食24周,在整个过程中测量代谢和心血管参数。在研究结束时对心脏和肝脏进行生化和免疫组织学分析,并分析了心脏的线粒体功能。还对来自接受选择性心脏手术的103名患者的人心房心肌样本进行了生化分析。
    结果:遵循HFHS饮食,WT小鼠表现出4-羟基壬烯醛(HNE)-加合物和羰基应激的适度增加,肝脏和心脏中的GPx4酶增加1.5倍,而gpx4单倍体不足(GPx4(+/-))小鼠在这些器官中有明显的羰基应激伴随着葡萄糖不耐受加剧,血脂异常,和肝脏脂肪变性.虽然血压正常,心脏肥大在肥胖时很明显,和心肌纤维化在肥胖GPx4(+/-)小鼠中更为明显。线粒体功能障碍表现为脂肪氧化能力降低和活性氧增加也存在于肥胖的GPx4(+/-),但不是WT心脏,以及促炎和促纤维化基因的上调。糖尿病和高血糖患者的心脏表现出明显较少的GPx4酶和较高的HNE加合物,与年龄匹配的非糖尿病患者相比。
    结论:这些研究结果表明,LPPs是肥胖患者心脏代谢紊乱的关键因素,GPx4作为一种适应性对策发挥着关键作用。
    OBJECTIVE: Lipid peroxides and their reactive aldehyde derivatives (LPPs) have been linked to obesity-related pathologies, but whether they have a causal role has remained unclear. Glutathione peroxidase 4 (GPx4) is a selenoenzyme that selectively neutralizes lipid hydroperoxides, and human gpx4 gene variants have been associated with obesity and cardiovascular disease in epidemiological studies. This study tested the hypothesis that LPPs underlie cardio-metabolic derangements in obesity using a high fat, high sucrose (HFHS) diet in gpx4 haploinsufficient mice (GPx4(+/-)) and in samples of human myocardium.
    METHODS: Wild-type (WT) and GPx4(+/-) mice were fed either a standard chow (CNTL) or HFHS diet for 24 weeks, with metabolic and cardiovascular parameters measured throughout. Biochemical and immuno-histological analysis was performed in heart and liver at termination of study, and mitochondrial function was analyzed in heart. Biochemical analysis was also performed on samples of human atrial myocardium from a cohort of 103 patients undergoing elective heart surgery.
    RESULTS: Following HFHS diet, WT mice displayed moderate increases in 4-hydroxynonenal (HNE)-adducts and carbonyl stress, and a 1.5-fold increase in GPx4 enzyme in both liver and heart, while gpx4 haploinsufficient (GPx4(+/-)) mice had marked carbonyl stress in these organs accompanied by exacerbated glucose intolerance, dyslipidemia, and liver steatosis. Although normotensive, cardiac hypertrophy was evident with obesity, and cardiac fibrosis more pronounced in obese GPx4(+/-) mice. Mitochondrial dysfunction manifesting as decreased fat oxidation capacity and increased reactive oxygen species was also present in obese GPx4(+/-) but not WT hearts, along with up-regulation of pro-inflammatory and pro-fibrotic genes. Patients with diabetes and hyperglycemia exhibited significantly less GPx4 enzyme and greater HNE-adducts in their hearts, compared with age-matched non-diabetic patients.
    CONCLUSIONS: These findings suggest LPPs are key factors underlying cardio-metabolic derangements that occur with obesity and that GPx4 serves a critical role as an adaptive countermeasure.
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  • 文章类型: Journal Article
    Acute liver failure (ALF) is a rare, potentially fatal complication of severe hepatic illness resulting from various causes. In a clinical setting, severe hepatic injury is usually recognised by the appearance of jaundice, encephalopathy and coagulopathy. The central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a central role in the pathogenesis. The role of newer ammonia lowering agents is still evolving. Liver transplant is the only effective therapy that has been identified to be of promise in those with poor prognostic factors, whereas in the others, aggressive intensive medical management has been documented to salvage a substantial proportion of patients. A small fraction of patients undergo liver transplant and the remaining are usually treated with medical therapy. Therefore, identification of the complications and causes of death in such patients, and use of appropriate prognostic models to identify those who need liver transplant and those who can be managed with medical treatment is a vital component of therapeutic strategy. In this review, we discuss the various pathogenetic mechanisms and treatment options available.
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