Antifungal activity of terpenes isolated from the Brazilian Caatinga: a review

Terpenoids, also named terpenes or isoprenoids, are a family of natural products found in all living organisms. Many plants produce terpenoids as secondary metabolites, and these make up a large part of essential oils. One of most important characteristic is that the compounds are volatile, have odor and can be used in a variety of applications in different industrial segments and traditional medicine. Brazil has a rich and diverse flora that can be used as a source of research for obtaining new molecules. Within the Brazilian flora, it is worth mentioning the Caatinga as an exclusively Brazilian biome where plants adapt to a specific series of weather conditions and therefore become a great storehouse of the terpenoid compounds to be described herein. Fungal infections have become increasingly common, and a great demand for new agents with low toxicity and side effects has thus emerged. Scientists must search for new molecules exhibiting antifungal activity to develop new drugs. This review aims to analyze scientific data from the principal published studies describing the use of terpenes and their biological applications as antifungals.

Boosting antitumor response with PSMA-targeted immunomodulatory VLPs, harboring costimulatory TNFSF ligands and GM-CSF cytokine

Therapeutic strategies based on immunomodulation have improved cancer therapy. Most approaches target co-stimulatory pathways or the inhibition of immunosuppressive mechanisms, to enhance immune response and overcome the immune tolerance of tumors. Here, we propose a novel platform to deliver targeted immunomodulatory signaling, enhancing antitumor response. The platform is based on virus-like particles derived from lentiviral capsids. These particles may be engineered to harbor multifunctional ligands on the surface that drive tropism to the tumor site and deliver immunomodulatory signaling, boosting the antitumor response. We generated virus-like particles harboring a PSMA-ligand, TNFSF co-stimulatory ligands 4-1BBL or OX40L, and a membrane-anchored GM-CSF cytokine. The virus-like particles are driven to PSMA-expressing tumors and deliver immunomodulatory signaling from the TNFSF surface ligands and the anchored GM-CSF, inducing T cell proliferation, inhibition of regulatory T cells, and potentiating elimination of tumor cells. The PSMA-targeted particles harboring immunomodulators enhanced antitumor activity in immunocompetent challenged mice and may be explored as a potential tool for cancer immunotherapy.

Alkaloid and acetogenin-rich fraction from Annona crassiflora fruit peel inhibits proliferation and migration of human liver cancer HepG2 cells

Plant species from Annonaceae are commonly used in traditional medicine to treat various cancer types. This study aimed to investigate the antiproliferative potential of an alkaloid and acetogenin-rich fraction from the fruit peel of Annona crassiflora in HepG2 cells. A liquid-liquid fractionation was carried out on the ethanol extract of A. crassiflora fruit peel in order to obtain an alkaloid and acetogenin-rich fraction (AF-Ac). Cytotoxicity, proliferation and migration were evaluated in the HepG2 cells, as well as the proliferating cell nuclear antigen (PCNA), vinculin and epidermal growth factor receptor (EGFR) expression. In addition, intracellular Ca2+ was determined using Fluo4-AM and fluorescence microscopy. First, 9 aporphine alkaloids and 4 acetogenins that had not yet been identified in the fruit peel of A. crassiflora were found in AF-Ac. The treatment with 50 μg/mL AF-Ac reduced HepG2 cell viability, proliferation and migration (p < 0.001), which is in accordance with the reduced expression of PCNA and EGFR levels (p < 0.05). Furthermore, AF-Ac increased intracellular Ca2+ in the HepG2 cells, mobilizing intracellular calcium stores, which might be involved in the anti-migration and anti-proliferation capacities of AF-Ac. Our results support the growth-inhibitory potential of AF-Ac on HepG2 cells and suggest that this effect is triggered, at least in part, by PCNA and EGFR modulation and mobilization of intracellular Ca2+. This study showed biological activities not yet described for A. crassiflora fruit peel, which provide new possibilities for further in vivo studies to assess the antitumoral potential of A. crassiflora, especially its fruit peel.

Decreased nuclear distribution nudE-like 1 enzyme activity in an animal model with dysfunctional disrupted-in-schizophrenia 1 signaling featuring aberrant neurodevelopment and amphetamine-supersensitivity

BACKGROUND

Interaction of nuclear-distribution element-like 1 with disrupted-in-schizophrenia 1 protein is crucial for neurite outgrowth/neuronal migration, and this interaction competitively inhibits nuclear-distribution element-like 1 peptidase activity. Nuclear-distribution element-like 1 activity is reduced in antipsychotic-naïve first-episode psychosis and in medicated chronic schizophrenia, with even lower activity in treatment-resistant schizophrenia.

AIMS

The purpose of this study was to investigate in a rat model overexpressing human non-mutant disrupted-in-schizophrenia 1, with consequent dysfunctional disrupted-in-schizophrenia 1 signaling, the relation of nuclear-distribution element-like 1 activity with neurodevelopment and dopamine-related phenotypes.

METHODS

We measured cell distribution in striatum and cortex by histology and microtomography, and quantified the basal and amphetamine-stimulated locomotion and nuclear-distribution element-like 1 activity (in blood and brain) of transgenic disrupted-in-schizophrenia 1 rat vs wild-type littermate controls.

RESULTS

3D assessment of neuronal cell body number and spatial organization of mercury-impregnated neurons showed defective neuronal positioning, characteristic of impaired cell migration, in striatum/nucleus accumbens, and prefrontal cortex of transgenic disrupted-in-schizophrenia 1 compared to wild-type brains. Basal nuclear-distribution element-like 1 activity was lower in the blood and also in several brain regions of transgenic disrupted-in-schizophrenia 1 compared to wild-type. Locomotion and nuclear-distribution element-like 1 activity were both significantly increased by amphetamine in transgenic disrupted-in-schizophrenia 1, but not in wild-type.

CONCLUSIONS

Our findings in the transgenic disrupted-in-schizophrenia 1 rat allow us to state that decreased nuclear-distribution element-like 1 activity reflects both a trait (neurodevelopmental phenotype) and a state (amphetamine-induced dopamine release). We thus define here a role for decreased nuclear-distribution element-like 1 peptidase activity both for the developing brain (the neurodevelopmental phenotype) and for the adult (interaction with dopaminergic responses), and present nuclear-distribution element-like 1 activity in a novel way, as unifying neurodevelopmental with dysfunctional dopamine response phenotypes.

P4519Sleep Apnea screening in Heart Failure: an exploratory analysis

Background

Sleep Apnea (SA) is increasingly recognized in patients (pts) with Heart Failure (HF). Nocturnal polysomnography (PSG) is the gold-standard to diagnose SA. Currently, portable devices have been thoroughly validated in HF cohorts.

Purpose

To determine the correlation between clinical, laboratory and respiratory measurements with the presence of SA (defined as apnea-hypopnea index (AHI) >15/h) and desaturation time with SpO2 <90% (T90) ≥22 minutes, a strong mortality predictor in HF with reduced ejection fraction (HFrEF); and to compare the features of pts with HFrEF vs HF with preserved ejection fraction (HFpEF).

Methods

Our work is based on a single-center retrospective cohort of pts hospitalized for decompensated HF during 2013–2018. All pts were screened for SA with ApneaLinkTM after compensation the night preceding discharge. HF was defined as recommended by the European Society of Cardiology guidelines. A left ventricular ejection fraction ≤45% and >45% was used to define HFrEF and HFpEF, respectively, as per SERVE-HF trial.

Results

A total of 228 pts were included in the analysis (mean age 75.3±10.5 years, 48.9% male). SA was present in 135 (59.2%) pts and 41.2% had HFrEF. Mean AHI was 24.5±19.2/h, mean O2 desaturation index (ODI) was 24.4±21.0/h and mean T90 was 169.6±151.2 minutes. In multivariate models, ODI, gender and ischemic HF were predictors of AHI >15/h (R2 65.8%), with ODI being the strongest predictor (standardized coefficient 64.8%). Similarly, mean SpO2 was the only predictor of T90 ≥22minutes (R2 65.8%) (Figure 1). HFrEF pts had more often AHI>15/h (73.4% vs 48.5%, p<0.001), more total apneas (62±148 vs 16±79, p<0.001), obstructive apneas (28±76 vs 8±43, p<0.001) and central apneas (6±20 vs 0±5, p<0.001) than those with HFpEF. In multivariate models, ODI (OR 1.14, CI 1.03–1.26, p=0.013 for HFrEF; OR 1.21, CI 1.11–1.33, p<0.0001 for HFpEF) and mean SpO2 (OR 0.29, CI 0.14–0.60, p=0.001 for HFrEF; OR 0.23, CI 0.10–0.52, p<0.0001 for HFpEF) were the only predictors of AHI >15/h and T90 ≥22 minutes in both groups, respectively.

Conclusions

SA was highly prevalent in HFrEF and HFpEF. ODI and mean SpO2 were highly predictive of AHI >15/h and T90 ≥22minutes, respectively, both prognostic markers validated in a population with HFrEF, and equally so in HFrEF and HFpEF. These findings hypothesize a similar pathophysiology of SA in HF, regardless of left ventricular systolic function. Also, whether simple pulse oximetry can be routinely used for SA screening, since PSG and portable devices are often not widely available, is a finding worth being prospectively assessed.

Acknowledgement/Funding

None

P5008Empagliflozin in a real-world chronic heart failure population

Introduction

Heart Failure (HF) is a burdensome syndrome with significant mortality, morbidity and costs. Its prognosis is further aggravated by diabetes mellitus (DM). The EMPA-REG OUTCOME trial suggested that empagliflozin significantly reduced HF hospitalizations compared to placebo in patients with DM.

Purpose

We aimed to investigate which patients with chronic HF and DM in the outpatient setting could have been enrolled in the main empagliflozin trial.

Methods

This analysis is based on a retrospective cohort enrolling chronic HF patients who consecutively attended the HF appointment between January and July 2018. Of these, those with concomitant DM were selected and further analysed. The key EMPA-REG OUTCOME trial inclusion criteria [(i.e., hemoglobin A1c 7–10%, high cardiovascular (CV) risk and glomerular filtration rate [GFR] ≥30mL/min/1,73m2) were considered. Further, the European Medicine Agency (EMA) restriction (GFR>60mL/min/1,73m2) was also considered in an additional analysis.

Results

Of 316 patients with HF, 114 (36%) concomitantly had DM. Mean age was 74±10 years, 63% were male and most (54%) had preserved left ventricular ejection fraction. Ischemic (51%) and hypertensive (27%) HF were the most often observed etiologies. According to the inclusion criteria, 21 (18.4%) (or 5.3% when further considering the EMA restriction) HF patients could have been potentially enrolled in the main trial and derive a HF hospitalization reduction benefit from starting empagliflozin. The remainder would be excluded due to GFR<30mL/min/1.73m2 (2.6%), absence of “high CV risk” as per trial's definition (7%), HbA1c off target (18,4%) or a combination of the above criteria (53.6%). In light of the new Standards of Medical Care in Diabetes 2019, controlled patients with HbA1c off target (i.e., <7% or >10%) could be switched to a SGLT2 inhibitors, hence possibly expanding the indication to start empagliflozin to 36.8% of our HF cohort.

Figure 1

Conclusions

Roughly 1 in every 5 patients with HF and DM could have been enrolled in the main empagliflozin trial, as per key inclusion criteria, and potentially derive CV benefit from it. Thus, only a minority of our cohort shared the features for EMPA-REG OUTCOME trial inclusion, limiting the extrapolation of the trial's observed CV benefits to our HF cohort. Indeed, whether these benefits also expand to overall HF cohort is eagerly awaited by ongoing trials.

Acknowledgement/Funding

None

Expression of the type 3 InsP3 receptor is a final common event in the development of hepatocellular carcinoma

BACKGROUND & OBJECTIVES

Hepatocellular carcinoma (HCC) is the second leading cause of cancer death worldwide. Several types of chronic liver disease predispose to HCC, and several different signalling pathways have been implicated in its pathogenesis, but no common molecular event has been identified. Ca²⁺ signalling regulates the proliferation of both normal hepatocytes and liver cancer cells, so we investigated the role of intracellular Ca²⁺ release channels in HCC.

DESIGN

Expression analyses of the type 3 isoform of the inositol 1, 4, 5-trisphosphate receptor (ITPR3) in human liver samples, liver cancer cells and mouse liver were combined with an evaluation of DNA methylation profiles of ITPR3 promoter in HCC and characterisation of the effects of ITPR3 expression on cellular proliferation and apoptosis. The effects of de novo ITPR3 expression on hepatocyte calcium signalling and liver growth were evaluated in mice.

RESULTS

ITPR3 was absent or expressed in low amounts in hepatocytes from normal liver, but was expressed in HCC specimens from three independent patient cohorts, regardless of the underlying cause of chronic liver disease, and its increased expression level was associated with poorer survival. The ITPR3 gene was heavily methylated in control liver specimens but was demethylated at multiple sites in specimens of patient with HCC. Administration of a demethylating agent in a mouse model resulted in ITPR3 expression in discrete areas of the liver, and Ca²⁺ signalling was enhanced in these regions. In addition, cell proliferation and liver regeneration were enhanced in the mouse model, and deletion of ITPR3 from human HCC cells enhanced apoptosis.

CONCLUSIONS

These results provide evidence that de novo expression of ITPR3 typically occurs in HCC and may play a role in its pathogenesis.

Biocompatible Fluorescent Core-Shell Nanoconjugates Based on Chitosan/Bi2S3 Quantum Dots

Bismuth sulfide (Bi2S3) is a narrow-bandgap semiconductor that is an interesting candidate for fluorescent biomarkers, thermoelectrics, photocatalysts, and photovoltaics. This study reports the synthesis and characterization of novel Bi2S3 quantum dots (QDs) functionalized using chitosan (CHI) as the capping ligands via aqueous "green" route at room temperature and ambient pressure. Transmission electron microscopy (TEM), UV-visible (UV-vis) spectroscopy, photoluminescence (PL) spectroscopy, dynamic light scattering (DLS), and zeta potential (ZP) analysis were used to characterize the hybrids made of biopolymer-functionalized Bi2S3 semiconductor nanocrystals. The results demonstrated that the CHI ligand was effective at nucleating and controlling the growth of water-soluble colloidal Bi2S3 nanoparticles. The average sizes of the Bi2S3 nanoparticles were significantly affected by the molar ratio of the precursors but less dependent on the pH of the aqueous media, leading to the formation of nanocrystals with average diameters varying from 4.2 to 6.7 nm. These surface-modified Bi2S3 nanocrystals with CHI exhibited photoluminescence in the visible spectral region. Moreover, the results of in vitro MTT (3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide) assay with human osteosarcoma cells (SAOS) cell line demonstrated no cytotoxic response of the nanoconjugates.Furthermore, the results indicated that the Bi2S3 QD-CHI nanoconjugates showed HEK293T cell uptake; therefore, they can be potentially used as novel fluorescent nanoprobes for the in vitro bioimaging of cells in biomedical applications. Graphical Abstract Schematic representation of the biocompatible core-shell nanostructure of the chitosan/Bi2S3 quantum dot conjugates with photoluminescent properties.

Retinoic acid-loaded polymeric nanoparticles enhance vascular regulation of neural stem cell survival and differentiation after ischaemia

Stroke is one of the leading causes of death and disability worldwide. However, current therapies only reach a small percentage of patients and may cause serious side effects. We propose the therapeutic use of retinoic acid-loaded nanoparticles (RA-NP) to safely and efficiently repair the ischaemic brain by creating a favourable pro-angiogenic environment that enhances neurogenesis and neuronal restitution. Our data showed that RA-NP enhanced endothelial cell proliferation and tubule network formation and protected against ischaemia-induced death. To evaluate the effect of RA-NP on vascular regulation of neural stem cell (NSC) survival and differentiation, endothelial cell-conditioned media (EC-CM) were collected. EC-CM from healthy RA-NP-treated cells reduced NSC death and promoted proliferation while EC-CM from ischaemic RA-NP-treated cells decreased cell death, increased proliferation and neuronal differentiation. In parallel, human endothelial progenitor cells (hEPC), which are part of the endogenous repair response to vascular injury, were collected from ischaemic stroke patients. hEPC treated with RA-NP had significantly higher proliferation, which further highlights the therapeutic potential of this formulation. To conclude, RA-NP protected endothelial cells from ischaemic death and stimulated the release of pro-survival, proliferation-stimulating factors and differentiation cues for NSC. RA-NP were shown to be up to 83-fold more efficient than free RA and to enhance hEPC proliferation. These data serve as a stepping stone to use RA-NP as vasculotrophic and neurogenic agents for vascular disorders and neurodegenerative diseases with compromised vasculature.

Comparison of two different severity scores (Paediatric Risk of Mortality [PRISM] and the Glasgow Meningococcal Sepsis Prognostic Score [GMSPS]) in meningococcal disease: preliminary analysis

Two different illness severity scores, Pediatric Risk of Mortality (PRISM) and the Glasgow Meningococcal Sepsis Prognostic Score (GMSPS), were evaluated and compared in meningococcal disease in two paediatric intensive care units. Forty-nine children with a median age of 36 months who had meningococcal sepsis confirmed by laboratory data were evaluated. Overall mortality was 18%. The median GMSPS was 3 in survivors and 8 in non-survivors. A GMSPS > or = 8 was significantly associated with death (p = 0.0001) with a mortality predictivity and specificity of 70% and 92.5%, respectively. The median PRISM score in survivors was 5.5 and 23 in non-survivors. A PRISM score of > or = 11 was significantly related to death (p < 0.0001). The Kendal correlation co-efficient between GMSPS and PRISM showed tau = 0.6859 (p = 0.0000). It is concluded that GMSPS and PRISM are useful methods for identifying and classifying children into low and high risk categories. GMSPS > or = 8 or a PRISM score > or = 11 are significantly predictive of mortality.

Vascular endothelial growth factor and hypertrophic osteoarthropathy

OBJECTIVE

Hypertrophic osteoarthropathy (HOA) is characterized by the coexistence of digital clubbing and periosteal proliferation of the tubular bones. Localized vascular proliferation associated with platelet/endothelial cell activation are recognized features of this syndrome. Current knowledge suggests that HOA develops from the presence in the systemic circulation of one or more growth factors that are normally inactivated in the lungs. The nature of these purported growth factors has not yet been identified. Vascular endothelial growth factor (VEGF) has several features that may fit in with the pathogenesis of HOA. The objective of our study was to measure serum and plasma levels of VEGF in different groups of patients with HOA.

METHODS

We studied 24 patients with HOA; of these, in 12 the HOA was secondary to cyanotic congenital heart disease and in 7 to lung cancer, while 5 represented primary cases. As controls we studied 28 individuals without HOA; of these, 12 were apparently healthy individuals, 7 had cyanosis secondary to chronic obstructive pulmonary disease, and 9 had lung cancer. ELISA was used to measure serum and plasma levels of VEGF.

RESULTS

Plasma levels of VEGF were significantly higher in the patients with primary HOA (median 46.2; range 19.4-398.8 pg/ml) and in those with lung cancer-HOA (median 75.5; range 24.6-166.7), compared to healthy controls (median 7.4; range: 0-26.1), p < 0.05. Serum VEGF levels were higher in patients with lung cancer and HOA (median 411.4; range 164.2-959.5 pg/ml) compared with lung cancer patients without HOA (median 74.5; range 13.2-205.4), p < 0.001.

CONCLUSIONS

Patients with primary HOA and those with HOA and lung cancer have increased circulating levels of VEGF. This cytokine may play a role in the pathogenesis of HOA.

Rheumatoid arthritis associated with ankylosing spondylitis defined by scintigraphic and CT abnormalities

Rheumatoid arthritis and ankylosing spondylitis were detected in the same patient after a long period of observation of the disease. X-ray studies demonstrated the characteristic rheumatoid arthritis changes in peripheral joints. By contrast, few X-ray changes of ankylosing spondylitis were detected, during follow-up. Diagnostic approach through scintigraphic studies disclosed a symmetric uptake of the radionuclide in sacroiliac joints, and computed tomography revealed bilateral ankylosis. The combination of these tests was useful to define the presence of axial disease. This patient was both HLA B27 and DR4 positive. Rheumatoid arthritis occurred before ankylosing spondylitis, that interestingly was defined as a late onset disease.

Risks of anticoagulant therapy in pregnant women with artificial heart valves

In an attempt to identify the best treatment for pregnant women with cardiac-valve prostheses who are receiving oral anticoagulants, we studied 72 pregnancies prospectively. In 23 pregnancies (Group I), the coumarin derivative acenocoumarol was discontinued and the patients received 5,000 U of subcutaneous heparin every 12 hours from the 6th to the 12th week of gestation, in 12 pregnancies (Group II), heparin was not substituted for the coumarin derivative until after the 7th week, and in 37 pregnancies, detected after the first trimester (Group III), the coumarin derivative was given throughout gestation. In most patients heparin was again substituted for the oral anticoagulant after the 38th week. Three mothers had thrombosis of a tilting-disk mitral prosthesis (two cases were fatal) during heparin treatment. No differences were found in the rates of spontaneous abortion in the three groups. Coumarin embryopathy occurred in 25 percent and 29.6 percent of the pregnancies in Groups II and III, respectively. We conclude that in the second and third trimesters of pregnancy, coumarin derivatives provide effective protection against thromboembolism while causing few fetopathic effects, but that these agents are contraindicated from the 6th to the 12th weeks of gestation. Low-dose heparin does not protect against prosthetic-valve thrombosis, and the possibility that a larger dose might be more effective requires further exploration.