Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Chronic
Resistence cortisol/leptin/ activation
insulin innate immune
system
Symptoms =
Auto-immune
disorders The medical visit
6 kilo of ATP/24 hours
100.000 beats/24 hours
10.000 liter of blood/24 hours
CVD
Depression
Diabetes
Obesity
Autoimmun Krankheiten
FM, CFS
Cancer
Infektion
Burn out
Pancreatitis
Rosas-Ballina, M., and Tracey, K.J. (2009). Cholinergic control of inflammation. J
10/7/10
9
Intern Med 265, 663-679.
Nance, D.M., and Sanders, V.M. (2007). Autonomic innervation and regulation of the
immune system (1987-2007). Brain Behav Immun 21, 736-745.
Tracey, K. J. Physiology and immunology of the cholinergic antiinflammatory
10/7/10
11
pathway. J Clin Invest 117, 289-296 (2007).
10/7/10
12
Immunol 9, 418-428.
Tracey, K.J. (2009). Reflex control of immunity. Nat Rev
Oke, S.L., and Tracey, K.J. (2007). The Inflammatory Reflex and the Role of
10/7/10
13
Complementary and Alternative Medical Therapies. Ann N Y Acad Sci
PGD2 is degraded to 15d-PGJ2 (through COX-2), a strong
ligand to PPAR and has strong anti-inflammatory
properties
Hand, K.V., Bruen, C.M., O'Halloran, F., Giblin, L., and Green, B.D. (2010). Acute
and chronic effects of dietary fatty acids on cholecystokinin
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16
expression, storage
and secretion in enteroendocrine STC-1 cells. Mol Nutr Food Res 54, S93-S103.
Effect of different liquid fatty
meals on CCK secretion
Maljaars, J., Romeyn, E.A., Haddeman, E., Peters, H.P., and Masclee, A.A. (2009).
10/7/10
Effect 17
intake. Am J Clin
of fat saturation on satiety, hormone release, and food
Nutr 89, 1019-024.
Effect of FAs on cell metabolism
!!!
Hand, K.V., Bruen, C.M., O'Halloran, F., Giblin, L., and Green, B.D. (2010). Acute
and chronic effects of dietary fatty acids on cholecystokinin
10/7/10
18
expression, storage
and secretion in enteroendocrine STC-1 cells. Mol Nutr Food Res 54, S93-S103.
Effect of FAs on cytotoxicity
Hand, K.V., Bruen, C.M., O'Halloran, F., Giblin, L., and Green, B.D. (2010). Acute
and chronic effects of dietary fatty acids on cholecystokinin
10/7/10
19
expression, storage
and secretion in enteroendocrine STC-1 cells. Mol Nutr Food Res 54, S93-S103.
nicotine as a potential remedy for
inflammatory diseases
10/7/10
21
Immunol 9, 418-428.
Tracey, K.J. (2009). Reflex control of immunity. Nat Rev
so its nicotinergic...
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23
Immunol 9, 418-428.
Tracey, K.J. (2009). Reflex control of immunity. Nat Rev
Cui, W.Y., and Li, M.D. (2010). Nicotinic Modulation of Innate Immune Pathways
10/7/10
24
Via alpha7 Nicotinic Acetylcholine Receptor. J Neuroimmune Pharmacol
Cui, W.Y., and Li, M.D. (2010). Nicotinic Modulation of Innate Immune Pathways
10/7/10
25
Via alpha7 Nicotinic Acetylcholine Receptor. J Neuroimmune Pharmacol
Studies
McClernon, F.J., Hiott, F.B., Westman, E.C., Rose, J.E., and Levin, E.D.
(2006). Transdermal nicotine attenuates depression symptoms in
nonsmokers: a double-blind, placebo-controlled trial.
Psychopharmacology (Berl) 189, 125-133.
Bruchfeld, A., Goldstein, R.S., Chavan, S., Patel, N.B., Rosas-Ballina, M.,
Kohn, N., Qureshi, A.R., and Tracey, K.J. (2010). Whole blood cytokine
attenuation by cholinergic agonists ex vivo and relationship to vagus
nerve activity in rheumatoid arthritis. J Intern Med
10/7/10
26
...but also cholinergic!
metabolism of acetylcholin
+ Acetyl CoA
10/7/10
http://www.cerefolin.com/template/img/
28
chart_hcycycle.gif
cholin in food
http://dgk.de/gesundheit/mikronaehrstoffebiosubstanzen/lexikon/weitere-
10/7/10
29
biosubstanzen/cholin-und-phosphatidylcholin-lecithin.html
degredation of Ach by acetylcholinesterase
10/7/10
http://wiki.medpedia.com/Image:Acetylcholinesterase.png?
30
filetimestamp=20080827183700
Plants with high acetylcholinesterase
inhibitory activities
Huperzia serrata
(syn. Lycopodium serratum)
influencing the parasympathetic tone one
step closer to resolution
Pace, T.W., Negi, L.T., Adame, D.D., Cole, S.P., Sivilli, T.I., Brown, T.D., Issa,
M.J., and Raison, C.L. (2009). Effect of compassion meditation on
neuroendocrine, innate immune and behavioral responses to
psychosocial stress. Psychoneuroendocrinology 34, 87-98.
Kiecolt-Glaser, J.K., Christian, L., Preston, H., Houts, C.R., Malarkey, W.B.,
Emery, C.F., and Glaser, R. (2010). Stress, inflammation, and yoga
practice. Psychosom Med 72, 113-121.
10/7/10
33
Hamer, M., and Steptoe, A. (2007). Association between physical fitness,
parasympathetic control, and proinflammatory responses to mental stress.
Psychosom Med 69, 660-66.
Endocannabinoids in
inflammation
Gomes, N.M., Rezende, C.M., Fontes, S.P., Matheus, M.E., and Fernandes, P.D. (2007).
Antinociceptive activity of Amazonian Copaiba oils. J Ethnopharmacol 109, 486-492.
PUFAs stimulate the production of endocannabinoids ->
activation of the CB2-receptor -> antiinflammatory &
proresolutive!
Banni, S., and Di Marzo, V. (2010). Effect of dietary fat on endocannabinoids and
related mediators: consequences on energy homeostasis, inflammation and
mood. Mol Nutr Food Res 54, 82-92.
The polyvagal theory one connection between
behaviour and inflammation
Steven Porges in 1995
The polyvagal theory
phylogenetic approach
three stages in the evolution of the autonomic nervous
system each associated with different behavioural
possibilities
neural regulation of the heart
Important
parts
of
the
DVC
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42
VVC - the social engagement system
Immune system
Porges, S.W. (2007). The polyvagal perspective. Biol Psychol 74, 116-143.
Porges, S.W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous
system. Int J Psychophysiol 42, 123-146.
Porges, S.W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous
system. Int J Psychophysiol 42, 123-146.
Porges, S.W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous
system. Int J Psychophysiol 42, 123-146.
=NTS
catecholaminergic
neurons
afferents
from IX & X
A & C-fibres
Craig, A.D. (2002). How do you feel? Interoception: the sense of the physiological
condition of the body. Nature Reviews Neuroscience 3, 655-666.
hedonic valuation
Craig, A.D. (2002). How do you feel? Interoception: the sense of the physiological
condition of the body. Nature Reviews Neuroscience 3, 655-666.
vagal input and behaviour
+ sensoric information through lamina I
(sensing disruption of homeostasis!)
Goehler, L.E., Lyte, M., and Gaykema, R.P. (2007). Infection-induced viscerosensory signals from
the gut enhance anxiety: implications for psychoneuroimmunology. Brain Behav Immun 21,
721-26.
influences on the autonomic
nervous system
Zautra, A.J., Fasman, R., Davis, M.C., and Craig, A.D. (2010). The effects of slow
breathing on affective responses to pain stimuli: An experimental study. Pain
sympathetic
segments
parasympathetic
segments
Pancreatic juices
HCO3
Chymotrypsin
Zymogene amylase,
lipase and protease
Function of the exocrine pancreas
Roxas, M. "The Role of Enzyme Supplementation in Digestive Disorders." Alternative medicine review: a journal of clinical
therapeutic 13, no. 4 (2008): 308.
Konturek, Stanislaw J, Romuald Zabielski, Jan W , and John Czarnecki.
"Neuroendocrinology of the Pancreas; Role of Brain-Gut Axis in Pancreatic
Secretion." European journal of pharmacology 481, no. 1 (2003): 1-14.
Food intake
Trypsin
Acinar-cells
Zymogenic enzyms
Chymotrypsin Duct cells HCO3
Carbon
anhydrase
Buffering of HCl
Enteropeptidase dependent (Zn)
Cleaves chymotrypsin
Konturek, Stanislaw J, Romuald Zabielski, Jan W , and John
Czarnecki. "Neuroendocrinology of the Pancreas; Role of Brain-Gut Axis
in Pancreatic Secretion." European journal of pharmacology 481, no. 1
(2003): 1-14.
The pancreas
distributes food during
day and night
Konturek, Stanislaw J,
Romuald Zabielski, Jan W
Konturek, and John
Czarnecki.
"Neuroendocrinology of
the Pancreas; Role of
Brain-Gut Axis in
Pancreatic Secretion."
European journal of
pharmacology 481, no. 1
(2003): 1-14.
Regulation of
pancreatic juice
production
pH, carbon
anhydrase, zinc
and digestion
Konturek, Stanislaw J, Romuald Zabielski, Jan W , and John
Czarnecki. "Neuroendocrinology of the Pancreas; Role of Brain-Gut Axis
in Pancreatic Secretion." European journal of pharmacology 481, no. 1
(2003): 1-14.
The long vagal-loop,
CCK, Tryptophan and
Melatonin
EPI
Moran CE, Sosa EG, Martinez SM, Geldern P, Messina D, Russo A: Bone
mineral density in patients with pancreatic insufficiency and
steatorrhea. Am J Gastroenterol
92:867 871, 1997
RBP = retinol
binding protein
CLINICAL
GASTROENTEROLOGY
AND HEPATOLOGY
2007;5:484488
De insulino-acinar connection
Insulin and the exocrine pancreas
Hypo-insulinemia
Pancreatic Atrophy
Steatose of the pancreas
Loss of CCK receptors
Insulin resistance
Decrease of HCO3
Decrease of CCK production
Lack of vagal activity
Hyperglycemia
Decrease of HCO3
Overall inhibition
Disorders: Mode of action endo - exo
Pancreatology 2009;9:351359
Clin Gastroenterol Hepatol. 2008 January ; 6(1): 7681. doi:
10.1016/j.cgh.2007.10.007.Insulin resistance and incident
gallbladder disease in pregnancy Cynthia W. Ko1, Shirley
A.A. Beresford2, Scott J. Schulte3,*, and Sum P. Lee1
Berry SM, Fink AS. Insulin inhibits secretin stimulated
pancreatic bicarbonate output by a dosedependent
neurally mediated mechanism. Am J
Physiol 1996; 270:G163-170.
Pancreatology 2009;9:351359
The pancreas weight
Newborn 5 gramm
1 year 14 15 gramm
Male adult < 40 jaar 112,4 gramm
Male average 80 jaar 68,4 gramm
Female adult < 40 jaar 92 gramm
Female average 80 jaar 66 gramm
Over-stimulated (alcohol-pancreatitis) 180 gramm?
The normal weight of the pancreas in the adult human being: A biometric
study. John H. Schaefer :Fellow in Pathology, The Mayo Foundation,
Rochester, Minnesota. From the Mayo Foundation for Medical Education and
Research, and the Department of Anatomy, University of Minnesota.Read by
title before the American association of anatomists, Cleveland, April 9 to 11,
1925.
The pancreas-
liver-brain-fat
axis
Protecting the
pancreas
Glucose clearance capacity
Eatron B, Cordain L. Preventive Medicine 49 (2009) 283285
Achim Peters1* and
Glucosa clearance capacity Dirk Langemann2
Frontiers in
neuroenergetics.
2009 (1): 1 - 15
200 gr glucose/24 hours
Nearly 40% of heart failure patients will die within one year of first
hospitalisation and only 25% of men and 38% of women will survive more
than five years following diagnosis2, 3
Over 3.6 million new cases of heart failure are reported each year in
Europe1
Admission to hospital with heart failure has more than doubled in the last
20 years1
70
60
50
40
30
mannen
20
vrouwen
10
Totaal
0
Activation (FAEES)
Activation CYP2E1
Fatty acid ethyl
esters synthetases
Activation ADHIII
(alcohol dehydrogenase)
Fatty acid ethyl esters
Acetaldehyde
Free radicals
Destabilisation lysosomes
Damage to chymo-enzymes
Activation NFkB
Depletion glutathion Increase cytoplasmatic Ca
Vonlaufen, Alain, Jeremy S Wilson, and Minoti V Apte. "Molecular Mechanisms of Pancreatitis: Current Opinion."
Journal of gastroenterology and hepatology 23, no. 9 (2008): doi:10.1111/j.1440-1746.2008.05520.x.
The consequence: Damaged
World J Gastroenterol. 2009 December
Pancreas 7; 15(45): 5732-5739
Curcumin Decreased Oxidative Stress,Inhibited NF-B Activation, and
Improved Liver Pathology in Ethanol-Induced Liver Injury in Rats.
Colitis ulcerosa
Morbus Crohn
Irritable Bowel Syndrome
*
A * *
c 25%
t
I 0% *
v
i
t
y Control 1.25 mmol 2.5 mmoll 5 mmol 10 mmoll
Results 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial
quality was generally good, with nine reporting adequate methods of
randomisation and six a method of concealment of allocation. There were
10 RCTs involving 918 patients providing outcomes as a dichotomous
variable. Probiotics were statistically significantly better than placebo (RR
of IBS not improving=0.71; 95% CI 0.57 to 0.88) with a number needed to
treat (NNT)=4 (95% CI 3 to 12.5). There was significant heterogeneity
(2=28.3, p=0.001, I2=68%) and possible funnel plot asymmetry. Fifteen trials
assessing 1351 patients reported on improvement in IBS score as a
continuous outcome (SMD=0.34; 95% CI 0.60 to 0.07). There was
statistically significant heterogeneity (2=67.04, p<0.001, I2=79%), but this
was explained by one outlying trial.
The solution
Indications of pancreas enzyme
supplementation
Chronic
Resistence cortisol/leptin/ activation
insulin innate immune
system
Symptoms =
Auto-immune
disorders The medical visit
Thanks for your attention