Ageing is associated with increased

Ageing is associated with increased reactive oxygen species (ROS) production, oxidative stress and oxidative damage [43,44]. Overproduction of ROS can impair endothelial function by suppressing NO synthesis and scavenging NO thereby decreasing its overall bioavailability. Moreover, sustained oxidative stress leads to eNOS uncoupling, a condition in which the oxygenase domain of eNOS monomers generates superoxide anions instead of NO exacerbating oxidative stress [11,42]. Exposure to chronic hypoxia results in oxidative stress [8,45] which may impair NO availability [46]. We observed lower levels of protein carbonyls in middle-aged Ladakhi women whereas MDA and 8-isoprostane levels were similar as compared to middle-aged lowland women. Studying oxidative stress levels of native highlanders, Sinha et al. have reported higher plasma uric 3-bromo-5-phenyl Salicylic Acid mediated antioxidant status of Ladakhi men at 4560 m [45]. Similarly, we have also observed lower protein oxidation and protein carbonyls in Ladakhi men as compared to acclimatized sojourners [8]. One of the possible mechanisms of such observed lower oxidative stress in Ladakhi women is enhanced NO availability. At physiological levels, NO acts as antioxidant and abates hydrogen peroxide and superoxide mediated oxidative stress. NO is reportedly a potent inhibitor of lipid peroxidation [47,48] and exerts potent cytoprotective effects during cardiovascular diseases [49]. Similarly, estrogen is a potent endogenous antioxidant and modulates ROS concentration through a mechanism that involves interaction with its nuclear receptors to decrease oxidative proteins and/or increase antioxidant enzymes expression [37,50].
Conflicts of interest
Acknowledgements The authors would like to acknowledge Dr Bhuvanesh Kumar, Dr Usha Panjwani, Dr Kaushik Ray, Dr Rina Wilfred for their support in high altitude studies. This work is supported by DRDO, Ministry of Defence, Government of India (Grant number DIP-263/S&T-14-15). Pooja is a recipient of UGC-Senior Research fellowship.
Introduction Cholangiocarcinoma (CCA) is an invasive cancer that originates from the bile duct epithelium. It is a major public health problem, with the highest incidence worldwide, in northeastern Thailand [1]. Pathogenesis is associated with liver fluke (Opisthorchis viverrini, Ov) infection which leads to chronic inflammation of the bile duct and is a major risk factor for developing CCA [2]. The correlation between Ov infection, chronic inflammation and CCA has been clearly defined [3]. Alteration in the genes and proteins involved in the kinase signaling pathway can promote CCA cell growth and migration [4], [5], [6], [7], [8], [9], [10]. We previously found that multiple protein kinases, including membrane receptor tyrosine kinase and cytoplasmic kinases, are over activated in CCA [4]. Among them, over-activated endothelial nitric oxide synthase (eNOS) was found in CCA cell lines and tissues. Endothelial nitric oxide synthase is an enzyme belonging to the nitric oxide synthase (NOS) family which is composed of neuronal nitric oxide synthase (nNOS), inducible nitric oxide synthase (iNOS) and eNOS. It plays a role in nitric oxide (NO) production [11]. Generally, eNOS is expressed in endothelial cells and plays a crucial role in vasodilation [12]. It also plays a role in pathological processes, including in cancer [13], [14], [15]. The expression of eNOS occurs in many types of cancer, such as pancreatic cancer [16] and prostate cancer [17]. Moreover, eNOS plays various roles in carcinogenesis, such as proliferation in the oral squamous cancer cell line TSCCa [18]. It also plays a role in anti-apoptosis found in a prostate cancer cell line [17] and angiogenesis in human pancreatic tumor biopsies [19], human gastric cancer [20] and human malignant melanoma [21]. In addition, eNOS plays a role in the invasion and metastasis in mammary cancer cells [22]. Several upstream signaling pathways can cause an increased expression and activation of eNOS. Vascular endothelial growth factor receptor 3 (VEGFR3) and its specific partner vascular endothelial growth factor C (VEGFC) can activate eNOS activity [23]. The ephrin A1 ligand and its specific receptor, the ephrin A3 receptor (EphA3) [24], are the upstream regulators of eNOS [25]. Interestingly, VEGFR3 and EphA3 are over-activated in CCA [4]. VEGFR3 and EphA3 modulate eNOS activation through the PI3K/AKT pathway [26], which is highly activated in CCA [10], phosphorylate eNOS at serine 1177 and increase nitric oxide production (NO) [27], [26].