Phytomedicines explored under in vitro and in silico studies against coronavirus: An opportunity to develop traditional medicines

The widespread COVID-19 pandemic, caused by novel coronavirus SARS-CoV-2, has emanated as one of the most life-threatening transmissible diseases. Currently, the repurposed drugs such as remdesivir, azithromycine, chloroquine, and hydroxychloroquine are being employed in the management of COVID-19 but their adverse effects are a matter of concern. In this regard, alternative treatment options i.e., traditional medicine, medicinal plants, and their phytochemicals, which exhibit significant therapeutic efficacy and show a low toxicity profile, are being explored. The current review aims at unraveling the promising medicinal plants, phytochemicals, and traditional medicines against SARS-CoV-2 to discover phytomedicines for the management of COVID-19 on the basis of their potent antiviral activities against coronaviruses, as demonstrated in various biochemical and computational chemical biology studies. The review consists of integrative and updated information on the potential traditional medicines against COVID-19 and will facilitate researchers to develop traditional medicines for the management of COVID-19.

Areas of minimal generator impedance drop during the index atrial fibrillation ablation correlate with pulmonary vein reconnection sites despite adopting the CLOSE protocol

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) management. However, AF recurrence is extremely common after a single procedure. The CLOSE protocol, which is the standardisation of radiofrequency catheter ablation by delivering a point-by-point lesion set defined by ablation index (AI), has demonstrated 80% freedom of AF. Yet PV reconnection is still up to 38% in these patients (1). A small decrease in generator impedance (GI), which is not part of the AI algorithm, has been associated with recovery of PV conduction.

Purpose

The study aimed to identify whether lesions having a poor impedance drop (PID) after wide area circumferential ablation (WACA) are associated with PV reconnection, despite adopting to the CLOSE protocol.

Methods

120 consecutive patients who had both the index (i-AFA) and redo AF ablations (r-AFA) due to AF recurrence at our centre from Jan 2018 to Jun 2021 were screened. 18 patients who had WACA around PVs using high power (40 to 50W) with a minimum AI of 400, whilst adhering the CLOSE protocol during the i-AFA, and who had evidence of PV reconnection during r-AFA, were included in the study. Ones who had left atrial (LA) substrate or cryoablation were excluded. GI was measured between the skin patch and ablation catheter. CARTO® system was used to create LA electroanatomical maps (EAMs) and register ablation lesions.

Each WACA around PVs was divided into eight anatomical segments (Figure). PID was defined as an impedance change of <8Ω, based on previous studies (2). These lesions were identified and categorised to the relevant anatomical segment in the i-AFA. Locations of the discrete ablation lesions that re-isolated PVs during the r-AFA, were used as a surrogate to denote areas of PV reconnection. These were also spatially matched to the relevant anatomical segment. Each EAM was reviewed by two electrophysiologists.

Results

30 out of the 36 WACAs (83%) and on average, at least 2 segments per WACA (2.6; 95% confidence interval (CI): 2.2-3.1) had reconnected. 54% of the reconnected segments had at least one lesion with PID. Having a lesion with PID in a PV segment in the i-AFA was significantly associated with evidence of PV reconnection in the same segment in the r-AFA (odds ratio: 2.1 [95% CI: 1.3-3.6; p<0.01]). Right posterior/inferior (56%) and left anterior/superior (50%) PV segments were the most common areas to reconnect and these areas were also associated with a higher incidence of PID lesions in the i-AFA (94% and 67%, respectively). Conversely, 80% of segments with all lesions having an impedance drop of ≥8Ω had no PV reconnection.

Conclusion

Lesions with PID in the i-AFA could impact PV reconnection, despite lesion contiguity and an adequate AI. Identifying and targeting these areas of PID, in addition to the CLOSE protocol, could potentially reduce AF recurrence. Prospective studies are needed to validate this hypothesis and its safety.

Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer

Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

126Dynamic high density functional substrate mapping improves outcomes in ventricular tachycardia ablation

Introduction

Activation and entrainment mapping of VT remains the gold standard for identifying critical sites for ablation of VT, however, this method is limited by poorly tolerated or non-sustained VT. Several substrate guided approaches have been developed, however, outcomes when comparing both methods are similar and overall success can be as low as 47%. A key element in facilitating VT is the presence of dynamic changes within the substrate which may not be evident during sinus rhythm substrate mapping, but may form a critical aspect of the tachycardia mechanism when conduction velocity slows dynamically and tissue refractory periods lengthen. These are rarely studied as part of clinical VT mapping. 

Purpose

This study aimed to investigate dynamic substrate changes to local abnormal ventricular activity (LAVA) and late potentials (LP), in relation to critical sites for VT ablation using high resolution mapping of the ventricle with the HD Grid (Abbott, Inc, USA), during short coupled singe extra stimuli from the right ventricle (RV) (Barts Sense Protocol), designed to invoke conduction delay. We hypothesized that the dynamic functional late potential mapping would improve the identification of critical substrate and ablation of these regions would improve outcomes. 

Methods

Thirty patients (age 67 +/- 9yrs, 27Male) underwent ablation. Mean ejection fraction was 25% (+/- 10%). Mapping was performed with the AdvisorTM HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and RV Sensed Protocol (SP) single extra pacing. SR and SP late potential (LP) and local abnormal ventricular activity (LAVA) maps were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites and LP/LAVA identified by the SP.

Results

At a median follow up of 10 months 90% of patients were free from symptomatic ATP or ICD shocks. The median area of late potentials across the 30 patients during sinus rhythm was 6.4mm2 during sinus rhythm mapping and 19.3mm2 during sense protocol pacing (p = 0.001). The functional unmasking of LP and LAVA was seen in 26 patients and showed good correlation to critical regions of the VT circuit (sites of best entrainment or pace map). In 24 patients functionally unmasked late potentials were located within 10mm of critical regions within the mapped VT circuit, with a median distance of 8.5mm, compared to 7 patients during sinus rhythm mapping with a median distance of 22mm (p= <0.001). Figure 1 demonstrates and example of the SP, where increased functional LP are seen along the mapped VT isthmus. 

Conclusion

Functional LP and LAVA can be unmasked by the sense protocol enabling better delineation of critical regions for VT ablation which may not be visible during sinus rhythm. This unique delineation of functional substrate changes combined with activation or pacemapping may improve outcomes.

Abstract Figure 1

Cost effective cosmetic prosthesis for lost digits

Leprosy causes nerve damage which leads to repeated injuries or ulcers causing the loss or absorption of digits. The loss of digits is also common in traumatic injuries. Irrespective of the etiology, the loss of a finger has a considerable negative functional and psychological impact on an individual. In order to solve these problems, prostheses are provided to patients. This short report demonstrates the advantages of using liquid latex in making a low cost cosmetic prosthesis. The possibility of using latex material offers a practical alternative where silicone prosthesis is not affordable.

Apoptosis mediated anti-proliferative effect of compound isolated from Cassia auriculata leaves against human colon cancer cell line

A compound was isolated from Cassia auriculata leaves and characterized by high-performance liquid chromatography (HPLC), liquid chromatography mass spectrometry (LC-MS), UV-vis spectroscopy (UV-vis), Fourier transform infrared spectroscopy (FT-IR) and nuclear magnetic resonance spectroscopy (NMR). The in vitro anticancer effect of the compound isolated from C. auriculata was evaluated in human colon cancer cells HCT 15 by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cytotoxicity, nuclear morphology analysis and measurement of lactate dehydrogenase. The isolated compound 4-(2,5 dichlorobenzyl)-2,3,4,5,6,7 hexahydro7(4 methoxyphenyl)benzo[h][1,4,7] triazecin8(1H)-one showed 50% inhibition of HCT 15 cells when tested at 20μg/ml after 24h incubation. Cytotoxicity, nuclear morphology and lactate dehydrogenase assays clearly show potent anticancer activity of the isolated compound against colon cancer. Thus, the in vitro findings suggest that the compound isolated from C. auriculata leaves have potent anti-cancer properties with possible clinical applications.

Anti-proliferative effect of a compound isolated from Cassia auriculata against human colon cancer cell line HCT 15

The compound was isolated from leaves of Cassia auriculata and its structure was characterized using high-performance liquid chromatography (HPLC), liquid chromatography mass spectrometry (LC-MS), UV-vis spectroscopy (UV-vis), fourier transform infrared spectroscopy (FT-IR) and nuclear magnetic resonance spectroscopy (NMR). 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, cytotoxicity, nuclear morphology and lactate dehydrogenase assay of isolated compound was tested against human colon cancer cell line HCT 15. The isolated compound, 4-(4-chlorobenzyl)-2,3,4,5,6,7-hexahydro-7-(2-ethoxyphenyl)benzo[h][1,4,7]triazecin-8(1H)-one at 25μg/ml concentration and by 48h showed 50% inhibition of human colon cancer cells (HCT 15). The results suggest that isolated compound from C. auriculata has potential to prevent colon cancer cell line.

A review on management of warts in Ayurveda

Human papilloma virus (HPV) is one of the common causes for the warts and most people will experience with this infection at some point in their life. In Ayurveda, warts can be compared with Charmakeela. The diagnosis is based on clinical examination and usually straight forward by visual inspection. The treatment of warts has to be done with endurance and careful selection of procedure according to the type and site of the disease; otherwise, it may lead to cosmetic derangement or recurrence of the ailment. Indications for treatment include pain, interference with function, cosmetic embarrassment, and risk of malignancy. Regarding the management of this disease, different types of treatment procedures are explained in contemporary science. In Ayurveda also, various treatment principles explained like administration of drugs internally, external application of drugs and parasurgical procedures [i.e. Raktamokshana (blood letting), Ksharakarma (chemical cauterization) and Agnikarma (thermal cauterization)]. These indigenous treatment methods are minimal invasive procedures which do not cause the scar formation, no recurrence and found to be more beneficial in the treatment of warts.

In vitro trans-differentiation of human umbilical cord derived hematopoietic stem cells into hepatocyte like cells using combination of growth factors for cell based therapy

The aim of the study was to develop a new strategy for the differentiation of hematopoietic stem cell (HSC) derived from UCB into hepatocyte like cells and also to estimate the effects of combination of fibroblast growth factor 4 (FGF 4) and hepatocyte growth factor (HGF) on hematopoietic stem cell differentiation. HSCs were isolated and purified by magnetic activated cell sorting. HSCs were induced to hepatocyte like cells under a 2-step protocol with combination of growth factors. Reverse transcription polymerase chain reaction was performed to detect multiple genes related to hepatocyte like cells development and function. Hepatocyte like morphology was illustrated by inverted repeat microscope and the secretion of albumin and α- fetoprotein by these cells was confirmed by enzyme linked immunosorbent assay. Hepatocyte like cells was observed at the end of the protocol (days 14). These differentiated cells were observed to show high expression of genes related to hepatocytes (tryptophan 2, 3-dioxygenase [TO], glucose 6-phosphate [G6P], cytokeratin 18 [CK 18], albumin and α- fetoprotein [AFP]). The quantities of albumin and AFP at day 0 were low and upon differentiation the cells were able to produce albumin and AFP at high levels. Our results show a new strategy for differentiation in a short duration, using a combination of growth factors for the differentiation of umbilical cord blood derived HSC into hepatocyte like cells under certain in vitro conditions. After further studies this approach has the potency, for widespread cell replacement therapy for liver diseases.

A comparative study of single-dose pegfilgrastim versus daily filgrastim in patients with acute myeloid leukemia

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Background: Prophylactic treatment with recombinant human granulocyte colony stimulating factor (rhGCSF) is used to decrease the severity and duration of neutropenia in patients receiving myelosupressive chemotherapy. It can be used during induction and consolidation chemotherapy in acute myeloid leukemia (AML). Mechanism of action of pegylated GCSF is the same as filgrastim except for delayed clearance. Few studies addressed the use of pegylated filgrasim in AML. Methods: After 24 hours of consolidation chemotherapy, 8 patients in the study arm received single dose of subcutaneous 6 mg pegfilgrastim. The control group received daily filgrastim at a dose of 5 microgram per kg.until absolute neutroophil count of 2 ×109 cells/μL for 2 consecutive days. The neutrophil recovery time, febrile neutropenia and its duration, duration of hospitalization and safety profiles were compared. Results: There were 20 episodes of pegfilgrastim administration. The median age was 41 years in pegfilgrastim arm and 39 years in filgrastim arm. Medium time to neutrophil recovery was 14 days for pegfilgrastim arm and 17 days for filgrastim arm. In the pegfilgrastim arm 12 (60%) episodes of febrile neutropenia occurred compared to 11 (55%) in filgrastim arm. The median duration of febrile neutropenia was 3 days in pegfilgrastim arm versus 4 days in filgrastim arm. The median duration of hospitalization was 15 days in pegfilgrastim arm and 18 days in filgrastim arm. Safety profile and complete remission status did not differ between the two groups. Conclusions: The present study showed favorable profile of pegfilgrastim for netrophil recovery, duration of neutropenia and hospital stay. There was no difference with regard to safety or response to treatment.

No significant financial relationships to disclose.

A phase IIb 4-arm open-label randomized study to assess the safety and efficacy of h-R3 monoclonal antibody against EGFR in combination with chemoradiation therapy or radiation therapy in patients with advanced (stage III or IVA) inoperable head and neck cancer

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Background: Patients (pt) with advanced inoperable squamous cell carcinoma of the head and neck (SCCHN) have poor radiotherapy alone (RT) outcome. EGFR is over-expressed in >90% SCCHN. h-R3mAb (BIOMAb/nimotuzumab/TheraCIM) is a humanized monoclonal antibody, a validated oncotherapeutic-targeting EGFR. Objective: To investigate the safety and efficacy of concurrent h-R3mAb in combination with chemoradiotherapy of SCCHN. Methods: September 2004–2005, pt 18–70 yrs, SCCHN stageIII-IVA, 113 screened, 92 enrolled and randomly asssigned to, Group A: radical radiotherapy (pt) and Group B: chemoradiotherapy (pt). Randomization within Group A: [RT]v/s[RT+h-R3mAb] and within Group B: [RT+CT]v/s[RT+CT+ h-R3mAb] (n = 23 in each arm). Protocol: Radiotherapy: TD: 66 Gy,2Gy/Fr,5Fr/w,6.5wks. Radiation sensitizer (chemotherapy): CDDP-50mg/wk x 6wks. Study Drug (h-R3mAb): 200 mg/wk I.V.60min x 6weeks. Results: Evaluable (n = 76) in Group A-36 and Group B-40. F/u Analysis at 30 months after end of RT. Survival rate ITT: Group B: CT+RT+hR3- 69.5% v/s CT+RT-21.7% (p - 0.0011), Group A: RT alone - 21.7% v/s RT+ hR3–39.1% (ns). Progression-free survival: RT alone - 3(13.04 %) v/s RT+hR3mAb-8 (34.78 %), RT+CT-5 (21.74 %) v/s RT+CT+hR3mAb-13 (56.52%). Median overall survival (OS): CT+RT+hR3 - NR* v/s CT+RT- 21.96 months (hazard ratio [HR]-0.337, p - 0.0018) and RT alone - 25.02 v/s RT+hR3 - NR*(HR-0.678, p - 0.39). Disease-free survival: CT+RT+hR3- NR*v/sCT+RT-21.30 mths (HR-0.344, p - 0.0052) and RT alone-25.02 v/s RT+hR3- NA* (HR-0.599, p - 0.32). (NR*- median OS is yet to be reached). Safety: few grade - 1/2AE, no HAMA observed. OS per protocol - adding h-R3mAb to chemoradiation resulted in a reduction in risk of death (rrd) by 85% (HR 0.15, p - 0.0006) and to RT a 36 % rrd (HR0.64, p - 0.33). Conclusions: Concurrent use of h-R3mAb with RT or RT+CT is safe and efficacious. It enhances radiation and chemotherapy responses. Concurrent use of h-R3mAb with chemoradiotherapy enhances long-term loco-regional control and survival. Adding biological agents to physically targeted modality improves long-term therapeutic outcome of SCCHN.

No significant financial relationships to disclose.