Marine alkaloids as bioactive agents against protozoal neglected tropical diseases and malaria.

Covering: 2000 up to 2021Natural products are an important resource in drug discovery, directly or indirectly delivering numerous small molecules for potential development as human medicines. Among the many classes of natural products, alkaloids have a rich history of therapeutic applications. The extensive chemodiversity of alkaloids found in the marine environment has attracted considerable attention for such uses, while the scarcity of these natural materials has stimulated efforts towards their total synthesis. This review focuses on the biological activity of marine alkaloids (covering 2000 to up to 2021) towards Neglected Tropical Diseases (NTDs) caused by protozoan parasites, and malaria. Chemotherapy represents the only form of treatment for Chagas disease, human African trypanosomiasis, leishmaniasis and malaria, but there is currently a restricted arsenal of drugs, which often elicit severe adverse effects, show variable efficacy or resistance, or are costly. Natural product scaffolds have re-emerged as a focus of academic drug discovery programmes, offering a different resource to discover new chemical entities with new modes of action. In this review, the potential of a range of marine alkaloids is analyzed, accompanied by coverage of synthetic efforts that enable further studies of key antiprotozoal natural product scaffolds.

Antitrypanosomal activity of isololiolide isolated from the marine hydroid Macrorhynchia philippina (Cnidaria, Hydrozoa).

Marine invertebrates are a rich source of small antiparasitic compounds. Among them, Macrorhynchia philippina is a chemically underexplored marine cnidarian. In the search for candidates against the neglected protozoan Chagas disease, we performed a bio-guided fractionation to obtain active compounds. The structural characterization of the active compound was determined using NMR analysis and MS and resulted in the isololiolide, a compound described for the first time in this species. It showed in vitro activity against both trypomastigote and intracellular amastigotes of Trypanosoma cruzi, with IC50 values of 32 µM and 40 µM, respectively, with no mammalian cytotoxicity (>200 µM). The lethal action was investigated in T. cruzi using different fluorophores to study: (i) mitochondrial membrane potential; (ii) plasma membrane potential and (iii) plasma membrane permeability. Our results demonstrated that isololiolide caused disruption of the plasma membrane integrity and a strong depolarization of the mitochondrial membrane potential, rapidly leading the parasite to death. Despite being considered a possible covalent inhibitor, safety in silico studies of isololiolide also considered neither mutagenic nor genotoxic potential. Additionally, isololiolide showed no resemblance to interference compounds (PAINS), and it succeeded in most filters for drug-likeness. Isololiolide is a promising candidate for future optimization against Chagas disease.

Investigation of the Anti-Leishmania (Leishmania) infantum Activity of Some Natural Sesquiterpene Lactones.

Leishmaniases are neglected infectious diseases caused by parasites of the 'protozoan' genus Leishmania. Depending on the parasite species, different clinical forms are known as cutaneous, muco-cutaneous, and the visceral leishmaniasis (VL). VL is particularly fatal and the therapy presents limitations. In the search for new anti-leishmanial hit compounds, seven natural sesquiterpene lactones were evaluated against promastigotes and intracellular amastigotes of Leishmania (Leishmania) infantum, a pathogen causing VL. The pseudoguaianolides mexicanin I and helenalin acetate demonstrated the highest selectivity and potency against intracellular amastigotes. In addition, promastigotes treated with helenalin acetate were subject to an ultrastructural and biochemical investigation. The lethal action of the compound was investigated by fluorescence-activated cell sorting and related techniques to detect alterations in reactive oxygen species (ROS) content, plasma membrane permeability, and mitochondrial membrane potential. Helenalin acetate significantly reduced the mitochondrial membrane potential and the mitochondrial structural damage was also confirmed by transmission electron microscopy, displaying an intense organelle swelling. No alteration of plasma membrane permeability or ROS content could be detected. Additionally, helenalin acetate significantly increased the production of nitric oxide in peritoneal macrophages, probably potentiating the activity against the intracellular amastigotes. Helenalin acetate could hence be a useful anti-leishmanial scaffold for further optimization studies.

Analogues of Marine Guanidine Alkaloids Are in Vitro Effective against Trypanosoma cruzi and Selectively Eliminate Leishmania (L.) infantum Intracellular Amastigotes.

Synthetic analogues of marine sponge guanidine alkaloids showed in vitro antiparasitic activity against Leishmania (L.) infantum and Trypanosoma cruzi. Guanidines 10 and 11 presented the highest selectivity index when tested against Leishmania. The antiparasitic activity of 10 and 11 was investigated in host cells and in parasites. Both compounds induced depolarization of mitochondrial membrane potential, upregulation of reactive oxygen species levels, and increased plasma membrane permeability in Leishmania parasites. Immunomodulatory assays suggested an NO-independent effect of guanidines 10 and 11 on macrophages. The same compounds also promoted anti-inflammatory activity in L. (L.) infantum-infected macrophages cocultived with splenocytes, reducing the production of cytokines MCP-1 and IFN-γ. Guanidines 10 and 11 affect the bioenergetic metabolism of Leishmania, with selective elimination of parasites via a host-independent mechanism.

Blackwater fever like in murine malaria.

Blackwater fever (BWF) is the term used to designate the occurrence of hemoglobin pigments in the urine of patients infected with malaria parasites. BWF is more often associated with Plasmodium falciparum infection in man. The pathogenesis of BWF has not been explained satisfactorily. In the present study, the clinical and pathological observations made upon CD1 mice infected with Plasmodium yoelii yoelii lethal strain with clinical signs of hemoglobinuria and acute renal failure were evaluated. From the 40 P. yoelii yoelii-infected mice, 14 presented hemoglobinuria. In the observations, it was emphasized that hemoglobinuria occurred in the animals 1-2 days before they die. At 6 days post-infection, infected hemoglobinuric mice (HM) exhibited clinical signs such as dark red urine, apnea, and evident oliguria and hematuria; urine microscopical examination showed very few red blood cells. The entire non hemoglobinuric infected mice had a high parasitemia preceding the time of death, while the HM parasitemia was just detectable. In HM, marked hepatosplenomegaly, anemia, and renal and hepatic dysfunction were observed with the blood chemistry analysis at 6 days post-infection. Severe renal lesions were demonstrated in histopathological and scanning electron microscopy samples. Occlusion and necrosis of convoluted tubules were the main lesions found. The conditions required for the experimental production of hemoglobinuria in CD1 mouse infected by P. yoelii yoelii is still unknown. The clinical picture of a BWF, like in our rodents, was produced exclusively by the interaction between the parasite and its host. Results showed that hemoglobinuria in CD1 mice infected with P. yoelii yoelii and BWF in man infected with P. falciparum are similar in their pathogenesis.

Association between drug prescribing and quality of life in primary care.

OBJECTIVE: To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. SETTING: Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. METHOD: Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. MAIN OUTCOME MEASURE: Quality of life among patients of Family Health Strategy Units. RESULTS: At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (-2.01, 95% CI = -2.89 to -1.35) and overall (-1.93, 95% CI = -2.81 to -0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (-1.02, 95% CI = -1.29 to -0.56), psychological (-2.52, 95% CI = -3.15 to -1.65) and overall (-0.97, 95% CI = -2.06 to -0.33) domains of the interviewees' quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. CONCLUSIONS: The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic characteristic of the interviewed patients, like having the quality of life at such a low level before starting the treatment, that the medication could not improve it to normal levels. Also, it can be a demonstration of the ineffectiveness of these treatments within primary health care.

Acute, subacute and chronic effect of cyclosporin-A on mean arterial pressure of rats with severe spinal cord contusion.

Cyclosporin-A (CsA) protects and regenerates the neural tissue after spinal cord (SC) injury. These beneficial effects are achieved when CsA is administered at a dose of 2.5mg/kg/12h during the first 2 days after lesion. In view of these observations, it is realistic to envision that, CsA could be tested in SC-clinical trials. Since CsA is a drug strongly related to hypertension, results imperative to evaluate experimentally the effect of the above CsA-dose regimen on blood pressure. For this purpose, one hundred and twenty adult rats were subjected (10 groups) or not (10 groups) to SC-injury. Five injured and five Sham-operated groups received CsA. The remaining groups received only vehicle. Mean arterial pressure (MAP) was recorded from these animals at acute (6 and 24h post surgery; p.s.), subacute (96h), or chronic (30 days) stages of injury. In the latter, the therapy (CsA or vehicle) was administered only during the first 2 days p.s. or daily during 30 days of follow-up. The results of this study showed that SC-injury by itself induces a significant decrease of MAP during the acute and subacute phases of injury. CsA therapy was able to reestablish MAP parameters to control values in these phases. Regardless the therapy, a reestablishment of MAP was observed in chronic stages. Only the daily administration of CsA induced a significant increase in MAP, however; such variation remained into the normal ranges of MAP for rats. The potential benefits offered by CsA support its usefulness after SC-injury.

Antiparasitic activity of new gibbilimbol analogues and SAR analysis through efficiency and statistical methods.

Chagas' disease and leishmaniasis are parasitic infections enrolled among the neglected tropical diseases, which urge for new treatments. In the search for new chemical entities as prototypes, gibbilimbols A/B have shown antiparasitic activity against Trypanosoma cruzi and Leishmania infantum, and then a set of analogues (LINS03 series) of this natural product were synthesized and evaluated in vitro against the parasites. In the present paper we reported five new compounds with activity against these protozoan parasites, and quite low cytotoxicity. Moreover, the interference of plasma membrane permeability of these analogues were also evaluated. We found that [(4-methoxyphenyl)methyl]octylamine (4) was noteworthy due to its high activity against the amastigote form of both parasites (IC50 1.3-5.8 µM) and good selectivity index. In order to unveil the SAR for this chemotype, we also presented a group efficiency analysis and PCA and HCA study, which indicated that the methoxyl provides good activity with lower cytotoxicity to mammalian cells. The results from SAR analyses suggest different mechanisms of action between the neutral and basic compounds. In summary, the analogues represent important activity against these parasites and must be prototypes for further exploitation.

Efficacy of a series of alpha-pyrone derivatives against Leishmania (L.) infantum and Trypanosoma cruzi.

The neglected tropical diseases Chagas disease and leishmaniasis affect together more than 20 million people living mainly in developing countries. The mainstay of treatment is chemotherapy, however the drugs of choice, which include benznidazole and miltefosine, are toxic and have numerous side effects. Safe and effective therapies are urgently needed. Marine alpha-pyrones have been previously identified as scaffolds with potential antiprotozoan activities. In this work, using a phenotypic screen, twenty-seven examples of 3-substituted 4-hydroxy-6-methyl alpha-pyrones were synthesized and their antiparasitic efficacy evaluated against Leishmania (L.) infantum and Trypanosoma cruzi in order to evaluate structure-activity relationships within the series. The mechanism of action and the in vivo efficacy of the most selective compound against T. cruzi were evaluated using different techniques. In vitro data indicated that compounds 8, 15, 25, 26 and 28 presented IC50 values in the range between 13 and 54 µM against L. infantum intracellular amastigotes. Among them, hexanoyl substituted pyrone 8 was the most selective and potent, with a Selectivity Index (SI) > 14. Fifteen of the alpha-pyrones were effective against T. cruzi trypomastigotes, with 3-undecanoyl (11) and 3-tetradecanoyl (12) substituted pyrones being the most potent against trypomastigotes, with IC50 values of 1 and 2 µM, respectively, and SI higher than 70. Using flow cytometry and fluorescent-based assays, pyrone 12 was found to induce hyperpolarization of the mitochondrial membrane potential of T. cruzi, without affecting plasma membrane permeability. An experimental acute phase-murine model, demonstrated that in vivo dosing of 12 (30 mg/kg/day; 5 days), had no efficacy at the first parasitemia onset of T. cruzi, but reduced the second onset by 55% (p < 0.05), suggesting a delayed action in BALB/c mice. Additionally, a histopathology study demonstrated no toxic effects to the treated mice. The finding that several 3-substituted alpha-pyrones have in vitro efficacy against both L. infantum and T. cruzi, and that one analogue exhibited moderate and non-toxic in vivo efficacy against T. cruzi is encouraging, and suggests that this compound class should be explored as long-term treatments in experimental Chagas disease.

Ependymal damage in a Plasmodium yoelii yoelii lethal murine malaria model.

Malaria continues to be a major global health problem, and over 40% of the world's population is at risk. Severe or complicated malaria is defined by clinical or laboratory evidence of vital organ dysfunction, including dysfunction of the central nervous system (CNS). The pathogenesis of complicated malaria has not been completely elucidated; however, the development of the multiorgan affection seems to play an important role in the disruption of the blood brain barrier (BBB) that protects the CNS against chemical insults. Historically, the BBB has received more attention in the pathogenesis of malaria than have the cerebrospinal fluid-brain barrier (CSFBB) and ependymal cells. This perspective may be misguided because, in the context of disease or toxicity, the CSFBB is more vulnerable to many foreign invaders than are the capillaries. Given the lack on studies of the damage to the CSFBB and ependymal epithelium in experimental murine malaria, the present study evaluated morphological changes in the ependymal cells of CD-1 male mice infected with lethal Plasmodium yoelii yoelii (Pyy) via histopathology and scanning electron microscopy (SEM). Samples were taken two, four and six days post-infection (PI). No lesions were observed upon the initial infection. By the fourth day PI, fourth ventricle ependymal samples exhibited disruptions and roughened epithelia. More severe injuries were observed at six days PI and included thickened cilia and deep separations between the ependymal intercellular spaces. In some of the analyzed areas, the absence of microvilli and cell layer detachment were observed, and some areas exhibited blebbing surfaces. The ependymal cell lesions observed in the CD1 male mice infected with lethal Pyy seemed to facilitate the paracellular permeability of the CSFBB and consequently promote the access of inflammatory mediators and toxic molecules through the barrier, which resulted in damage to the brain tissue. Understanding the mechanism of ependymal disruption during lethal murine malaria could help to elucidate the local and systemic factors that are involved in the pathogenesis of the disease and may provide essential clues for the prevention and treatment of complicated human malaria.

Short-term treatment of osteoarthritis: a comparison of sodium meclofenamate and ibuprofen.

A double-blind crossover study compared sodium meclofenamate (300 mg daily) and ibuprofen (900 mg daily) in thirty patients with osteoarthritis. Each treatment period was of 3 weeks duration. Both drugs were effective in reducing the severity of joint symptoms and in improving the range of motion, with the exception of spine movement which did not show any changes from the baseline. Tolerance was good.

Potential of 2-hydroxy-3-phenylsulfanylmethyl-[1,4]-naphthoquinones against Leishmania (L.) infantum: biological activity and structure-activity relationships.

Naphtoquinones have been used as promising scaffolds for drug design studies against protozoan parasites. Considering the highly toxic and limited therapeutic arsenal, the global negligence with tropical diseases and the elevated prevalence of co-morbidities especially in developing countries, the parasitic diseases caused by various Leishmania species (leishmaniasis) became a significant public health threat in 98 countries. The aim of this work was the evaluation of antileishmanial in vitro potential of thirty-six 2-hydroxy-3-phenylsulfanylmethyl-[1,4]-naphthoquinones obtained by a three component reaction of lawsone, the appropriate aldehyde and thiols adequately substituted, exploiting the in situ generation of o-quinonemethides (o-QM) via the Knoevenagel condensation. The antileishmanial activity of the naphthoquinone derivatives was evaluated against promastigotes and intracellular amastigotes of Leishmania (Leishmania) infantum and their cytotoxicity was verified in mammalian cells. Among the thirty-six compounds, twenty-seven were effective against promastigotes, with IC50 values ranging from 8 to 189 µM; fourteen compounds eliminated the intracellular amastigotes, with IC50 values ranging from 12 to 65 µM. The compounds containing the phenyl groups at R1 and R2 and with the fluorine substituent at the phenyl ring at R2, rendered the most promising activity, demonstrating a selectivity index higher than 15 against amastigotes. A QSAR (quantitative structure activity relationship) analysis yielded insights into general structural requirements for activity of most compounds in the series. Considering the in vitro antileishmanial potential of 2-hydroxy-3-phenylsulfanylmethyl-[1,4]-naphthoquinones and their structure-activity relationships, novel lead candidates could be exploited in future drug design studies for leishmaniasis.

The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009.

OBJECTIVE: To estimate the cost of psychotropic drugs and its impact on the Brazilian family budget in 2003 and 2009 comparatively. METHODS: This study had a cross-sectional design. Data were obtained from the Family Budget Surveys conducted in 2003 and 2009, including interviews in 48,470 and 55,970 homes of all Brazilian regions, respectively. The main measures are prevalence of psychotropic drug acquisition, monetary and nonmonetary expenses with psychotropic drugs, total spending on drugs, spending on health, total household spending, and estimated mean monthly household income. All incomes and expenses from the 2003 survey were adjusted by inflation. RESULTS: There was a reduction in the prevalence of psychotropic drug acquisition by Brazilian households from 13.0% in 2003 to 11.2% in 2009. The mean monthly household spending on psychotropic drugs, however, rose from R $54.38 in 2003 to R $78.73 in 2009. The percentage of spending on psychotropic drugs from the expenses with health increased 27%. CONCLUSIONS: The increase in spending on psychotropic drugs can be due to a rise in their prices, the acquisition of more modern or more expensive drugs, or the increase in the number of drugs used. Proportionally, spending on psychotropic drugs grew more than did spending on health by Brazilian families.

Efficacy of a series of alpha-pyrone derivatives against Leishmania (L. ) infantum and Trypanosoma cruzi

The neglected tropical diseases Chagas disease and leishmaniasis affect together more than 20 million people living mainly in developing countries. The mainstay of treatment is chemotherapy, however the drugs of choice, which include benznidazole and miltefosine, are toxic and have numerous side effects. Safe and effective therapies are urgently needed. Marine alpha-pyrones have been previously identified as scaffolds with potential antiprotozoan activities. In this work, using a phenotypic screen, twenty-seven examples of 3-substituted 4-hydroxy-6-methyl alpha-pyrones were synthesized and their antiparasitic efficacy evaluated against Leishmania (L.) infantum and Trypanosoma cruzi in order to evaluate structure-activity relationships within the series. The mechanism of action and the in vivo efficacy of the most selective compound against T. cruzi were evaluated using different techniques. In vitro data indicated that compounds 8, 15, 25, 26 and 28 presented IC50 values in the range between 13 and 54 µM against L. infantum intracellular amastigotes. Among them, hexanoyl substituted pyrone 8 was the most selective and potent, with a Selectivity Index (SI) > 14. Fifteen of the alpha-pyrones were effective against T. cruzi trypomastigotes, with 3-undecanoyl (11) and 3-tetradecanoyl (12) substituted pyrones being the most potent against trypomastigotes, with IC50 values of 1 and 2 µM, respectively, and SI higher than 70. Using flow cytometry and fluorescent-based assays, pyrone 12 was found to

As doenças tropicais negligenciadas A doença de Chagas e a leishmaniose afetam juntas mais de 20 milhões de pessoas que vivem principalmente nos países em desenvolvimento. O suporte principal do tratamento é a quimioterapia, no entanto, os medicamentos de escolha, que incluem benznidazol e miltefosina, são tóxicos e têm inúmeros efeitos colaterais. Terapias seguras e eficazes são urgentemente necessárias. As alfa-pironas marinhas foram previamente identificadas como andaimes com potenciais atividades antiprotozoárias. Neste trabalho, usando uma tela fenotípica, sintetizaram-se 27 exemplos de 4-hidroxi-6-metil alfa-pironas 3-substituídas e avaliou-se sua eficácia antiparasitária contra Leishmania (L.) infantum e Trypanosoma cruzi para avaliar a estrutura relações de atividade dentro da série. O mecanismo de ação e a eficácia in vivo do composto mais seletivo contra T. cruzi foram avaliados por diferentes técnicas. Dados in vitro indicaram que os compostos 8, 15, 25, 26 e 28 apresentaram valores de IC50 na faixa entre 13 e 54 µM contra amastigotas intracelulares de L. infantum. Entre elas, a pirona 8 substituída com hexanoílo foi a mais seletiva e potente, com um índice de seletividade (SI)> 14. Quinze das alfa-pironas foram eficazes contra as tripomastigotas de T. cruzi, com 3-undecanoil (11) e 3-tetradecanoil ( 12) pironas substituídas sendo as mais potentes contra tripomastigotas, com valores de IC50 de 1 e 2 µM, respectivamente, e SI superiores a 70. Usando citometria de fluxo e ensaios à base de fluorescência, a pirona 12 foi encontrada para

Impact of an anesthesia discharge scoring system on postoperative monitoring after circumcision in children: a randomized trial.

BACKGROUND: Ambulatory surgery in children, combined with new anesthetic methods, leads to shorter hospital stays and an increase in patient and parental satisfaction. AIM: Aim of the study was to determine the feasibility and safety of transferring children directly to the ward without a previous stay in a post anesthesia care unit (PACU), after undergoing circumcision for phimosis under regional anesthesia and non-opioid analgesia. METHODS: 187 healthy children undergoing circumcision were studied in a randomized manner. After surgery, children who met predefined inclusion criteria in the operating room were randomly assigned to one of two groups. Children in the first group (Group A) bypassed the PACU and were admitted directly to the ward, after undergoing assessment using the White and Song scoring system. Children in the second group (Group B) were first transferred to a PACU and then to the ward. The children in Group A who did not meet the criteria of the White and Song scoring system represent the level of risk associated with direct transfer to the ward and no PACU stay. Recovery in the PACU and the ward, parental satisfaction, number of readmissions and the number of parental contacts for medical problems after discharge were recorded and compared between the two study groups. RESULTS: 157 children were randomly assigned into two groups (79 children in Group A and 78 in Group B). Demographic data, the duration of surgery, and recovery in the PACU or the ward were similar for the two groups. No readmissions were observed and most parents were very satisfied with the procedure. CONCLUSION: Children undergoing circumcision do not routinely require admission to a PACU and if the appropriate criteria are met, it is safe to transfer them directly to the ward.

Amniotic fluid embolism managed with success during labour: report of a severe clinical case and review of literature.

BACKGROUND: AFE (amniotic fluid embolism) is widely known as a disastrous rapid-progressing clinical entity. The incident ranges from 1:800 to 1:8,000. The mortality rate reaches 61-86%. Neonatal survival is reported at 70%. METHODS: We describe the case of a healthy 29-year old primigravida developing amniotic fluid embolism during labour. Acute respiratory failure and hypotension combined with seizures were the initial symptoms. The patient under went an urgent caesarean section with extreme blood loss, complicated by disseminated coagulopathy. RESULTS: A total hysterectomy was performed due to profuse bleeding. Aggressive management was practiced with continuous transfusion of blood products and administration of vasocopressors. CONCLUSION: Amniotic fluid embolism or anaphylactoid syndrome of pregnancy is a life-threatening condition. Diagnosis is one of the exclusion. Its management is very difficult and requires quick management and cooperation of physicians from different specialties.