1
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Kim Y, Pool E, Kim E, Dampalla CS, Nguyen HN, Johnson DK, Lovell S, Groutas WC, Chang KO. Potent small molecule inhibitors against the 3C protease of foot-and-mouth disease virus. Microbiol Spectr 2024; 12:e0337223. [PMID: 38466127 DOI: 10.1128/spectrum.03372-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 03/12/2024] Open
Abstract
Foot-and-mouth disease (FMD) is one of the most devastating diseases of livestock which can cause significant economic losses, especially when introduced to FMD-free countries. FMD virus (FMDV) belongs to the family Picornaviridae and is antigenically heterogeneous with seven established serotypes. The prevailing preventive and control strategies are limited to restriction of animal movement and elimination of infected or exposed animals, which can be potentially combined with vaccination. However, FMD vaccination has limitations including delayed protection and lack of cross-protection against different serotypes. Recently, antiviral drug use for FMD outbreaks has increasingly been recognized as a potential tool to augment the existing early response strategies, but limited research has been reported on potential antiviral compounds for FMDV. FMDV 3C protease (3Cpro) cleaves the viral-encoded polyprotein into mature and functional proteins during viral replication. The essential role of viral 3Cpro in viral replication and the high conservation of 3Cpro among different FMDV serotypes make it an excellent target for antiviral drug development. We have previously reported multiple series of inhibitors against picornavirus 3Cpro or 3C-like proteases (3CLpros) encoded by coronaviruses or caliciviruses. In this study, we conducted structure-activity relationship studies for our in-house focused compound library containing 3Cpro or 3CLpro inhibitors against FMDV 3Cpro using enzyme and cell-based assays. Herein, we report the discovery of aldehyde and α-ketoamide inhibitors of FMDV 3Cpro with high potency. These data inform future preclinical studies that are related to the advancement of these compounds further along the drug development pathway.IMPORTANCEFood-and-mouth disease (FMD) virus (FMDV) causes devastating disease in cloven-hoofed animals with a significant economic impact. Emergency response to FMD outbreaks to limit FMD spread is critical, and the use of antivirals may overcome the limitations of existing control measures by providing immediate protection for susceptible animals. FMDV encodes 3C protease (3Cpro), which is essential for virus replication and an attractive target for antiviral drug discovery. Here, we report a structure-activity relationship study on multiple series of protease inhibitors and identified potent inhibitors of FMDV 3Cpro. Our results suggest that these compounds have the potential for further development as FMD antivirals.
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Affiliation(s)
- Yunjeong Kim
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Emma Pool
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Eunji Kim
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | | | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, Kansas, USA
| | - David K Johnson
- Computational Chemical Biology Core, The University of Kansas, Lawrence, Kansas, USA
| | - Scott Lovell
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas, USA
| | - William C Groutas
- Department of Chemistry, Wichita State University, Wichita, Kansas, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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2
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Li P, Kim Y, Dampalla CS, Nhat Nguyen H, Meyerholz DK, Johnson DK, Lovell S, Groutas WC, Perlman S, Chang KO. Potent 3CLpro inhibitors effective against SARS-CoV-2 and MERS-CoV in animal models by therapeutic treatment. mBio 2024; 15:e0287823. [PMID: 38126789 PMCID: PMC10865860 DOI: 10.1128/mbio.02878-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East respiratory syndrome coronavirus (MERS-CoV) are zoonotic betacoronaviruses that continue to have a significant impact on public health. Timely development and introduction of vaccines and antivirals against SARS-CoV-2 into the clinic have substantially mitigated the burden of COVID-19. However, a limited or lacking therapeutic arsenal for SARS-CoV-2 and MERS-CoV infections, respectively, calls for an expanded and diversified portfolio of antivirals against these coronavirus infections. In this report, we examined the efficacy of two potent 3CLpro inhibitors, 5d and 11d, in fatal animal models of SARS-CoV-2 and MERS-CoV to demonstrate their broad-spectrum activity against both viral infections. These compounds significantly increased the survival of mice in both models when treatment started 1 day post infection compared to no treatment which led to 100% fatality. Especially, the treatment with compound 11d resulted in 80% and 90% survival in SARS-CoV-2 and MERS-CoV-infected mice, respectively. Amelioration of lung viral load and histopathological changes in treated mice correlated well with improved survival in both infection models. Furthermore, compound 11d exhibited significant antiviral activities in K18-hACE2 mice infected with SARS-CoV-2 Omicron subvariant XBB.1.16. The results suggest that these are promising candidates for further development as broad-spectrum direct-acting antivirals against highly virulent human coronaviruses.IMPORTANCEHuman coronaviruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East respiratory syndrome coronavirus (MERS-CoV) continue to have a significant impact on public health. A limited or lacking therapeutic arsenal for SARS-CoV-2 and MERS-CoV infections calls for an expanded and diversified portfolio of antivirals against these coronavirus infections. We have previously reported a series of small-molecule 3C-like protease (3CLpro) inhibitors against human coronaviruses. In this report, we demonstrated the in vivo efficacy of 3CLpro inhibitors for their broad-spectrum activity against both SARS-CoV-2 and MERS-CoV infections using the fatal animal models. The results suggest that these are promising candidates for further development as broad-spectrum direct-acting antivirals against highly virulent human coronaviruses.
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Affiliation(s)
- Pengfei Li
- Department of Microbiology and Immunology, The University of Iowa, lowa, USA
| | - Yunjeong Kim
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | | | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, Kansas, USA
| | | | - David K. Johnson
- Computational Chemical Biology Core, The University of Kansas, Lawrence, Kansas, USA
| | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas, USA
| | | | - Stanley Perlman
- Department of Microbiology and Immunology, The University of Iowa, lowa, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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3
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Nguyen TB, Nguyen TTH, Huynh SQ, Phu TV, Taha AM, Nguyen D, Le HM, Nguyen HN, Nguyen LTK, Tran NT. Seroprevalence of Toxocara at Tra Vinh University Hospital in Vietnam. Eur Rev Med Pharmacol Sci 2023; 27:10334-10341. [PMID: 37975357 DOI: 10.26355/eurrev_202311_34308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The study aims to assess the seroprevalence of Toxocariasis and its associated risk factors among individuals attending the outpatient department at Tra Vinh University Hospital, Vietnam, in 2022. SUBJECTS AND METHODS A cross-sectional survey was conducted among outpatients of Tra Vinh University Hospital. Toxocariasis diagnosis was based on the Enzyme-Linked Immunosorbent Assay (ELISA) performed at the hospital's laboratory department. We assessed the seroprevalence of Toxocariasis and evaluated associated risk factors, including demographics and certain behaviors. RESULTS Of the 249 participants surveyed, 165 tested positive for Toxocariasis, yielding a seroprevalence of 66.3% (95% CI: 60.4-72.1). Multivariate analysis revealed that age groups up to 30 and 30-60 years had higher odds of Toxocariasis infection, with adjusted odds ratios (aOR) of 2.52 (95% CI: 1.04-6.11) and 3.21 (95% CI: 1.44-7.15) respectively. Additionally, individuals residing in rural areas and those in contact with dogs or cats had increased risks, with aORs of 2.21 (95% CI: 1.21-4.01) and 2.04 (95% CI: 1.10-3.79), respectively. Notably, hand washing before eating emerged as a protective factor against Toxocariasis, presenting an aOR of 0.38 (95% CI: 0.19-0.76). CONCLUSIONS Our findings underscore a significant seroprevalence (66.3%) of Toxocara spp. among outpatients at Tra Vinh University Hospital. Proactive measures, including hand hygiene before meals and after pet interactions, are advocated. There is a pronounced need for community-level epidemiological surveillance for human Toxocariasis.
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Affiliation(s)
- T B Nguyen
- Faculty of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Vietnam.
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4
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Dampalla CS, Miller MJ, Kim Y, Zabiegala A, Nguyen HN, Madden TK, Thurman HA, Machen AJ, Cooper A, Liu L, Battaile KP, Lovell S, Chang KO, Groutas WC. Structure-guided design of direct-acting antivirals that exploit the gem-dimethyl effect and potently inhibit 3CL proteases of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) and middle east respiratory syndrome coronavirus (MERS-CoV). Eur J Med Chem 2023; 254:115376. [PMID: 37080108 PMCID: PMC10105399 DOI: 10.1016/j.ejmech.2023.115376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
The high morbidity and mortality associated with SARS-CoV-2 infection, the etiological agent of COVID-19, has had a major impact on global public health. Significant progress has been made in the development of an array of vaccines and biologics, however, the emergence of SARS-CoV-2 variants and breakthrough infections are an ongoing major concern. Furthermore, there is an existing paucity of small-molecule host and virus-directed therapeutics and prophylactics that can be used to counter the spread of SARS-CoV-2, and any emerging and re-emerging coronaviruses. We describe herein our efforts to address this urgent need by focusing on the structure-guided design of potent broad-spectrum inhibitors of SARS-CoV-2 3C-like protease (3CLpro or Main protease), an enzyme essential for viral replication. The inhibitors exploit the directional effects associated with the presence of a gem-dimethyl group that allow the inhibitors to optimally interact with the S4 subsite of the enzyme. Several compounds were found to potently inhibit SARS-CoV-2 and MERS-CoV 3CL proteases in biochemical and cell-based assays. Specifically, the EC50 values of aldehyde 1c and its corresponding bisulfite adduct 1d against SARS-CoV-2 were found to be 12 and 10 nM, respectively, and their CC50 values were >50 μM. Furthermore, deuteration of these compounds yielded compounds 2c/2d with EC50 values 11 and 12 nM, respectively. Replacement of the aldehyde warhead with a nitrile (CN) or an α-ketoamide warhead or its corresponding bisulfite adduct yielded compounds 1g, 1eand1f with EC50 values 60, 50 and 70 nM, respectively. High-resolution cocrystal structures have identified the structural determinants associated with the binding of the inhibitors to the active site of the enzyme and, furthermore, have illuminated the mechanism of action of the inhibitors. Overall, the high Safety Index (SI) (SI=CC50/EC50) displayed by these compounds suggests that they are well-suited to conducting further preclinical studies.
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Affiliation(s)
- Chamandi S Dampalla
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA
| | - Matthew J Miller
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
| | - Alexandria Zabiegala
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
| | - Harry Nhat Nguyen
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA
| | - Trent K Madden
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA
| | - Hayden A Thurman
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA
| | - Alexandra J Machen
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, KS, 66047, USA
| | - Anne Cooper
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, KS, 66047, USA
| | - Lijun Liu
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, KS, 66047, USA
| | | | - Scott Lovell
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, KS, 66047, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA.
| | - William C Groutas
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, KS, 67260, USA.
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5
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Dampalla C, Nguyen HN, Rathnayake AD, Kim Y, Perera KD, Madden TK, Thurman HA, Machen AJ, Kashipathy MM, Liu L, Battaile KP, Lovell S, Chang KO, Groutas WC. Broad-Spectrum Cyclopropane-Based Inhibitors of Coronavirus 3C-like Proteases: Biochemical, Structural, and Virological Studies. ACS Pharmacol Transl Sci 2023; 6:181-194. [PMID: 36654747 PMCID: PMC9841783 DOI: 10.1021/acsptsci.2c00206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 12/29/2022]
Abstract
The advent of SARS-CoV-2, the causative agent of COVID-19, and its worldwide impact on global health, have provided the impetus for the development of effective countermeasures that can be deployed against the virus, including vaccines, monoclonal antibodies, and direct-acting antivirals (DAAs). Despite these efforts, the current paucity of DAAs has created an urgent need for the creation of an enhanced and diversified portfolio of broadly acting agents with different mechanisms of action that can effectively abrogate viral infection. SARS-CoV-2 3C-like protease (3CLpro), an enzyme essential for viral replication, is a validated target for the discovery of SARS-CoV-2 therapeutics. In this report, we describe the structure-guided utilization of the cyclopropane moiety in the design of highly potent inhibitors of SARS-CoV-2 3CLpro, SARS-CoV-1 3CLpro, and MERS-CoV 3CLpro. High-resolution cocrystal structures were used to identify the structural determinants associated with the binding of the inhibitors to the active site of the enzyme and unravel the mechanism of action. Aldehydes 5c and 11c inhibited SARS-CoV-2 replication with EC50 values of 12 and 11 nM, respectively. Furthermore, the corresponding aldehyde bisulfite adducts 5d and 11d were equipotent with EC50 values of 13 and 12 nM, respectively. The safety index (SI) values for compounds 5c / 11c and 5d / 11d ranged between 7692 and 9090. Importantly, aldehydes 5c / 11c and bisulfite adducts 5d / 11d potently inhibited MERS-CoV 3CLpro with IC50 values of 80 and 120 nM, and 70 and 70 nM, respectively. Likewise, compounds 5c / 11c and 5d / 11d inhibited SARS-CoV-1 with IC50 values of 960 and 350 nM and 790 and 240 nM, respectively. Taken together, these studies suggest that the inhibitors described herein have low cytotoxicity and high potency and are promising candidates for further development as broad-spectrum direct-acting antivirals against highly pathogenic coronaviruses.
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Affiliation(s)
- Chamandi
S. Dampalla
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
| | - Harry Nhat Nguyen
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
| | - Athri D. Rathnayake
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
| | - Yunjeong Kim
- Department
of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - Krishani Dinali Perera
- Department
of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - Trent K. Madden
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
| | - Hayden A. Thurman
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
| | - Alexandra J. Machen
- Protein
Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Maithri M. Kashipathy
- Protein
Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Lijun Liu
- Protein
Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Kevin P. Battaile
- NYX,
New York Structural Biology Center, Upton, New York 11973, United States
| | - Scott Lovell
- Protein
Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Kyeong-Ok Chang
- Department
of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - William C. Groutas
- Department
of Chemistry and Biochemistry, Wichita State
University, Wichita, Kansas 67260, United States
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6
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Dampalla CS, Rathnayake AD, Kankanamalage ACG, Kim Y, Perera KD, Nguyen HN, Miller MJ, Madden TK, Picard HR, Thurman HA, Kashipathy MM, Liu L, Battaile KP, Lovell S, Chang KO, Groutas WC. Structure-Guided Design of Potent Spirocyclic Inhibitors of Severe Acute Respiratory Syndrome Coronavirus-2 3C-like Protease. J Med Chem 2022; 65:7818-7832. [PMID: 35638577 PMCID: PMC9172056 DOI: 10.1021/acs.jmedchem.2c00224] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 12/22/2022]
Abstract
The worldwide impact of the ongoing COVID-19 pandemic on public health has made imperative the discovery and development of direct-acting antivirals aimed at targeting viral and/or host targets. SARS-CoV-2 3C-like protease (3CLpro) has emerged as a validated target for the discovery of SARS-CoV-2 therapeutics because of the pivotal role it plays in viral replication. We describe herein the structure-guided design of highly potent inhibitors of SARS-CoV-2 3CLpro that incorporate in their structure novel spirocyclic design elements aimed at optimizing potency by accessing new chemical space. Inhibitors of both SARS-CoV-2 3CLpro and MERS-CoV 3CLpro that exhibit nM potency and high safety indices have been identified. The mechanism of action of the inhibitors and the structural determinants associated with binding were established using high-resolution cocrystal structures.
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Affiliation(s)
- Chamandi S. Dampalla
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Athri D. Rathnayake
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | | | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - Krishani Dinali Perera
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - Harry Nhat Nguyen
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Matthew J. Miller
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Trent K. Madden
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Hunter R. Picard
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Hayden A. Thurman
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
| | | | - Lijun Liu
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, USA
| | | | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - William C. Groutas
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, USA
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7
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Dampalla CS, Rathnayake AD, Perera KD, Jesri ARM, Nguyen HN, Miller MJ, Thurman HA, Zheng J, Kashipathy MM, Battaile KP, Lovell S, Perlman S, Kim Y, Groutas WC, Chang KO. Structure-Guided Design of Potent Inhibitors of SARS-CoV-2 3CL Protease: Structural, Biochemical, and Cell-Based Studies. J Med Chem 2021; 64:17846-17865. [PMID: 34865476 PMCID: PMC8673480 DOI: 10.1021/acs.jmedchem.1c01037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic is having a major impact on public health worldwide, and there is an urgent need for the creation of an armamentarium of effective therapeutics, including vaccines, biologics, and small-molecule therapeutics, to combat SARS-CoV-2 and emerging variants. Inspection of the virus life cycle reveals multiple viral- and host-based choke points that can be exploited to combat the virus. SARS-CoV-2 3C-like protease (3CLpro), an enzyme essential for viral replication, is an attractive target for therapeutic intervention, and the design of inhibitors of the protease may lead to the emergence of effective SARS-CoV-2-specific antivirals. We describe herein the results of our studies related to the application of X-ray crystallography, the Thorpe-Ingold effect, deuteration, and stereochemistry in the design of highly potent and nontoxic inhibitors of SARS-CoV-2 3CLpro.
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Affiliation(s)
| | - Athri D. Rathnayake
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Krishani Dinali Perera
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | | | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Matthew J. Miller
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Hayden A. Thurman
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Jian Zheng
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA 52242, USA
| | | | | | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA 52242, USA
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - William C. Groutas
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
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8
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Dampalla CS, Kim Y, Bickmeier N, Rathnayake AD, Nguyen HN, Zheng J, Kashipathy MM, Baird MA, Battaile KP, Lovell S, Perlman S, Chang KO, Groutas WC. Structure-Guided Design of Conformationally Constrained Cyclohexane Inhibitors of Severe Acute Respiratory Syndrome Coronavirus-2 3CL Protease. J Med Chem 2021; 64:10047-10058. [PMID: 34213885 PMCID: PMC8276672 DOI: 10.1021/acs.jmedchem.1c00319] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 12/12/2022]
Abstract
A series of nondeuterated and deuterated dipeptidyl aldehyde and masked aldehyde inhibitors that incorporate in their structure a conformationally constrained cyclohexane moiety was synthesized and found to potently inhibit severe acute respiratory syndrome coronavirus-2 3CL protease in biochemical and cell-based assays. Several of the inhibitors were also found to be nanomolar inhibitors of Middle East respiratory syndrome coronavirus 3CL protease. The corresponding latent aldehyde bisulfite adducts were found to be equipotent to the precursor aldehydes. High-resolution cocrystal structures confirmed the mechanism of action and illuminated the structural determinants involved in binding. The spatial disposition of the compounds disclosed herein provides an effective means of accessing new chemical space and optimizing pharmacological activity. The cellular permeability of the identified inhibitors and lack of cytotoxicity warrant their advancement as potential therapeutics for COVID-19.
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Affiliation(s)
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - Naemi Bickmeier
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - Athri D. Rathnayake
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | - Jian Zheng
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | | | - Matthew A. Baird
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
| | | | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
| | - William C. Groutas
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, USA
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9
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Dampalla CS, Zheng J, Perera KD, Wong LYR, Meyerholz DK, Nguyen HN, Kashipathy MM, Battaile KP, Lovell S, Kim Y, Perlman S, Groutas WC, Chang KO. Postinfection treatment with a protease inhibitor increases survival of mice with a fatal SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2021; 118:e2101555118. [PMID: 34210738 PMCID: PMC8307543 DOI: 10.1073/pnas.2101555118] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a serious global public health threat. The 3C-like protease (3CLpro) is a virus protease encoded by SARS-CoV-2, which is essential for virus replication. We have previously reported a series of small-molecule 3CLpro inhibitors effective for inhibiting replication of human coronaviruses including SARS-CoV-2 in cell culture and in animal models. Here we generated a series of deuterated variants of a 3CLpro inhibitor, GC376, and evaluated the antiviral effect against SARS-CoV-2. The deuterated GC376 displayed potent inhibitory activity against SARS-CoV-2 in the enzyme- and the cell-based assays. The K18-hACE2 mice develop mild to lethal infection commensurate with SARS-CoV-2 challenge doses and were proposed as a model for efficacy testing of antiviral agents. We treated lethally infected mice with a deuterated derivative of GC376. Treatment of K18-hACE2 mice at 24 h postinfection with a derivative (compound 2) resulted in increased survival of mice compared to vehicle-treated mice. Lung virus titers were decreased, and histopathological changes were ameliorated in compound 2-treated mice compared to vehicle-treated mice. Structural investigation using high-resolution crystallography illuminated binding interactions of 3CLpro of SARS-CoV-2 and SARS-CoV with deuterated variants of GC376. Taken together, deuterated GC376 variants have excellent potential as antiviral agents against SARS-CoV-2.
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Affiliation(s)
| | - Jian Zheng
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, IA 52242
| | - Krishani Dinali Perera
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506
| | - Lok-Yin Roy Wong
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, IA 52242
| | - David K Meyerholz
- Department of Pathology, The University of Iowa, Iowa City, IA 52242
| | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, KS 67260
| | | | | | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, KS 66047
| | - Yunjeong Kim
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506;
| | - Stanley Perlman
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, IA 52242;
| | - William C Groutas
- Department of Chemistry, Wichita State University, Wichita, KS 67260;
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506;
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Nguyen HN, Stringer LD, Hong KJ. Influence of Irradiation on the Biology of the Brown Marmorated Stink Bug (Hemiptera: Pentatomidae). J Econ Entomol 2021; 114:1211-1218. [PMID: 33730146 DOI: 10.1093/jee/toab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 06/12/2023]
Abstract
Fifth-instar brown marmorated stink bug (Halyomorpha halys Stål) nymphs were treated by gamma-radiation 60Co at different doses of 8-64 Gy to investigate their irradiation biology and potential for the sterile insect technique (SIT). At adult emergence, males were mated with non-irradiated virgin females to assess the longevity of both sexes, female fecundity, and egg sterility. Biological parameters of their F1 progeny were investigated to determine whether negative effects from parental exposure to radiation were inherited. Results showed that irradiation significantly reduced the lifespan of male insects at doses above 20 Gy. Irradiated males did not affect the longevity and fecundity of their female partners, nor of their resulting adult progenies, but it did reduce the developmental duration of nymphs as well as weight gain of male F1 offspring. Egg hatch was significantly reduced at all tested doses and reached complete sterility at 64 Gy. Low hatch of eggs produced by F1 or F1 crossed adults indicated that negative effects from radiation were inherited by the subsequent generation. But F1 male offspring were not less fertile than their irradiated male parent, unlike what was observed in Lepidoptera. The results support the potential for the use of SIT for H. halys management by irradiating the fifth-instar male nymphs at doses from 16 Gy to 64 Gy.
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Affiliation(s)
- H N Nguyen
- Department of Plant Medicine, Sunchon National University, Suncheon, Republic of Korea
- Plant Protection Research Institute, Hanoi, Vietnam
| | - L D Stringer
- The New Zealand Institute for Plant and Food Research Ltd, PB 4704, Christchurch, New Zealand
| | - K-J Hong
- Department of Plant Medicine, Sunchon National University, Suncheon, Republic of Korea
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11
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Rathnayake AD, Kim Y, Dampalla CS, Nguyen HN, Jesri ARM, Kashipathy MM, Lushington GH, Battaile KP, Lovell S, Chang KO, Groutas WC. Structure-Guided Optimization of Dipeptidyl Inhibitors of Norovirus 3CL Protease. J Med Chem 2020; 63:11945-11963. [PMID: 32945669 DOI: 10.1021/acs.jmedchem.0c01252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute gastroenteritis caused by noroviruses has a major impact on public health worldwide in terms of morbidity, mortality, and economic burden. The disease impacts most severely immunocompromised patients, the elderly, and children. The current lack of approved vaccines and small-molecule therapeutics for the treatment and prophylaxis of norovirus infections underscores the need for the development of norovirus-specific drugs. The studies described herein entail the use of the gem-dimethyl moiety as a means of improving the pharmacological activity and physicochemical properties of a dipeptidyl series of transition state inhibitors of norovirus 3CL protease, an enzyme essential for viral replication. Several compounds were found to be potent inhibitors of the enzyme in biochemical and cell-based assays. The pharmacological activity and cellular permeability of the inhibitors were found to be sensitive to the location of the gem-dimethyl group.
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Affiliation(s)
- Athri D Rathnayake
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - Chamandi S Dampalla
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Abdul-Rahman M Jesri
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Maithri M Kashipathy
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | | | - Kevin P Battaile
- NYX, New York Structural Biology Center, Upton, New York 11973, United States
| | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - William C Groutas
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
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Nguyen TA, Cuong QN, Kim ALT, Huong TN, Nguyen HN, Fox GJ, Marks GB. Adapting a TB contact investigation strategy for COVID-19. Int J Tuberc Lung Dis 2020; 24:548-550. [PMID: 32398215 DOI: 10.5588/ijtld.20.0169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- T-A Nguyen
- Woolcock Institute of Medical Research, Hanoi, Viet Nam, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Q N Cuong
- Save the Children International, Vientiane Capital, Lao PDR
| | - A L T Kim
- Hanoi University of Public Health, Hanoi, Viet Nam
| | - T N Huong
- Strategic Consultancy Company, Hanoi, Viet Nam
| | - H N Nguyen
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - G J Fox
- Woolcock Institute of Medical Research, Hanoi, Viet Nam, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G B Marks
- Woolcock Institute of Medical Research, Hanoi, Viet Nam, University of New South Wales, Sydney, NSW, Australia, ,
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Damalanka VC, Kim Y, Galasiti Kankanamalage AC, Rathnayake AD, Mehzabeen N, Battaile KP, Lovell S, Nguyen HN, Lushington GH, Chang KO, Groutas WC. Structure-guided design, synthesis and evaluation of oxazolidinone-based inhibitors of norovirus 3CL protease. Eur J Med Chem 2018; 143:881-890. [PMID: 29227928 PMCID: PMC5737831 DOI: 10.1016/j.ejmech.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/18/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
Acute nonbacterial gastroenteritis caused by noroviruses constitutes a global public health concern and a significant economic burden. There are currently no small molecule therapeutics or vaccines for the treatment of norovirus infections. A structure-guided approach was utilized in the design of a series of inhibitors of norovirus 3CL protease that embody an oxazolidinone ring as a novel design element for attaining optimal binding interactions. Low micromolar cell-permeable inhibitors that display anti-norovirus activity have been identified. The mechanism of action, mode of binding, and structural rearrangements associated with the interaction of the inhibitors and the enzyme were elucidated using X-ray crystallography.
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Affiliation(s)
- Vishnu C Damalanka
- Department of Chemistry, Wichita State University, Wichita, KS 67260, USA
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA
| | | | - Athri D Rathnayake
- Department of Chemistry, Wichita State University, Wichita, KS 67260, USA
| | - Nurjahan Mehzabeen
- Protein Structure Laboratory, The University of Kansas, Lawrence, KS 66047, USA
| | - Kevin P Battaile
- IMCA-CAT, Hauptman-Woodward Medical Research Institute, APS Argonne National Laboratory, Argonne, IL 60439, USA
| | - Scott Lovell
- Protein Structure Laboratory, The University of Kansas, Lawrence, KS 66047, USA
| | - Harry Nhat Nguyen
- Department of Chemistry, Wichita State University, Wichita, KS 67260, USA
| | | | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA.
| | - William C Groutas
- Department of Chemistry, Wichita State University, Wichita, KS 67260, USA.
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Pehl C, Keller J, Allescher HD, Feussner H, Frieling T, Goebel-Stengel M, Gschossmann J, Kuhlbusch-Zicklam R, Mönnikes H, Nguyen HN, Müller M, Schirra J, Storr M, van der Voort I, Yüce B. [Diagnosis of oesophageal reflux by PH, impedance, and bilirubin measurement: recommendations of the German Society of Neurogastroenterology and of the working group for neurogastroenterology of the German Society for Digestive and Metabolic Diseases]. Z Gastroenterol 2012; 50:1310-32. [PMID: 23225560 DOI: 10.1055/s-0032-1325483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current recommendations on indications, technical performance, and interpretation of diagnostic techniques for oesophageal reflux update the German recommandations about 24 hour pH measurement of 2003. The recommendations encompass conventional pH measurement, wireless pH measurement, pH and impedance measurements, and bilirubin measurement (duodenogastro-oesophageal reflux).
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Affiliation(s)
- C Pehl
- Medizinische Klinik, Kreiskrankenhaus Vilsbiburg, Vilsbiburg.
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Mariotti J, Nguyen HN, Engel M. Abstract 3905: Structure–function relationships between RUNX1-MTG fusion proteins and core components of the Notch transcription complex. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-3905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The myeloid translocation genes (MTG) are preferred targets of chromosomal translocations with the Runx1 gene in acute myeloid leukemia (AML) pathogenesis. The resulting fusion proteins, RUNX1-MTG8 and RUNX1-MTG16, influence gene expression programs that control self-renewal and differentiation in hematopoiesis. How they engage the machinery of self-renewal to alter hematopoietic development is poorly understood. To gain additional insights into this question, we investigated structure–function relationships between RUNX1-MTG fusion proteins and core components of the Notch transcription complex, a critical determinant of cell fate specification in diverse tissues. The Notch transcription complex is composed minimally of the transcriptional repressor CSL, the intracellular domain of Notch receptors (N-ICD) and the transcriptional co-activator Mastermind (MAML). We show that RUNX1-MTG fusion proteins transactivate a Notch-responsive element from the Hes1 promoter. Using MTG16 as a model protein, we show that N-ICDs interact with a discrete domain in the MTG N-terminus. We translated these findings to the fusion proteins and found N-ICD binding was retained by RUNX1-MTGs and a RUNX1-MTG16 mutant that lacks the N1-ICD binding site. In parallel experiments, we defined the binding region for MTG proteins and their fusion protein derivatives on the N1-ICD. Informed by these structural relationships, we utilized RUNX1-MTG proteins or mutants that lack N1-ICD binding sites in transcriptional reporter assays. Our findings suggest that RUNX1-MTG fusion proteins alter transcription of the Notch target gene, Hes1 and intimate a structure–function relationship between RUNX1-MTG fusion proteins and Notch signaling.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3905.
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Nguyen HN, Domingues GR, Winograd R, Lammert F, Silny J, Matern S. Relationship between bolus transit and LES-relaxation studied with concurrent impedance and manometry. Hepatogastroenterology 2006; 53:218-23. [PMID: 16608028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND/AIMS Neuromuscular mechanisms regulating esophageal bolus transport are well studied. However, detailed data about the relationship between bolus transit and lower esophageal sphincter (LES)-relaxation during conventional motility testing are still lacking. METHODOLOGY We performed systematic studies in 25 normal subjects, employing a catheter that integrates the two techniques impedancometry and manometry in a single instrument for simultaneous recording and analysis of the relationship between bolus transit and LES relaxation after swallowing saline or yogurt. RESULTS 195 swallows were analyzed. LES relaxation occurred frequently later than UES relaxation. The mean latency between bolus entry into the esophagus and LES relaxation was 3.6 +0.2 sec. Two types of swallow-induced LES relaxation were observed: (a) LES relaxation preceding bolus transit (46 cases or 24%) and (b) LES relaxation occurring during bolus transit (149 cases or 76%). In the later case, during 114 (76%) cases of this deglutition, the position of the bolus was very close to the LES. CONCLUSIONS During deglutition, LES relaxation seems to be modulated by bolus transit and occurs predominantly upon arrival of the bolus in the distal esophagus.
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Affiliation(s)
- H N Nguyen
- Department of Medicine, Division of Gastroenterology and Helmholtz Institute of Biomedical Engineering University of Technology RWTH-Aachen, Germany.
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Abstract
Detailed data on patterns of esophageal bolus transport in patients with achalasia are still lacking. To study these we applied the novel technique of multichannel intraluminal impedance measurements. Ten patients with achalasia were studied using a 16 channel system. Liquid and semisolid boluses of 10 mL were applied with the patients in a supine position. Patterns of bolus transport were determined and analyzed as compared to results obtained from 20 healthy subjects. The healthy subjects featured a unique typical primary peristalsis pattern independent of bolus viscosity. In contrast, achalasia patients demonstrated different impedance characteristics, including: (i) significantly lower baseline esophageal impedance during the resting state as compared with healthy volunteers (999 omega +/- 108 versus 2749 omega +/- 113); (ii) failed bolus transport through the esophagus in all cases; (iii) impedance evidence of luminal content regurgitation in 35% of the swallows (iv) impedance evidence of pathological air movement within the proximal esophagus during deglutition in 38% of the swallows, so called air trapping. Thus, impedance characteristics of achalasia have been defined and can be attributed to known symptoms of achalasia. They can be used as basic findings for further classification of pathological bolus transports in other esophageal motility disorders.
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Affiliation(s)
- H N Nguyen
- Department of Internal Medicine University Hospital, University of Technology RWTH-Aachen, Germany.
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Nguyen HN, Lalonde P. [Clozapine and pregnancy]. Encephale 2003; 29:119-24. [PMID: 14567163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This article reviews the relations between clozapine and pregnancy. Six case reports are identified in the literature of pregnant patients who received clozapine. Novartis at Basle, Switzerland, through its pharmacovigilance and epidemiology, service, has data on nearly 200 cases summarized in this article. We also describe the case of a patient with paranoid schizophrenia who was hospitalized 10 times between the age of 22 to 32. She received clozapine when she was 29 years old and, with a daily dosage of 350 mg, she became asymptomatic. At the age of 33 and 37, she became pregnant and continued clozapine during her 2 pregnancies. During her first pregnancy, she received insulin due to gestational diabetes associated with a body weight mass (BWM) of 30.4 (N = 20 to 25). During her second pregnancy, the BWM was 23.7 and she did not develop diabetes. She delivered at term 2 daughters who are at the time of this report 5 and 3 years old. The two girls are doing well and have no developmental delay. Psychotic symptoms exacerbation: the plasma concentration of clozapine diminishes during pregnancy due to a higher hepatic metabolism and distribution volume. Monitoring plasma concentration of clozapine can help to adjust its dosage. In case of psychotic symptoms exacerbation, the following can be recommended: 1) Increase the clozapine dosage; 2) Add a classic antipsychotic like perphenazine, trifluoperazine or haloperidol. Diabetes: obesity, glucose intolerance or a family history of diabetes are risk factors to develop gestational diabetes. The follow-up of patients, who take an atypical antipsychotic, should include constant monitoring of the blood glucose or Hb1A and lipid dosages. Complications at labor: Clozapine increases the secretion of oxytocine and the contraction of the uterine muscle. But, no studies can explain how clozapine affects the labor exactly. Some case studies report use of forceps, vacuum or cesarean. CONVULSIONS Stoner (1997) described neonatal convulsions 8 days after birth. The mother was receiving 350 mg of clozapine, but also lorazepam and haloperidol during her pregnancy. The newborn withdrawal of lorazepam can increase the risk of convulsions and also haloperidol can diminish the convulsion threshold. Floppy infant syndrome: in the case described by Dimichele (1996), the mother received a daily dosage of 300 mg of clozapine and 2.5 mg of lorazepam 3 to 5 times a day. This can explain hypotonia. Stoner (1997) reports a second case where a mother, who received 600 mg of clozapine during pregnancy, gave birth to a child who had no convulsions neither hypotonia. DEVELOPMENT The cases described concerning studies of children until age 2 to 3 years by Stoner (1997) and Dickson (1998) and until 6 years old by Barnas (1994), do not mention any developmental problem, similar to the two daughters of our patient. The pharmacovigilance service of Novarits reports 6% of malformations. But these reports must be considered with caution since they represent only the pregnancies reported spontaneously to the pharmaceutical company. This is only a portion of all pregnancies associated with clozapine. CONCLUSION No specific risks for the mother and children can be attributed to the use of clozapine during pregnancy. However, the plasma concentration of clozapine is higher in the fetus compared to the mother (Barnas, 1994); therefore, a minimal dosage should be used. Since clozapine is present in the maternal milk, breast feeding should be avoided. The advantages to use clozapine during pregnancy must exceed the risks. It is justified to continue the use of this medication even if data on classic antipsychotics (e.g.: haloperidol) are more extensive. Because the risk of psychotic exacerbation is higher, the substitution of clozapine is not recommended. The psychosocial support and the obstetrical follow-up must be intensive too. An institutional pharmacovigilance service should complement the one provided by the industry. Also, further case-control and cohort studies are essential to better estimate the long-term risks.
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Affiliation(s)
- H N Nguyen
- Hôpital Louis-H. Lafontaine, Montréal, Canada
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Lammert F, Nguyen HN. [Familial hypolipoproteinemia with liver steatosis]. Dtsch Med Wochenschr 2002; 127:1964-5. [PMID: 12239658 DOI: 10.1055/s-2002-34205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F Lammert
- Medizinische Klinik III, Universitätsklinikum Aachen.
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Ganzera S, Nguyen HN, Wiemann H, Schneider J, Jakubowski HD. [Retroperitoneal giant angiomyolipoma diagnosed post-partum with lymph node involvement]. Dtsch Med Wochenschr 2002; 127:1463-6. [PMID: 12098097 DOI: 10.1055/s-2002-32674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
HISTORY AND PRESENTING COMPLAINT A 30-year-old primipara after a normal pregnancy had delivered a 3340 g child. After an uneventful post-partum period she had noticed her abdomen failing to reduce in size. INVESTIGATIONS, DIAGNOSIS AND TREATMENT The abdominal sonography discovered a large retroperitoneal tumor. CT and MRI showed a giant tumor which originated from the right kidney. Suspecting the diagnosis of renal liposarcoma the kidney and tumor were excised with removal of enlarged precaval and preaortal lymph nodes. Gross inspection revealed a ca. 3,2 kg myxoid tumor, measuring 27 x 19 x 10 cm. The histological examination of the surgical preparation revealed a retroperitoneal angiomyolipoma. CONCLUSION This is the first case of a giant retroperitoneal angiomyolipoma with lymph node involvement diagnosed post partum.
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Nguyen HN. [What measures are necessary in the demonstration of Clostridium difficile toxin?]. Dtsch Med Wochenschr 2002; 127:578-9. [PMID: 11894182 DOI: 10.1055/s-2002-22054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schönfelder T, Nguyen HN, Lammert F, Busch N, Matern S. [Treatment options for vascular ectasias of the gastric antrum (watermelon stomach)]. Dtsch Med Wochenschr 2001; 126:985-8. [PMID: 11544553 DOI: 10.1055/s-2001-16959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- T Schönfelder
- Medizinische Klinik III, Bundes-Knappschaftskrankenhaus, Bardenberg, Germany
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Lammert F, Nguyen HN, Schönfelder T, Handt S, Matern S. [Diagnosis of vascular ectasias of the gastric antrum (watermelon stomach)]. Dtsch Med Wochenschr 2001; 126:953-6. [PMID: 11523020 DOI: 10.1055/s-2001-16577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Lammert
- Medizinische Klinik III, Achen, Germany.
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Nguyen HN, Matern S. [Reference values in patients with daily alcohol consumption]. Dtsch Med Wochenschr 2001; 126:767-8. [PMID: 11455672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum, RWTH-Aachen, Pauwelstrasse 30 52074 Aachen.
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25
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Nguyen HN, Matern S. [Chronic diarrhea following cholecystectomy]. Dtsch Med Wochenschr 2001; 126:735-6. [PMID: 11446032 DOI: 10.1055/s-2001-15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH Pauwelstrasse 30 52074 Aachen.
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Nguyen HN. [Eradication therapy of Helicobacter pylori in antibiotic resistance]. Dtsch Med Wochenschr 2001; 126:571-2. [PMID: 11402917 DOI: 10.1055/s-2001-13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH-Aachen Pauwelsstrasse 30 52074 Aachen.
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Nguyen HN, Matern S. [Endoscopic monitoring in short segment Barrett esophagus]. Dtsch Med Wochenschr 2001; 126:314-5. [PMID: 11296572 DOI: 10.1055/s-2001-11854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH Pauwelstr. 30 52074 Aachen.
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Lammert F, Nguyen HN, Strohbach P, Wylenzek M, Kierdorf HP, Matern S. Therapy of refractory ascites with ultrafiltration and peritoneal reinfusion in a patient with right ventricular dilated cardiomyopathy. Dig Dis Sci 2001; 46:499-503. [PMID: 11318522 DOI: 10.1023/a:1005682728508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- F Lammert
- Department of Medicine III, University of Technology-RWTH, Aachen, Germany
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29
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Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH Pauwelstrasse 30 52074 Aachen.
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30
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Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH Pauwelstrasse 30 52074 Aachen.
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31
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Nguyen HN, Matern S. [Idiopathic chronic pancreatitis]. Dtsch Med Wochenschr 2000; 125:1516. [PMID: 11149215 DOI: 10.1055/s-2000-9117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum der RWTH, Pauwelstr. 30 52074 Aachen
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32
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Nguyen HN, Matern S. [Finishing treatment with percutaneous endoscopic gastrostomy]. Dtsch Med Wochenschr 2000; 125:1483. [PMID: 11153420 DOI: 10.1055/s-2000-8665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Universitätsklinikum der RWTH Pauwelstr. 30 52074 Aachen
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33
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Nguyen HN, Tewfik TL, Schloss MD, Frenkiel S, Bernard C. Adenocarcinoma of the paranasal sinuses: two case reports in a child and an adolescent. J Otolaryngol 2000; 29:389-92. [PMID: 11770150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- H N Nguyen
- Department of Otolaryngology, McGill University, Montreal, Quebec
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34
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35
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Nguyen HN. [Clinical significance of Helicobacter pylori: pathogen or saprophyte?]. Dtsch Med Wochenschr 2000; 125:1313-4. [PMID: 11098233 DOI: 10.1055/s-2000-8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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36
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Purucker E, Nguyen HN, Lammert F, Koch A, Matern S. Central pontine myelinolysis and myocardial infarction following severe hypoglycemia. Intensive Care Med 2000; 26:1406-7. [PMID: 11089780 DOI: 10.1007/s001340000592] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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Nguyen HN. [Lactose intolerance]. Dtsch Med Wochenschr 2000; 125:612. [PMID: 11320723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III Klinikum der Rheinisch-Westfälischen Technischen Hochschule Pauwelsstr. 30 52074 Aachen
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38
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Nguyen HN, Matern S. [Ocular myasthenia gravis and autoimmune thyroiditis]. Dtsch Med Wochenschr 2000; 125:167-8. [PMID: 10700882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum der RWTH, Aachen
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39
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Nguyen HN. [Undefined periumbilical pain]. Dtsch Med Wochenschr 1999; 124:1437-8. [PMID: 10605427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum der RWTH, Aachen
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40
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Nguyen HN. [Therapeutic actions in recurrent Helicobacter pylori-positive duodenal ulcer]. Dtsch Med Wochenschr 1999; 124:1220. [PMID: 10572524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule, Aachen
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41
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Lê DL, Hoeffel CC, Nguyen QK, Nguyen HN. [Gilford progeria. A case report]. Ann Med Interne (Paris) 1999; 150:512-8. [PMID: 10615539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Hutchinson-Gilford progeria syndrome is a rare syndrome of premature aging with multiple skeletal abnormalities. We report one case. The literature is reviewed. Characteristics of 30 patients with radiological records are presented. Pronounced acro-osteolysis, osteolysis of the clavicle are the main features. Modern imaging is useful to diagnose the complications.
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Affiliation(s)
- D L Lê
- Service de Pédiatrie, Hôpital An Binh Q5, Ho Chi Minh Ville, Vietnam
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42
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Nguyen HN. [Additional drug therapy in acute non-varicose upper gastrointestinal bleeding]. Dtsch Med Wochenschr 1999; 124:980-1. [PMID: 10481759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III des Universitätsklinikum, RWTH-Aachen.
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43
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Nguyen HN, Backes B, Lammert F, Wildberger J, Winograd R, Busch N, Rieband H, Matern S. Long-term survival after diagnosis of hepatic metastatic VIPoma: report of two cases with disparate courses and review of therapeutic options. Dig Dis Sci 1999; 44:1148-55. [PMID: 10389687 DOI: 10.1023/a:1026672022917] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This report describes two patients with pancreatic cholera caused by vasoactive intestinal polypeptide (VIP)-producing tumors, which originated in the pancreas and showed metastases in both hepatic lobes at time of diagnosis. However, the two tumors displayed remarkably disparate clinical courses. Due to the protracted but progressive course over more than 10 years, a multifaceted therapeutic approach was performed to control symptoms and to improve quality of life. The long-acting somatostatin analog octreotide was the most effective treatment for relieving symptoms and correcting fluid and electrolytes disturbances. The effects of complementary treatments, including systemic chemotherapy and hyperselective chemoembolization, as well as concurrent application of octreotide and prednisolone or interferon with respect to clinical symptoms, VIP levels, and tumor growth are reviewed. Our experience, although small, emphasizes the need for an expert, well-planned, adaptive, and multidisciplinary approach in the care of these complex patients.
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Affiliation(s)
- H N Nguyen
- Department of Internal Medicine III, University of Technology RWTH-Aachen, Germany
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Abstract
Cervical cancer is generally a locoregional disease. The endopelvic fascia envelops the cervix in anterior-posterior fashion and serves as a natural barrier. Thus, cervical cancer preferentially grows to the parametria and involves the ureters before it infiltrates the bladder or rectum. Disease stage, grade, cell type, tumor volume, depth of stromal invasion, vascular space invasion, and lymph node status are common prognostic indicators. Irregular vaginal bleeding and discharge are the two most frequent complaints. Although cervical cancer is still staged clinically, data continue to accumulate favoring a conversion to surgical staging to improve accuracy and treatment outcome.
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Affiliation(s)
- H N Nguyen
- Gynecologic Associates, Sheridan Healthcare Corporation, Hollywood, Florida 33021, USA.
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Abstract
Cervical cancer is easily recognized when it presents as a visible lesion, but a problem arises when it adopts unusual presentations. Cervical cancer can develop high in the endocervical canal, beyond the reach of cone biopsy. Copious vaginal discharge from cervical adenocarcinoma may lead to a false-negative Papanicolaou (Pap) smear. Treatment of cervicitis can result in a delay in diagnosis. Successful and timely diagnosis and treatment of cervical cancer requires experience and vigilance. Careful intraoperative palpation of the cervix and uterus can help determine the location and extent of the lesion. Flexibility during surgery is required to utilize intraoperative findings and thus optimize treatment. Pitfalls of cervical cancer diagnosis and treatment with actual case presentations are presented along with other special problems in cervical cancer management such as incidental findings of cervical cancer in hysterectomy specimens, treatment of cervical stump cancers, and unusual cervical cancer cell types.
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Affiliation(s)
- H N Nguyen
- Gynecologic Associates, Sheridan Healthcare Corporation, Hollywood, Florida 33021, USA.
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Abstract
Chemotherapy is used primarily to treat advanced or recurrent cervical cancer. There are three major applications: primary therapy, as a radiation sensitizer, and neoadjuvant therapy. Primary chemotherapy is employed in advanced and disseminated cervical carcinoma (Stage VB). The four best single drugs with moderate activity against cervical cancer are: cisplatin, ifosfamide, dibromodulcitol (mitolactol), and Adriamycin (doxorubicin). Cisplatin and ifosfamide appear to be the best combination therapy: they provide an objective response rate of 33%. However, because the overall survival was not significantly improved with combination therapy, single-agent therapy with one of the above active drugs is acceptable. For stages IIB, III and IVA, the primary therapy is still radiation. Concomitant chemotherapy with hydroxyurea or a combination of cisplatin and 5-fluorouracil (5-FU) have been shown to enhance radiation response in several randomized trials. Hydroxyurea is the preferred radiation sensitizer because it offers less toxicity, ease of administration, and equivalent results. Chemotherapy in neoadjuvant setting produces promising results. Various cisplatin combinations of mitomycin C, 5-FU, vincristine, and bleomycin have been employed to shrink locally advanced cervical cancer and permit safe, radical excision. Early results with these combinations in small trials are encouraging but further studies are needed to fully evaluate their potential.
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Affiliation(s)
- H N Nguyen
- Gynecological Oncology Associates, Sheridan Health Care Corporation, Hollywood, Florida 33021, USA.
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Abstract
The Bethesda Pap Smear system and its 1991 revisions aim to simplify Papanicolaou (Pap) smear reporting and make it more reproducible. It redefines the Pap smear request as a medical consultation. The pathologist consultant is required not only to provide the smear reading but also its clinical recommendation. The Bethesda system insists on a detailed Pap smear report assessing specimen adequacy and types of epithelial changes. Squamous cell abnormalities are grouped according to their biologic potential. Both cervical intraepithelial neoplasia, grade I (CIN I) (mild dysplasia) and human papillomavirus (HPV) lesions are grouped together as low-grade squamous intraepithelial lesions (LGSIL), while moderate and severe dysplasia (CIN II and III) belong to the high-grade squamous intraepithelial lesion (HGSIL) category. Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGCUS) need further qualification as to whether they favor either a reactive or neoplastic process. Guidelines for management of abnormal Pap smears are discussed in detail.
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Affiliation(s)
- H N Nguyen
- Gynecologic Oncology Associates, Sheridan Health Care Corporation, Hollywood, Florida 33021, USA.
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48
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Nguyen HN. [Risk of liver cancer due to peanut butter?]. Dtsch Med Wochenschr 1999; 124:299. [PMID: 10191826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum der RWTH, Aachen
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49
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Nguyen HN, Matern S. [Modified triple therapies for Helicobacter pylori eradication]. Dtsch Med Wochenschr 1999; 124:271. [PMID: 10102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- H N Nguyen
- Medizinische Klinik III, Universitätsklinikum der RWTH, Aachen.
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50
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Nguyen HN, Silny J, Matern S. Multiple intraluminal electrical impedancometry for recording of upper gastrointestinal motility: current results and further implications. Am J Gastroenterol 1999; 94:306-17. [PMID: 10022621 DOI: 10.1111/j.1572-0241.1999.00847.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review focuses on current aspects of the novel technology of multiple intraluminal electrical impedance measurement. It presents methodological features, summarizes current results, and discusses potential implications for further research. The impedance technique assesses a bolus transport and its associated peristalsis. Validation studies showed a good analogy between physically deduced impedance characteristics and characteristics derived from cineradiography and manometry. From the impedance tracings, it is possible to distinguish between resting states, bolus transit, and wall contraction. Characteristics of a peristaltic wave can be obtained. In human studies, esophageal and small intestinal peristaltic patterns can quantitatively and qualitatively be assessed. A high resolution recording of bolus movements with interesting details of transport and mixing can be obtained. On the basis of several prior characterized impedance tracings duodenal contractile patterns have been classified, and the interdigestive and postprandial states characterized. For reflux evaluation the impedance technique was especially useful for the detection of nonacid gastroesophageal reflux, which is not detectable by pH monitoring. In summary, the main impact of the impedance technique is its capability to characterize esophageal and intestinal chyme transport. Important data on luminal chyme transport have been obtained. This technique is developing into an interesting investigative tool to complement standard techniques for study of upper GI motility, in particular for basic research.
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Affiliation(s)
- H N Nguyen
- Department of Internal Medicine III (Gastroenterology, Hepatology and Endocrinology), University Hospital, University of Technology RWTH-Aachen, Germany
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