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Hepatoprotective Marine Phytochemicals
Published in Se-Kwon Kim, Marine Biochemistry, 2023
BR Annapoorna, S Vasudevan, K Sindhu, V Vani, V Nivya, VP Venkateish, P Madan Kumar
Side effects are common during treatment in patients with HCC. Therefore, the timely and appropriate use of hepatoprotective agents is essential. Some functions of these hepatoprotective agents include antioxidant, anti-inflammatory, enzyme-reducing, detoxifying, hepatocyte membrane repair. Most commonly used hepatoprotective drugs include magnesium isoglycyrrhizinate injection, diammonium glycyrrhizinate, compound glycyrrhizin, bicyclol, silymarin, reduced glutathione, ademetionine, ursodeoxycholic acid, polyene phosphatidylcholine, and ulinastatin (Zhou et al. 2020).
Kawasaki disease
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Effective treatment: a single infusion of intravenous immunoglobulin (IVIG), given at a dose of 2 g/kg, forms the mainstay of treatment of Kawasaki disease. It should be given between days five and ten of the illness, with the onset of fever marking day one of the illness. It is effective in reducing fever within 36 hours of administration and reduces the risk of developing coronary artery aneurysms significantly. It can and should be administered after day ten of the illness if the diagnosis was initially missed or if there is evidence of ongoing inflammation and fever. It is believed to work by having a generalised anti-inflammatory effect. Aspirin is used in conjunction with IVIG as an anti-inflammatory and antiplatelet agent. High doses are usually prescribed during the febrile phase, with a lower maintenance dose until a normal echocardiogram is seen at around 6 weeks. Aspirin does not appear to have a protective effect against the development of coronary artery disease. Other anti-inflammatory agents and treatment modalities that have been used in cases where fever persists despite IVIG include corticosteroids, plasmapharesis, cyclophosphamide, ciclosporin, ulinastatin (human trypsin inhibitor), abciximab (platelet glycoprotein IIb/IIIa receptor inhibitor) and infliximab (monoclonal antibodies against tumour necrosis factor-α).
Cytokine release syndrome in COVID-19: a major mechanism of morbidity and mortality
Published in International Reviews of Immunology, 2022
Yifan Que, Chao Hu, Kun Wan, Peng Hu, Runsheng Wang, Jiang Luo, Tianzhi Li, Rongyu Ping, Qinyong Hu, Yu Sun, Xudong Wu, Lei Tu, Yingzhen Du, Christopher Chang, Guogang Xu
Ulinastatin is a naturally occurring protease inhibitor. By inhibiting the generation and release of inflammatory mediators, ulinastatin protects vascular endothelium, improves capillary permeability and effectively reduces 28-day mortality in patients with acute infection. Ulinastatin also reduces the generations of proinflammatory factors such as TNF-α, IL-6, IFN-γ and enhances the level of the anti-inflammatory factor IL-10 to restore the balance between proinflammatory and anti-inflammatory responses [94]. Ulinastatin therefore may play a role in attenuating CRS and blocking the progression of SIRS to MODS. However, ulinastatin will not suppress immune function and may cause femoral head necrosis and other sequelae. A tolerance and dosing study of ulinastatin in healthy adult subjects in China showed good safety and tolerance [95]. A prospective, observational clinical study of ulinastatin injection in the treatment of severe COVID-19 cases has been launched in Guangdong Province in China.
Emerging medical therapies in crush syndrome – progress report from basic sciences and potential future avenues
Published in Renal Failure, 2020
Ning Li, Xinyue Wang, Pengtao Wang, Haojun Fan, Shike Hou, Yanhua Gong
Ulinastatin is an acidic glycoprotein purified from the urine and blood of healthy people [82]. It is a multifunctional serine protease inhibitor that inhibits a variety of serine proteases, such as trypsin, thrombin, chymotrypsin, kallikrein and plasmin [83,84]. Yang et al. [85] found that the early administration of ulinastatin to CS rat model can reduce CS-induced AKI and reduce inflammation. Ulinastatin can also significantly reduce the levels of BUN, CK, Cre, Mb, and K+ in the serum of CS rat model. It also inhibits the infiltration of inflammatory cells, reduces sarcomere rupture in compressed muscle tissues, reduces glomerular hyperemia and edema, and reduces the amount of Mb in kidney tissue. At the same time, the ratio of regulatory T (Treg) cells in CD4+ T cells after treatment with ulinastatin was significantly higher than that of the crush injury group, while the expression of IL-17 decreased. Therefore, the authors believe that Ulinastatin may play a renal protective role by regulating the balance between Th17 and Treg cells.
Managing sepsis in the era of precision medicine: challenges and opportunities
Published in Expert Review of Anti-infective Therapy, 2022
Richard R. Watkins, Robert A. Bonomo, Jordi Rello
Many immunomodulating therapies other than steroids have a potential role in sepsis. Ulinastatin is a serine protease inhibitor that reduces pro-inflammatory cytokines [48]. A meta-analysis of 13 RCTs and two prospective studies that included 1,358 patients with sepsis, severe sepsis, or septic shock found that ulinastatin significantly reduced all-cause mortality (odds ratio [OR], 0.48; 95% CI, 0.35–0.6; P < 0.00001) [49]. There was also a reduction in Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score (mean difference [MD], −2.40; 95% CI, −4.37, −0.44; P = 0.02) and incidence of multiple organ dysfunction syndrome (MODS) (OR, 0.3; 95% CI, 0.18–0.49; P < 0.00001).