1 1460 147 DISORDERS OF CONSCIOUSNESS AND PHARMACEUTICALS THAT ACT ON OXYGEN BASED AMINO ACID AND MONOAMINE NEUROTRANSMITTER PATHWAYS OF THE BRAIN. OXYGEN BASED NEUROTRANSMITTERS IN THE SYNAPSES OF THE BRAIN ARE PROPOSED TO PLAY AN IMPORTANT ROLE IN THE GENERATION OF CONSCIOUSNESS. THEY INCLUDE THE AMINO ACIDS GLUTAMATE AND GABA WHICH USE KREBS CYCLE PRECURSORS FOR THEIR SYNTHESIS, AND THE MONOAMINES DOPAMINE, NORADRENALIN, ADRENALIN AND SEROTONIN, WHICH ARE DERIVED FROM TYROSINE AND TRYPTOPHAN. DURING ISCHEMIA AFTER AN ACUTE BRAIN INJURY, A GABA SURGE OFTEN INITIATES BRAIN SUPPRESSION. IT HAS BEEN PROPOSED THAT WITH CHRONIC ISCHEMIA, A SECONDARY, POSSIBLY EPIGENETIC RESPONSE OCCURS WHEN NEUROTRANSMITTERS DEPLETE, A GLUCOSE AND OXYGEN SAVING MECHANISM TERMED NEURODORMANCY THAT MAY INVOKE ALTERNATIVE LONG TERM LOW ENERGY METABOLIC PATHWAYS IN THE BRAIN, ENCOUNTERED IN DISORDERS OF CONSCIOUSNESS. SOME MEDICATIONS CAN REVERSE DISORDERS OF CONSCIOUSNESS IN SOME PATIENTS. VIRTUALLY ALL OF THEM ACT ON NEUROTRANSMITTER SYSTEMS THAT USE OXYGEN AS A BUILDING BLOCK OR AS AN ENERGY SOURCE WITHIN THE BRAIN. PHARMACEUTICALS THAT ACT IN THE OXYGEN BASED AMINO ACID SYSTEMS OF THE BRAIN INCLUDE THE GABAERGIC MEDICATIONS ZOLPIDEM AND BACLOFEN, WHILE THOSE THAT ACT IN THE MONOAMINE AXES INCLUDE THE DOPAMINERGIC MEDICATIONS L DOPA, AMANTADINE, BROMOCRIPTINE, APOMORPHINE AND METHYLPHENIDATE, AND THE NORADRENERGIC AND SEROTONERGIC MEDICATIONS DESIPRAMINE, AMITRIPTYLINE, PROTRIPTYLINE AND FLUOXETINE. ANOTHER GROUP ARE THE CHOLINESTERASE INHIBITORS, RESPONSIBLE FOR INCREASING ACETYLCHOLINE, WHICH IS SYNTHESIZED FROM THE KREBS CYCLE INITIATOR, ACETYL COA. IT APPEARS THAT PHARMACEUTICALS THAT ARE ACTIVE IN THE OXYGEN BASED NEUROTRANSMITTER PATHWAYS OF THE BRAIN ARE SUCCESSFUL TO AROUSE TO CONSCIOUSNESS PATIENTS THAT SUFFER FROM ITS DISORDERS. RESEARCH NEEDS TO BE SUPPORTED AS FOUNDATION TO UNDERSTAND THE BIOCHEMICAL MECHANISMS THAT ARE INVOLVED IN CONSCIOUSNESS DISORDERS AND TO EXPLORE FURTHER THE PHARMACOLOGICAL TREATMENT POSSIBILITIES FOR THESE DEVASTATING NEUROLOGICAL CONDITIONS. 2014 2 6754 28 WILL WE NEED NOVEL COMBINATIONS TO CURE HBV INFECTION? CHRONIC HEPATITIS B IS A NUMERICALLY IMPORTANT CAUSE OF CIRRHOSIS AND HEPATOCELLULAR CARCINOMA. NUCLEOSIDE ANALOGUE THERAPY MAY MODIFY THE RISK. HOWEVER, MAINTENANCE SUPPRESSIVE THERAPY IS REQUIRED, AS A FUNCTIONAL CURE (GENERALLY DEFINED AS LOSS OF HBSAG OFF TREATMENT) IS AN UNCOMMON OUTCOME OF ANTIVIRAL TREATMENT. CHRONIC HEPATITIS B IS A NUMERICALLY IMPORTANT CAUSE OF CIRRHOSIS AND HEPATOCELLULAR CARCINOMA. NUCLEOSIDE ANALOGUE THERAPY MAY MODIFY THE RISK. HOWEVER, MAINTENANCE SUPPRESSIVE THERAPY IS REQUIRED, AS A FUNCTIONAL CURE (GENERALLY DEFINED AS LOSS OF HBSAG OFF TREATMENT) IS AN UNCOMMON OUTCOME OF ANTIVIRAL TREATMENT. CURRENTLY NUMEROUS INVESTIGATIONAL AGENTS BEING DEVELOPED TO EITHER INTERFERE WITH SPECIFIC STEPS IN HBV REPLICATION OR AS HOST CELLULAR TARGETING AGENTS, THAT INHIBIT VIRAL REPLICATION, AND DEPLETE OR INACTIVATE CCCDNA, OR AS IMMUNE MODULATORS. SYNERGISTIC MECHANISMS WILL BE NEEDED TO INCORPORATE A DECREASE IN HBV TRANSCRIPTION, IMPAIRMENT OF TRANSCRIPTION FROM HBV GENOMES, LOSS OF CCCDNA OR ALTERED EPIGENETIC REGULATION OF CCCDNA TRANSCRIPTION, AND IMMUNE MODULATION OR IMMUNOLOGICALLY STIMULATED HEPATOCYTE CELL TURNOVER. NUCLEOSIDE ANALOGUE SUPPRESSED PATIENTS ARE BEING INCLUDED IN MANY CURRENT TRIALS. TRIALS ARE PROGRESSING TO COMBINATION THERAPY AS ADDITIVE OR SYNERGISTIC EFFECTS ARE SOUGHT. THESE TRIALS WILL PROVIDE IMPORTANT INSIGHTS INTO THE BIOLOGY OF HBV AND PERTURBATIONS OF THE IMMUNE RESPONSE, REQUIRED TO EFFECT HBSAG LOSS AT DIFFERENT STAGES OF THE DISEASE. THE PROSPECT OF CURES OF HEPATITIS B WOULD ENSURE THAT A WIDE RANGE OF PATIENTS COULD BE DEEMED CANDIDATES FOR TREATMENT WITH NEW COMPOUNDS IF THESE WERE HIGHLY EFFECTIVE, FINITE AND SAFE. WITHDRAWAL OF THERAPY IN SHORT-TERM TRIALS IS CHALLENGING BECAUSE SHORT-TERM THERAPIES MAY RISK SEVERE HEPATITIS FLARES, AND HEPATIC DECOMPENSATION. THE LIMITED CLINICAL TRIAL DATA TO DATE SUGGEST THAT COMBINATION THERAPY IS INEVITABLE. 2020 3 4955 29 PATHOGENESIS OF COVID-19 DESCRIBED THROUGH THE LENS OF AN UNDERSULFATED AND DEGRADED EPITHELIAL AND ENDOTHELIAL GLYCOCALYX. THE GLYCOCALYX SURROUNDS EVERY EUKARYOTIC CELL AND IS A COMPLEX MESH OF PROTEINS AND CARBOHYDRATES. IT CONSISTS OF PROTEOGLYCANS WITH GLYCOSAMINOGLYCAN SIDE CHAINS, WHICH ARE HIGHLY SULFATED UNDER NORMAL PHYSIOLOGICAL CONDITIONS. THE DEGREE OF SULFATION AND THE POSITION OF THE SULFATE GROUPS MAINLY DETERMINE BIOLOGICAL FUNCTION. THE INTACT HIGHLY SULFATED GLYCOCALYX OF THE EPITHELIUM MAY REPEL SEVERE ACUTE RESPIRATORY SYNDROME-RELATED CORONAVIRUS 2 (SARS-COV-2) THROUGH ELECTROSTATIC FORCES. HOWEVER, IF THE GLYCOCALYX IS UNDERSULFATED AND 3-O-SULFOTRANSFERASE 3B (3OST-3B) IS OVEREXPRESSED, AS IS THE CASE DURING CHRONIC INFLAMMATORY CONDITIONS, SARS-COV-2 ENTRY MAY BE FACILITATED BY THE GLYCOCALYX. THE DEGREE OF SULFATION AND POSITION OF THE SULFATE GROUPS WILL ALSO AFFECT FUNCTIONS SUCH AS IMMUNE MODULATION, THE INFLAMMATORY RESPONSE, VASCULAR PERMEABILITY AND TONE, COAGULATION, MEDIATION OF SHEER STRESS, AND PROTECTION AGAINST OXIDATIVE STRESS. THE RATE-LIMITING FACTOR TO SULFATION IS THE AVAILABILITY OF INORGANIC SULFATE. VARIOUS GENETIC AND EPIGENETIC FACTORS WILL AFFECT SULFUR METABOLISM AND INORGANIC SULFATE AVAILABILITY, SUCH AS VARIOUS DIETARY FACTORS, AND EXPOSURE TO DRUGS, ENVIRONMENTAL TOXINS, AND BIOTOXINS, WHICH WILL DEPLETE INORGANIC SULFATE. THE ROLE THAT UNDERSULFATION PLAYS IN THE VARIOUS COMORBID CONDITIONS THAT PREDISPOSE TO CORONAVIRUS DISEASE 2019 (COVID-19), IS ALSO CONSIDERED. THE UNDERSULFATED GLYCOCALYX MAY NOT ONLY INCREASE SUSCEPTIBILITY TO SARS-COV-2 INFECTION, BUT WOULD ALSO RESULT IN A HYPERINFLAMMATORY RESPONSE, VASCULAR PERMEABILITY, AND SHEDDING OF THE GLYCOCALYX COMPONENTS, GIVING RISE TO A PROCOAGULANT AND ANTIFIBRINOLYTIC STATE AND EVENTUAL MULTIPLE ORGAN FAILURE. THESE SYMPTOMS RELATE TO A DIAGNOSIS OF SYSTEMIC SEPTIC SHOCK SEEN IN ALMOST ALL COVID-19 DEATHS. THE FOCUS OF PREVENTION AND TREATMENT PROTOCOLS PROPOSED IS THE PRESERVATION OF EPITHELIAL AND ENDOTHELIAL GLYCOCALYX INTEGRITY. 2022 4 1368 31 DEVELOPMENTAL ORIGINS OF DISEASE AND DETERMINANTS OF CHROMATIN STRUCTURE: MATERNAL DIET MODIFIES THE PRIMATE FETAL EPIGENOME. CHROMATIN STRUCTURE IS EPIGENETICALLY ALTERED VIA COVALENT MODIFICATIONS OF HISTONES TO ALLOW FOR HERITABLE GENE REGULATION WITHOUT ALTERING THE NUCLEOTIDE SEQUENCE. MULTIPLE LINES OF EVIDENCE FROM RODENTS HAVE ESTABLISHED A ROLE FOR EPIGENETIC REMODELING IN REGULATING GENE TRANSCRIPTION IN RESPONSE TO AN ALTERED GESTATIONAL MILIEU. HOWEVER, TO DATE, IT IS UNKNOWN WHETHER VARIATIONS IN THE INTRAUTERINE ENVIRONMENT IN PRIMATES SIMILARLY INDUCE CHANGES IN KEY DETERMINANTS OF HEPATIC CHROMATIN STRUCTURE. WE HYPOTHESIZED THAT A MATERNAL HIGH-FAT DIET WOULD ALTER THE EPIGENOMIC PROFILE OF THE DEVELOPING OFFSPRING, WHICH WOULD RESULT IN ALTERATIONS IN FETAL GENE EXPRESSION. AGE- AND WEIGHT-MATCHED ADULT FEMALE JAPANESE MACAQUES WERE PLACED ON CONTROL (13% FAT) OR HIGH-FAT (35% FAT) BREEDER DIETS AND MATED ANNUALLY OVER A 4-YEAR INTERVAL. FETUSES IN SUCCESSIVE YEARS WERE DELIVERED NEAR TERM (E130 OF 167 DAYS) AND UNDERWENT NECROPSY WITH TISSUE HARVEST. FETAL HISTONES WERE ACID EXTRACTED FOR CHARACTERIZATION OF H3 MODIFICATION AND CHROMATIN IMMUNOPRECIPITATION (CHIP) WITH DIFFERENTIAL DISPLAY PCR; FETAL RNA, DNA, AND CYTOPLASMIC AND NUCLEAR PROTEIN EXTRACTS WERE SIMILARLY EXTRACTED FOR COMPARISON. CHRONIC CONSUMPTION OF A MATERNAL HIGH-FAT DIET RESULTS IN A THREEFOLD INCREASE IN FETAL LIVER TRIGLYCERIDES AND HISTOLOGIC CORRELATES OF NON-ALCOHOLIC FATTY LIVER DISEASE. THESE GROSS CHANGES IN THE FETAL LIVER ARE ACCOMPANIED BY A STATISTICALLY SIGNIFICANT HYPERACETYLATION OF FETAL HEPATIC TISSUE AT H3K14 (199.85+/-9.64 VS 88.8+/-45.4; P=0.038) WITH A TREND TOWARDS THE INCREASED ACETYLATION AT H3K9 (140.9+/-38.7 VS 46.6+/-6.53; P=0.097) AND AT H3K18 (69.0+/-3.54 VS 58.0+/-4.04; P=0.096). HOWEVER, EPIGENETIC MODIFICATIONS ON FETAL HEPATIC H3 ASSOCIATED WITH GENE REPRESSION WERE ABSENT OR SUBTLE (P>0.05). SUBSEQUENT CHARACTERIZATION OF KEY EPIGENETIC DETERMINANTS ASSOCIATED WITH H3 ACETYLATION MARKS REVEALED SIMILAR SIGNIFICANT ALTERATIONS IN ASSOCIATION WITH A HIGH-FAT MATERNAL DIET (E.G., RELATIVE FETAL HISTONE DEACETYLASE 1 (HDAC1) GENE EXPRESSION 0.61+/-0.25; P=0.011). CONSISTENT WITH OUR MRNA EXPRESSION PROFILE, FETAL NUCLEAR EXTRACTS FROM OFFSPRING OF HIGH-FAT DIET ANIMALS WERE OBSERVED TO BE SIGNIFICANTLY RELATIVELY DEPLETE OF HDAC1 PROTEIN (36.07+/-6.73 VS 83.18+/-7.51; P=0.006) AND IN VITRO HDAC FUNCTIONAL ACTIVITY (0.252+/-0.03 VS 0.698+/-0.02; P<0.001). WE EMPLOY THESE OBSERVATIONS IN CHIP DIFFERENTIAL DISPLAY PCR TO ATTEMPT TO IDENTIFY POTENTIAL FETAL GENES WHOSE EXPRESSION IS REPROGRAMED UNDER CONDITIONS OF A HIGH-FAT MATERNAL DIET. WE QUANTITATIVELY CONFIRM A MINIMUM OF A 40% ALTERATION IN THE EXPRESSION OF SEVERAL GENES OF INTEREST: GLUTAMIC PYRUVATE TRANSAMINASE (ALANINE AMINOTRANSFERASE) 2 (GPT2) (1.59+/-0.23-FOLD; P=0.08), DNAJA2 (1.36+/-0.21; P=0.09), AND RDH12 (1.88+/-0.15; P=0.01) ARE APPRECIABLY INCREASED IN FETAL HEPATIC TISSUE FROM MATERNAL CALORIC-DENSE DIET ANIMALS WHEN COMPARED WITH CONTROL WHILE NPAS2, A PERIPHERAL CIRCADIAN REGULATOR, WAS SIGNIFICANTLY DOWNMODULATED IN THE OFFSPRING OF HIGH-FAT DIET ANIMALS (0.66+/-0.08; P=0.03). IN THIS STUDY, WE SHOW THAT A CURRENT SIGNIFICANT IN UTERO EXPOSURE (CALORIC-DENSE HIGH-FAT MATERNAL DIET) INDUCES SITE-SPECIFIC ALTERATIONS IN FETAL HEPATIC H3 ACETYLATION. EMPLOYING CHIP, WE EXTEND THESE OBSERVATIONS TO LINK MODIFICATIONS OF H3 ACETYLATION WITH ALTERATIONS IN GENE-SPECIFIC EXPRESSION. THESE RESULTS SUGGEST THAT A CALORIC-DENSE MATERNAL DIET LEADING TO OBESITY EPIGENETICALLY ALTERS FETAL CHROMATIN STRUCTURE IN PRIMATES VIA COVALENT MODIFICATIONS OF HISTONES AND HENCE LENDS A MOLECULAR BASIS TO THE FETAL ORIGINS OF ADULT DISEASE HYPOTHESIS. 2008 5 3839 31 IPSC-DERIVED NEURAL PRECURSOR CELLS: POTENTIAL FOR CELL TRANSPLANTATION THERAPY IN SPINAL CORD INJURY. A NUMBER OF STUDIES HAVE DEMONSTRATED THAT TRANSPLANTATION OF NEURAL PRECURSOR CELLS (NPCS) PROMOTES FUNCTIONAL RECOVERY AFTER SPINAL CORD INJURY (SCI). HOWEVER, THE NPCS HAD BEEN MOSTLY HARVESTED FROM EMBRYONIC STEM CELLS OR FETAL TISSUE, RAISING THE ETHICAL CONCERN. YAMANAKA AND HIS COLLEAGUES ESTABLISHED INDUCED PLURIPOTENT STEM CELLS (IPSCS) WHICH COULD BE GENERATED FROM SOMATIC CELLS, AND THIS INNOVATIVE DEVELOPMENT HAS MADE RAPID PROGRESSION IN THE FIELD OF SCI REGENERATION. WE AND OTHER GROUPS SUCCEEDED IN PRODUCING NPCS FROM IPSCS, AND DEMONSTRATED BENEFICIAL EFFECTS AFTER TRANSPLANTATION FOR ANIMAL MODELS OF SCI. IN PARTICULAR, EFFICACY OF HUMAN IPSC-NPCS IN NON-HUMAN PRIMATE SCI MODELS FOSTERED MOMENTUM OF CLINICAL APPLICATION FOR SCI PATIENTS. AT THE SAME TIME, HOWEVER, ARTIFICIAL INDUCTION METHODS IN IPSC TECHNOLOGY CREATED ALTERNATIVE ISSUES INCLUDING GENETIC AND EPIGENETIC ABNORMALITIES, AND TUMORIGENICITY AFTER TRANSPLANTATION. TO OVERCOME THESE PROBLEMS, IT IS CRITICALLY IMPORTANT TO SELECT ORIGINS OF SOMATIC CELLS, USE INTEGRATION-FREE SYSTEM DURING TRANSFECTION OF REPROGRAMMING FACTORS, AND THOROUGHLY INVESTIGATE THE CHARACTERISTICS OF IPSC-NPCS WITH RESPECT TO QUALITY MANAGEMENT. MOREOVER, SINCE MOST OF THE PREVIOUS STUDIES HAVE FOCUSED ON SUBACUTE PHASE OF SCI, ESTABLISHMENT OF EFFECTIVE NPC TRANSPLANTATION SHOULD BE EVALUATED FOR CHRONIC PHASE HEREAFTER. OUR GROUP IS CURRENTLY PREPARING CLINICAL-GRADE HUMAN IPSC-NPCS, AND WILL MOVE FORWARD TOWARD CLINICAL STUDY FOR SUBACUTE SCI PATIENTS SOON IN THE NEAR FUTURE. 2018 6 5918 19 TARGETING BMI-1 IN B CELLS RESTORES EFFECTIVE HUMORAL IMMUNE RESPONSES AND CONTROLS CHRONIC VIRAL INFECTION. INEFFECTIVE ANTIBODY-MEDIATED RESPONSES ARE A KEY CHARACTERISTIC OF CHRONIC VIRAL INFECTION. HOWEVER, OUR UNDERSTANDING OF THE INTRINSIC MECHANISMS THAT DRIVE THIS DYSREGULATION ARE UNCLEAR. HERE, WE IDENTIFY THAT TARGETING THE EPIGENETIC MODIFIER BMI-1 IN MICE IMPROVES HUMORAL RESPONSES TO CHRONIC LYMPHOCYTIC CHORIOMENINGITIS VIRUS. BMI-1 WAS UPREGULATED BY GERMINAL CENTER B CELLS IN CHRONIC VIRAL INFECTION, CORRELATING WITH CHANGES TO THE ACCESSIBLE CHROMATIN LANDSCAPE, COMPARED TO ACUTE INFECTION. B CELL-INTRINSIC DELETION OF BMI1 ACCELERATED VIRAL CLEARANCE, REDUCED SPLENOMEGALY AND RESTORED SPLENIC ARCHITECTURE. DELETION OF BMI1 RESTORED C-MYC EXPRESSION IN B CELLS, CONCOMITANT WITH IMPROVED QUALITY OF ANTIBODY AND COUPLED WITH REDUCED ANTIBODY-SECRETING CELL NUMBERS. SPECIFICALLY, BMI-1-DEFICIENCY INDUCED ANTIBODY WITH INCREASED NEUTRALIZING CAPACITY AND ENHANCED ANTIBODY-DEPENDENT EFFECTOR FUNCTION. USING A SMALL MOLECULE INHIBITOR TO MURINE BMI-1, WE COULD DEPLETE ANTIBODY-SECRETING CELLS AND PROHIBIT DETRIMENTAL IMMUNE COMPLEX FORMATION IN VIVO. THIS STUDY DEFINES BMI-1 AS A CRUCIAL IMMUNE MODIFIER THAT CONTROLS ANTIBODY-MEDIATED RESPONSES IN CHRONIC INFECTION. 2022 7 454 31 APPLICATIONS OF INDUCED PLURIPOTENT STEM CELL TECHNOLOGIES IN SPINAL CORD INJURY. NUMEROUS BASIC RESEARCH STUDIES HAVE SUGGESTED THE POTENTIAL EFFICACY OF NEURAL PRECURSOR CELL (NPC) TRANSPLANTATION IN SPINAL CORD INJURY (SCI). HOWEVER, IN MOST SUCH STUDIES, THE ORIGIN OF THE CELLS USED WAS MAINLY FETAL TISSUE OR EMBRYONIC STEM CELLS, BOTH OF WHICH CARRY POTENTIAL ETHICAL CONCERNS WITH RESPECT TO CLINICAL USE. THE DEVELOPMENT OF INDUCED PLURIPOTENT STEM CELLS (IPSCS) OPENED A NEW PATH TOWARD REGENERATIVE MEDICINE FOR SCI. IPSCS CAN BE GENERATED FROM SOMATIC CELLS BY INDUCTION OF TRANSCRIPTION FACTORS, AND INDUCED TO DIFFERENTIATE INTO NPCS WITH CHARACTERISTICS OF CELLS OF THE CENTRAL NERVOUS SYSTEM. THE BENEFICIAL EFFECT OF IPSC-DERIVED NPC TRANSPLANTATION HAS BEEN REPORTED FROM OUR GROUP AND OTHERS WORKING IN RODENT AND NON-HUMAN PRIMATE MODELS. THESE PROMISING RESULTS FACILITATE THE APPLICATION OF IPSCS FOR CLINICAL APPLICATIONS IN SCI PATIENTS. HOWEVER, IPSCS ALSO HAVE ISSUES, SUCH AS GENETIC/EPIGENETIC ABNORMALITIES AND TUMORIGENESIS BECAUSE OF THE ARTIFICIAL INDUCTION METHOD, THAT MUST BE ADDRESSED PRIOR TO CLINICAL USE. THE SELECTION OF SOMATIC CELLS, GENERATION OF INTEGRATION-FREE IPSCS, AND CHARACTERIZATION OF DIFFERENTIATED NPCS WITH THOROUGH QUALITY MANAGEMENT ARE ALL NEEDED TO ADDRESS THESE POTENTIAL RISKS. TO ENHANCE THE EFFICACY OF THE TRANSPLANTED IPSC-NPCS, ESPECIALLY AT CHRONIC PHASE OF SCI, ADMINISTRATION OF A CHONDROITINASE OR SEMAPHORIN3A INHIBITOR REPRESENTS A POTENTIALLY IMPORTANT MEANS OF PROMOTING AXONAL REGENERATION THROUGH THE LESION SITE. THE COMBINED USE OF REHABILITATION WITH SUCH CELL THERAPY APPROACHES IS ALSO IMPORTANT, AS REPETITIVE TRAINING ENHANCES NEURITE OUTGROWTH OF TRANSPLANTED CELLS AND STRENGTHENS NEURAL CIRCUITS AT CENTRAL PATTERN GENERATORS. OUR GROUP HAS ALREADY EVALUATED CLINICAL GRADE IPSC-DERIVED NPCS, AND WE LOOK FORWARD TO INITIATING CLINICAL TESTING AS THE NEXT STEP TOWARD DETERMINING WHETHER THIS APPROACH IS SAFE AND EFFECTIVE FOR CLINICAL USE. THIS ARTICLE IS PART OF THE MINI REVIEW SERIES "60TH ANNIVERSARY OF THE JAPANESE SOCIETY FOR NEUROCHEMISTRY". 2017 8 6302 30 THE PUTATIVE ROLE OF VIRUSES, BACTERIA, AND CHRONIC FUNGAL BIOTOXIN EXPOSURE IN THE GENESIS OF INTRACTABLE FATIGUE ACCOMPANIED BY COGNITIVE AND PHYSICAL DISABILITY. PATIENTS WHO PRESENT WITH SEVERE INTRACTABLE APPARENTLY IDIOPATHIC FATIGUE ACCOMPANIED BY PROFOUND PHYSICAL AND OR COGNITIVE DISABILITY PRESENT A SIGNIFICANT THERAPEUTIC CHALLENGE. THE EFFECT OF PSYCHOLOGICAL COUNSELING IS LIMITED, WITH SIGNIFICANT BUT VERY SLIGHT IMPROVEMENTS IN PSYCHOMETRIC MEASURES OF FATIGUE AND DISABILITY BUT NO IMPROVEMENT ON SCIENTIFIC MEASURES OF PHYSICAL IMPAIRMENT COMPARED TO CONTROLS. SIMILARLY, EXERCISE REGIMES EITHER PRODUCE SIGNIFICANT, BUT PRACTICALLY UNIMPORTANT, BENEFIT OR PROVOKE SYMPTOM EXACERBATION. MANY SUCH PATIENTS ARE AFFORDED THE EXCLUSIONARY, NON-SPECIFIC DIAGNOSIS OF CHRONIC FATIGUE SYNDROME IF RUDIMENTARY TESTING FAILS TO DISCOVER THE CAUSE OF THEIR SYMPTOMS. MORE SOPHISTICATED INVESTIGATIONS OFTEN REVEAL THE PRESENCE OF A RANGE OF PATHOGENS CAPABLE OF ESTABLISHING LIFE-LONG INFECTIONS WITH SOPHISTICATED IMMUNE EVASION STRATEGIES, INCLUDING PARVOVIRUSES, HHV6, VARIANTS OF EPSTEIN-BARR, CYTOMEGALOVIRUS, MYCOPLASMA, AND BORRELIA BURGDORFERI. OTHER PATIENTS HAVE A HISTORY OF CHRONIC FUNGAL OR OTHER BIOTOXIN EXPOSURE. HEREIN, WE EXPLAIN THE EPIGENETIC FACTORS THAT MAY RENDER SUCH INDIVIDUALS SUSCEPTIBLE TO THE CHRONIC PATHOLOGY INDUCED BY SUCH AGENTS, HOW SUCH AGENTS INDUCE PATHOLOGY, AND, INDEED, HOW SUCH PATHOLOGY CAN PERSIST AND EVEN AMPLIFY EVEN WHEN INFECTIONS HAVE CLEARED OR WHEN BIOTOXIN EXPOSURE HAS CEASED. THE PRESENCE OF ACTIVE, REACTIVATED, OR EVEN LATENT HERPES VIRUS COULD BE A POTENTIAL SOURCE OF INTRACTABLE FATIGUE ACCOMPANIED BY PROFOUND PHYSICAL AND OR COGNITIVE DISABILITY IN SOME PATIENTS, AND THE SAME MAY BE TRUE OF PERSISTENT PARVOVIRUS B12 AND MYCOPLASMA INFECTION. A HISTORY OF CHRONIC MOLD EXPOSURE IS A FEASIBLE EXPLANATION FOR SUCH SYMPTOMS, AS IS THE PRESENCE OF B. BURGDORFERI. THE COMPLEX TROPISM, LIFE CYCLES, GENETIC VARIABILITY, AND LOW TITER OF MANY OF THESE PATHOGENS MAKES THEIR DETECTION IN BLOOD A CHALLENGE. EXAMINATION OF LYMPHOID TISSUE OR CSF IN SUCH CIRCUMSTANCES MAY BE WARRANTED. 2016 9 1066 41 CLINICAL USE OF AMINO ACIDS AS DIETARY SUPPLEMENT: PROS AND CONS. NITROGEN SUPPLY IS PIVOTAL FOR THE MAINTENANCE OF LIFE. AMINO ACIDS CAN BE UTILIZED TO SYNTHESIZE BOTH GLUCOSE AND LIPIDS. THE OPPOSITE, I.E., PRODUCTION OF AMINO ACIDS FROM EITHER ONE OF THEM, IS NOT POSSIBLE IN THE ABSENCE OF OTHER AMINO ACIDS AS DONORS OF NITROGEN. THE QUALITY OF AMINO ACID CONTENT IN PROTEIN HAS BEEN RE-EVALUATED RECENTLY, AND THE RELEVANCE OF ESSENTIAL AMINO ACIDS HAS BEEN REPEATEDLY UNDERLINED. ESSENTIAL AMINO ACID REQUIREMENTS IN DIFFERENT MAMMALS ARE NOT IDENTICAL, AND RATIOS AMONG THEM SHOULD BE TAKEN INTO ACCOUNT WHEN PROJECTING AN EFFICIENT FORMULATION. RECENT RESEARCH HAS DEMONSTRATED THAT GENES RESPOND TO DIFFERENT QUALITIES AND QUANTITIES OF NUTRITIONAL SUPPLY, AND INCREASED PROVISION OF ESSENTIAL AMINO ACIDS INCREASES LIFESPAN IN ANIMAL EXPERIMENTS THROUGH MITOCHONDRIOGENESIS AND MAINTENANCE OF ELEVATED RATES OF SYNTHESIS OF ANTI-OXIDANT MOLECULES. MOREOVER, GENETIC EXPRESSION OF KEY CONTROLLERS OF SYNTHESIS, LIKE MTOR, MAY BE PARTICULARLY IMPORTANT FOR UNDERSTANDING SKELETAL MUSCLE MAINTENANCE. LOSSES OF MUSCLE MASS AND IMPAIRED IMMUNE FUNCTION ARE RELATED TO REDUCED PROTEIN SUPPLY, AND THERE IS INCREASING EVIDENCE THAT REGULAR ESSENTIAL AMINO ACID INTAKE AS PART OF AN ORAL DIET IS EFFECTIVE IN REVERSING MUSCLE CATABOLISM, PROMOTING MUSCLE ANABOLISM, AND RESTORING IMMUNOLOGICAL FUNCTION. THEREFORE, THE USE OF AMINO ACIDS AS SUPPLEMENTS TO DIET WOULD BE EXPANDING IN THE NEAR FUTURE. IS THIS SAFE? FEW DATA ARE AVAILABLE ON AMINO ACID TOXICITY, AND ONLY ONE ESSENTIAL AMINO ACID MAY BE CONSIDERED TO HAVE CLINICALLY RELEVANT TOXICITY: METHIONINE, BECAUSE IT IS TRANSFORMED INTO A TOXIC INTERMEDIATE, HOMOCYSTEINE, WHEN CYSTEINE SYNTHESIS IS REQUIRED BY METABOLIC NEEDS. MATCHING OF STOICHIOMETRIC RATIOS BETWEEN METHIONINE AND CYSTEINE MAY SOLVE THE PROBLEM OF SUPPLYING SUFFICIENT AMOUNTS OF SULFUR TO THE BODY. ARGININE AND GLUTAMINE ARE TWO NON-ESSENTIAL AMINO ACIDS THAN CAN BECOME "CONDITIONALLY ESSENTIAL" BECAUSE OF ELEVATED NEEDS DURING PATHOLOGICAL CONDITIONS, AND METABOLISM MAY NOT BE ABLE TO MAINTAIN THEIR CONCENTRATIONS AT SUFFICIENT LEVELS TO MATCH METABOLIC REQUIREMENTS. CHRONIC EXOGENOUS ARGININE SUPPLEMENTATION HAS NOT PROVEN TO EXERT POSITIVE CLINICAL EFFECTS IN DIFFERENT TRIALS, AND SEQUENTIAL ARTICULATION OF THE KNOWLEDGE OF INTRODUCTION OF ARGININE-DRIVEN TRANSCRIPTIONAL, TRANSLATIONAL, AND EPIGENETIC ADAPTATIONS MAY GIVE US A KEY FOR INTERPRETING THOSE PUZZLING RESULTS. 2011 10 835 33 CHEMICAL CARCINOGEN MECHANISMS OF ACTION AND IMPLICATIONS FOR TESTING METHODOLOGY. CHEMICAL CARCINOGENS ARE OF TWO DISTINCT TYPES, DNA-REACTIVE AND EPIGENETIC. TESTING METHODOLOGY CAN BE DIRECTED TOWARD DETECTING EFFECTS OF BOTH TYPES OF CARCINOGEN. CARCINOGENS OF THE DNA-REACTIVE TYPE ARE DEFINED BY THE FORMATION OF COVALENTLY BOUND DNA ADDUCTS. THESE CHEMICALS HAVE STRUCTURES THAT YIELD ELECTROPHILIC REACTANTS EITHER DIRECTLY OR AFTER BIOACTIVATION. THESE AGENTS CAUSE GENOMIC ALTERATION IN THE STRUCTURE OR FUNCTION OF DNA IN THE TARGET CELL. IN ADDITION, THESE COMPOUNDS CAN EXERT OTHER CELLULAR AND TISSUE EPIGENETIC EFFECTS, SUCH AS CELL PROLIFERATION AND GROWTH PROMOTION. CARCINOGENS OF THE EPIGENETIC (PARAGENETIC) TYPE, IN CONTRAST, DO NOT REACT WITH DNA, BUT RATHER DISPLAY CELLULAR EFFECTS SUCH AS NEOPLASM GROWTH PROMOTION, CYTOTOXICITY, INHIBITION OF TISSUE GROWTH REGULATION, PEROXISOME PROLIFERATION, ENDOCRINE MODIFICATION, IMMUNOSUPPRESSION AND/OR SUSTAINED TISSUE ISCHEMIA THAT CAN BE THE BASIS FOR INCREASES IN NEOPLASIA. THEIR CHEMICAL STRUCTURE IS SUCH THAT THEY DO NOT GIVE RISE TO A REACTIVE ELECTROPHILE. THE TESTING METHODOLOGIES TO IDENTIFY EITHER TYPE FOLLOW A DECISION POINT APPROACH DESIGNED TO IDENTIFY POTENTIAL CARCINOGENICITY AND YIELD MECHANISTIC INFORMATION ON THE PRODUCTION OF EFFECTS THAT UNDERLIE CARCINOGENICITY. IT HAS 5 STAGES FOCUSING ON THE CHEMICAL STRUCTURE, DNA-REACTIVITY, EPIGENETIC EFFECTS, LIMITED BIOASSAYS AND FINALLY THE APPLICATION OF THE ACCELERATED BIOASSAY (ABA). ABA REQUIRES 40 WEEKS AND APPLIES THE USE OF SENSITIVE MARKERS FOR INDUCTION OF NEOPLASIA IN COMPARISON TO POSITIVE CONTROL COMPOUNDS FOR IMPORTANT ORGANS IN HUMAN CARCINOGENESIS. IT ENABLES DATA ACQUISITION OF THE ENTIRE CARCINOGENIC PROCESS DIRECTED TOWARD DEVELOPING MECHANISTIC INFORMATION. THE ABA HAS THE POTENTIAL TO REPLACE THE CHRONIC BIOASSAY IN RODENTS IN SOME CIRCUMSTANCES AND CAN SERVE AS AN ALTERNATIVE TO A CHRONIC BIOASSAY IN A SECOND SPECIES. 1996 11 1711 32 DYSFUNCTIONAL STATE OF T CELLS OR EXHAUSTION DURING CHRONIC VIRAL INFECTIONS AND COVID-19: A REVIEW. CORONAVIRUS DISEASE 2019 (COVID-19) CONTINUOUSLY AFFECTING THE LIVES OF MILLIONS OF PEOPLE. THE VIRUS IS SPREAD THROUGH THE RESPIRATORY ROUTE TO AN UNINFECTED PERSON, CAUSING MILD-TO-MODERATE RESPIRATORY DISEASE-LIKE SYMPTOMS THAT SOMETIMES PROGRESS TO SEVERE FORM AND CAN BE FATAL. WHEN THE HOST IS INFECTED WITH THE VIRUS, BOTH INNATE AND ADAPTIVE IMMUNITY COMES INTO PLAY. THE EFFECTOR T CELLS ACT AS THE MASTER PLAYER OF ADAPTIVE IMMUNE RESPONSE IN ERADICATING THE VIRUS FROM THE SYSTEM. BUT DURING CANCER AND CHRONIC VIRAL INFECTIONS, THE FATE OF AN EFFECTOR T CELL IS ALTERED, AND THE T CELL MAY ENTERS A STATE OF EXHAUSTION, WHICH IS MARKED BY LOSS OF EFFECTOR FUNCTION, DEPLETED PROLIFERATIVE CAPACITY AND CYTOTOXIC EFFECT ACCOMPLISHED BY AN INCREASED EXPRESSION OF NUMEROUS INHIBITORY RECEPTORS SUCH AS PROGRAMMED CELL DEATH PROTEIN 1 (PD-1), LYMPHOCYTE-ACTIVATION PROTEIN 3 (LAG-3), AND CYTOTOXIC T LYMPHOCYTE-ASSOCIATED ANTIGEN 4 (CTLA-4) ON THEIR SURFACE. VARIOUS OTHER TRANSCRIPTIONAL AND EPIGENETIC CHANGES TAKE PLACE INSIDE THE T CELL WHEN IT ENTERS INTO AN EXHAUSTED STATE. LATEST STUDIES POINT TOWARD THE INDUCTION OF AN ABNORMAL IMMUNE RESPONSE SUCH AS LYMPHOPENIA, CYTOKINE STORM, AND T CELL EXHAUSTION DURING SARS-COV-2 (SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2) INFECTION. THIS REVIEW SHEDS LIGHT ON THE DYSFUNCTIONAL STATE OF T CELLS DURING CHRONIC VIRAL INFECTION AND COVID-19. UNDERSTANDING THE CAUSE AND THE EFFECT OF T CELL EXHAUSTION OBSERVED DURING COVID-19 MAY HELP RESOLVE NEW THERAPEUTIC POTENTIALS FOR TREATING CHRONIC INFECTIONS AND OTHER DISEASES. 2022 12 4856 27 OPTIMIZING RETROVIRAL GENE EXPRESSION FOR EFFECTIVE THERAPIES. WITH THEIR ABILITY TO INTEGRATE THEIR GENETIC MATERIAL INTO THE TARGET CELL GENOME, RETROVIRAL VECTORS (RV) OF BOTH THE GAMMA-RETROVIRAL (GAMMA-RV) AND LENTIVIRAL VECTOR (LV) CLASSES CURRENTLY REMAIN THE MOST EFFICIENT AND THUS THE SYSTEM OF CHOICE FOR ACHIEVING TRANSGENE RETENTION AND THEREFORE POTENTIALLY LONG-TERM EXPRESSION AND THERAPEUTIC BENEFIT. HOWEVER, GAMMA-RV AND LV INTEGRATION COMES AT A COST IN THAT TRANSCRIPTION UNITS WILL BE PRESENT WITHIN A NATIVE CHROMATIN ENVIRONMENT AND THUS BE SUBJECT TO EPIGENETIC EFFECTS (DNA METHYLATION, HISTONE MODIFICATIONS) THAT CAN NEGATIVELY IMPACT ON THEIR FUNCTION. INDEED, HIGHLY VARIABLE EXPRESSION AND SILENCING OF GAMMA-RV AND LV TRANSGENES ESPECIALLY RESULTING FROM PROMOTER DNA METHYLATION IS WELL DOCUMENTED AND WAS THE CAUSE OF THE FAILURE OF GENE THERAPY IN A CLINICAL TRIAL FOR X-LINKED CHRONIC GRANULOMATOUS DISEASE. THIS REVIEW WILL CRITICALLY EXPLORE THE USE OF DIFFERENT CLASSES OF GENETIC CONTROL ELEMENTS THAT CAN IN PRINCIPLE REDUCE VECTOR INSERTION SITE POSITION EFFECTS AND EPIGENETIC-MEDIATED SILENCING. THESE TRANSCRIPTIONAL REGULATORY ELEMENTS BROADLY DIVIDE THEMSELVES INTO EITHER THOSE WITH A CHROMATIN BOUNDARY OR BORDER FUNCTION (SCAFFOLD/MATRIX ATTACHMENT REGIONS, INSULATORS) OR THOSE WITH A DOMINANT CHROMATIN REMODELING AND TRANSCRIPTIONAL ACTIVATING CAPABILITY (LOCUS CONTROL REGIONS,, UBIQUITOUS CHROMATIN OPENING ELEMENTS). ALL THESE TYPES OF ELEMENTS HAVE THEIR STRENGTHS AND WEAKNESSES WITHIN THE CONSTRAINTS OF A GAMMA-RV AND LV BACKBONE, SHOWING VARYING DEGREES OF EFFICACY IN IMPROVING REPRODUCIBILITY AND STABILITY OF TRANSGENE FUNCTION. COMBINATIONS OF BOUNDARY AND CHROMATIN REMODELING; TRANSCRIPTIONAL ACTIVATING ELEMENTS, WHICH DO NOT IMPEDE VECTOR PRODUCTION; TRANSDUCTION EFFICIENCY; AND STABILITY ARE MOST LIKELY TO MEET THE REQUIREMENTS WITHIN A GENE THERAPY CONTEXT ESPECIALLY WHEN TARGETING A STEM CELL POPULATION. 2013 13 1242 34 CURRENT AND NOVEL THERAPEUTIC APPROACHES IN MYELODYSPLASTIC SYNDROMES. MYELODYSPLASTIC SYNDROMES (MDS) ARE A HETEROGENEOUS GROUP OF HEMATOLOGIC NEOPLASMS WITH AN ANNUAL INCIDENCE OF 4.1 CASES PER 100,000 AMERICANS. PATIENTS WITH MDS SUFFER FROM CHRONIC CYTOPENIAS THAT MAY LEAD TO RECURRENT TRANSFUSIONS, INFECTIONS, AND INCREASED RISK FOR BLEEDING. THEY ARE ALSO AT RISK FOR PROGRESSION TO ACUTE MYELOID LEUKEMIA. ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION IS THE ONLY POTENTIALLY CURATIVE TREATMENT FOR MDS, ALTHOUGH 3 DRUGS HAVE BEEN APPROVED BY THE US FOOD AND DRUG ADMINISTRATION FOR ITS TREATMENT: LENALIDOMIDE, 5-AZACITIDINE, AND DECITABINE. THESE THERAPIES CAN BE EFFECTIVE IN THE RELIEF OF CYTOPENIAS, ACHIEVEMENT OF CYTOGENETIC REMISSIONS, AND REDUCTION IN BONE MARROW BLASTS. 5-AZACITIDINE HAS ALSO BEEN SHOWN TO IMPROVE OVERALL SURVIVAL. HOWEVER, THERE REMAIN MANY UNMET NEEDS IN THE TREATMENT OF MDS. BREAKTHROUGHS IN OUR UNDERSTANDING OF THE COMPLEX PATHOGENESIS OF MDS THROUGH EPIGENETIC, GENETIC, IMMUNOLOGIC, AND OTHER BIOLOGICAL MECHANISMS HAVE ALLOWED US TO DEVELOP NEW THERAPEUTIC STRATEGIES THAT CAN LEAD TO IMPROVEMENTS IN OUTCOMES IN MDS. IN THIS REVIEW, WE AIM TO PROVIDE AN OVERVIEW OF THE EVOLUTION IN CLASSIFCATION AND RISK STRATIFCATION IN MDS AND TO ILLUSTRATE HOW WE CAN USE THIS TO GUIDE US IN TAILORING THERAPEUTIC CHOICES IN THIS DISEASE. RESPONSES AND OUTCOMES RELATED TO COM MONLY USED MDS THERAPIES WILL BE DISCUSSED TOGETHER WITH NOVEL THERAPIES THAT HAVE EVOLVED WITH THE IMPROVED UNDERSTANDING OF MDS PATHOPHYSIOLOGY. 2014 14 6166 31 THE GLUTATHIONE SYSTEM: A NEW DRUG TARGET IN NEUROIMMUNE DISORDERS. GLUTATHIONE (GSH) HAS A CRUCIAL ROLE IN CELLULAR SIGNALING AND ANTIOXIDANT DEFENSES EITHER BY REACTING DIRECTLY WITH REACTIVE OXYGEN OR NITROGEN SPECIES OR BY ACTING AS AN ESSENTIAL COFACTOR FOR GSH S-TRANSFERASES AND GLUTATHIONE PEROXIDASES. GSH ACTING IN CONCERT WITH ITS DEPENDENT ENZYMES, KNOWN AS THE GLUTATHIONE SYSTEM, IS RESPONSIBLE FOR THE DETOXIFICATION OF REACTIVE OXYGEN AND NITROGEN SPECIES (ROS/RNS) AND ELECTROPHILES PRODUCED BY XENOBIOTICS. ADEQUATE LEVELS OF GSH ARE ESSENTIAL FOR THE OPTIMAL FUNCTIONING OF THE IMMUNE SYSTEM IN GENERAL AND T CELL ACTIVATION AND DIFFERENTIATION IN PARTICULAR. GSH IS A UBIQUITOUS REGULATOR OF THE CELL CYCLE PER SE. GSH ALSO HAS CRUCIAL FUNCTIONS IN THE BRAIN AS AN ANTIOXIDANT, NEUROMODULATOR, NEUROTRANSMITTER, AND ENABLER OF NEURON SURVIVAL. DEPLETION OF GSH LEADS TO EXACERBATION OF DAMAGE BY OXIDATIVE AND NITROSATIVE STRESS; HYPERNITROSYLATION; INCREASED LEVELS OF PROINFLAMMATORY MEDIATORS AND INFLAMMATORY POTENTIAL; DYSFUNCTIONS OF INTRACELLULAR SIGNALING NETWORKS, E.G., P53, NUCLEAR FACTOR-KAPPAB, AND JANUS KINASES; DECREASED CELL PROLIFERATION AND DNA SYNTHESIS; INACTIVATION OF COMPLEX I OF THE ELECTRON TRANSPORT CHAIN; ACTIVATION OF CYTOCHROME C AND THE APOPTOTIC MACHINERY; BLOCKADE OF THE METHIONINE CYCLE; AND COMPROMISED EPIGENETIC REGULATION OF GENE EXPRESSION. AS SUCH, GSH DEPLETION HAS MARKED CONSEQUENCES FOR THE HOMEOSTATIC CONTROL OF THE IMMUNE SYSTEM, OXIDATIVE AND NITROSATIVE STRESS (O&NS) PATHWAYS, REGULATION OF ENERGY PRODUCTION, AND MITOCHONDRIAL SURVIVAL AS WELL. GSH DEPLETION AND CONCOMITANT INCREASE IN O&NS AND MITOCHONDRIAL DYSFUNCTIONS PLAY A ROLE IN THE PATHOPHYSIOLOGY OF DIVERSE NEUROIMMUNE DISORDERS, INCLUDING DEPRESSION, MYALGIC ENCEPHALOMYELITIS/CHRONIC FATIGUE SYNDROME AND PARKINSON'S DISEASE, SUGGESTING THAT DEPLETED GSH IS AN INTEGRAL PART OF THESE DISEASES. THERAPEUTICAL INTERVENTIONS THAT AIM TO INCREASE GSH CONCENTRATIONS IN VIVO INCLUDE N-ACETYL CYSTEINE; NRF-2 ACTIVATION VIA HYPERBARIC OXYGEN THERAPY; DIMETHYL FUMARATE; PHYTOCHEMICALS, INCLUDING CURCUMIN, RESVERATROL, AND CINNAMON; AND FOLATE SUPPLEMENTATION. 2014 15 265 40 ADVERSE EFFECTS OF RECREATIONAL AND MEDICAL CANNABIS. PURPOSE OF REVIEW: THIS COMPREHENSIVE REVIEW DISCUSSES THE ADVERSE EFFECTS KNOWN TODAY ABOUT MARIJUANA, FOR EITHER MEDICAL OR RECREATIONAL USE. IT REVIEWS THE ROLE OF CANNABIS IN THE TREATMENT OF CHRONIC PAIN, COGNITIVE AND NEUROLOGICAL ADVERSE EFFECTS, SPECIAL CASES AND ADDICTION. RECENT FINDINGS: CANNABINOIDS WORK THROUGH THE ENDOCANNABINOIDS SYSTEM AND INHIBIT THE RELEASE OF GABA AND GLUTAMATE IN THE BRAIN, IMPACT NEUROMODULATION, AS WELL AS DOPAMINE, ACETYLCHOLINE AND NOREPINEPHRINE RELEASE. THEY AFFECT REWARD, LEARNING AND PAIN. THE USE OF CANNABIS IS INCREASING NATIONALLY AND WORLD-WIDE FOR BOTH RECREATIONAL AND MEDICINAL PURPOSES, HOWEVER, THERE IS RELATIVELY ONLY LOW QUALITY EVIDENCE TO THE EFFICACY AND ADVERSE EFFECTS OF THIS. CANNABIS AND ITS DERIVATIVES MAY BE USED FOR TREATMENT OF CHRONIC PAIN. THEY ARE VIA CB1 RECEPTORS THAT ARE THOUGHT TO MODULATE NOCICEPTIVE SIGNALS IN THE BRAIN. CB2 RECEPTORS IN THE DRG LIKELY AFFECT PAIN INTEGRATION IN THE AFFERENT PATHWAYS, AND PERIPHERALLY CB2 ALSO AFFECTS NORADRENERGIC PATHWAYS INFLUENCING PAIN. A LARGE PROPORTION OF USERS MAY SEE MORE THAN 50% OF CHRONIC PAIN ALLEVIATION COMPARED WITH PLACEBO. CANNABIS AFFECTS COGNITION, MOST NOTABLY EXECUTIVE FUNCTION, MEMORY AND ATTENTION, AND MAY DETERIORATE THE BOUNDARY BETWEEN EMOTIONAL AND EXECUTIVE PROCESSING. CANNABIS IMPAIRS MEMORY IN THE SHORT RUN, WHICH BECOME MORE SIGNIFICANT WITH CHRONIC USE, AND MAY ALSO BE ACCOMPANIED BY POORER EFFORT, SLOWER PROCESSING AND IMPACTED ATTENTION. IT IS GENERALLY BELIEVED THAT LONG-TERM USE AND EARLIER AGE ARE RISK FACTOR FOR NEUROCOGNITIVE DEFICITS; NEUROIMAGING STUDIES HAVE SHOWN REDUCED HIPPOCAMPAL VOLUME AND DENSITY. EXECUTIVE FUNCTIONS AND MEMORY ARE WORSE IN ADOLESCENT USERS VERSUS ADULTS. CANNABIS ADDICTION IS DIFFERENT AND LIKELY LESS COMMON THAN OTHER ADDICTIVE SUBSTANCES, BUT UP TO 10% OF USERS MEET CRITERIA FOR LIFETIME CANNABIS DEPENDENCE. ADDICTION PATTERNS MAY BE LINKED TO GENETIC AND EPIGENETIC DIFFERENCES. IT IS STILL UNCLEAR WHETHER ABSTINENCE REVERSES PATTERNS OF ADDICTION, AND MORE RESEARCH IS REQUIRED INTO THIS TOPIC. SUMMARY: CANNABIS USE HAS BECOME MORE ABUNDANT FOR BOTH MEDICAL AND RECREATIONAL USE. IT CARRIES LIKELY BENEFITS IN THE FORM OF ANALGESIA, ANTI-EMESIS AND IMPROVED APPETITE IN CHRONIC PATIENTS. THE EVIDENCE REVIEWING ADVERSE EFFECTS OF THIS USE ARE STILL LIMITED, HOWEVER, EXITING DATA POINTS TO A CLEAR LINK WITH NEUROCOGNITIVE DETERIORATION, BACKED BY LOSS OF BRAIN VOLUME AND DENSITY. ADDICTION IS LIKELY COMPLEX AND VARIABLE, AND NO GOOD DATA EXISTS TO SUPPORT TREATMENT AT THIS POINT. IT IS BECOMING CLEAR THAT USE IN EARLIER AGES CARRIES A HIGHER RISK FOR LONG-TERM DEFICITS. AS WITH ANY OTHER DRUG, THESE RISKS SHOULD BE CONSIDERED ALONGSIDE BENEFITS PRIOR TO A DECISION ON CANNABIS USE. 2021 16 4707 32 NMR PLASMA METABOLOMICS STUDY OF PATIENTS OVERCOMING ACUTE MYOCARDIAL INFARCTION: IN THE FIRST 12 H AFTER ONSET OF CHEST PAIN WITH STATISTICAL DISCRIMINATION TOWARDS METABOLOMIC BIOMARKERS. ACUTE MYOCARDIAL INFARCTION (AMI) IS ONE OF THE LEADING CAUSES OF DEATH AMONG ADULTS IN OLDER AGE. UNDERSTANDING MECHANISMS HOW ORGANISM RESPONDS TO ISCHEMIA IS ESSENTIAL FOR THE ISCHEMIC PATIENT'S PREVENTION AND TREATMENT. DESPITE THE GREAT PREVALENCE AND INCIDENCE ONLY A SMALL NUMBER OF STUDIES UTILIZE A METABOLOMIC APPROACH TO DESCRIBE AMI CONDITION. RECENT STUDIES HAVE SHOWN THE IMPACT OF METABOLITES ON EPIGENETIC CHANGES, IN THESE STUDIES PLASMA METABOLITES WERE RELATED TO NEUROLOGICAL OUTCOME OF THE PATIENTS MAKING METABOLOMIC STUDIES INCREASINGLY INTERESTING. THE AIM OF THIS STUDY WAS TO DESCRIBE METABOLOMIC RESPONSE OF AN ORGANISM TO ISCHEMIC STRESS THROUGH THE CHANGES IN ENERGETIC METABOLITES AND AMINOACIDS IN BLOOD PLASMA IN PATIENTS OVERCOMING ACUTE MYOCARDIAL INFARCTION. BLOOD PLASMA FROM PATIENTS IN THE FIRST 12 H AFTER ONSET OF CHEST PAIN WAS COLLECTED AND COMPARED WITH VOLUNTEERS WITHOUT ANY HISTORY OF ISCHEMIC DISEASES VIA NMR SPECTROSCOPY. LOWERED PLASMA LEVELS OF PYRUVATE, ALANINE, GLUTAMINE AND NEUROTRANSMITTER PRECURSORS TYROSINE AND TRYPTOPHAN WERE FOUND. FURTHER, WE OBSERVED INCREASED PLASMA LEVELS OF 3-HYDROXYBUTYRATE AND ACETOACETATE IN BALANCE WITH DECREASED LEVEL OF LIPOPROTEINS FRACTION, SUGGESTING THE ONGOING KETONIC STATE OF AN ORGANISM. DISCRIMINATORY ANALYSIS SHOWED VERY PROMISING PERFORMANCE WHERE COMPOUNDS: LIPOPROTEINS, ALANINE, PYRUVATE, GLUTAMINE, TRYPTOPHAN AND 3-HYDROXYBUTYRATE WERE OF THE HIGHEST DISCRIMINATORY POWER WITH FEASIBILITY OF SUCCESSFUL STATISTICAL DISCRIMINATION. 2020 17 2915 30 GENE THERAPY FOR CHRONIC HBV-CAN WE ELIMINATE CCCDNA? CHRONIC INFECTION WITH THE HEPATITIS B VIRUS (HBV) IS A GLOBAL HEALTH CONCERN AND ACCOUNTS FOR APPROXIMATELY 1 MILLION DEATHS ANNUALLY. AMONGST OTHER LIMITATIONS OF CURRENT ANTI-HBV TREATMENT, FAILURE TO ELIMINATE THE VIRAL COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) AND EMERGENCE OF RESISTANCE REMAIN THE MOST WORRISOME. VIRAL REBOUND FROM LATENT EPISOMAL CCCDNA RESERVOIRS OCCURS FOLLOWING CESSATION OF THERAPY, PATIENT NON-COMPLIANCE, OR THE DEVELOPMENT OF ESCAPE MUTANTS. SIMULTANEOUS VIRAL CO-INFECTIONS, SUCH AS BY HIV-1, FURTHER COMPLICATE THERAPEUTIC INTERVENTIONS. THESE CHALLENGES HAVE PROMPTED DEVELOPMENT OF NOVEL TARGETED HEPATITIS B THERAPIES. GIVEN THE EASE WITH WHICH HIGHLY SPECIFIC AND POTENT NUCLEIC ACID THERAPEUTICS CAN BE RATIONALLY DESIGNED, GENE THERAPY HAS GENERATED INTEREST FOR ANTIVIRAL APPLICATION. GENE THERAPY STRATEGIES DEVELOPED FOR HBV INCLUDE GENE SILENCING BY HARNESSING RNA INTERFERENCE, TRANSCRIPTIONAL INHIBITION THROUGH EPIGENETIC MODIFICATION OF TARGET DNA, GENOME EDITING BY DESIGNER NUCLEASES, AND IMMUNE MODULATION WITH CYTOKINES. DNA-BINDING DOMAINS AND EFFECTORS BASED ON THE ZINC FINGER (ZF), TRANSCRIPTION ACTIVATOR-LIKE EFFECTOR (TALE), AND CLUSTERED REGULARLY INTERSPACED SHORT PALINDROMIC REPEAT (CRISPR) SYSTEMS ARE REMARKABLY WELL SUITED TO TARGETING EPISOMAL CCCDNA. THIS REVIEW DISCUSSES RECENT DEVELOPMENTS AND CHALLENGES FACING THE FIELD OF ANTI-HBV GENE THERAPY, ITS POTENTIAL CURATIVE SIGNIFICANCE AND THE PROGRESS TOWARDS CLINICAL APPLICATION. 2018 18 5048 34 PHARMACOLOGICAL APPROACHES IN EITHER INTERMITTENT OR PERMANENT HYPOXIA: A TALE OF TWO EXPOSURES. HYPOXIA INDUCES SEVERAL RESPONSES AT CARDIOVASCULAR, PULMONARY AND REPRODUCTIVE LEVELS, WHICH MAY LEAD TO CHRONIC DISEASES. THIS IS RELEVANT IN HUMAN POPULATIONS EXPOSED TO HIGH ALTITUDE (HA), IN EITHER CHRONIC CONTINUOUS (PERMANENT INHABITANTS) OR INTERMITTENT FASHION (HA WORKERS, TOURISTS AND MOUNTAINEERS). IN CHILE, IT IS ESTIMATED THAT 1.000.000 PEOPLE LIVE AT HIGHLANDS AND MORE THAN 55.000 WORK IN HA SHIFTS. INITIAL RESPONSES TO HYPOXIA ARE COMPENSATORY AND INDUCE ACTIVATION OF CARDIOPROTECTIVE MECHANISMS, SUCH AS THOSE SEEN UNDER INTERMITTENT HYPOBARIC (IH) HYPOXIA, EVENTS THAT COULD MEDIATE PRECONDITIONING. HOWEVER, WHENEVER HYPOXIA IS PROLONGED, THE CHRONIC ACTIVATION OF CELLULAR RESPONSES INDUCES LONG-LASTING MODIFICATIONS THAT MAY RESULT IN ACCLIMATIZATION OR PRODUCE MALADAPTIVE CHANGES WITH INCREASE IN CARDIOVASCULAR RISK. HA EXPOSURE DURING PREGNANCY INDUCES HYPOXIA AND OXIDATIVE STRESS, WHICH IN TURN MAY PROMOTE CELLULAR RESPONSES AND EPIGENETIC MODIFICATIONS RESULTING IN SEVERE IMPAIRMENT IN GROWTH AND DEVELOPMENT. SADLY, THIS CONDITION IS ACCOMPANIED WITH AN INCREASED FETAL AND NEONATAL MORBI-MORTALITY. FURTHER, DEVELOPMENTAL HYPOXIA MAY PROGRAM CARDIO-PULMONARY CIRCULATIONS LATER IN POSTNATAL LIFE, ENDING IN VASCULAR STRUCTURAL AND FUNCTIONAL ALTERATIONS WITH AUGMENTED RISK ON PULMONARY AND CARDIOVASCULAR FAILURE. ADDITIONALLY, PERMANENT HA INHABITANTS HAVE AUGMENTED RISK AND PREVALENCE OF CHRONIC HYPOXIC PULMONARY HYPERTENSION, RIGHT VENTRICULAR HYPERTROPHY AND CARDIOPULMONARY REMODELING. SIMILAR RESPONSES ARE SEEN IN ADULTS THAT ARE INTERMITTENTLY EXPOSED TO CHRONIC HYPOXIA (CH) SUCH AS SHIFT WORKERS IN HA AREAS. THE MECHANISMS INVOLVED DETERMINING THE IMMEDIATE, SHORT AND LONG-LASTING EFFECTS ARE STILL UNCLEAR. FOR SEVERAL YEARS, THE STUDY OF THE RESPONSES TO HYPOXIC INSULTS AND PHARMACOLOGICAL TARGETS HAS BEEN THE MOTIVATION OF OUR GROUP. THIS REVIEW DESCRIBES SOME OF THE MECHANISMS UNDERLYING HYPOXIC RESPONSES AND POTENTIAL THERAPEUTIC APPROACHES WITH ANTIOXIDANTS SUCH AS MELATONIN, ASCORBATE, OMEGA 3 (OMEGA3) OR COMPOUNDS THAT INCREASE THE NITRIC OXIDE (NO) BIOAVAILABILITY. 2015 19 5631 24 SENESCENCE-INFLAMMATORY REGULATION OF REPARATIVE CELLULAR REPROGRAMMING IN AGING AND CANCER. THE INABILITY OF ADULT TISSUES TO TRANSITORILY GENERATE CELLS WITH FUNCTIONAL STEM CELL-LIKE PROPERTIES IS A MAJOR OBSTACLE TO TISSUE SELF-REPAIR. NUCLEAR REPROGRAMMING-LIKE PHENOMENA THAT INDUCE A TRANSIENT ACQUISITION OF EPIGENETIC PLASTICITY AND PHENOTYPE MALLEABILITY MAY CONSTITUTE A REPARATIVE ROUTE THROUGH WHICH HUMAN TISSUES RESPOND TO INJURY, STRESS, AND DISEASE. HOWEVER, TISSUE REJUVENATION SHOULD INVOLVE NOT ONLY THE TRANSIENT EPIGENETIC REPROGRAMMING OF DIFFERENTIATED CELLS, BUT ALSO THE COMMITTED RE-ACQUISITION OF THE ORIGINAL OR ALTERNATIVE COMMITTED CELL FATE. CHRONIC OR UNRESTRAINED EPIGENETIC PLASTICITY WOULD DRIVE AGING PHENOTYPES BY IMPAIRING THE REPAIR OR THE REPLACEMENT OF DAMAGED CELLS; SUCH UNCONTROLLED PHENOMENA OF IN VIVO REPROGRAMMING MIGHT ALSO GENERATE CANCER-LIKE CELLULAR STATES. WE HEREIN PROPOSE THAT THE ABILITY OF SENESCENCE-ASSOCIATED INFLAMMATORY SIGNALING TO REGULATE IN VIVO REPROGRAMMING CYCLES OF TISSUE REPAIR OUTLINES A THRESHOLD MODEL OF AGING AND CANCER. THE DEGREE OF SENESCENCE/INFLAMMATION-ASSOCIATED DEVIATION FROM THE HOMEOSTATIC STATE MAY DELINEATE A TYPE OF THRESHOLDING ALGORITHM DISTINGUISHING BENEFICIAL FROM DELETERIOUS EFFECTS OF IN VIVO REPROGRAMMING. FIRST, TRANSIENT ACTIVATION OF NF-KAPPAB-RELATED INNATE IMMUNITY AND SENESCENCE-ASSOCIATED INFLAMMATORY COMPONENTS (E.G., IL-6) MIGHT FACILITATE REPARATIVE CELLULAR REPROGRAMMING IN RESPONSE TO ACUTE INFLAMMATORY EVENTS. SECOND, PARA-INFLAMMATION SWITCHES MIGHT PROMOTE LONG-LASTING BUT REVERSIBLE REFRACTORINESS TO REPARATIVE CELLULAR REPROGRAMMING. THIRD, CHRONIC SENESCENCE-ASSOCIATED INFLAMMATORY SIGNALING MIGHT LOCK CELLS IN HIGHLY PLASTIC EPIGENETIC STATES DISABLED FOR REPARATIVE DIFFERENTIATION. THE CONSIDERATION OF A CELLULAR REPROGRAMMING-CENTERED VIEW OF EPIGENETIC PLASTICITY AS A FUNDAMENTAL ELEMENT OF A TISSUE'S CAPACITY TO UNDERGO SUCCESSFUL REPAIR, AGING DEGENERATION OR MALIGNANT TRANSFORMATION SHOULD PROVIDE CHALLENGING STOCHASTIC INSIGHTS INTO THE CURRENT DETERMINISTIC GENETIC PARADIGM FOR MOST CHRONIC DISEASES, THEREBY INCREASING THE SPECTRUM OF THERAPEUTIC APPROACHES FOR PHYSIOLOGICAL AGING AND CANCER. 2017 20 103 29 A REHABILOMICS FRAMEWORK FOR PERSONALIZED AND TRANSLATIONAL REHABILITATION RESEARCH AND CARE FOR INDIVIDUALS WITH DISABILITIES: PERSPECTIVES AND CONSIDERATIONS FOR SPINAL CORD INJURY. DESPITE MANY PEOPLE HAVING SIMILAR CLINICAL PRESENTATION, DEMOGRAPHIC FACTORS, AND CLINICAL CARE, OUTCOME CAN DIFFER FOR THOSE SUSTAINING SIGNIFICANT INJURY SUCH AS SPINAL CORD INJURY (SCI) AND TRAUMATIC BRAIN INJURY (TBI). IN ADDITION TO TRADITIONAL DEMOGRAPHIC, SOCIAL, AND CLINICAL FACTORS, VARIABILITY ALSO MAY BE ATTRIBUTABLE TO INNATE (INCLUDING GENETIC, TRANSCRIPTOMIC PROTEOMIC, EPIGENETIC) BIOLOGICAL VARIATION THAT INDIVIDUALS BRING TO RECOVERY AND THEIR UNIQUE RESPONSE TO THEIR CARE AND ENVIRONMENT. TECHNOLOGIES COLLECTIVELY CALLED "-OMICS" ENABLE SIMULTANEOUS MEASUREMENT OF AN ENORMOUS NUMBER OF BIOMOLECULES THAT CAN CAPTURE MANY POTENTIAL BIOLOGICAL CONTRIBUTORS TO HETEROGENEITY OF INJURY/DISEASE COURSE AND OUTCOME. DUE TO THE NATURE OF INJURY AND COMPLEX DISEASE, AND ITS ASSOCIATIONS WITH IMPAIRMENT, DISABILITY, AND RECOVERY, REHABILITATION DOES NOT LEND ITSELF TO A SINGULAR "PROTOCOLIZED" PLAN OF THERAPY. YET, BY NATURE AND BY NECESSITY, REHABILITATION MEDICINE OPERATES AS A FUNCTIONAL MODEL OF "PERSONALIZED CARE". THUS, THE CHALLENGE FOR SUCCESSFUL PROGRAMS OF TRANSLATIONAL REHABILITATION CARE AND RESEARCH IS TO IDENTIFY VIABLE APPROACHES TO EXAMINE BROAD POPULATIONS, WITH VARIED IMPAIRMENTS AND FUNCTIONAL LIMITATIONS, AND TO IDENTIFY EFFECTIVE TREATMENT RESPONSES THAT INCORPORATE PERSONALIZED PROTOCOLS TO OPTIMIZE FUNCTIONAL RECOVERY. THE REHABILOMICS FRAMEWORK IS A TRANSLATIONAL MODEL THAT PROVIDES AN "-OMICS" OVERLAY TO THE SCIENTIFIC STUDY OF REHABILITATION PROCESSES AND MULTIDIMENSIONAL OUTCOMES. REHABILOMICS RESEARCH PROVIDES NOVEL OPPORTUNITIES TO EVALUATE THE NEUROBIOLOGY OF COMPLEX INJURY OR CHRONIC DISEASE AND CAN BE USED TO EXAMINE METHODS AND TREATMENTS FOR PERSON-CENTERED CARE AMONG POPULATIONS WITH DISABILITIES. EXEMPLARS FOR APPLICATION IN SCI AND OTHER NEUROREHABILITATION POPULATIONS ARE DISCUSSED. 2014