Prioritization of initiatives 2024-2027 of the strategic map of pharmaceutical outpatient care of the Spanish Society of Hospital Pharmacy. / Priorización de iniciativas 2024­2027 del mapa estratégico de atención farmacéutica al paciente externo de la Sociedad Española de Farmacia Hospitalaria.

OBJECTIVE: To prioritize the initiatives to be developed for the development of the Strategic Map of Outpatient Care (MAPEX) project to improve the quality of care and Pharmaceutical Care for patients seen in Hospital Pharmacy outpatient clinics in the period 2024-2027 in Spain. METHOD: The study was carried out in 4 phases between January and December 2023. For phase 1, a literature review of the evolution of the project was carried out by the coordinating committee with the aim of establishing a basis on which to define a new proposal for initiatives. In addition, an analysis was made of the health trends that will have an impact in the coming years. In phase 2, a working group of 19 specialists from all the autonomous communities was created, who were called regional ambassadors. They all made a preliminary proposal of initiatives and established revisions for their adjustment and final version both online and in telematic meetings. In phase 3, a consensus was established based on the Delphi-Rand/UCLA methodology with two rounds of online voting to select the initiatives classified as: priority and key or breakthrough. Between the first and second round of voting, a face-to-face "Consensus Conference" was held, where the results of the first round were presented. In phase 4, a public presentation was made in scientific forums and through the web. RESULTS: Ten trends in the health sector were identified. A list of 34 initiatives grouped into five lines of work was established. A total of 103 panelists participated in the first round and 76 in the second. Finally, five initiatives were established as priority and 29 as key. Among those prioritized were external visibility, adaptations to the CMO methodology, strengthening certification and improving training. CONCLUSIONS: The initiatives agreed upon as priorities were aimed at improving professional visibility, broadening the methodology of care work, expanding the quality of care, enhancing the training of professionals and the voice of patients.

Mitochondrial calcium uniporter deficiency in dentate granule cells remodels neuronal metabolism and impairs reversal learning.

The mitochondrial calcium uniporter (MCU) is the main route of calcium (Ca2+ ) entry into neuronal mitochondria. This channel has been linked to mitochondrial Ca2+ overload and cell death under neurotoxic conditions, but its physiologic roles for normal brain function remain poorly understood. Despite high expression of MCU in excitatory hippocampal neurons, it is unknown whether this channel is required for learning and memory. Here, we genetically down-regulated the Mcu gene in dentate granule cells (DGCs) of the hippocampus and found that this manipulation increases the overall respiratory activity of mitochondrial complexes I and II, augmenting the generation of reactive oxygen species in the context of impaired electron transport chain. The metabolic remodeling of MCU-deficient neurons also involved changes in the expression of enzymes that participate in glycolysis and the regulation of the tricarboxylic acid cycle, as well as the cellular antioxidant defenses. We found that MCU deficiency in DGCs does not change circadian rhythms, spontaneous exploratory behavior, or cognitive function in middle-aged mice (11-13 months old), when assessed with a food-motivated working memory test with three choices. DGC-targeted down-regulation of MCU significantly impairs reversal learning assessed with an 8-arm radial arm water maze but does not affect their ability to learn the task for the first time. Our results indicate that neuronal MCU plays an important physiologic role in memory formation and may be a potential therapeutic target to develop interventions aimed at improving cognitive function in aging, neurodegenerative diseases, and brain injury.

Soluble pathogenic tau enters brain vascular endothelial cells and drives cellular senescence and brain microvascular dysfunction in a mouse model of tauopathy.

Vascular mechanisms of Alzheimer's disease (AD) may constitute a therapeutically addressable biological pathway underlying dementia. We previously demonstrated that soluble pathogenic forms of tau (tau oligomers) accumulate in brain microvasculature of AD and other tauopathies, including prominently in microvascular endothelial cells. Here we show that soluble pathogenic tau accumulates in brain microvascular endothelial cells of P301S(PS19) mice modeling tauopathy and drives AD-like brain microvascular deficits. Microvascular impairments in P301S(PS19) mice were partially negated by selective removal of pathogenic soluble tau aggregates from brain. We found that similar to trans-neuronal transmission of pathogenic forms of tau, soluble tau aggregates are internalized by brain microvascular endothelial cells in a heparin-sensitive manner and induce microtubule destabilization, block endothelial nitric oxide synthase (eNOS) activation, and potently induce endothelial cell senescence that was recapitulated in vivo in microvasculature of P301S(PS19) mice. Our studies suggest that soluble pathogenic tau aggregates mediate AD-like brain microvascular deficits in a mouse model of tauopathy, which may arise from endothelial cell senescence and eNOS dysfunction triggered by internalization of soluble tau aggregates.

TELEA-Farmacia: Pharmaceutical care by Telepharmacy to oncology patients from a hospital pharmacy service.

OBJECTIVE: To describe the implementation of a pilot Telepharmacy project (TELEA-Farmacia) in adult patients with cancer, analyze the results obtained, and identify opportunities for improvement, from a hospital  pharmacy service. METHOD: Between October and December 2021, oncology patients, collecting  their oral antineoplastic drugs at the Unit of Oncology Pharmacy of the hospital pharmacy service were stratified using the MAPEX model. Oncology patients  candidates for inclusion in the TELEA-Farmacia project included "medium-high  priority" hospital pharmacy patients, along with oncology patients who,  according to pharmacist's opinion, could benefit from Telepharmacy. On a  weekly basis, oncology patients recorded on the TELEA platform their biological  measurements and completed the questionnaires on medication  adherence and pain. Questionnaires on quality of life were completed on a  monthly basis. To score health indicators, oncology patients accessed TELEA  through the SERGAS-MOBIL app or a web browser. Follow-up of health  indicators was performed by the Unit of Oncology Pharmacy of the hospital  pharmacy service. RESULTS: The study sample included 29 oncology patients (48% were male)  with a mean age of 59 years (44-75). According to the stratification model,  31% were low-priority patients, 62% had medium-priority, and 7%  had high  priority. The digital gap in patients with advanced ages was the main obstacle  to inclusion. Reports were monitored daily, and a total of 364 responses were  received. In the presence of alarming reports and/or out-of-range values,  active monitoring and/or telephonic follow-up were initiated. Pharmaceutical  care was adapted to the health problem detected according to individual  patient needs. CONCLUSIONS: The Telemedicine pilot project TELEA-Farmacia made it possible  to test TELEA in patients with cancer in a real-life context. TELEA facilitated  continuous follow-up, early detection of drug-related problems, and the  identification of new needs and improvement points. To such purpose, clinical  oncology pharmacists combined face-to-face consults with patient stratification  and remote follow-up. This study demonstrated that new  stratification models are necessary in hospital pharmacy services to identify  patients with technology skills who can benefit from using Telemedicine tools  as TELEA.

OBJETIVO: Describir la implantación de un proyecto piloto de Telefarmacia (TELEA-Farmacia) en el paciente oncológico adulto y analizar los resultados recabados, así como identificar las oportunidades de mejora, desde un servicio de farmacia hospitalario.Método: Entre octubre y diciembre de 2021, los pacientes oncológicos a  tratamiento con antineoplásicos orales citados en la consulta de farmacia oncológica del servicio de farmacia de hospital fueron estratificados a  través del modelo MAPEX. Se consideraron susceptibles de inclusión en TELEA- Farmacia a quienes requerían atención farmacéutica con "prioridad media-alta" y a aquellos que, según criterio farmacéutico, pudieran beneficiarse de la herramienta. A través del aplicativo TELEA se programaron semanalmente biomedidas y cuestionarios de adherencia y evaluación del  dolor, y mensualmente un cuestionario de calidad de vida. Accediendo a TELEA  mediante la aplicación móvil SERGAS-MÓBIL o un navegador web, los  pacientes oncológicos respondieron a los indicadores de salud programados, de cuyo seguimiento fue responsable la Unidad de Farmacia Oncológica del  servicio de farmacia de hospital. RESULTADOS: Se incluyeron 29 pacientes oncológicos (48% hombres), con una  media de 59 años (44-75). Un 31% fueron de prioridad baja, 62% media y 7%  alta según el modelo de estratificación, siendo la brecha digital existente  en edades avanzadas el principal impedimento para la inclusión. Se realizó un  seguimiento diario de las notificaciones, recibiéndose un total de 364  respuestas. A partir de las consideradas alarmantes y de los valores fuera de  rango, se procedió al seguimiento activo y/o contacto telefónico,  proporcionando atención farmacéutica adaptada al problema de salud  detectado en función de las necesidades. CONCLUSIONES: El proyecto piloto de Telemedicina TELEA-Farmacia permitió testar la herramienta en pacientes oncológicos en vida real, facilitando el seguimiento continuado, la detección temprana de problemas  relacionados con medicamentos y la identificación de nuevas necesidades y  puntos de mejora para su implantación definitiva en la actividad asistencial.  Para ello, fue necesario compaginar la actividad presencial en consulta con el tiempo requerido para la estratificación y seguimiento telemático. Además, ha evidenciado la necesidad de disponer de nuevos modelos de  estratificación en un servicio de farmacia de hospital para la atención  farmacéutica que contemplen el manejo de las tecnologías por parte de los  pacientes, para identificar así a quienes más se puedan beneficiar de la  herramienta de Telemedicina TELEA.

TELEA-Farmacia: Atención farmacéutica mediante Telefarmacia a pacientes oncológicos desde un servicio de farmacia hospitalaria / TELEA-Farmacia: Pharmaceutical care by Telepharmacy to oncology patients from a hospital pharmacy service

Objetivo: Describir la implantación de un proyecto piloto de Telefarmacia (TELEA-Farmacia) en el paciente oncológico adulto y analizar losresultados recabados, así como identificar las oportunidades de mejora,desde un servicio de farmacia hospitalario.Método: Entre octubre y diciembre de 2021, los pacientes oncológicosa tratamiento con antineoplásicos orales citados en la consulta de farmaciaoncológica del servicio de farmacia de hospital fueron estratificados a travésdel modelo MAPEX. Se consideraron susceptibles de inclusión en TELEA-Farmacia a quienes requerían atención farmacéutica con “prioridad media-alta”y a aquellos que, según criterio farmacéutico, pudieran beneficiarse de laherramienta. A través del aplicativo TELEA se programaron semanalmentebiomedidas y cuestionarios de adherencia y evaluación del dolor, y mensualmente un cuestionario de calidad de vida. Accediendo a TELEA mediantela aplicación móvil SERGAS-MÓBIL o un navegador web, los pacientesoncológicos respondieron a los indicadores de salud programados, de cuyoseguimiento fue responsable la Unidad de Farmacia Oncológica del serviciode farmacia de hospital.Resultados: Se incluyeron 29 pacientes oncológicos (48% hombres),con una media de 59 años (44-75). Un 31% fueron de prioridad baja,62% media y 7% alta según el modelo de estratificación, siendo la brecha. digital existente en edades avanzadas el principal impedimento para lainclusión. Se realizó un seguimiento diario de las notificaciones, recibiéndose un total de 364 respuestas. A partir de las consideradas alarmantesy de los valores fuera de rango, se procedió al seguimiento activo y/ocontacto telefónico, proporcionando atención farmacéutica adaptada alproblema de salud detectado en función de las necesidades. (AU)

Objective: To describe the implementation of a pilot Telepharmacy project (TELEA-Farmacia) in adult patients with cancer, analyze the resultsobtained, and identify opportunities for improvement, from a hospital pharmacy service.Method: Between October and December 2021, oncology patients,collecting their oral antineoplastic drugs at the Unit of Oncology Pharmacy of the hospital pharmacy service were stratified using the MAPEXmodel. Oncology patients candidates for inclusion in the TELEA-Farmaciaproject included “medium-high priority” hospital pharmacy patients, alongwith oncology patients who, according to pharmacist’s opinion, couldbenefit from Telepharmacy. On a weekly basis, oncology patients recorded on the TELEA platform their biological measurements and completedthe questionnaires on medication adherence and pain. Questionnaires onquality of life were completed on a monthly basis. To score health indicators, oncology patients accessed TELEA through the SERGAS-MOBIL appor a web browser. Follow-up of health indicators was performed by theUnit of Oncology Pharmacy of the hospital pharmacy service.Results: The study sample included 29 oncology patients (48% weremale) with a mean age of 59 years (44-75). According to the stratificationmodel, 31% were low-priority patients, 62% had medium-priority, and 7%. had high priority. The digital gap in patients with advanced ages was themain obstacle to inclusion. Reports were monitored daily, and a total of364 responses were received. In the presence of alarming reports and/orout-of-range values, active monitoring and/or telephonic follow-up wereinitiated. Pharmaceutical care was adapted to the health problem detected according to individual patient needs. (AU)

Administration of Glutaredoxin-1 Attenuates Liver Fibrosis Caused by Aging and Non-Alcoholic Steatohepatitis.

Liver fibrosis is a sign of non-alcoholic fatty liver disease progression towards steatohepatitis (NASH) and cirrhosis and is accelerated by aging. Glutaredoxin-1 (Glrx) controls redox signaling by reversing protein S-glutathionylation, induced by oxidative stress, and its deletion causes fatty liver in mice. Although Glrx regulates various pathways, including metabolism and apoptosis, the impact of Glrx on liver fibrosis has not been studied. Therefore, we evaluated the role of Glrx in liver fibrosis induced by aging or by a high-fat, high-fructose diet. We found that: (1) upregulation of Glrx expression level inhibits age-induced hepatic apoptosis and liver fibrosis. In vitro studies indicate that Glrx regulates Fas-induced apoptosis in hepatocytes; (2) diet-induced NASH leads to reduced expression of Glrx and higher levels of S-glutathionylated proteins in the liver. In the NASH model, hepatocyte-specific adeno-associated virus-mediated Glrx overexpression (AAV-Hep-Glrx) suppresses fibrosis and apoptosis and improves liver function; (3) AAV-Hep-Glrx significantly inhibits transcription of Zbtb16 and negatively regulates immune pathways in the NASH liver. In conclusion, the upregulation of Glrx is a potential therapeutic for the reversal of NASH progression by attenuating inflammatory and fibrotic processes.

Redox Regulation via Glutaredoxin-1 and Protein S-Glutathionylation.

Significance: Over the past several years, oxidative post-translational modifications of protein cysteines have been recognized for their critical roles in physiology and pathophysiology. Cells have harnessed thiol modifications involving both oxidative and reductive steps for signaling and protein processing. One of these stages requires oxidation of cysteine to sulfenic acid, followed by two reduction reactions. First, glutathione (reduced glutathione [GSH]) forms a S-glutathionylated protein, and second, enzymatic or chemical reduction removes the modification. Under physiological conditions, these steps confer redox signaling and protect cysteines from irreversible oxidation. However, oxidative stress can overwhelm protein S-glutathionylation and irreversibly modify cysteine residues, disrupting redox signaling. Critical Issues: Glutaredoxins mainly catalyze the removal of protein-bound GSH and help maintain protein thiols in a highly reduced state without exerting direct antioxidant properties. Conversely, glutathione S-transferase (GST), peroxiredoxins, and occasionally glutaredoxins can also catalyze protein S-glutathionylation, thus promoting a dynamic redox environment. Recent Advances: The latest studies of glutaredoxin-1 (Glrx) transgenic or knockout mice demonstrate important distinct roles of Glrx in a variety of pathologies. Endogenous Glrx is essential to maintain normal hepatic lipid homeostasis and prevent fatty liver disease. Further, in vivo deletion of Glrx protects lungs from inflammation and bacterial pneumonia-induced damage, attenuates angiotensin II-induced cardiovascular hypertrophy, and improves ischemic limb vascularization. Meanwhile, exogenous Glrx administration can reverse pathological lung fibrosis. Future Directions: Although S-glutathionylation modifies many proteins, these studies suggest that S-glutathionylation and Glrx regulate specific pathways in vivo, and they implicate Glrx as a potential novel therapeutic target to treat diverse disease conditions. Antioxid. Redox Signal. 32, 677-700.

Endothelial cell-specific redox gene modulation inhibits angiogenesis but promotes B16F0 tumor growth in mice.

Glutaredoxin-1 (Glrx) is a small cytosolic enzyme that removes S-glutathionylation, glutathione adducts of protein cysteine residues, thus modulating redox signaling and gene transcription. Although Glrx up-regulation prevented endothelial cell (EC) migration and global Glrx transgenic mice had impaired ischemic vascularization, the effects of cell-specific Glrx overexpression remained unknown. Here, we examined the role of EC-specific Glrx up-regulation in distinct models of angiogenesis; namely, hind limb ischemia and tumor angiogenesis. EC-specific Glrx transgenic (EC-Glrx TG) overexpression in mice significantly impaired EC migration in Matrigel implants and hind limb revascularization after femoral artery ligation. Additionally, ECs migrated less into subcutaneously implanted B16F0 melanoma tumors as assessed by decreased staining of EC markers. Despite reduced angiogenesis, EC-Glrx TG mice unexpectedly developed larger tumors compared with control mice. EC-Glrx TG mice showed higher levels of VEGF-A in the tumors, indicating hypoxia, which may stimulate tumor cells to form vascular channels without EC, referred to as vasculogenic mimicry. These data suggest that impaired ischemic vascularization does not necessarily associate with suppression of tumor growth, and that antiangiogenic therapies may be ineffective for melanoma tumors because of their ability to implement vasculogenic mimicry during hypoxia.-Yura, Y., Chong, B. S. H., Johnson, R. D., Watanabe, Y., Tsukahara, Y., Ferran, B., Murdoch, C. E., Behring, J. B., McComb, M. E., Costello, C. E., Janssen-Heininger, Y. M. W., Cohen, R. A., Bachschmid, M. M., Matsui, R. Endothelial cell-specific redox gene modulation inhibits angiogenesis but promotes B16F0 tumor growth in mice.

Production of adeno-associated virus vectors for in vitro and in vivo applications.

Delivering and expressing a gene of interest in cells or living animals has become a pivotal technique in biomedical research and gene therapy. Among viral delivery systems, adeno-associated viruses (AAVs) are relatively safe and demonstrate high gene transfer efficiency, low immunogenicity, stable long-term expression, and selective tissue tropism. Combined with modern gene technologies, such as cell-specific promoters, the Cre/lox system, and genome editing, AAVs represent a practical, rapid, and economical alternative to conditional knockout and transgenic mouse models. However, major obstacles remain for widespread AAV utilization, such as impractical purification strategies and low viral quantities. Here, we report an improved protocol to produce serotype-independent purified AAVs economically. Using a helper-free AAV system, we purified AAVs from HEK293T cell lysates and medium by polyethylene glycol precipitation with subsequent aqueous two-phase partitioning. Furthermore, we then implemented an iodixanol gradient purification, which resulted in preparations with purities adequate for in vivo use. Of note, we achieved titers of 1010-1011 viral genome copies per µl with a typical production volume of up to 1 ml while requiring five times less than the usual number of HEK293T cells used in standard protocols. For proof of concept, we verified in vivo transduction via Western blot, qPCR, luminescence, and immunohistochemistry. AAVs coding for glutaredoxin-1 (Glrx) shRNA successfully inhibited Glrx expression by ~66% in the liver and skeletal muscle. Our study provides an improved protocol for a more economical and efficient purified AAV preparation.

IL-33 induction and signaling are controlled by glutaredoxin-1 in mouse macrophages.

Interleukin (IL)-33 is an interleukin-1 like cytokine that enhances Th2 responses and mediates mucosal immunity and allergic inflammation but the mechanism regulating endogenous IL-33 production are still under investigation. In macrophages, lipopolysaccharide (LPS) administration resulted in marked induction of IL-33 mRNA that was blunted in macrophages from glutaredoxin-1 (Glrx) knockout mice and in RAW264.7 macrophages with Glrx knockdown by siRNA. Glutaredoxin-1 is a small cytosolic thioltransferase that controls a reversible protein thiol modification, S-glutationylation (protein-GSH adducts), thereby regulating redox signaling. In this study, we examined the mechanism of Glrx regulation of endogenous IL-33 induction in macrophages. Glrx knockdown resulted in impaired de-glutathionylation of TRAF6, which is required for TRAF6 activation, and inhibited downstream IKKß and NF-κB activation. Inhibitors of NF-κB suppressed IL-33 induction and chromatin IP sequencing data analysis confirmed that IL-33 is an NF-κB-responsive gene. Since TRAF6-NF-κB activation is also essential for IL-33 signaling through its receptor, ST2L, we next tested the involvement of Glrx in exogenous IL-33 responses in RAW264.7 cells. Recombinant IL-33 (rIL-33) administration induced IL-33 mRNA expression in RAW264.7 macrophages, and this was inhibited by Glrx knockdown. Interestingly, rIL-33-induced IL-33 protein was identified as the 20 kDa cleaved form whereas LPS-induced IL-33 protein was identified as full-length IL-33, which may be less active than the cleaved form. In a clinically-relevant mouse model of asthma, intra-tracheal cockroach antigen treatment induced Glrx protein in wild type mouse lungs but Glrx induction was attenuated in IL-33 knockout mouse lungs, suggesting that IL-33 may regulate Glrx induction in vivo in response to allergen challenge. In summary, our data reveal a novel mechanism by which Glrx controls both LPS- and IL-33-mediated NF-κB activation leading to IL-33 production, and paracrine IL-33 can induce Glrx to further regulate inflammatory reactions.

The nuclear receptor NOR-1 regulates the small muscle protein, X-linked (SMPX) and myotube differentiation.

Recent works have highlighted the role of NOR-1 in both smooth and skeletal muscle, and have proposed this nuclear receptor as a nexus that coordinates muscle performance and metabolic capacity. However, no muscle specific genes regulated by NOR-1 have been identified so far. To identify NOR-1 target genes, we over-expressed NOR-1 in human vascular smooth muscle cells (VSMC). These cells subjected to sustained over-expression of supraphysiological levels of NOR-1 experienced marked phenotypic changes and up-regulated the skeletal muscle protein X-linked (SMPX), a protein typically expressed in striated muscle and associated to cell shape. By transcriptional studies and DNA-protein binding assays, we identified a non-consensus NBRE site in human SMPX promoter, critical for NOR-1 responsiveness. The expression of SMPX was higher in human skeletal muscle myoblasts (HSMM) than in human VSMC, and further increased in HSMM differentiated to myotubes. NOR-1 silencing prevented SMPX expression in HSMM, as well as their differentiation to myotubes, but the up-regulation of SMPX was dispensable for HSMM differentiation. Our results indicate that NOR-1 regulate SMPX in human muscle cells and acts as a muscle regulatory factor, but further studies are required to unravel its role in muscle differentiation and hypertrophy.

NR4A receptors up-regulate the antiproteinase alpha-2 macroglobulin (A2M) and modulate MMP-2 and MMP-9 in vascular smooth muscle cells.

Matrix metalloproteinases (MMPs) are associated with tissue remodelling and repair. In non-vascular tissues, NR4A receptors have been involved in the regulation of MMPs by transcriptional repression mechanisms. Here, we analyse alternative mechanisms involving NR4A receptors in the modulation of MMP activity in vascular smooth muscle cells (VSMC). Lentiviral overexpression of NR4A receptors (NOR-1, Nurr1 and Nur77) in human VSMC strongly decreased MMP-2 and MMP-9 activities (analysed by zymography and DQ-gelatin assays) and protein levels. NR4A receptors also down-regulated MMP-2 mRNA levels. Real-time PCR analysis evidenced that alpha-2-macroglobulin (A2M), but not other MMP inhibitors (TIMP-1 and TIMP-2) were up-regulated in NR4A-transduced cells. Interestingly, A2M was expressed in human vascular tissues including the smooth muscle media layer. While NR4A receptors increased A2M expression and secretion in VSMC, NR4A knockdown significantly reduced basal A2M expression in these cells. The direct transcriptional regulation of the human A2M promoter by NR4A receptors was characterised in luciferase reporter assays, electrophoretic mobility shift assays and by chromatin immunoprecipitation, identifying a NGFI-B response element (NBRE-71/-64) essential for the NR4A-mediated induction. The blockade of A2M partially prevented the reduction of MMPs activity observed in NR4A-transduced cells. Although mouse A2M promoter was unresponsive to NR4A receptors, vascular MMP expression was attenuated in transgenic mice over-expressing human NOR-1 in VSMC challenged with lipopolysaccharide. Our results show that the pan-proteinase inhibitor A2M is expressed in the vasculature and that NR4A receptors modulate VSMC MMP activity by several mechanisms including the up-regulation of A2M.

NOR-1 modulates the inflammatory response of vascular smooth muscle cells by preventing NFκB activation.

Recent work has highlighted the role of NR4A receptors in atherosclerosis and inflammation. In vascular smooth muscle cell (VSMC) proliferation, however, NOR-1 (neuron-derived orphan receptor-1) exerts antagonistic effects to Nur77 and Nurr1. The aim of this study was to analyse the effect of NOR-1 in VSMC inflammatory response. We assessed the consequence of a gain-of-function of this receptor on the response of VSMC to inflammatory stimuli. In human VSMC, lentiviral over-expression of NOR-1 reduced lipopolysaccharide (LPS)-induced up-regulation of cytokines (IL-1ß, IL-6 and IL-8) and chemokines (MCP-1 and CCL20). Similar effects were obtained in cells stimulated with TNFα or oxLDL. Conversely, siRNA-mediated NOR-1 inhibition significantly increased the expression of pro-inflammatory mediators. Interestingly, in the aortas from transgenic mice that over-express human NOR-1 in VSMC (TgNOR-1), the up-regulation of cytokine/chemokine by LPS was lower compared to wild-type littermates. Similar results were obtained in VSMC from transgenic animals. NOR-1 reduced the transcriptional activity of NFκB sensitive promoters (in transient transfections), and the binding of NFκB to its responsive element (in electrophoretic mobility shift assays). Furthermore, NOR-1 prevented the activation of NFκB pathway by decreasing IκBα phosphorylation/degradation and inhibiting the phosphorylation and subsequent translocation of p65 to the nucleus (assessed by Western blot and immunocytochemistry). These effects were associated with an attenuated phosphorylation of ERK1/2, p38 MAPK and Jun N-terminal kinase, pathways involved in the activation of NFκB. In mouse challenged with LPS, the activation of the NFκB signalling was also attenuated in the aorta from TgNOR-1. Our data support a role for NOR-1 as a negative modulator of the acute response elicited by pro-inflammatory stimuli in the vasculature.

El receptor nuclear NOR-1 regula la activación de las células vasculares y el remodelado vascular en respuesta a estrés hemodinámico / The nuclear receptor NOR-1 regulates the activation of vascular cells and vascular remodelling in response to hemodynamic stress

Introducción: Estudios previos sugieren que la pérdida de función de NOR-1 modula la activación de las células musculares lisas vasculares (CMLV). En este estudio utilizamos un ratón que sobreexpresa NOR-1 en CMLV para analizar su efecto en la activación celular y en la hiperplasia de la íntima inducida por estrés hemodinámico. Métodos Para generar el modelo animal el ADNc de NOR-1 humano se situó bajo el control del promotor de SM22α. La expresión de NOR-1 se analizó mediante PCR a tiempo real, Western-blot, inmunohistoquímica e inmunocitoquímica, y su funcionalidad se determinó mediante ensayos de actividad luciferasa. Como índice de proliferación celular se determinó la incorporación de timidina tritiada. La carótida izquierda se sometió a ligadura y en secciones de la misma se realizaron análisis morfométricos e inmunohistoquímicos. Resultados El transgénico desarrollado exhibía niveles significativos de NOR-1 humano en la aorta y las arterias carótidas. En las CMLV de los animales transgénicos se detectó un aumento de la actividad transcripcional de la ciclina D2, una mayor actividad proliferativa y niveles incrementados de Myh10. En estos animales la ligadura de la carótida indujo mayor formación de neoíntima y de estenosis que en los animales control, en consonancia con el marcaje de Myh10 e histona H3 fosforilada. Conclusiones Estos resultados refuerzan el papel de NOR-1 en la proliferación de las CMLV y en el remodelado vascular, y permiten proponer este modelo como una herramienta útil para estudiar la implicación de este receptor en la función vascular y en enfermedades como la arteriosclerosis y la reestenosis

Introduction: Previous studies have shown that the loss of NOR-1 function modulates the activation of vascular smooth muscle cells (VSMC). In this study we use a mouse that over-expresses human NOR-1 in VSMC to analyze the effect of a gain of NOR-1 function on the activation ofVSMC and in the hyperplasia of the intima induced by hemodynamic stress. Methods: To generate the transgenic animal the human NOR-1 cDNA was placed under the control of the SM22promoter. The expression of NOR-1 was analyzed by real time PCR, Westernblot, immunohistochemistry and immunocitochemistry, and NOR-1 functionality was evaluated by luciferase activity assays. The incorporation of tritiated thymidine was determined as a cellproliferation index. The left carotid artery was ligated, and cross-sections were subjected tomorphometric and immunostaining analysis. Results: The transgenic mouse exhibited significant levels of human NOR-1 in aorta and carotidarteries. In aortic VSMC from transgenic mice an increase in the transcriptional activity of ciclinD2 was detected, as well as higher proliferative rates and increased levels of the marker Myh10.In these animals, carotid artery ligation induced a greater neointimal formation and a higherstenotic grade than in wild-type animals, in accordance with the labelling detected for Myh10and phosphorylated Histone H3.Conclusions: These results reinforce the role of NOR-1 in VSMC proliferation and in vascular remodelling, and allow us to propose this model as a useful tool to study the involvement ofNOR-1 in vascular function and in vascular diseases such as atherosclerosis and restenosis

[The nuclear receptor NOR-1 regulates the activation of vascular cells and vascular remodelling in response to hemodynamic stress]. / El receptor nuclear NOR-1 regula la activación de las células vasculares y el remodelado vascular en respuesta a estrés hemodinámico.

INTRODUCTION: Previous studies have shown that the loss of NOR-1 function modulates the activation of vascular smooth muscle cells (VSMC). In this study we use a mouse that over-expresses human NOR-1 in VSMC to analyze the effect of a gain of NOR-1 function on the activation of VSMC and in the hyperplasia of the intima induced by hemodynamic stress. METHODS: To generate the transgenic animal the human NOR-1 cDNA was placed under the control of the SM22α promoter. The expression of NOR-1 was analyzed by real time PCR, Western blot, immunohistochemistry and immunocitochemistry, and NOR-1 functionality was evaluated by luciferase activity assays. The incorporation of tritiated thymidine was determined as a cell proliferation index. The left carotid artery was ligated, and cross-sections were subjected to morphometric and immunostaining analysis. RESULTS: The transgenic mouse exhibited significant levels of human NOR-1 in aorta and carotid arteries. In aortic VSMC from transgenic mice an increase in the transcriptional activity of ciclin D2 was detected, as well as higher proliferative rates and increased levels of the marker Myh10. In these animals, carotid artery ligation induced a greater neointimal formation and a higher stenotic grade than in wild-type animals, in accordance with the labelling detected for Myh10 and phosphorylated Histone H3. CONCLUSIONS: These results reinforce the role of NOR-1 in VSMC proliferation and in vascular remodelling, and allow us to propose this model as a useful tool to study the involvement of NOR-1 in vascular function and in vascular diseases such as atherosclerosis and restenosis.

Over-expression of neuron-derived orphan receptor-1 (NOR-1) exacerbates neointimal hyperplasia after vascular injury.

We have previously shown that NOR-1 (NR4A3) modulates the proliferation and survival of vascular cells in culture. However, in genetically modified animal models, somewhat conflicting results have been reported concerning the involvement of NOR-1 in neointimal formation after vascular injury. The aim of this study was to generate a transgenic mouse model over-expressing NOR-1 in smooth muscle cells (SMCs) and assess the consequence of a gain of function of this receptor on intimal hyperplasia after vascular injury. The transgene construct (SM22-NOR1) was prepared by ligating the full-length human NOR-1 cDNA (hNOR-1) and a mouse SM22α minimal promoter able to drive NOR-1 expression to SMC. Two founders were generated and two stable transgenic mouse lines (TgNOR-1) were established by backcrossing the transgene-carrying founders with C57BL/6J mice. Real-time PCR and immunohistochemistry confirmed that hNOR-1 was mainly targeted to vascular beds such as aorta and carotid arteries, and was similar in both transgenic lines. Vascular SMC from transgenic animals exhibit increased NOR-1 transcriptional activity (assessed by electrophoretic mobility shift assay and luciferase assays), increased mitogenic activity (determined by [(3)H]-thymidine incorporation; 1.58-fold induction, P < 0.001) and increased expression of embryonic smooth muscle myosin heavy chain (SMemb) than wild-type cells from control littermates. Using the carotid artery ligation model, we show that neointima formation was increased in transgenic versus wild-type mice (2.36-fold induction, P < 0.01). Our in vivo data support a role for NOR-1 in VSMC proliferation and vascular remodelling. This NOR-1 transgenic mouse could be a useful model to study fibroproliferative vascular diseases.

TLP01, an mshA mutant of Vibrio cholerae O139 as vaccine candidate against cholera.

No commercially live vaccine against cholera caused by Vibrio cholerae O139 serogroup is available and it is currently needed. Virulent O139 strain CRC266 was genetically modified by firstly deleting multiple copies of the filamentous phage CTXφ, further tagging by insertion of the endoglucanase A coding gene from Clostridium thermocellum into the hemagglutinin/protease gene and finally deleting the mshA gene, just to improve the vaccine biosafety. One of the derived strains designated as TLP01 showed full attenuation and good colonizing capacity in the infant mouse cholera model, as well as highly immunogenic properties in the adult rabbit and rat models. Since TLP01 lacks MSHA fimbriae, it is refractory to infection with another filamentous phage VGJφ and therefore protected of acquiring CTXφ from a recombinant hybrid VGJφ/CTXφ. This strategy could reduce the possibilities of stable reversion to virulence out of the human gut. Furthermore, this vaccine strain was impaired to produce biofilms under certain culture conditions, which might have implications for the strain survival in natural settings contributing to vaccine biosafety as well. The above results has encouraged us to consider TLP01 as a live attenuated vaccine strain having an adequate performance in animal models, in terms of attenuation and immunogenicity, so that it fulfills the requirements to be evaluated in human volunteers.

Temsirolimus in renal cell carcinoma with sarcomatoid differentiation: a report of three cases.

Renal cell carcinoma (RCC) with sarcomatoid features has an aggressive course. There is no standard treatment for this histological subtype. Some authors have previously reported the use of chemotherapy, but the activity of new agents against renal carcinoma with sarcomatoid differentiation has to be formally evaluated. Temsirolimus, an inhibitor of the mammalian target or rapamycin, is active in RCC, including those tumors with non-clear histologies. We have tested the activity of this agent in three consecutive patients. A first patient showed a rapid progression, dying 2 months after the diagnosis. The second patient showed clinical improvement and a partial response to lung metastasis that was maintained for 14 months. The third patient is still alive, evaluated as stable disease after 7 months on temsirolimus. Importantly, toxicity was not a main issue during the use of temsirolimus and only grade 2 hyperglycemia, asthenia, hyperlipidemia, and pleural effusion were detected. Temsirolimus is a valid therapy in this subset of patients, with some lasting stabilizations and with manageable toxicity.

DNA binding proteins of the filamentous phages CTXphi and VGJphi of Vibrio cholerae.

The native product of open reading frame 112 (orf112) and a recombinant variant of the RstB protein, encoded by Vibrio cholerae pathogen-specific bacteriophages VGJphi and CTXphi, respectively, were purified to more than 90% homogeneity. Orf112 protein was shown to specifically bind single-stranded genomic DNA of VGJphi; however, RstB protein unexpectedly bound double-stranded DNA in addition to the single-stranded genomic DNA. The DNA binding properties of these proteins may explain their requirement for the rolling circle replication of the respective phages and RstB's requirement for single-stranded-DNA chromosomal integration of CTXphi phage dependent on XerCD recombinases.