Protective effects of novel diazepinone derivatives in snake venom induced sterile inflammation in experimental animals

Snake envenomation leads to the formation of damage-associated molecular patterns (DAMPs), which are mediated by endogenous intracellular molecules. These are recognized by pattern-recognition receptors (PRRs) and can induce sterile inflammation.

AIMS

In the present study, we aim at understanding the mechanisms involved in DAMPs induced sterile inflammation to unravel the novel therapeutic strategies for treating snake bites. The potential of benzodiazepinone derivatives to act against snake venom induced inflammation has been explored in the present investigation.

MAIN METHODS

Three compounds VA 17, VA 43 and PA 03 were taken from our library of synthetic compounds. Oxidative stress markers such as lipid peroxidation, superoxide and nitric oxide were measured along with the analysis of DAMPs (IL6, HMGB1, vWF, S100b and HSP70). These compounds have been docked using molecular docking against the snake venom PLA₂ structure (PDB code: 1OXL).

KEY FINDINGS

The compounds have been found to effectively neutralize viper and cobra venoms induced lethal activity both ex vivo and in vivo. The compounds have also neutralized the viper venom induced hemorrhagic, coagulant, anticoagulant reactions as well as inflammation. The fold of protection have always been found to be higher in case of ex vivo than in in vivo. These compounds have neutralized the venom induced DAMPs as exhibited by IL6, HMGB1, vWF, S100b and HSP70. The fold of neutralization is found to be higher in VA 43.

SIGNIFICANCE

The identified compounds could be used as potential candidates for developing treatment of snakebites in areas where antiserums are not yet available.

Key role of Extracellular RNA in hypoxic stress induced myocardial injury

Myocardial infarction (MI), atherosclerosis and other inflammatory and ischemic cardiovascular diseases (CVDs) have a very high mortality rate and limited therapeutic options. Although the diagnosis is based on markers such as cardiac Troponin-T (cTrop-T), the mechanism of cTrop-T upregulation and release is relatively obscure. In the present study, we have investigated the mechanism of cTrop-T release during acute hypoxia (AH) in a mice model by ELISA & immunohistochemistry. Our study showed that AH exposure significantly induces the expression and release of sterile inflammatory as well as MI markers in a time-dependent manner. We further demonstrated that activation of TLR3 (mediated by eRNA) by AH exposure in mice induced cTrop-T release and Poly I:C (TLR3 agonist) also induced cTrop-T release, but the pre-treatment of TLR3 immuno-neutralizing antibody or silencing of Tlr3 gene or RNaseA treatment two hrs before AH exposure, significantly abrogated AH-induced Caspase 3 activity as well as cTrop-T release. Our immunohistochemistry and Masson Trichrome (MT) staining studies further established the progression of myocardial injury by collagen accumulation, endothelial cell and leukocyte activation and adhesion in myocardial tissue which was abrogated significantly by pre-treatment of RNaseA 2 hrs before AH exposure. These data indicate that AH induced cTrop-T release is mediated via the eRNA-TLR3-Caspase 3 pathway.

Naringenin mitigates behavioral alterations and provides neuroprotection against 3-nitropropinoic acid-induced Huntington's disease like symptoms in rats

BACKGROUND

Naringenin is a powerful antioxidant and anti-inflammatory flavonoid which has been widely used as a therapeutic agent in various toxic models. However, few studies have clearly discussed the neuromodulatory effects of naringenin against different neurodegenerative disorders.

AIM

We investigated the neuroprotective efficacy of naringenin against 3-nitropropionic acid (3-NP)-induced neurobehavioral, biochemical and histopathological alterations in rats.

METHODS

Albino Wistar rats were randomly divided into three experimental groups. Group 1, the vehicle administered group, received saline. Group 2 received 3-NP (20 mg/kg body weight, i.p.) for 4 consecutive days. Group 3 received naringenin (50 mg/kg body weight, p.o.) twice daily for a period of 4 days, 30 min before and 6 h after the 3-NP administration. On the 5th day, neurobehavioral experiments were performed to access the behavioral outcomes and the striatum tissue was used for analysis of the monoamine oxidase (MAO) activity and serotonin (5-HT) levels. In addition, astrocytes activation was observed by glial fibrillary acidic protein (GFAP) immunostaining.

RESULTS

Our results showed that naringenin co-treatment provides neuroprotection against 3-NP-induced neurological disorders. Naringenin also increased the MAO activity and 5-HT levels in the striatum. Moreover, co-treatment with naringenin reduced the expression of GFAP protein in the striatal part and significantly attenuated the neuronal cell death. The findings of the present study suggest that naringenin provides neuroprotection and mitigates neurobehavioral alterations in experimental rats.

CONCLUSION

The results show that co-treatment with naringenin ameliorates 3-NP-induced HD-like symptoms in rats.

PGE2 -induced migration of human brain endothelial cell is mediated though protein kinase A in cooperation of EP receptors

PGE₂ plays a critical role in angiogenesis, ischemic, and neuro-inflammatory disorders of the brain, which breakdown the blood-brain barrier (BBB). However, the effects of PGE₂ on human brain endothelial cell (HBECs) migration, a key process in the angiogenic response and BBB stability, are not well defined. In this study, we investigated the mechanism of PGE₂ in HBECs migration in vitro. Here we showed that PGE₂ stimulated migration of HBECs in a dose-time and matrix-dependent manner, evaluated by the Boyden chamber assay, but other prostanoids failed to do so. PGE₂ receptor (EP2; butaprost), EP3 (sulprostone), and EP4 (PGE₁ -OH) receptor agonists stimulated HBECs migration, but the silencing of EP significantly attenuated this effect. EP1 agonist (11-trinor PGE₁ ) had no effect on HBECs migration on silencing of the EP1 receptor. We further showed that PGE₂ stimulated cAMP production and activated protein kinase A (PKA), whereas pretreatment with the adenyl cyclase inhibitor (dideoxyadenosine; 1 μM) or PKA inhibitors, H89 (0.5 μM)/PKAI (1 μM), completely abrogated PGE₂ -induced migration. Furthermore, silencing of the EP2/EP4 receptors significantly inhibited PGE₂ -induced cAMP and PKA activation, whereas EP3 receptor silencing failed to do so. These results suggest that PGE₂ regulates HBEC migration via cooperation of EP2, EP3, and EP4 receptors. Coupling of PGE₂ to these receptors resulted in increased production of cAMP, which regulates HBEC migration via PKA pathway. The elucidation of molecular events involved is critical for the development of targeted strategies to treat cerebrovascular diseases associated with dysregulated angiogenesis.

Sterile Inflammatory Role of High Mobility Group Box 1 Protein: Biological Functions and Involvement in Disease

High mobility group box 1 protein (HMGB1), a sterile inflammatory molecule and damage-associated molecular pattern (DAMP) released from various cells during stress has been implicated in inflammation. Several reports show that there is a direct relationship between inflammation and cardiovascular diseases (CVDs) such as thrombosis, hypertension, insulin resistance, preeclampsia, etc. Here, we intend to summarize the concept of the emerging link between HMGB1 and CVDs. Furthermore, we will discuss the possible therapeutic strategies that target HMGB1 for the treatment of different CVDs.

Pharmacokinetics of a losartan potassium released from a transdermal therapeutic system for the treatment of hypertension

Monolithic transdermal therapeutic systems (TTS) were developed for sustained antihypertensive effect of losartan potassium using the polymers Eudragit E 100 and polyvinyl pyrrolidone VA 64. The developed formulations (polymeric films) were evaluated for physical characteristics, ex vivo (histopathology) and in vivo (pharmacokinetic studies). Pharmacokinetic parameters, such as C(max), t(max), and AUC were estimated. The transdermal formulation in the present study was found to enhance the relative bioavailability of losartan potassium by 2.2 times with reference to an oral delivery. The increased bioavailability might be due to elimination of hepatic first pass metabolism. Thus, the transdermal formulation F3E with polymeric composition of Eudragit E 100 and polyvinyl pyrrolidone VA 64 (5:3) was found to provide prolonged steady state concentrations of losartan potassium with minimal fluctuations and improved bioavailability.

Prefabrication of vascularized bone flap induced by recombinant human bone morphogenetic protein 2 (rhBMP-2)

An experimental model for the prefabrication of a vascularized bone flap was developed in this study. To form vascularized bone in the desired configuration and to increase the survival rate of the grafted bone, a muscle vascularized pedicle (MVP) was transformed into vascularized bone by the inducer recombinant human bone morphogenetic protein 2 (rhBMP-2). The muscle flap (8 x 8 mm) raised on saphenous vessels in the rat thigh was sandwiched between same-size collagen (Terudermis) sheets in the presence or absence of impregnated 25 microg of rhBMP-2 for the experimental group and the control group, respectively. The flaps were harvested 1, 2 and 3 weeks postoperatively. Bone transformation was detected by gross examination, radiology, and histologic testing. No evidence of muscle tissue transformation was found in control flaps, whereas all of the experimental flaps produced new bone. Saphenous vessels were observed to supply the new bone upon harvesting, and the newly formed vascularized bone showed good configuration with shape of the Terudermis sheet. This study indicates that this model of effective bone reconstruction could be potentially applied in a therapeutic setting.

Snake venom neutralization by Indian medicinal plants (Vitex negundo and Emblica officinalis) root extracts

The methanolic root extracts of Vitex negundo Linn. and Emblica officinalis Gaertn. were explored for the first time for antisnake venom activity. The plant (V. negundo and E. officinalis) extracts significantly antagonized the Vipera russellii and Naja kaouthia venom induced lethal activity both in in vitro and in vivo studies. V. russellii venom-induced haemorrhage, coagulant, defibrinogenating and inflammatory activity was significantly neutralized by both plant extracts. No precipitating bands were observed between the plant extract and snake venom. The above observations confirmed that the plant extracts possess potent snake venom neutralizing capacity and need further investigation.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children

PURPOSE

To reduce the incidence of nephrectomy or hydronephrosis in children.

MATERIALS AND METHODS

From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients.

RESULTS

In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications.

CONCLUSIONS

Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.

Evaluation of ceramics composed of different hydroxyapatite to tricalcium phosphate ratios as carriers for rhBMP-2

We have investigated pellet-shaped implants prepared from biphasic calcium phosphate (BCP) ceramics with five different ratios of hydroxyapatite (HAP) to beta tricalcium phosphate (beta-TCP). The purpose of this study was to evaluate these BCP ceramics as carriers for rhBMP-2. BCP ceramics impregnated with the different doses of recombinant human bone morphogenetic protein 2 (rhBMP-2) (1, 5 and 10g) were used for the experimental purpose and the ceramics without rhBMP-2 were used as control. The pellets were placed into subcutaneous pockets on the dorsum of 4-week-old male Wistar rats. The animals were sacrificed 2 and 4 weeks after implantation. Bone induction was estimated by alkaline phosphatase (ALP) activity measured at 2 weeks after implantation. Pellets were also examined radiologically, histologically and histomorphometrically. The results showed that all experimental pellets exhibited new bone formation whereas the control pellets produced only fibrous connective tissue. Here, 100% HAP ceramic showed most amount of bone formation, whereas 25% HAP to 75% TCP ceramic produced the bone least in amount among different BCP ceramics at the end of 4 weeks. This study indicates that formation of new bone depends on the ceramic content with high HAP-TCP ratio and high dose of rhBMP-2.

Bone regeneration using recombinant human bone morphogenetic protein-2 (rhBMP-2) in alveolar defects of primate mandibles

The efficacy of bone morphogenetic protein (BMP) for bone reconstruction has been widely studied in numerous animal experiments, but insufficient information exists about its ability to regenerate bone in primates. The purpose of this study was to evaluate the effects of recombinant human BMP-2 (rhBMP-2) on bone formation in alveolar bone defects in the mandibles of young primates. Marginal bone defects were created in the mandibles of nine 5-year-old rhesus monkeys and rhBMP-2 permeated in a polylactic-co-glycolic acid-coated gelatin sponge (PGS) was implanted into the bone defects. The resected bone treated with rhBMP-2 regenerated completely at 12 weeks postoperatively, and remodelling and consolidation of new bone were seen histologically. This study provides evidence of considerable bone regeneration in alveolar defects after surgical implantation of rhBMP-2 in non-human primates. This technique may be an effective alternative to autogenous bone grafts for reconstructive surgery in clinical practice.

Prefabricated vascularized bone flap: a tissue transformation technique for bone reconstruction

In this study, an attempt was made to transform a muscle vascularized pedicle raised on host vessels into a vascularized bone flap, using recombinant human bone morphogenetic protein 2 (rhBMP-2). The purpose of this study was to produce new bone vascularized in nature to increase the survival rate of the subsequently grafted bone and to fabricate the newly formed bone into the desired shape. Silicone molds in the shape of a rat mandible were used to deliver rat bone matrix impregnated with or without rhBMP-2. A muscle pedicle the same size as the mold was raised on the saphenous vessels in the rat thigh and then sandwiched in the center of the silicone molds. The molds were sliced in half and each section was filled with rat bone matrix that was impregnated either with 25 microg of rhBMP-2 for the experimental group or with diluting material alone for the control group. The sandwiched flaps were then secured by tying them to the adjacent muscles and were harvested at 2 and 4 weeks after surgery. Three and six rats were used in the control and experimental groups at each time point, respectively. Bone formation was assessed in the ex vivo specimens by macroscopic, radiologic, and histologic evaluation. Macroscopically, the continuation of the vascular pedicle was clearly visible for both the control and experimental muscle flaps. However, no evidence of muscle-tissue transformation was observed in the control flaps, whereas all the flaps treated with rhBMP-2 produced new bone that replicated the shape of the mold exactly and had saphenous vessels supplying the newly formed bone. This study demonstrates that this experimental model has the potential to be therapeutically applied for effective bone reconstruction.

Bidder's organ extract induced anaphylaxis in experimental animals

Bidder's organ (BO, a vestigeal organ), present in toad Bufo melanostictus (Schenider), is a characteristic feature of all male bufo. Its possible anaphylactic properties are investigated on experimental animals. BO extract produced both in vivo and in vitro anaphylactic reaction in guineapig. Dyspnoea and bronchoconstriction was a major cause of anaphylactic death. Blood histamine level was significantly increased in the anaphylactic animals. BO extract significantly released histamine from chopped lung preparation, an action antagonised by disodium chromoglycate. BO extract degranulated peritoneal mast cell in vitro. Passive cutaneous anaphylactic reactions were enhanced by BO extract and were significantly inhibited by disodium chromoglycate. Anaphylotoxin (identity not known) present in bidder's organ is probably involved in toad defence.

Adjuvant effects and antiserum action potentiation by a (herbal) compound 2-hydroxy-4-methoxy benzoic acid isolated from the root extract of the Indian medicinal plant 'sarsaparilla' (Hemidesmus indicus R. Br.)

The adjuvant effect and antiserum potentiation of a compound 2-hydroxy-4-methoxy benzoic acid were explored in the present investigation. This compound, isolated and purified from the Indian medicinal plant Hemidesmus indicus R. Br, possessed antisnake venom activity. Rabbits immunized with Vipera russellii venom in the presence and absence of the compound along with Freund's complete adjuvant, produced a precipitating band in immunogel diffusion and immunogel electrophoresis. The venom neutralizing capacity of this antiserum showed positive adjuvant effects as evident by the higher neutralization capacity (lethal and hemorrhage) when compared with the antiserum raised with venom alone. The pure compound potentiated the lethal action neutralization of venom by commercial equine polyvalent snake venom antiserum in experimental models. These observations raised the possibility of the use of chemical antagonists (from herbs) against snake bite, which may provide a better protection in presence of antiserum, especially in the rural parts of India.

An experimental study on evaluation of chemical antagonists induced snake venom neutralization

The present investigation explored the snake venom neutralizing capacity of four chemical compounds (2-hydroxy-4-methoxy benzoic acid, anisic acid, salicylic acid and aspirin) in experimental animals. The venoms of common Indian snakes Viper russellii, Echis carinatus, Naja kaouthia and Ophiophagus hannah were taken to evaluate the lethal, haemorrhagic and defibrinogenation action neutralization. Lethal action of venom was maximum neutralized with 2-hydroxy-4-methoxy benzoic acid and anisic acid, both in in vitro and in vivo studies. Haemorrhagic activity of venom (Viper and Echis) was maximum neutralized with salicylic acid. Viper venom induced defibrination was maximally neutralized with 2-hydroxy-4-methoxy benzoic acid and anisic acid in vitro studies. The exact mechanisms of venom neutralization by the chemical compounds were not established, except for 2-hydroxy-4-methoxy benzoic acid, where the functional groups, methoxy and hydroxy were partly responsible for the neutralization of the lethal effect and haemorrhagic activity.

Viper venom-induced inflammation and inhibition of free radical formation by pure compound (2-hydroxy-4-methoxy benzoic acid) isolated and purified from anantamul (Hemidesmus indicus R. BR) root extract

The present investigation explored the possible venom neutralizing effect of a pure compound (2-hydroxy-4-methoxy benzoic acid) isolated and purified from the methanolic root extract of Hemidesmus indicus R.Rr. 2-OH-4-MeO benzoic acid possessed potent anti-inflammatory, antipyretic and antioxidant properties. The compound effectively neutralized inflammation induced by Vipera russelli venom in male albino mice and reduced cotton pellet-induced granuloma in rats. The compound produced a significant fall in body temperature in yeast-induced pyrexia in rats but did not change the normothermic body temperature. The compound effectively neutralized viper venom-induced changes in serum phosphatase and transaminase activity in male albino rats. It also neutralized free radical formation as estimated by TBAPS and superoxide dismutase activities. The antisnake venom activity of the pure compound is partly mediated through the above physiological process.

A lethal cardiotoxic protein isolated from Bidder's organ of common Indian toad, Bufo melanostictus Schneider

A lethal cardiotoxic (BO-CT; Bidder's organ cardiotoxin) protein was purified from the Bidder's organ of the common Indian toad B. melanostictus by gel filtration on Sephadex G-200. The homogeneity of cardiotoxin was tested by gel electrophoresis. The molecular weight of lethal BO-CT was 62 KDa and was devoid of glycoprotein. LD50 of the BO-CT was 50 micrograms/20 g (i.v.) in male albino mice. On isolated heart and auricle BO-CT initially increased the rate and amplitude of contraction and finally produced irreversible blockade of contraction. BO-CT induced auricular blockade, was not influenced by verapamil, propranolol and atropine. On isolated chick biventer cervicis preparation BO-CT produced irreversible blockade of electrically induced twitch response followed by contracture. This action was not antagonized by 4-aminopyridine and neostigmine. BO-CT induced contracture on chick biventer cervicis was increased by Ca2+, decreased by Na+ and abolished by K+. Cardiotoxic and neuromuscular activity of BO-CT was heat stable and abolished by proteolytic enzyme.

A lethal protein toxin (toxin-PC) from the Indian catfish (Plotosus canius, Hamilton) venom

Isolation and purification of a lethal protein toxin from the Indian catfish Plotosus canius, Hamilton, venom is described. The purification procedure involved ammonium sulfate precipitate of crude venom followed by DEAE-ion exchange chromatography. The purified toxin (toxin-PC) was homogeneous on one-dimensional PAGE and PAS-negative, and had a molecular weight 15 Kd. Toxin-PC was lethal (LD50 225 micrograms/kg, intravenous, in mice) and cardiotoxic, having neuromuscular blocking activity. Toxin-PC produced cardiac arrest on isolated toad and guinea pig hearts. Prior administration of atropine and propanolol failed to counteract toxin activity on isolated heart preparations. On isolated chick biventer cervicis, toxin-PC produced total blockage of electrically-induced twitch response without affecting carbachol- and acetylcholine-induced contraction. The tension developed by the muscle was Ca++ ion-dependent. Neuromuscular blocking time was reduced when K+ ion concentration was increased in the medium. Antiserum raised against toxin-PC failed to antagonize lethal activity of toxin-PC in mice. Toxin-PC probably represents a major toxic component of catfish venom (P. canius), and was responsible for the pathophysiological changes.

Isolation, purification and partial characterization of viper venom inhibiting factor from the root extract of the Indian medicinal plant sarsaparilla (Hemidesmus indicus R. Br.)

An organic acid, isolated and purified from the root extract of an Indian medicinal plant sarsaparilla Hemidesmus indicus R. Br, possessed viper venom inhibitory activity. The compound (designated HI-RVIF) was isolated by solvent extraction, silica gel column chromatography and thin layer chromatography, and was homogeneous in nature. The white needle-shaped crystals were soluble in water, methanol and chloroform and had a melting point of 155-158 degrees C and lambda max 260 nm. Spectral analysis confirmed the presence of a benzene ring, methoxy group, and hydroxyl group; the mol. wt of the compound was 168. HI-RVIF significantly antagonized viper venom-induced lethal, haemorrhagic, coagulant and anticoagulant activity in experimental rodents.

Isolation, purification and partial characterization of a haemolytic protein from Bidder's organ of toad Bufo melanostictus (Schneider)

A haemolytic protein toxin (BO-HT) from Bidder's organ of toad, B. melanostictus, purified by DEAE-cellulose column chromatography was electrophoretically homogeneous and was glycoprotein in nature (PAS-positive). The molecular weight was estimated to be 14.4 kDa by SDS-polyacrylamide gel electrophoresis. The sensitivity of the haemolysin of different RBC ghost cell preparation was in the order: buffalo > goat > ox > guinea pig > mice > human > chick > rabbit > rat. The haemolytic activity was increased with the decrease in RBC concentration and was produced over a wide range of temperature. Maximum haemolytic effect was produced at 2 hr of incubation. The toxin showed maximum activity at 3 and minimum at 10 pH. Divalent cations (Ca2+, Zn2+, Cu2+, Mg2+) showed inhibitory effect on BO-HT induced haemolysis, whereas sucrose, EDTA, cholesterol, 2-mercaptoethanol and oxygen did not alter the haemolytic activity. Haemolytic activity was reduced by proteolytic enzymes (trypsin, protease) and was totally antagonized by the toad serum.

Pharmacological actions of the venom of the Indian catfish (Plotosus canius Hamilton)

The venom of the common Indian catfish P. canius Hamilton (locally called 'Kanmagur') was examined for its pharmacodynamic activity. The LD50 of the venom in mice was found to be 3.9 mg/kg (ip). At lower doses, the venom produced a positive inotropic effect on toad and rabbit hearts, while at higher doses it produced cardiac arrest. In the isolated guinea pig auricle, the venom increased the rate and amplitude of contraction. The venom increased rat blood pressure--an action antagonised by alpha-adrenergic blocker (phenoxybenzamine). It reduced the rate and amplitude of rat and guinea pig respiration leading to respiratory arrest and death. The venom did not alter the cutaneous capillary permeability of guinea pig but produced vasoconstrictor effect on rat hindquarter perfusion. It induced contractions in several smooth muscle preparations viz., ileum and colon of guinea pig, fundus, uterus and ileum of rat. On isolated guinea pig ileum, the venom produced contraction which was not antagonised by atropine and mepyramine, but was partially antagonised by methysergide associated with a residual contraction which was abolished by SC 19220, a prostaglandin receptor blocker. The venom produced irreversible blockade of electrically induced twitch response on isolated rat phrenic nerve diaphragm and chick biventer cervicis preparation. Haemolysis was not produced by the venom on mice, guinea pig and human RBC (washed).

Effects of methotrexate and total body irradiation on mouse lungs

Separate and combined effects of methotrexate and total body irradiation were studied on normal lungs of mouse. Forty female albino mice weighing 25 to 30 gms were divided into five groups including that of controls. On gross inspection, 70% of lungs of combined therapy group showed signs of congestion, 10% edematous changes and 20% blackish mottling. Microscopic examination revealed marked histopathological changes in the lungs of combined therapy group and milder changes in the methotrexate (Group III) and total body irradiation (Group IV) groups. These findings confirm the enhanced effects of combination of radiations and methotrexate.