Mucosal neuroimmune mechanisms in gastro-oesophageal reflux disease (GORD) pathogenesis.

Gastro-oesophageal reflux disease (GORD) is a chronic condition characterised by visceral pain in the distal oesophagus. The current first-line treatment for GORD is proton pump inhibitors (PPIs), however, PPIs are ineffective in a large cohort of patients and long-term use may have adverse effects. Emerging evidence suggests that nerve fibre number and location are likely to play interrelated roles in nociception in the oesophagus of GORD patients. Simultaneously, alterations in cells of the oesophageal mucosa, namely epithelial cells, mast cells, dendritic cells, and T lymphocytes, have been a focus of GORD research for several years. The oesophagus of GORD patients exhibits both macro- and micro-inflammation as a response to chronic acidic reflux at the epithelium. In other conditions of the GI tract, such as IBS and IBD, well-characterised bidirectional processes between immune cells and mucosal nerve fibres contribute to pathogenesis and symptom generation. Sensory alterations in these conditions such as nerve fibre outgrowth and hypersensitivity can be driven by inflammatory processes, which promote visceral pain signalling. This review will examine what is currently known of the molecular pathways linking inflammation and sensory perception leading to the development of GORD symptoms and explore potentially relevant mechanisms in other GI regions which may indicate new areas in GORD research.

Acute administration of metformin prior to cardiac ischemia/reperfusion injury protects brain injury.

Myocardial ischemia is the malperfusion of cardiac tissue due to a blockage in a coronary artery. Subsequent return of blood flow to the ischemic area of the heart, results in ischemia/reperfusion (I/R) injury in the heart and other organs, including the brain. Besides the cardioprotective effects of metformin on the heart against cardiac I/R injury, metformin also reduced neuronal injury in a stroke model. However, the effects of metformin on the brain following cardiac I/R injury has not yet been investigated. Therefore, we hypothesize that metformin reduces brain damage via decreasing brain mitochondrial dysfunction, microglial hyperactivity, and Alzheimer's proteins in rats after cardiac I/R injury. Rats (n = 50) received either a sham operation (n = 10) or cardiac I/R (n = 40). Cardiac I/R was induced by 30 min of cardiac ischemia, followed by 120 min of reperfusion. Rats in cardiac I/R group were divided into 4 groups (n = 10/group); vehicle, metformin 100 mg/kg, metformin 200 mg/kg, and metformin 400 mg/kg. Metformin was given via femoral vein at 15 min prior to cardiac ischemia. At the end of reperfusion, brains were removed to determine dendritic spine density, brain mitochondrial function, microglial morphology, and amyloid beta formation. Cardiac I/R injury led to brain mitochondrial dysfunction, microglial hyperactivation, amyloid beta formation, Tau hyperphosphorylation, and reduced dendritic spine density with an increase in AMPK activation. All doses of metformin improved brain pathologies in rats with cardiac I/R injury possibly via activating cerebral AMPK. In summary, pre-treatment with metformin offers neuroprotection against the brain damages caused by cardiac I/R injury.

Acute metformin treatment provides cardioprotection via improved mitochondrial function in cardiac ischemia / reperfusion injury.

Cardiac ischemia/reperfusion (I/R) injury following reperfusion therapy in acute myocardial infarction results in mitochondrial dynamic imbalance and cardiomyocyte apoptosis. Although diabetic patients taking metformin have been shown to have a lower risk of myocardial infarction, the efficacy of the cardioprotection conferred by metformin regarding the mitochondrial function and dynamic in cardiac I/R injury are still inconclusive. In addition, the comparative effects between different doses of metformin given acutely prior to cardiac I/R injury have never been investigated. Fifty 8-week-old male Wistar rats weighing 300-350 g were divided into sham-operated (n = 10) and cardiac I/R-operated (n = 40) groups. In the cardiac I/R group, rats underwent 30-min ischemia followed by 120-min reperfusion and were randomly divided into four subgroups (n = 10/group): control (received normal saline), metformin (100, 200, and 400 mg/kg). The arrhythmia score, cardiac function, infarct size, mortality rate, mitochondrial function and apoptosis, were determined. Metformin (200 mg/kg) exerted the highest level of cardioprotection through reduction in arrhythmia, infarct size, mitochondrial fission, and apoptosis, in addition to preservation of mitochondrial function, leading to the attenuation of cardiac dysfunction. Doses of metformin (100 and 400 mg/kg) also improved mitochondrial and cardiac function, but to a lesser extent than metformin (200 mg/kg). In conclusion, metformin exerts cardioprotection by attenuating mitochondrial dysfunction, mitochondrial dynamic imbalance, and apoptosis. These led to decreased infarct size and eventual improvement in cardiac function in rats with acute cardiac I/R injury. These findings indicate the potential clinical benefits of acute metformin treatment in acute myocardial infarction.

D-galactose-induced aging does not cause further deterioration in brain pathologies and cognitive decline in the obese condition.

Largely as a consequence of changes in modern lifestyle, a significant proportion of global population have become obese. When obese people grow old, pathologies aggravate neurodegeneration. Several studies have demonstrated that both aging and obesity have deleterious impact on brain. However, the time course effects of combined aging-induced by d-galactose and obesity caused by high-fat diet on cognitive and brain function have not been explored. We hypothesize that D-galactose accelerates and aggravates brain pathologies and cognitive dysfunction in the state of obesity. Ninety-six Wistar rats were separated into two groups to be fed with either a normal diet (ND) or a high-fat diet (HFD) for 16 to 20 weeks. At the end of 12 weeks, ND and HFD-fed rats were injected with vehicle (0.9% NSS, s.c) or d-galactose (150 mg/kg/d, s.c) for 4 or 8 weeks. Data from behavioral test, metabolic parameters and brain pathologies were determined at 4 and 8-weeks after d-galactose administration. The results from both d-galactose-treated rats and HFD-fed rats showed that there was an equal increase in advanced glycation end products, and microglial activation, and an impairment in long-term depression, long-term potentiation, and synaptic protein and dendritic spine density in hippocampus, resulting in cognitive decline. However, d-galactose did not accelerate or aggravate these parameters and cognitive decline in HFD-fed rats. These results suggest that aging, obesity, and combined model have equally adverse effects on cognition. These findings can be used to increase public awareness of the negative impact of both aging and obesity on neurodegeneration.

The beneficial roles of metformin on the brain with cerebral ischaemia/reperfusion injury.

Cerebral ischaemia/reperfusion (I/R) injury is the transient loss, followed by rapid return, of blood flow to the brain. This condition is often caused by strokes and heart attacks. The underlying mechanisms resulting in brain damage during cerebral I/R injury include mitochondrial dysregulation, increased oxidative stress/reactive oxygen species, blood-brain-barrier breakdown, inflammation of the brain, and increased neuronal apoptosis. Metformin is the first-line antidiabetic drug which has recently been shown to be capable of acting through the aforementioned pathways to improve recovery following cerebral I/R injury. However, some studies have suggested that metformin therapy may have no effect or even worsen recovery following cerebral I/R injury. The present review will compile and examine the available in vivo, in vitro, and clinical data concerning the neuroprotective effects of metformin following cerebral I/R injury. Any contradictory evidence will also be assessed and presented to determine the actual effectiveness of metformin treatment in stroke recovery.