Is aristolochic acid nephropathy a widespread problem in developing countries?: A case study of Aristolochia indica L. in Bangladesh using an ethnobotanical–phytochemical approach

Ethnopharmacological relevance

Species of Aristolochia are associated with aristolochic acid nephropathy (AAN), a renal interstitial fibrosis and upper urinary tract cancer (UUC). Aristolochic acid nephropathy has been reported in ten countries but its true incidence is unknown and most likely underestimated. By combining an ethnobotanical and phytochemical approach we provide evidence for the risk of AAN occurring in Bangladesh. More specifically, we assess the intra-specific variation of aristolochic acid analogues in medicinally used Aristolochia indica samples from Bangladesh.

Materials and methods

Ethnobotanical information was collected from 16 kavirajes (traditional healers) in different study locations in Bangladesh. Plant samples were obtained from native habitats, botanical gardens, herbal markets and pharmaceutical companies. The samples were extracted using 70% methanol and were analysed using LC-DAD-MS and ¹H-NMR.

Results

Roots as well as leaves are commonly used for symptoms such as snake bites and sexual problems. Among the informants knowledge about toxicity or side effects is very limited and Aristolochia indica is often administered in very high doses. Replacement of Aristolochia indica with other medicinal plants such as Rauvolfia serpentina (L.) Benth. ex Kurz was common. Aristolochia indica samples contained a variety of aristolochic acid analogues such as aristolochic acid I, aristolochic acid II, cepharadione A and related compounds.

Conclusions

AAN cases are likely to occur in Bangladesh and more awareness needs to be raised about the health risks associated with the use of Aristolochia indica and other species of Aristolochia as herbal medicines.     

The diencephalic peninsula: self-stimulation after unilateral precollicular transection and removal of the telencephalon

Electrical self-stimulation in the lateral hypothalamus was examined in the ‘diencephalic peninsula’ preparation. For this purpose the telencephalic structures were surgically removed in one hemisphere and the diencephalon was separated from the brainstem by a precollicular transection. Thus, the diencephalon of one hemisphere was connected with the rest of the brain only via diencephalic interhemispheric fibers. Six rats self-stimulated by lever-pressing. Their rate of responding decreased rapidly upon withdrawal of reinforcement; d-amphetamine increased the rate of self-stimulation.     

Family history of cancer among cases of upper urothelial tumours in a Balkan nephropathy area

Summary The highest relative risk of developing tumours of the renal pelvis and ureters (TPU) in a general population is confined to areas where Balkan nephropathy (BN) is endemic. Whether there is a higher frequency of cancer of any site in families with TPU cases from this BN endemic part of the world was tested by a case-referent study. A group of 65 rural patients with histologically proven TPU was individually matched with the same number of their nearest neighbours, who served as controls. Comparison of age-standardized ratios revealed that over a period of 30 years family members of the cases experienced a significantly higher risk of (non-urinary) cancer deaths than family members of their pairmates.     

Etiology of Balkan endemic nephropathy: A multifactorial disease?

Balkan endemic nephropathy (BEN) is of great clinical importance in the restricted areas of Bulgaria, Rumania, Croatia, Serbia, Bosnia and Herzegovina. So far, studies on the etiological factors for BEN have not discovered any single environmental causative agent of this puzzling disease. These data reject the possibility of a purely environmental causation of BEN. The pattern of BEN transmission in the risk families is not typical for single gene disorders. Extensive epidemiological and genetic studies disclose characteristics of multifactorial (polygenic) inheritance of BEN. The evidences of 'familial tendency', variation of the risk for BEN depending on the number of sick parents and the degree of relatedness; the development of BEN in individuals from at-risk families who were born in non-endemic areas; the data that disease is not found in the gypsy population and the expressions of 3q25 cytogenetic marker suggest that the genetic factors play an important role as causative factors in BEN development. The possible impact of environmental triggers on individuals genetically predisposed to BEN could be supposed by the following data: the cytogenetic results of the increased frequency of folate sensitive Fra sites, spontaneous or radiation-induced aberrations in several bands in BEN patients, the data from the detailed analysis of breaks in BEN patients and controls that generate structural chromosome aberrations; the occurrence of BEN in immigrants. Genetical epidemiological approaches to etiology and prevention of BEN are proposed. The predisposing genes for BEN could be genes localized in a region between 3q25-3q26; transforming growth factor- (TGF-), genetic heterogeneity of xenobiotic-metabolizing enzymes; defects in the host's immune system. The predisposing genes for BEN patients with urinary tract tumors could be germline mutations in tumor suppressor genes and acquired somatic mutations in oncogenes.     

Global and specific histone acetylation pattern in patients with Balkan endemic nephropathy,a worldwide disease

Background: Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial nephropathy present in the Danube river regions in several Balkan countries. There appears to be a polygenic susceptibility to the disease in interaction with multiple environmental factors (aristolochic acid, ochratoxin A). In a previous study SEC61G, IL17RA, HDAC11 proved to be differently methylated throughout all patient-control pairs of BEN patients from Serbia and Bulgaria. Emerging connections between DNA methylation and histone acetylation prompted the present study on histone acetylation in patients with BEN. Methods: The study involved 39 patients with BEN, and 39 controls collected from non-endemic regions in Serbia. The EpiSeeker Histone H3 and H4 Total Acetylation Detection colorimetric Kits and specific acetylated at lysine 18 H3K18 and H3K36 acetylated at lysine 36 detection kits were used. Results: It was documented that total H4 histone acetylation level was increased significantly, while total H3 histone acetylation did not differ significantly. Specific histone structure and functional properties may be affected by the observed derangement of H3 histone acetylation pattern, since H3K36 site was significantly more acetylated, while H3K18 tended to be less acetylated than in control subjects. Multiple regression analysis revealed a statistically significant relationship between H4, H3T and H3K36 in BEN patients. Conclusion: This preliminary study suggests that the acetylation of histone lysine residues was detectable and found increased at specific sites of H3 and total H4 histones isolated from urothelial cells of patients with BEN. Having in mind a possible mechanism and biological role of epigenetic chromatin modification in urothelial tumor development they obtained results may open opportunity for selective therapeutic interventions in patients with BEN.     

Estimation of ochratoxin A in some Turkish populations: An analysis in urine as a simple,sensitive and reliable biomarker

In this study, ochratoxin A (OTA) occurrence and level in human urine samples, collected from four different regions of Turkey was analyzed by NaHCO₃ dilution, immunoaffinity column clean-up and high-performance liquid chromatography with fluorescent detection. For the repeatability of the method, RSD (%) values were found between 3.83 and 8.86, for the accuracy, the recovery values were found between 85.7% and 110.5% and limit of detection and limit of quantification of the method were measured as 0.006 and 0.018 ng mL⁻¹ respectively. For the analysis, first morning urine samples were collected and the results were adjusted with creatinine levels. From the total collected samples of 233 larger amounts of 83% was contaminated with OTA. Among the calculated to be OTA levels, positive sample rate, average OTA amount and the highest contamination was found in Ankara. (Positive sample rate; 90.1%, average OTA concentration; 14.34 ng g⁻¹ creatinine and highest OTA value; 75.60 ng g⁻¹ creatinine). In order to define the exposure profile of OTA in human a questionnaire was conducted among the voluntaries as well. But related to the gender, age, dietary habits, coffee consumption, smoking and alcohol habits of the volunteers, no correlation was found with the OTA exposure.     

Application of non-supervised pattern recognition techniques to classify Cabernet Sauvignon wines from the Balkan region based on individual phenolic compounds

Phenolic compounds in sixteen Cabernet Sauvignon wines from different wine-growing sub-regions in the Balkan region were investigated using HPLC with DAD and fluorescence detector and spectroscopic analysis, as well as statistical PC/F and cluster analysis. The HPLC analysis of investigated red wines showed that the content of total hydroxybenzoic acids, detected at 280 nm, was the highest in wines from Tikveš wine-growing subregion, Macedonia (127–140 mg L⁻¹). Total hydroxycinnamic acids, detected at 320 nm, were the highest in wines from Župa wine-growing subregion, Serbia (43–45 mg L⁻¹). The concentration of total flavonoids (flavan-3-ols, flavonols, flavons and flavanon), detected at 280, 360 and 322/275 nm, respectively, was the highest in wine from Katarzyna Estate wine-growing subregion, Bulgaria (167 mg L⁻¹). Finally, the concentration of total anthocyanins, detected at 520 nm, was the highest in wine from Šumadija wine-growing subregion, Serbia (1463 mg L⁻¹). The results of PCA and cluster analysis together confirmed that the content of phenolic compounds in Cabernet Sauvignon wines depends on agro-climatic factors, oenological practice in different wineries and the growing season in the Balkan region that were investigated. The areas in the Balkan region in this study with similar agro-climatic characteristics showed shorter clustering distance, indicating similar phenol profiling in the red wines tested.     

Prof. Vatroslav Florschütz and the Balkan beam frame

Prof. Vatroslav Florschütz constructed in 1911 an extension table for repositioning bone fracture fragments of the upper and lower extremities, after which a plaster splint was applied—this later became to be known as the Balkan beam frame. Florschütz's personal insistences of new techniques at the beginning of the 1900 have helped shape war surgery and traumatology.     

Beta2-Microglobulin and Alpha1-Microglobulin as Markers of Balkan Endemic Nephropathy,a Worldwide Disease

Background:?Urine beta2-microglobulin (beta2-MG) was mainly used as a tubular marker of Balkan endemic nephropathy (BEN) but recently alpha1-microglobulin (alpha1-MG) was proposed for the diagnosis of BEN. In this study, the potential of urine beta2-MG, alpha1-MG, albumin, and total protein in the differentiation of BEN from healthy persons and patients with glomerulonephritis (GN) and nephrosclerosis (NS) was examined.?Methods:?This study involved 47 patients with BEN, 36 with GN, 11 with NS, 30 healthy subjects from BEN families, and 46 healthy subjects from non-BEN families.?Results:?In BEN patients area under the curve (AUC) for urine beta2-MG (0.828) and alpha1-MG (0.782) was higher than for urine albumin (0.740), but in GN patients AUC for urine protein (0.854) and albumin (0.872) was significantly higher than for the two low molecular weight proteins. AUC for all four urinary markers in NS patients was significantly lower than in BEN patients, ranging between 500 and 595. Median urine beta2-MG excretion in BEN patients was 17.5 times higher than in GN patients and 18.3 times higher than in controls; median alpha1-MG excretion was higher only 3.0 and 2.25 times, respectively. In the differentiation of BEN from healthy controls, beta2-MG had higher sensitivity and specificity at the cutoff levels (p < 0.001) than alpha1-MG (p < 0.05). In the differentiation of BEN from GN, beta2-MG was the best marker.?Conclusion:?All four urinary markers can be used for the differential diagnosis of BEN, beta2-MG being the best. Like in aristolochic acid nephropathy, beta2-MG seems to be an early marker of tubular damage in BEN.     

Interstitial capillary in normal and in transplanted kidneys: an ultrastructural study

Knowledge about the normal structure and pathology of interstitial capillary is limited. Splitting and multilayering of the basal membrane (BM), as a marker of chronic rejection, has been published in association with transplant glomerulopathy. The authors investigated the ultrastructural features of the interstitial capillary basal membrane in normal (15 biopsies) and in transplanted kidneys (27 biopsies from 21 patients), expressing transplant glomerulopathy (8 biopsies from 6 patients), acute tubulo-interstitial rejection (9 biopsies from 6 patients), and recurrent or de novo glomerulonephritis (10 biopsies from 8 patients). All biopsies were fixed in 1%OsO 4 , embedded in Epon, and examined by electron microscope. Measurements of the interstitial capillary BM were made. The BM of interstitial capillary of intact kidney was a homogenous continuous structure, 88 nm in width on average. Thickening with diffuse multilayering of BM was most intensive in patients with transplant glomerulopathy, and much less intensive in patients with acute tubulointerstitial rejection and in patients with recurrent or de novo glomerulonephritis. These findings may provide the first information about the morphology of the normal basal lamina of interstitial capillary and support the diagnostic value of interstitial capillary changes in chronic rejection.