Detoxification of gluten by means of enzymatic treatment

Celiac disease (CD) is an inflammatory disease of the upper small intestine in genetically predisposed individuals caused by glutamine- and proline-rich peptides from cereal storage proteins (gluten) with a minimal length of nine amino acids. Such peptides are insufficiently degraded by gastrointestinal enzymes; they permeate the lymphatic tissue, are bound to celiac-specific, antigen-presenting cells, and stimulate intestinal T-cells. The typical clinical pattern is a flat small intestinal mucosa and malabsorption. Currently, the only therapy is a strict, lifelong gluten-free diet. Recent research has shown that gluten and gluten peptides can be degraded by prolyl endopeptidases from different sources. These peptidases can either be used to produce gluten-free foods from gluten-containing raw materials, or they have been suggested as an oral therapy for CD, in which dietary gluten is hydrolyzed by coingested peptidases already in the stomach, thus preventing CD-specific immune reactions in the small intestine. This would be an alternative for CD patients to the gluten-free diet. Furthermore, microbial transglutaminase could be used to detoxify gluten either by selectively modifying glutamine residues of intact gluten by transamidation with lysine methyl ester or by crosslinking gluten peptides in beverages via isopeptide bonds so that they can be removed by filtration.     

A sensory evaluation of irradiated cookies made from flaxseed meal

The growing consumer demand for food with sensory quality and nutritional has called for research to develop new products with consumer acceptance as cookies made from flaxseed meal, that can be inserted in diet of celiacs. Celiac disease characterized by an inappropriate immune response to dietary proteins found in wheat, rye and barley (gluten and gliadin). It can affect anyone at any age and is more common in women. The celiac disease does not have cure and the only scientifically proven treatment is a gluten free diet. Irradiation as a decontamination method used for a many variety of foodstuffs, being very feasible, useful method to increase the shelf life, effective and environmental friendly without any sensory properties significant change. Sensory analyses were used to assess gluten-free bakery foods subjected to ionizing radiation sensory attributes.     

Gluten and celiac disease--an immunological perspective

Gluten, a complex protein group in wheat, rye, and barley, causes celiac disease (CD), an autoimmune enteropathy of the small intestine, in genetically susceptible individuals. CD affects about 1% of the general population and causes significant health problems. Adverse inflammatory reactions to gluten are mediated by inappropriate T-cell activation leading to severe damage of the gastrointestinal mucosa, causing atrophy of absorptive surface villi. Gluten peptides bind to the chemokine receptor, CXCR3, and induce release of zonulin, which mediates tight-junction disassembly and subsequent increase in intestinal permeability. Proinflammatory cytokine IL-15 also contributes to the pathology of CD, by driving the expansion of intra-epithelial lymphocytes that damage the epithelium and promote the onset of T-cell lymphomas. There is no cure or treatment for CD, except for avoiding dietary gluten. Current gluten thresholds for food labeling have been established based on the available analytical methods, which show variation in gluten detection and quantification. Also, the clinical heterogeneity of celiac patients poses difficulty in defining clinically acceptable gluten thresholds in gluten-free foods. Presently, there is no bioassay available to measure gluten-induced immunobiological responses. This review focuses on various aspects of CD, and the importance of gluten thresholds and reference material from an immunological perspective.     

Gluten and gluten-free: issues and considerations of labeling regulations, detection methods, and assay validation

Gluten is a commonly used cereal derivative found in bakery products, among other items. In some susceptible individuals, however, it triggers immune responses of different kinds; there is, to a lesser extent, the wheat allergy that is immunoglobulin E (IgE)-mediated and leads to histamine release and typical allergic symptoms. In this case, other water-soluble proteins, like albumins, are also involved. On the other hand, there is, more frequently, celiac disease (CD), where the gluten causes immune reactions in the intestines of certain individuals, leading to degeneration of villi, which typically leads to malabsorption of nutrients and, consequently, malnutrition. The only currently effective health strategy for affected consumers is avoidance of gluten-containing products, based on clear labeling rules. However, despite unanimously accepted Codex definitions by all member jurisdictions, the national implementation of equivalent laws shows significant differences. In the context of CD and in support of the gluten-free statement, regulatory enforcement, as well as manufacturers' quality controls are mostly based on analytical results. However, numerous methods are available, some of which have been validated better than others, and many provide different results on identical samples. Reasons include detection of different gluten components and variability in extraction efficiency due to different buffer compositions, especially from processed foods. Last but not least, the lack of reference materials is hindering the process of generating comparable data across different ELISA kits, as well as other methods. How can such data still be used to support a gluten-free claim? New methodologies, in particular mass spectrometric analysis of gluten derived peptides, are being introduced in numerous laboratories. This methodology is not only capable of detecting gluten derived peptides but can also differentiate between and quantitate wheat, barley, rye, and oat. This paper presents analytical limitations, as well as promising new approaches in support of industry and enforcement activities to ensure compliance with the gluten-free claim under the current regulatory framework.     

Quality improvement in wellness reports in patients with Crohn’s disease

Quality-of-life tests are used because they provide information about symptoms, potential complications, and response to treatment with patients as active participants. We took Crohn’s disease (CD) during diet supplement with omega 3 or 6 fatty acids (ω-3FA vs. ω-6FA) Impact^® as an example and assessed three quality-of-life tests: The inflammatory bowel disease questionnaire (IBDQ), the Beck depression inventory (BDI), and the visual analogue scale (VAS). These tests have been found inconvenient, not informative in daily clinical use, and inhomogeneous in international studies.We used the body mass index (BMI) (kg/m²) as a clinical quantitative effect parameter and the patient self-rated quality of life as qualitative variables during recovery. All ratings were converted into numeric standardized percent point before isolation of optimized ratings.BMI increased on average 2 BMI units in both diet groups. The classical wellness tests or their traditional sub-scores identified improved outcome during recovery, primarily in the ω-3FA group. Separate items on bowel function, wellness, and asthenia possessed the best item responsiveness – (30–35 percent point). A new selective scale with the six most responsive items is proposed as a specific optimized questionnaire.Based on CD as an example, we described a method to isolate responsive items from quality-of-life tests and described a method to optimize their sensitivity. We propose for validation a new optimized disease – specific VAS scale for rating of wellness during treatment in inflammatory bowel disease, in which ω-3FA seemed superior in improving outcome.Presented at the 10th Conference Quality in the Spotlight, March 2005, Antwerp, Belgium.     

Analytical methods for detection of gluten in food--method developments in support of food labeling legislation

The current essential therapy of celiac disease is a strict adherence to a gluten-free diet. Besides food products that are naturally gluten-free, "very low gluten" and "gluten-free" bakery products have become available. The availability of immunochemical and other analytical methods to determine gluten markers in foods is of utmost importance to ensure the well being of gluten-sensitive individuals. The aim of this review was to evaluate if currently available methodologies are suitable to meet the requirements of food labeling standards for individual gluten source declaration, in order to achieve policy objectives. Codex Alimentarius and European Union (EU) legislation and gluten detection methodologies applicable at present have been summarized and compared. In 2009, the European Commission issued Regulation No. 41/2009 concerning the composition and labeling of foodstuffs suitable for people intolerant to gluten. This review constitutes a basis to investigate the possibility to develop a proteomic-based method for the specific detection of gluten-containing cereals in food products, especially at or around the limits specified in EU legislation.     

1H NMR based metabolic profiling in Crohn's disease by random forest methodology

The present study was designed to search for metabolic biomarkers and their correlation with serum zinc in Crohn's disease patients. Crohn's disease (CD) is a form of inflammatory bowel disease that may affect any part of the gastrointestinal tract and can be difficult to diagnose using the clinical tests. Thus, introduction of a novel diagnostic method would be a major step towards CD treatment. Proton nuclear magnetic resonance spectroscopy (¹H NMR) was employed for metabolic profiling to find out which metabolites in the serum have meaningful significance in the diagnosis of CD. CD and healthy subjects were correctly classified using random forest methodology. The classification model for the external test set showed a 94% correct classification of CD and healthy subjects. The present study suggests Valine and Isoleucine as differentiating metabolites for CD diagnosis. These metabolites can be used for screening of risky samples at the early stages of CD diagnoses. Moreover, a robust random forest regression model with good prediction outcomes was developed for correlating serum zinc level and metabolite concentrations. The regression model showed the correlation (R²) and root mean square error values of 0.83 and 6.44, respectively. This model suggests valuable clues for understanding the mechanism of zinc deficiency in CD patients. Copyright © 2014 John Wiley & Sons, Ltd.     

肺心病患者全血锌、铜和外周血T淋巴细胞亚群的关系探讨

对28例住宅的肺心病患者和40例健康人分别进行了全血锌、铜的检测,并对28例肺心病患者全血锌、铜与其T淋巴细胞亚群（CD3、CD4、CD8,CD4／CD8）分别做线性相关分析。结果表明：（1）肺心病组全血锌低于健康人组（P＜0．01）,全血铜高于健康人组（P＜0．05）。（2）全血锌与T淋巴细胞亚群CD3、CD4、CD4／CD8呈明显正相关（P＜0．05）,与CD8呈负相关（P＜0．05）。提示慢性肺心病急性期患者全血锌下降,造成T淋巴细胞免疫功能低下,导致肺心病患者易合并肺部感染,使肺心病病情加重。认为慢性肺心病急性加重期患者在予以积极抗感染、对症的同时适当补充锌剂,能改善外周血T淋巴细胞亚群功能,提高机体免疫力,有助于慢性肺心病急性期患者的康复。     

An ELIME assay for the rapid diagnosis of coeliac disease

Coeliac disease (CD) is a gluten-induced autoimmune enteropathy found in genetically susceptible subjects. Because of the high number of undetected cases, rapid and cheaper screening methods are needed. Currently, the CD diagnosis involves the detection of anti-transglutaminase IgA antibodies (anti-tTG IgA) in blood serum through the use of ELISA systems with confirmation by histology of the intestinal mucosa. A new, rapid magneto-electrochemical immunosensor for CD diagnosis has been developed and applied to serum sample analysis. The system uses magnetic beads coated with tTG antigen to detect anti-tTG antibodies in positive serum samples and an alkaline phosphatase-conjugated anti-human IgA as label. An electrochemical readout, using magnetized screen-printed electrodes coupled with a portable instrument, is made after the addition of α-naphtyl phosphate, which is enzymatically converted into the electrochemically active α-naphthol product. The work involved the following considerations: (1) optimization of analytical parameters; (2) recovery evaluation, adding known concentrations of anti-tTG IgA to “blank” sera; (3) analysis of 107 blood serum samples; (4) calculation of the ROC curve, resulting in a cut-off of 1.0 U/ml, 100% of clinical sensitivity and 98.36% of clinical specificity; evaluation of the agreement between electrochemical and ELISA kit values (r ² of 0.943). The system developed could be an useful tool for a correct and rapid CD diagnosis. This method is simple, cheap, rapid, and suitable for screening analyses performed outside of the classical diagnostic laboratory.     

蒙脱石负载氧化铈纳米酶用于克罗恩肠炎治疗

通过水热法合成由临床用药蒙脱石(Montmorillonite, MMT)负载的高效纳米酶氧化铈(Cerium dioxide, CeO₂), 通过开展体内外实验, 拓展其在炎症性肠病治疗中的普适性. 结果显示, CeO₂@MMT具有良好的类超氧化物歧化酶活性及类过氧化氢酶活性, 并且在小鼠克罗恩病的治疗中体现了明显的疗效及优异的生物安全性, 为CeO₂@MMT的应用拓宽了方向.     

Liquid-phase microextraction of biomarkers: A review on current methods

The detection and quantification of biomarkers have gained more attention in the medical discipline to evaluating disease progression to manage medical treatment. Biomarkers range from gases to biological macromolecules. Because of the nanomolar range levels of typical biomarkers in plasma, blood, urine, exhalation samples, and other biological fluids as well as complex matrix of biological media, adequate sample preparation methods should be used for quantification of biomarkers. Biomarkers are discussed here generally classified mainly into two subgroups which arisen from disease or exposure compounds. The analytical method is critical for the validity/reliability of a biomarker. Accuracy, precision, reproducibility, recovery, sensitivity, and specificity all have high influence to the consistency with the limit and reference values concerned. In this paper, developments in well-established liquid-phase microextraction techniques for the clinical analysis of biological samples will be reviewed and discussed. This article presents an overview of microextraction methods for biological samples, focusing especially on biomarkers.     

中西医结合治疗复发性口疮102例疗效观察

用参麦汤合葡萄糖酸锌片治疗复发性口疮１０２例，经过３个月治疗，观察到该药能有效地改善临床症状，降低复发率，明显地提高体内锌的水平，与维生素类对照组比较，疗效有显著性差异（Ｐ＜０．０１）。     

Role of vitamin D-binding protein in isocyanate-induced occupational asthma

The development of a serological marker for early diagnosis of isocyanate-induced occupational asthma (isocyanate-OA) may improve clinical outcome. Our previous proteomic study found that expression of vitamin D-binding protein (VDBP) was upregulated in the patients with isocyanate-OA. In the present study, we evaluated the clinical relevance of VDBP as a serological marker in screening for isocyanate-OA among exposed workers and its role in the pathogenesis of isocyanate-OA. Three study groups including 61 patients with isocyanate-OA (group I), 180 asymptomatic exposed controls (AECs, group II), 58 unexposed healthy controls (NCs, group III) were enrolled in this study. The baseline serum VDBP level was significantly higher in group I compared with groups II and III. The sensitivity and specificity for predicting the phenotype of isocyanate-OA with VDBP were 69% and 81%, respectively. The group I subjects with high VDBP (≥311 μg/ml) had significantly lower PC(20) methacholine levels than did subjects with low VDBP. The in vitro studies showed that TDI suppressed the uptake of VDBP into RLE-6TN cells, which was mediated by the downregulation of megalin, an endocytic receptor of the 25-hydroxycholecalciferol-VDBP complex. Furthermore, toluene diisocyanate (TDI) increased VEGF production and secretion from this epithelial cells by suppression of 1,25-dihydroxycholecalciferol [1,25(OH)(2)D(3)] production. The findings of this study suggest that the serum VDBP level may be used as a serological marker for the detection of isocyanate-OA among workers exposed to isocyanate. The TDI-induced VEGF production/ secretion was reversed by 1,25(OH)(2)D(3) treatment, which may provide a potential therapeutic strategy for patients with isocyanate-OA.     

Lactoferricin/verbascoside topical emulsion: a possible alternative treatment for atopic dermatitis in dogs

Atopic dermatitis affects 3–15% of the general dog population and it has been diagnosed by veterinarians up to 58% of dogs affected with skin disease. It is usually a life-long pathology which can be controlled, but it can be seldom cured. The present investigation describes a case study in which lactoferricin and verbascoside are part of a formulation to obtain a dermatological lotion for canine dermatitis treatment. The study was an open-label trial design of two-week treatment. Thirty-eight dogs (23 females and 15 males), with atopic dermatitis and secondary bacterial or yeast overgrowth have been included. During treatment period the total clinical score progressively decreased associated with an improvement in clinical signs. No adverse effects were reported in any of the treated dogs. The present research suggests that daily applications of tested emulsion are effective in reducing bacterial overgrowth and clinical signs in skin folds and atopic dermatitis.     

Preparation and characterization of enzymatically hydrolyzed prolamins from wheat,rye, and barley as references for the immunochemical quantitation of partially hydrolyzed gluten

Celiac disease (CD) is a permanent gastrointestinal disorder characterized by the intolerance to a group of proteins called gluten present in wheat, rye, barley, and possibly oats. The only therapy is a strict lifelong gluten-free diet. The standard method for gluten determination in foods produced for CD patients is the R5-enzyme-linked immunosorbent assay (ELISA) as proposed by the recent Codex Alimentarius Draft Revised Standard. This test is based on the determination of prolamins, the alcohol-soluble proteins of gluten, and is available as a sandwich ELISA for intact proteins and as a competitive ELISA for gluten-derived peptides. While the suitability of the sandwich ELISA including a wheat prolamin (gliadin) reference for calibration has been shown by various studies and a ring test, the competitive ELISA still lacks a convenient reference for the quantitation of gluten peptides in fermented cereal foods (e.g., sourdough products, starch syrup, malt extracts, beer). Therefore, the aim of the present study was to prepare a suitable reference for the quantitation of partially hydrolyzed gluten in fermented wheat, rye, and barley products. The prolamin fractions from barley (hordein) and rye (secalin) were isolated from corresponding flours by means of a modified preparative Osborne fractionation. The prolamin fraction from wheat was obtained as reference gliadin from the Prolamin Working Group. The prolamin fractions were successively digested by pepsin and trypsin or pepsin and chymotrypsin procedures, which have been used for CD-specific toxicity tests on cereal storage proteins for many years. The protein/peptide content (N × 5.7) of the prolamin fractions and digests, which was the basis for the calculation of the gluten content by means of ELISA, varied between 67.1% and 96.0%. The prolamin fractions and enzymatic digests were then tested for their response in both sandwich and competitive assays. Intact prolamins responded similarly in both ELISA showing no important differences between the cereals. In the case of digested proteins, however, the sandwich ELISA was considerably less sensitive than the competitive ELISA. The former provided approximately 40% and the latter 70% of the signal intensity obtained with the intact prolamins. Thus, the combination of the competitive ELISA and the enzymatic digests of prolamin fractions as reference was considered to be an adequate system for the analysis of partially hydrolyzed gluten. The limit of detection using a peptic-tryptic hordein digest as reference was 2.3 μg prolamin equivalent per milliliter, and the limit of quantitation was 6.7 μg prolamin equivalent per milliliter. This system was applied for the determination of gluten equivalents in five commercial beverages based on fermented cereals.      

大隐静脉高位结扎联合泡沫硬化剂注射治疗大隐静脉曲张的临床护理观察

目的对应用全面护理模式对患有大隐静脉曲张疾病的患者在接受大隐静脉高位结扎联合泡沫硬化剂注射治疗期间实施护理的临床效果进行研究。方法选择广州市番禺区中医院收治的88例患有大隐静脉曲张疾病的患者,随机分为对照组和治疗组,平均每组44例。采用传统大隐静脉剥脱术和常规护理模式对对照组患者实施治疗和护理;采用大隐静脉高位结扎联合泡沫硬化剂注射方式和全面护理模式对治疗组患者实施治疗和护理。结果治疗组患者大隐静脉曲张疾病的治疗手术治疗效果明显优于对照组;对大隐静脉曲张手术治疗期间的护理满意度明显高于对照组;住院治疗总时间明显短于对照组。结论应用全面护理模式对患有大隐静脉曲张疾病的患者在接受大隐静脉高位结扎联合泡沫硬化剂注射治疗期间实施护理的临床效果非常明显。     

Novel Antiretroviral Therapeutic Strategies for HIV

When the first cases of HIV infection appeared in the 1980s, AIDS was a deadly disease without any therapeutic alternatives. Currently, there is still no cure for most cases mainly due to the multiple tissues that act as a reservoir for this virus besides the high viral mutagenesis that leads to an antiretroviral drug resistance. Throughout the years, multiple drugs with specific mechanisms of action on distinct targets have been approved. In this review, the most recent phase III clinical studies and other research therapies as advanced antiretroviral nanodelivery systems will be here discussed. Although the combined antiretroviral therapy is effective in reducing viral loading to undetectable levels, it also presents some disadvantages, such as usual side effects, high frequency of administration, and the possibility of drug resistance. Therefore, several new drugs, delivery systems, and vaccines have been tested in pre-clinical and clinical trials. Regarding drug delivery, an attempt to change the route of administration of some conventional antiretrovirals has proven to be successful and surpassed some issues related to patient compliance. Nanotechnology has brought a new approach to overcoming certain obstacles of formulation design including drug solubility and biodistribution. Overall, the encapsulation of antiretroviral drugs into nanosystems has shown improved drug release and pharmacokinetic profile.     

替硝唑联合盐酸左氧氟沙星对慢性盆腔炎患者的临床治疗价值

目的研究分析替硝唑联合盐酸左氧氟沙星对慢性盆腔炎患者的临床治疗价值。方法选取2015年9月至2016年9月期间在江西省共青城市人民医院治疗的90例慢性盆腔炎患者作为研究对象,采用随机数字表法将90例患者分为观察组和对照组,每组各为45例,评价两组治疗效果,评价指标包括治疗有效率和不良反应发生率。结果观察组患者治疗有效率比对照组高,两组数据比较差异有统计学意义(P0.05);观察组患者不良反应发生率比对照组低,两组数据比较差异有统计学意义(P0.05)。结论替硝唑联合盐酸左氧氟沙星对慢性盆腔炎患者的临床治疗价值较高,值得推荐采纳。     

Polymeric coating of surface modified nitinol stent with POSS-nanocomposite polymer

Stent angioplasty is a successful treatment for arterial occlusion, particularly in coronary artery disease. The clinical communities were enthusiastic about the use of drug-eluting stents; however, these stents have a tendency to be a contributory factor towards late stage thrombosis, leading to mortality in a significant number of patients per year. This work presents an innovative approach in self-expanding coronary stents preparation. We developed a new nanocomposite polymer based on polyhedral oligomeric silsesquioxanes (POSS) and poly(carbonate-urea)urethane (PCU), which is an antithrombogenic and a non-biodegradable polymer with in situ endothelialization properties. The aim of this work is to coat a NiTi stent alloy with POSS-PCU. In prolonged applications in the human body, the corrosion of the NiTi alloy can result in the release of deleterious ions which leads to unwanted biological reactions. Coating the nitinol (NiTi) surface with POSS-PCU can enhance surface resistance and improve biocompatibility. Electrohydrodynamic spraying was used as the polymer deposition process and thus a few experiments were carried out to compare this process with casting. Prior to deposition the NiTi has been surface modified. The peel strength of the deposit was studied before and after degradation of the coating. It is shown that the surface modification enhances the peel strength by 300%. It is also indicated how the adhesion strength of the POSS-PCU coating changes post-exposure to physiological solutions comprised of hydrolytic, oxidative, peroxidative and biological media. This part of the study shows that the modified NiTi presents far greater resistance to decay in peel strength compared to the non-modified NiTi.     

缺锌儿童的舌苔改变及其分析

从中医舌诊角度对193例缺锌儿童舌苔改变作了临床观察及理论分析,认为人体内微量元素锌与舌苔之间存在着有机联系,锌的吸收障碍由脾、胃功能失司引起,相应地引起舌苔的改变,大多数表现为“地图舌”。发现“地图舌”患儿在其他临床症状方面与机体“缺锌”状态表现出来的症状相似,而且病因相同,在病理机制及组织学方面曲解释一致,且用“锌”制剂治疗后,“地图舌”明显很快地消失或得到改变。笔者提出,“地图舌”可以作为机体缺锌的临床体征之一,本文为此提供了初步的理论依据。