dinsdag 27 september 2016

Autacoid Medicine contributes to Eye Medicine: the value of natural compounds

Autacoid Medicine is a new kid on the block, making use of triggering natural, physiological mechanisms of action and thus is quite devoid of most of the side effects related to non-endogenous NCE''s:

Autacoid Medicine holds great promises for many branches in Mediicine, and we presenr an example, in ophtalmology! 

https://www.dovepress.com/articles.php?article_id=29149



vrijdag 15 mei 2015

Eye protection with palmitoylethanolamide: uveitis reduction comparable to corticosteroid

Anterior uveitis is an inflammation of the iris and parts of the muscles of the eye-lens. The main therapies for uveitis are corticosteroids. In a recent experiment (2015) Italian pharmacologists proved that palmitoylethanolamide reduces this inflammation as effective as corticosteroids.
In a series of elaborate experiments they tested PEA and compared the effects to dexamethasone, a corticosteroid. Their conclusion was:
PEA is a protective endogenous mediator produced during inflammatory conditions to counteract inflammation, neuronal damage and pain. This study demonstrates that PEA treatment is able to attenuate the eye inflammation induced by inflammatory molecules in the rat.
Importantly, PEA was effective in counteracting the uveitis-inducing effects of LPS, when administered, 1 h before and 7h after challenge with such inflammatory molecules. The later time is a point when inflammatory responses, including TNF-α and NO release in the aqueous humor, have already commenced.
Thus, these protective effects of PEA may be due to the inhibition of some specific cytokines which are under the control of NF-κB pathway.
The final conclusion was:
Anyway, the results of the present study suggest that PEA could have an important role as therapeutic target in ocular inflammation and could be an interesting agent for the treatment of human uveitis.
Source:
Impellizzeri D, Ahmad A, Bruschetta G, Di Paola R, Crupi R, Paterniti I, Esposito E, Cuzzocrea S. The anti-inflammatory effects of palmitoylethanolamide (PEA) on endotoxin-induced uveitis in rats.
Eur J Pharmacol. 2015 Apr 28. pii: S0014-2999(15)00369-6. doi: 10.1016/j.ejphar.2015.04.025.
PMID: 25934566

zondag 3 augustus 2014

Palmitoylethanolamide: a natural therapy for eye disorders: glaucoma and neurodegeneration

Eye disorders: Relevance of Palmitoylethanolamide

Palmitoylethanolamide-Treat-Glaucoma
Palmitoylethanolamide-Treat-Glaucoma
Palmitoylethanolamide can protect our eyes against neurodegeneration as well as against high intraocular pressure, such as in glaucoma. We will review a number of trials related to the effiacy of palmitoylethanolamide in eye disorders.

Improved endothelial function in glaucoma due to palmitoylethanolamide

A generalized peripheral endothelial dysfunction has been demonstrated in patients suffering from glaucoma (ocular hypertension) and related glaucoma related eye disorders. One important biological molecule belonging to the complex and pleiotropic endogenous lipid signaling system that is activated “on demand” following a perturbation of cell homeostasis to aid in the re-establishment of this homeostasis is the nutraceutical palmitoylethanolamide. PEA exerst an important role in endothelial protection.
In a randomized, double-blind, placebo-controlled, crossover, single-center study was conducted between September 2010 and March 2012, at the Ophthalmology Unit of University of Bologna, 40 untreated glaucoma patients and 40 healthy age-matched controls were enrolled. None of the healthy controls in this study was treated.
Patients and controls were assigned randomly to one of the two parallel treatment arms at baseline: 300 mg PEA or a matching placebo, per os, twice a day, for a period of 90 days.
All of the patients who were included at the onset of the study completed the study. At baseline, endothelium-dependent flow-mediated vasodilation (FMD) values of the OH patients were significantly lower than FMD values of the controls.
Results: patients who were undergoing PEA therapy showed a significant improvement in FMD values (8.46 ± 1.09% vs. 6.08 ± 0.62%, P < 0.001, r = 0.96) and a significant IOP reduction 22.18 ± 1.26 vs. 23.03 ± 0.88 mm Hg, P 0.05 and 22.95 ± 0.90 vs. 23.25 ± 0.76 mm Hg, P > 0.05,
In their study, the ophtalmologists could demonstrated that 600 mg PEA administered daily over a period of three months may improved systemic endothelial function in patients with ocular hypertension with no local side effects or systemic adverse events, and they showed that its protective action may last longer than its intake period as the effect on IOP.

Tissue and cellular protection via palmitoylethanolamide

Palmitoylethanolamide: a tissue protector

Protection of PEA in the rat isolated heart against ischaemia has been found in a preclinical study conducted by Lepicier and colleagues in 2003. It was already by that time known that endogenous compounds such as palmitoylethanolamide were protective for tissue in disstress.
PEA and 2-AG have been detected in rat cardiac tissue already by Schmid et al. in 2000 but at that time little was known about the role played by these lipid signal molecules played in the heart. It was reported that the ability of a prior exposure to lipopolysaccharide to limit infarct size in rats is blocked by a CB2-receptor antagonists. (Lagneux & Lamontagne, 2001). The first aim of their study was to evaluate the cardioprotective effect of endocannabinoids and PEA in the rat isolated heart. Secondly, the contribution of protein kinase C (PKC) and mitogen-activated protein kinases (MAP kinases) in this cardioprotective effect was assessed.
The results were impressive, as we can see in the graph. PEA could reduce the infarct size of an inschemic myocardium considerably.
PEA protects the hart against ischemia
PEA protects the hart against ischemia
Their conclusion was:
None of the untreated hearts recovered from ischaemia during the reperfusion period. Perfusion with either 300nm palmitoylethanolamide (PEA) or 300nm 2-arachidonoylglycerol (2-AG), but not anandamide (up to 1 mm), 15 min before and throughout the ischaemic period, improved myocardial recovery and decreased the levels of coronary CK and LDH. PEA and 2-AG also reduced infarct size.
Philippe Le ́picier, Jean-Franc ̧ois Bouchard et al Endocannabinoids protect the rat isolated heart against ischaemia British Journal of Pharmacology (2003) 139, 805–815

A major lipid signaling compound: palmitoylethanolamide

Palmitoylethanolamide: a lipid transmitter

In the first part of palmitoylethanolamide’s story, between 1957 and 1993 it became clear that PEA had significant biological effects such as analgesia and anti-inflammation. In 1993 Montalcini unraveled the first mechanism of action of PEA: the modulation of the mast cell and the inhibition of the inflammatory effects of compounds such as histamine and Nerve Growth Factor (NGF).
In the period 1993 and 2000 most scientists though palmitoylethanolamide was an endocannabinoid, but little by little one started to understand palmitoylethanolamide is NOT an endocannabinoid, but a lipid neurotransmitter of its own. Or better, a lipid signaling molecule.
Lipids Signaling, broadly defined, refers to any biological signaling event involving a lipid messenger that binds a protein target, such as a receptor, kinase or phosphatase, which in turn mediate the effects of these lipids on specific cellular responses.
The groups of lipid signaling molecules consists of:
Ceramide
Eicosanoids
Endocannabinoids
Endogenous Cannabinoids
Palmitoylethanolamide and other N-acyl-ethanolamides
PI3 Kinase (PI3K)
Phosphatidylinositol bisphosphate (PIP2) Second Messenger Systems
Phosphoinositide 3-Kinase (PI3K)
Phospholipases
Ceramides for instance are lipids composed of sphingosine and a fatty acid and derive from the hydrolisis of sphingolipids. Sphingolipids have an important structural role in cell membrane but, when hydrolized by sphingomyelinase (wiki), they release ceramides in the cytosol that can act as second messengers, promoting differentiation, proliferation and apoptosis.
Exactly the same mechanism holds true for PEA: it is a fatty acid amine derived from a lipid fraction of the membranes, NAPE and is synthesized by NAPE hydrolyzing enzymes, the released PEA shuttles into the cytosol via protein carriers and travels to its target, for instance the PPAR receptor.
Signalling lipids such as eicosanoids, phosphoinositides, sphingolipids and fatty acids control important cellular processes, including cell proliferation, apoptosis, metabolism and migration. Extracellular signals from cytokines, growth factors and nutrients control the activity of a key set of lipid-modifying enzymes: phospholipases, prostaglandin synthase, 5-lipoxygenase, phosphoinositide 3-kinase, sphingosine kinase and sphingomyelinase. These enzymes and their downstream targets constitute a complex lipid signalling network with multiple nodes of interaction and cross-regulation. Imbalances in this network contribute to the pathogenesis of human disease. Although the function of a particular signalling lipid is traditionally studied in isolation, this review attempts a more integrated overview of the key role of these signalling lipids in inflammation, cancer and metabolic disease, and discusses emerging strategies for therapeutic intervention.
A recent symposium (april 2013) carries the title:
Unveiling the Significance of Lipid Signaling in Neurodegeneration and Neuroprotection…
We know lipid signaling is a hot topic and palmitoylethanolamide is one of those lipid mediators which has been available for the clinic since 5 years now. PEA has been tested in around 4000 patients for its analgesic and anti-inflammatory effects and currently is available world wide as the supplement PeaPure.

In the Journal ‘Pain” Daniele Piomelli, the Americal professor widely known for his work on lipid signaling drugs discusses the growing insight in the important biological roles of lipids like PEA. He uses a scedule to explain the biological action of PEA via the nucleas, see artist impression of his scedule:
Image
He discusses the role of lipid mediators, which are synthesized from membrane components:
Among these membrane-derived analgesics is a small family of lipid molecules in which a saturated or monounsaturated fatty acid – such as palmitic or oleic acid – is chemically linked to ethanolamine through an amide bond. In neurons and innate immune cells, these endogenous lipid amides are formed by cleavage of the phospholipid precursor, N-acylphosphatidylethanolamine, a process that is carried out by a specialized phospholipase D enzyme. One of the best-known members of this family, palmitoylethanolamide (PEA), produces profound analgesic and anti-inflammatory effects in animals by recruiting a nuclear receptor called peroxisome proliferator-activated receptor-a (PPAR-a).
He discussed new findings were data point into the direction that that PPAR-a stimulates the transcription of genes encoding for steroidogenic enzymes, resulting in an up-regulation of neurosteroids that contribute to the analgesic effects of PEA.
Commentary of Danielle Piomelli:
A thickening network of lipids in: PAIN 153 (2012) 3–4

Palmitoylethanolamide against nerve injury due to pressure

Palmitoylethanolamide, TNF-α and sciatic injury model

Current evidence shows that tumor necrosis factor alpha (TNF-α) plays an important role in the onset of neuropathic pain. It has been shown that chronic constriction injury (CCI) model induces a bilateral increase of TNF-α expression at the dorsal root ganglion (DRG). Recently it has been determined that the palmitoylethanolamide (PEA) has analgesic effects on animal models of neuropathic pain.
The present study evaluated a potential relation between the analgesic effect of PEA and the changes on TNF-α expression at the DRG in neuropathic pain. CCI induced pain behaviors on ipsilateral paw and a bilateral increase of immunoreactivity (IR) to TNF-α in the L4 and L5 DRG was observed. Administration of PEA (10 mg/kg i.p.), reduced significantly both, thermal hyperalgesia and mechanical allodynia. Thermal threshold values (hyperalgesia) were - 2,96 ± 0,31 s (-7,36 ± 0,12 s control) on day 5 and -1,81 ± 0,30 s (-8,52 ± 0,18 s control) on day 7, while the mechanical threshold (allodynia) values were -1 ranks (-5 ranks control) on day 5 and -0,5 ranks (-6 ranks control) on day 7. In the present study it was also found that the administration of PEA (10 mg / kg, i.p.) reversed the bilateral increase of TNF-α IR in L4 and L5 DRG neurons observed after CCI.
Although these findings give clear evidence about the regulating role of PEA on the expression of TNF-α at the first sensory neuron, the bilateral effects support the hypotheses that the analgesic effect of PEA is not related with the effect on the expression of TNF-α at the DRG.

One of the mechanisms of palmitoylethanolamide: an anti-oxydant protecting tissues

Palmitoylethanolamide as antioxidant and for tissue protection

N-Acylethanolamines (NAEs) (fatty acid ethanolamides) are naturally occurring hydrophobic molecules usually present in a very small amount in many mammalian tissues and cells [1] and [2]. Moreover, NAEs are normally present in biological fluids, such as blood [2], in very low concentrations. The physiological levels of important NAEs in mammalian blood plasma are in the range 2.8–5.2 pmol/ml for anandamide (AEA); 9.4–16.7 pmol/ml for PEA; 8.1–10.3 pmol/ml for oleylethanolamide (OEA) [2], [3] and [4]. However, the NAEs levels in blood plasma could be modified in pathological conditions, e.g., the physiological concentrations of AEA in human plasma are 4 pmol/ml, but these concentrations are increased up to 18–30 pmol/ml in sera of patients with endotoxic shocks [5]. In vivo studies demonstrated that NAEs could accumulate in injured tissues, such as, e.g., in myocardium infarcted areas [6], and in post decapitative brain ischemia [7].
AND:
Palmitoylethanolamide (C16:0) (PEA), a shorter and fully saturated analogue of anandamide, exhibits a number of biochemical, physiological and pharmacological effects [12] and [13]. However, its mechanism of action remains unclear [12] and [13] and its effects are not always reproducible. Among the others, it was identified as the anti-inflammatory principle present in many natural products, and its anti-inflammatory properties were confirmed by recent research [12], [13] and [14], although they seem less marked in human systems [13]. In vitro studies demonstrated that PEA inhibits the nitric oxide production in macrophages [15], affects the time course of capacitation of human spermatozoa [16], and increases the PLA2 hydrolytic activity [17]. In those studies, PEA concentrations inducing significant effects ranged from 5 [16] to 30 μM [17]. Physiologically relevant concentrations of PEA (3 nM–3 μM) [18] may also have important physiological and/or pharmacological effects. For example, 300 nM PEA was shown to protect rat isolated heart against ischemia [19].
Forms the introduction of a hallmark paper on the protective aspects of the natural painkiller palmitoylethanolamide, written by Zolese et al. Based on their knowledge of blood fats (cholesterol etc) and the detrimental effects of oxydation, the authors conducted a study in order to evaluate the possible effect of physiologically relevant concentrations of PEA on the resistance of plasma lipoproteins to oxidation.
They found in their in vitro experiments indicatations of anti-oxidative effects of PEA on the oxidation of LDL, isolated from plasma after incubation with this endogenous fatty acid amide.The protective effect of PEA occurs in physiological and supraphysiological conditions, such also takes place during for instance septic shock:
It has to be stressed that the anti-oxidant effect is obtained at low PEA concentrations in plasma is similar to those observed in pathological conditions, such as endotoxic shock
Main source:
Zolese G, Bacchetti T, Ambrosini A, Wozniak M, Bertoli E, Ferretti G. Increased plasma concentrations of palmitoylethanolamide, an endogenous fatty acid amide, affect oxidative damage of human low-density lipoproteins: an in vitro study. Atherosclerosis. 2005 Sep;182(1):47-55.
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