Effectiveness of oral phloroglucinol as a premedication for unsedated esophagogastroduodenoscopy: A prospective, double-blinded, placebo-controlled, randomized trial

Hyaluronan-decorated-phloroglucinol-loaded mesoporous silica nanoparticles downregulate GLI1 and SMO genes of hedgehog signaling pathway in gastrointestinal cancer stem-like cells

Cancer stem-like cells (CSCs), a small subset of cells within the tumor microenvironment, favor tumor relapse and remain a major obstacle in cancer therapy. Hence, hyaluronan-based mesoporous silica nano-formulation with phloroglucinol (MSN-PG-HA) was employed in our study to address the cancer relapse by targeting CD44. Various in vitro cellular assays were conducted to assess the nano-formulation's effect on suppressing CSC characteristics in AGS, HCT-116 and SW-620. The CUA assay indicated increased uptake of FITC-labeled MSN-PG-HA by all GI cancer cell lines and no uptake by CD44- (3T3) cell line confirming the receptor-mediated endocytosis. Moreover, MSN-PG-HA nano-formulation has shown a significantly higher efficacy than free PG in other cellular assays by controlling cell migration, colony and spheroid formation, inducing apoptosis and suppressing the elevated MMP levels, for all the three GI cell lines with p ≤ 0.05, highlighting the nano-formulation's ability to target CSC. Further, the gene and protein expression analyses of hedgehog signaling pathway components, such as GLI1 and SMO, showed a 0.7 to 0.8-fold decrease in expression with MSN-PG-HA treated groups, proving that our nano-formulation could significantly target CSC-related proteins. Furthermore, the expression analysis utilizing inhibitors such as GANT-61 (GLI1 inhibitor) and Sonidegib (SMO inhibitor) have demonstrated that the MSN-PG-HA has shown a significant level of inhibition as that of GANT-61, indicating a similarity in their mechanism of action in inhibiting the cancer cell proliferation. Thus, our findings conclude that MSN-PG-HA could serve as a potential drug for targeting GI cancer stem cells.

Esophagogastroduodenoscopy Quality Improvement and the Role of Topical Antiperistaltic Agents: A Systematic Review and Meta-Analysis

Gastric cancer (GC) represents one of the most lethal forms of cancer. When identified at an early stage, conventional treatment can be curative. The key to identifying GC at an early stage is high-quality esophagogastroduodenoscopy (EGD). This has led to an increased focus on quality standards in EGD to improve the detection rates of early GC and its premalignant lesions (PMLs), such as atrophic gastritis. In Asia, the routine use of antiperistaltic (antispasmodic) agents is advocated to improve the quality of mucosal visualization during diagnostic EGD. The rationale is that the cessation of peristalsis should yield a more stable intragastric visual field to enhance the detection of early GC. Hyoscine and glucagon are commonly used as antiperistaltic agents. Both, however, must be given either intravenously or via intramuscular injection. They both also have potentially serious systemic side effects, which can limit their routine use, particularly in the elderly or co-morbid patients. As a result of these side effects, there is growing interest in using peppermint oil or L-menthol topically as anti-peristaltic agents. As these agents are applied topically (either via direct spraying during the EGD or consumed as a premedication before the EGD), they are associated with fewer adverse events than systemically applied agents. This study aimed to synthesize, for the first time, the available data on the use of topically applied anti-peristaltic agents to decrease or stop peristalsis during diagnostic EGDs. This study is a systematic review and meta-analysis of published randomized controlled trials. Its reporting is per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. This study was registered prospectively with the PROSPERO register, registration number CRD42024601488. This systematic review and meta-analysis encompassed five high-quality randomized controlled trials with a low risk of bias. All included studies were conducted in Asian countries between 2011 and 2022. They comprised 538 patients, with a mean age of 62.7. Four of the included studies look at topically applied L-menthol at 160 mg, while one study looked at the role of 160 mg of phloroglucinol administered as a 20 mL oral premedication liquid 15 minutes before the EGD. All included trials involved diagnostic EGDs and reported their primary outcomes using the same scoring systems. The primary outcome of interest for this study was the efficacy of the antiperistaltic agents at stopping peristalsis for the duration of a diagnostic EGD. We found an odds ratio of 4.22 with a 95% confidence interval ranging from 2.47 to 7.21, favoring the antiperistaltic agents in terms of attaining a peristalsis score of 1 after administration.  This systematic review and meta-analysis represent the most up-to-date review on topical antiperistaltic agents during diagnostic EGD. We found that topical antiperistaltic agents effectively decrease or stop peristalsis during an EGD, and these effects persist for the duration of the EGD. Larger-scale studies will be required to determine whether their routine use translates into increased detection rates of early GC and its PMLs.

Development of Phloroglucinol-Linked Tris-Quaternary Ammonium Salt Antimicrobial Peptide Mimics with Low Cytotoxicity and Broad-Spectrum Antibacterial Activity

Encouraged by the significantly different toxicities and antibacterial activities of diverse linkers, such as alkyl and aromatic nuclei linkers, and the unique structure of phloroglucinol, we synthesized a series of tris-quaternary ammonium salt (tris-QAS) antibacterial peptide mimics based on the marketed drug phloroglucinol. Among them, 2f displayed excellent activity against Staphylococcus aureus (MIC = 0.5 μg/mL) and high selectivity (SI > 2560). Surprisingly, the cytotoxicity of 2f (CC50 = 152.7 μg/mL) was dramatically better than those of alkyl QAS I and hydroquinone QAS II. Additionally, 2f possessed rapid bactericidal capability, was not prone to inducing bacterial resistance, and also exhibited excellent activity against S. aureus biofilms and persistent bacteria. Mechanistic research and transcriptome analysis revealed that 2f can interfere with the normal metabolism of bacterial cells, and it can specifically bind with phosphatidylglycerol to destroy the cell membrane. Importantly, 2f exhibited potent in vivo antibacterial activity in a mouse subcutaneous methicillin-resistant S. aureus (MRSA) infection model.

Effects of Phloroglucinol on Embryo Transfer: A Systematic Review and Meta-Analysis

INTRODUCTION

Phloroglucinol may be able to improve embryo transfer outcomes. We aimed to systematically evaluate the effects of phloroglucinol on embryo transfer outcomes.

METHODS

The databases searched were PubMed, Ovid MEDLINE, Web of Science, Wanfang, CQVIP, China National Knowledge Infrastructure, and ClinicalTrials.gov. The last search was on February 7, 2023. The included studies were written in English or Chinese. Randomized controlled trials and cohort studies aiming to assess the effect of phloroglucinol on embryo transfer outcomes were included. The studies reported at least one of the primary outcomes (biochemical pregnancy rate, clinical pregnancy rate, and live birth rate). The odds ratio (OR) and 95% confidence interval (CI) were calculated. A random-effects or fixed model was used where applicable to estimate the results.

RESULTS

Seventeen articles reporting 5,953 cycles were included. Biochemical pregnancy rate (OR = 1.58, 95% CI = 1.20-2.08, I2 = 71%), clinical pregnancy rate (OR = 1.69, 95% CI = 1.35-2.10, I2 = 64%), and live birth rate (OR = 1.45, 95% CI = 1.23-1.71, I2 = 36%) were improved by phloroglucinol. Less miscarriage (OR = 0.46, 95% CI = 0.35-0.60, I2 = 0%), less ectopic pregnancy (OR = 0.45, 95% CI = 0.28-0.72, I2 = 0%), higher implantation rate (OR = 1.45, 95% CI = 1.24-1.71, I2 = 62%) but more multiple pregnancy rate (OR = 1.48, 95% CI = 1.13-1.94, I2 = 0%) were induced by phloroglucinol. Endometrial peristaltic waves were improved by phloroglucinol (OR = 22.87, 95% CI = 5.52-94.74, I2 = 72%).

CONCLUSION

Phloroglucinol may improve the outcomes of embryo transfer, including biochemical pregnancy, clinical pregnancy, and live birth rates. Further studies are warranted.

Hyaluronan-based nano-formulation with mesoporous silica enhances the anticancer efficacy of phloroglucinol against gastrointestinal cancers

Gastrointestinal cancers are one among the most frequently reported cancers where colorectal and gastric cancers ranks third leading cause of cancer related death worldwide. Phloroglucinol, a well-known therapeutic agent for cancer, where its usage has been limited due to its poor water solubility and bioavailability. Hence, our study aims to synthesize and characterize Hyaluronan grafted phloroglucinol loaded Mesoporous silica nanoparticles (MSN-PG-HA). Our nano-formulation hasn't shown any teratogenic effect on Zebrafish embryos, no hemolysis and toxic effect with normal fibroblast cells with a maximum concentration of 300 μg/mL. The cumulative drug release profile of MSN-PG-HA showed a maximum drug release of 96.9 % with 5 mM GSH under redox responsive drug release, which is crucial for targeting cancer cells. In addition, the MSN-PG-HA nanoparticles showed significant a cytotoxic effect against HCT-116, AGS and SW-620 with IC50 values of 86.5 μg/mL, 80.65 μg/mL and 109.255 μg/mL respectively. Also, the cellular uptake assay has shown an increased uptake of FITC-labeled-MSN-PG-HA by HA-receptor mediated endocytosis than FITC-labeled-MSN-PG without HA modification in CD44+ gastrointestinal cancer cell lines. The ability of MSN-PG-HA to target CD44+ cells was further exploited for its application in cancer stem cell research utilizing in silico analysis with various stem cell pathway related targets, in which PG showed higher binding affinity with Gli 1 and the simulation studies proving its effectiveness in disrupting the protein structure. Thus, the findings of our study with nano-formulation are safe and non-toxic to recommend for targeted drug delivery against gastrointestinal cancers as well as its affinity towards cancer stem cell pathway related proteins proving to be a significant formulation for cancer stem cell research.

Construction of prokaryotic nanocompartment in Yarrowia lipolytica to assist phloroglucinol production

Phloroglucinol is an important chemical intermediate which has been tentatively produced by engineered bacteria. However, its biosynthesis in industry is limited due to its natural antibacterial activity. Our study firstly selected Yarrowia lipolytica as the chassis strain, which was verified to be tolerable to phloroglucinol. Then the gene of type III polyketone synthase PhlD (the key biosynthetic gene) was overexpressed to facilitate phloroglucinol production with a concentration of 107.4 mg/L. Furthermore, we introduced the prokaryotic nanocompartment to assist the intracellular catalytic activity. The results showed that the concentration of phloroglucinol was increased by about 2.5 times, indicating this multifunctional nanocompartment is orthogonal to the physiological activities of Y. lipolytica. Additionally, fermentations with xylose and lignocellulosic hydrolysates as the carbon source were performed with the engineered Y. lipolytica, resulting in a total concentration of 580.2 mg/L and 328.9 mg/L, respectively. These findings revealed the potential of Y. lipolytica in phloroglucinol production and provided an effective nanocompartment strategy to improve the catalytic activity of the enzyme for boosting phloroglucinol production. KEY POINTS: • The first time to select and use Y. lipolytica to produce phloroglucinol. • Successful construction of prokaryotic nanocompartment in Y. lipolytica to increase production of phloroglucinol. • Lignocellulose hydrolysate is used as a substrate in fermentation.

Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series

BACKGROUND

To summarize the clinical and epidemiological characteristics of acute intussusception.

METHODS

This retrospective study included pediatric patients with acute intussusception admitted to the Department of Pediatric Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, from January 2014 to December 2019.

RESULTS

A total of 402 infants/children were included (301 males and 101 females) with a mean age of 2.4 ± 1.5 years (2 months to 9 years). Thirty patients (7.5%) had a history of cold food intake, diarrhea, and upper respiratory infection before disease onset. Paroxysmal abdominal pain and crying occurred in 338 patients (84.1%). Eight patients (2.0%) had the typical triad, 167 (41.5%) had vomiting, 24 (6.0%) had bloody stools, and 273 (67.9%) had palpable abdominal mass. The average intussusception depth was 4.0 ± 1.4 cm. Air enema reduction was performed in 344 cases: 335 (97.3%) were successful. Fifty-eight patients were treated with intravenous phloroglucinol (2 mg/kg), and 53 (91.4%) were successful. Sixty-five patients suffered relapses, with a relapse rate of 16.8%.

CONCLUSIONS

Pediatric acute intussusception is common. There was no obvious etiology. The clinical manifestations are mostly atypical. Abdominal pain is the most common complaint. Air enema reduction is an effective treatment. The recurrence rate is high.

Polyphenol and Tannin Nutraceuticals and Their Metabolites: How the Human Gut Microbiota Influences Their Properties

Nutraceuticals have been receiving increasing attention in the last few years due to their potential role as adjuvants against non-communicable chronic diseases (cardiovascular disease, diabetes, cancer, etc.). However, a limited number of studies have been performed to evaluate the bioavailability of such compounds, and it is generally reported that a substantial elevation of their plasma concentration can only be achieved when they are consumed at pharmacological levels. Even so, positive effects have been reported associated with an average dietary consumption of several nutraceutical classes, meaning that the primary compound might not be solely responsible for all the biological effects. The in vivo activities of such biomolecules might be carried out by metabolites derived from gut microbiota fermentative transformation. This review discusses the structure and properties of phenolic nutraceuticals (i.e., polyphenols and tannins) and the putative role of the human gut microbiota in influencing the beneficial effects of such compounds.