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1.
PLoS One ; 16(6): e0248479, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34115763

RESUMO

The Coronavirus disease (COVID-19) caused by the virus SARS-CoV-2 has become a global pandemic in a very short time span. Currently, there is no specific treatment or vaccine to counter this highly contagious disease. There is an urgent need to find a specific cure for the disease and global efforts are directed at developing SARS-CoV-2 specific antivirals and immunomodulators. Ayurvedic Rasayana therapy has been traditionally used in India for its immunomodulatory and adaptogenic effects, and more recently has been included as therapeutic adjuvant for several maladies. Amongst several others, Withania somnifera (Ashwagandha), Tinospora cordifolia (Guduchi) and Asparagus racemosus (Shatavari) play an important role in Rasayana therapy. The objective of this study was to explore the immunomodulatory and anti SARS-CoV2 potential of phytoconstituents from Ashwagandha, Guduchi and Shatavari using network pharmacology and docking. The plant extracts were prepared as per ayurvedic procedures and a total of 31 phytoconstituents were identified using UHPLC-PDA and mass spectrometry studies. To assess the immunomodulatory potential of these phytoconstituents an in-silico network pharmacology model was constructed. The model predicts that the phytoconstituents possess the potential to modulate several targets in immune pathways potentially providing a protective role. To explore if these phytoconstituents also possess antiviral activity, docking was performed with the Spike protein, Main Protease and RNA dependent RNA polymerase of the virus. Interestingly, several phytoconstituents are predicted to possess good affinity for the three targets, suggesting their application for the termination of viral life cycle. Further, predictive tools indicate that there would not be adverse herb-drug pharmacokinetic-pharmacodynamic interactions with concomitantly administered drug therapy. We thus make a compelling case to evaluate the potential of these Rasayana botanicals as therapeutic adjuvants in the management of COVID-19 following rigorous experimental validation.


Assuntos
Antivirais/metabolismo , Asparagus/química , COVID-19/metabolismo , Fatores Imunológicos/metabolismo , Simulação de Acoplamento Molecular/métodos , Extratos Vegetais/metabolismo , SARS-CoV-2/enzimologia , Tinospora/química , Withania/química , Antivirais/farmacocinética , Sítios de Ligação , COVID-19/virologia , Proteases 3C de Coronavírus/metabolismo , RNA-Polimerase RNA-Dependente de Coronavírus/metabolismo , Interações Ervas-Drogas , Humanos , Fatores Imunológicos/farmacocinética , Índia , Ayurveda/métodos , Fitoterapia/métodos , Extratos Vegetais/farmacocinética , Ligação Proteica , Glicoproteína da Espícula de Coronavírus/metabolismo , Tratamento Farmacológico da COVID-19
2.
J Nutr Biochem ; 97: 108787, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34089819

RESUMO

The outbreak of mysterious pneumonia at the end of 2019 is associated with widespread research interest worldwide. The coronavirus disease-19 (COVID-19) targets multiple organs through inflammatory, immune, and redox mechanisms, and no effective drug for its prophylaxis or treatment has been identified until now. The use of dietary bioactive compounds, such as phenolic compounds (PC), has emerged as a putative nutritional or therapeutic adjunct approach for COVID-19. In the present study, scientific data on the mechanisms underlying the bioactivity of PC and their usefulness in COVID-19 mitigation are reviewed. In addition, antioxidant, antiviral, anti-inflammatory, and immunomodulatory effects of dietary PC are studied. Moreover, the implications of digestion on the putative benefits of dietary PC against COVID-19 are presented by addressing the bioavailability and biotransformation of PC by the gut microbiota. Lastly, safety issues and possible drug interactions of PC and their implications in COVID-19 therapeutics are discussed.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antioxidantes/uso terapêutico , COVID-19/terapia , Suplementos Nutricionais , Microbioma Gastrointestinal , Fenóis/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/farmacocinética , Anti-Inflamatórios não Esteroides/farmacologia , Antioxidantes/farmacocinética , Antioxidantes/farmacologia , Antivirais/farmacocinética , Antivirais/farmacologia , Antivirais/uso terapêutico , Disponibilidade Biológica , Curcumina/farmacocinética , Curcumina/farmacologia , Curcumina/uso terapêutico , Suplementos Nutricionais/análise , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Fatores Imunológicos/uso terapêutico , Fenóis/farmacocinética , Fenóis/farmacologia , Quercetina/farmacocinética , Quercetina/farmacologia , Quercetina/uso terapêutico , Resveratrol/farmacocinética , Resveratrol/farmacologia , Resveratrol/uso terapêutico , SARS-CoV-2/efeitos dos fármacos
3.
Mediators Inflamm ; 2021: 6699560, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33505216

RESUMO

Licorice extract is a Chinese herbal medication most often used as a demulcent or elixir. The extract usually consists of many components but the key ingredients are glycyrrhizic (GL) and glycyrrhetinic acid (GA). GL and GA function as potent antioxidants, anti-inflammatory, antiviral, antitumor agents, and immuneregulators. GL and GA have potent activities against hepatitis A, B, and C viruses, human immunodeficiency virus type 1, vesicular stomatitis virus, herpes simplex virus, influenza A, severe acute respiratory syndrome-related coronavirus, respiratory syncytial virus, vaccinia virus, and arboviruses. Also, GA was observed to be of therapeutic valve in human enterovirus 71, which was recognized as the utmost regular virus responsible for hand, foot, and mouth disease. The anti-inflammatory mechanism of GL and GA is realized via cytokines like interferon-γ, tumor necrotizing factor-α, interleukin- (IL-) 1ß, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, and IL-17. They also modulate anti-inflammatory mechanisms like intercellular cell adhesion molecule 1 and P-selectin, enzymes like inducible nitric oxide synthase (iNOS), and transcription factors such as nuclear factor-kappa B, signal transducer and activator of transcription- (STAT-) 3, and STAT-6. Furthermore, DCs treated with GL were capable of influencing T-cell differentiation toward Th1 subset. Moreover, GA is capable of blocking prostaglandin-E2 synthesis via blockade of cyclooxygenase- (COX-) 2 resulting in concurrent augmentation nitric oxide production through the enhancement of iNOS2 mRNA secretion in Leishmania-infected macrophages. GA is capable of inhibiting toll-like receptors as well as high-mobility group box 1.


Assuntos
Anti-Inflamatórios/farmacocinética , Ácido Glicirretínico/farmacocinética , Ácido Glicirrízico/farmacocinética , Fatores Imunológicos/farmacocinética , Animais , Citocinas/metabolismo , Medicamentos de Ervas Chinesas/farmacocinética , Glycyrrhiza/química , Humanos , Inflamação , Interferons/metabolismo , Interleucinas/metabolismo , Leishmania/metabolismo , Sistema de Sinalização das MAP Quinases , Macrófagos/metabolismo , Macrófagos/parasitologia , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Prostaglandinas/metabolismo , RNA Mensageiro/metabolismo , Células Th1/citologia , Receptores Toll-Like/metabolismo
4.
Expert Rev Gastroenterol Hepatol ; 15(6): 633-641, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33440996

RESUMO

Introduction: Women with inflammatory bowel disease (IBD) endorse a tremendous amount of concern about medication exposure during pregnancy and their effects on the fetus. Medical providers caring for this patient population should be well informed and feel comfortable counseling their patients for the best pregnancy outcome possible.Areas covered: It is of particular importance to understand the implications of use of biologics in preconception, pregnancy, and postpartum timeframes. Herein, we aim to inform the clinician about the impact of uncontrolled inflammation during pregnancy, the mechanisms of biologic transport through the placenta, the effects of biologics in maternal and neonatal outcomes, and additional postpartum considerations such as breastfeeding and vaccination safety.Expert opinion: The groundwork already set by previous research in terms of safety of biologic therapy during pregnancy has been reassuring. With the advent of more mechanisms of action but similar protein structure, i.e. they are IgG1 antibodies; the authors anticipate the recommendation of continuation of therapy throughout pregnancy will be sustained.


Assuntos
Produtos Biológicos/uso terapêutico , Terapia Biológica/métodos , Fatores Imunológicos/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Serviços de Saúde Materna , Complicações na Gravidez/tratamento farmacológico , Produtos Biológicos/farmacocinética , Aleitamento Materno , Esquema de Medicação , Feminino , Humanos , Fatores Imunológicos/farmacocinética , Recém-Nascido , Segurança do Paciente , Gravidez , Resultado da Gravidez , Resultado do Tratamento
5.
Nanoscale ; 12(20): 11008-11025, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32301458

RESUMO

Photodynamic therapy (PDT), as one of the most powerful photo-therapeutic strategies for cancer treatment with minimum invasiveness, can effectively damage local tumor cells and significantly induce systemic antitumor immunity. However, current nanotechnology-assisted PDT-immunomodulators have either poor penetration for deep tumors or low singlet oxygen generation. Herein, we construct a novel theranostic nanocarrier (HA-PEG-CyI, HPC) by inducing the self-assembly of PEGylated CyI and attaching the ligand HA to its surface. The prepared HPC can be used as an ideal PDT-immunomodulator for synergistic cancer therapy. CyI is an iodinated-cyanine dye with enhanced singlet oxygen generation ability as well as excellent photo-to-photothermal and near-infrared fluorescence imaging properties. Under 808 nm laser irradiation, the prepared HPC can generate both reactive oxygen species (ROS) and elevate temperature which can subsequently result in apoptosis and necrosis at tumor sites. Moreover, the HPC-induced cell death can generate a series of acute inflammatory reactions, leading to systemic immunity induction and secondary death of tumor cells, which further results in reducing tumor recurrence. In vitro and in vivo results show that HPC can enhance the tumor targeting efficacy, generate ROS efficiently and exhibit a high temperature response under NIR irradiation, which working together can activate immune responses for synergistic phototherapy on tumor cells. Accordingly, the proposed multi-functional HPC nanocarriers represent an important advance in PDT and can be used as a superior cancer treatment strategy with great promise for clinical applications.


Assuntos
Carbocianinas , Portadores de Fármacos , Hidrocarbonetos Iodados , Fatores Imunológicos , Nanoestruturas , Neoplasias Experimentais , Fotoquimioterapia , Animais , Apoptose/efeitos dos fármacos , Carbocianinas/química , Carbocianinas/farmacocinética , Carbocianinas/farmacologia , Linhagem Celular Tumoral , Portadores de Fármacos/química , Portadores de Fármacos/farmacocinética , Portadores de Fármacos/farmacologia , Feminino , Humanos , Hidrocarbonetos Iodados/química , Hidrocarbonetos Iodados/farmacocinética , Hidrocarbonetos Iodados/farmacologia , Fatores Imunológicos/química , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Nanoestruturas/química , Nanoestruturas/uso terapêutico , Neoplasias Experimentais/diagnóstico por imagem , Neoplasias Experimentais/tratamento farmacológico , Neoplasias Experimentais/metabolismo , Células RAW 264.7
6.
Phytomedicine ; 65: 153090, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31557666

RESUMO

BACKGROUND AND OBJECTIVE: Echinacea angustifolia DC. and Zingiber officinale Roscoe are two natural products with documented immunomodulatory activity, both able to modulate the expression of important immune-related genes. Thus, their use in combination seems to be particularly promising. In this context, we have considered the oral supplementation of a highly standardized lipophilic extract combining both above-mentioned phytocomplexes, formulated in attractive softgel capsules, with two objectives: on the one hand to study oral pharmacokinetic of main active extracts' components and on the other hand to examine the immunomodulation and anti-inflammatory properties by gene expression profiling. METHODS: Softgel capsules containing a combination of E. angustifolia DC. and Z. officinale Roscoe (5 mg and 25 mg, respectively) were given by oral administration to 10 healthy volunteers. The plasma concentrations of dodeca-2E,4E,8Z,10E/Z-tetraenoic isobutylamide (tetraene) for E. angustifolia DC., 6-gingerol and 6-shogaol (free and glucuronide) for Z. officinale Roscoe were determined by LC-MS analysis, and the pharmacokinetic analysis was performed. To understand the functional mechanisms responsible for the documented health benefits, we also examined the overall transcriptional remodeling induced in the peripheral blood mononuclear cells and performed an integrative functional analysis on the generated gene expression. RESULTS: All bioactive components were absorbed very rapidly, and their tmax were detected in plasma from 30 min to 1.40 h. The peak concentrations of tetraene, 6-gingerol, 6-shogaol and their glucuronide metabolites were 14.74, 5.66, 9.25, 29.2 and 22.24 ng/ml, respectively. Integrated analysis performed on the generated gene expression data highlighted immunomodulatory and anti-inflammatory effects similar to those exerted by hydrocortisone. CONCLUSION: These data demonstrated that the bioactive ingredients are highly and rapidly absorbed from softgel capsules containing the combination of the above-mentioned lipophilic extracts, providing evidence to support their immunomodulatory and anti-inflammatory properties. These data also help in defining the mechanistic pathways underlying the health benefits of these plant-derived bioactive compounds.


Assuntos
Echinacea/química , Fatores Imunológicos/farmacocinética , Extratos Vegetais/imunologia , Extratos Vegetais/farmacocinética , Zingiber officinale/química , Administração Oral , Anti-Inflamatórios/farmacocinética , Cápsulas , Catecóis/sangue , Álcoois Graxos/sangue , Feminino , Perfilação da Expressão Gênica , Humanos , Leucócitos Mononucleares/efeitos dos fármacos , Masculino , Extratos Vegetais/administração & dosagem
7.
Nutrients ; 11(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234376

RESUMO

Gnetin-C is a naturally occurring stilbene derived from the seeds of Gnetum gnemon L., an edible plant native to Southeast Asia that is called melinjo. Although the biological properties and safety of G. gnemon extract, which contains nearly 3% Gnetin-C, have been confirmed in various human studies, whether or not pure Gnetin-C is safe for humans is unclear at present. We conducted a randomized, double-blind, placebo-controlled trial. Healthy subjects were randomly divided into two groups. The interventional group (n = 6) was given Gnetin-C, and the control group (n = 6) was provided a placebo, for 14 days. Lipid profiles, biomarkers of oxidative stress and circulating blood cells were assessed before and after the intervention. All subjects completed the study, with no side effects reported across the study duration. Gnetin-C supplementation demonstrated a statistically significant increase in the absolute number of circulating natural killer (NK) cells expressing the activating receptors NKG2D and NKp46. NK cells derived from subjects who received Gnetin-C for two weeks showed higher cytotoxicity against K562 target cells than those before receiving Gnetin-C. In addition, Gnetin-C also resulted in a significant decrease in the absolute neutrophil count in the blood compared with the placebo. Furthermore, Gnetin-C significantly reduced the levels of uric acid, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total adiponectin, and high-molecular-weight adiponectin. These data indicate that Gnetin-C has biological effects of enhancing the NK activity on circulating human immune cells. The immunomodulatory effects are consistent with a putative improvement in cancer immunosurveillance via the upregulation of the NKG2D receptor. The study was registered with UMIN-CTR, number 000030364, on 12 December 2017.


Assuntos
Benzofuranos/administração & dosagem , Suplementos Nutricionais , Metabolismo Energético/efeitos dos fármacos , Fatores Imunológicos/administração & dosagem , Células Matadoras Naturais/efeitos dos fármacos , Estilbenos/administração & dosagem , Adulto , Benzofuranos/efeitos adversos , Benzofuranos/farmacocinética , Biomarcadores/sangue , Técnicas de Cocultura , Citotoxicidade Imunológica/efeitos dos fármacos , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/farmacocinética , Japão , Células K562 , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Subfamília K de Receptores Semelhantes a Lectina de Células NK/sangue , Receptor 1 Desencadeador da Citotoxicidade Natural/sangue , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Estresse Oxidativo/efeitos dos fármacos , Estilbenos/efeitos adversos , Estilbenos/farmacocinética , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Prev Alzheimers Dis ; 4(4): 236-241, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29181488

RESUMO

Tau neurofibrillary tangles are found in the brains of patients suffering from Alzheimer's disease and other tauopathies. The progressive spreading of tau pathology from one brain region to the next is believed to be caused by extracellular transsynaptic transmission of misfolded tau between neurons. Preclinical studies have shown that antibodies against tau can prevent this transfer of misfolded tau between cells. Thus, antibodies against tau have the potential to stop or slow the progression of tau pathology observed in human tauopathies. To test this hypothesis, a humanized anti-tau antibody (ABBV-8E12) was developed and a phase 1 clinical trial of this antibody has been completed. The double-blind, placebo-controlled phase 1 study tested single doses of ABBV-8E12 ranging from 2.5 to 50 mg/kg in 30 patients with progressive supranuclear palsy (PSP). ABBV-8E12 was found to have an acceptable safety profile with no clinically concerning trends in the number or severity of adverse events between the placebo and dosed groups. Pharmacokinetic modelling showed that the antibody has a plasma half-life and cerebrospinal fluid:plasma ratio consistent with other humanized antibodies, and there were no signs of immunogenicity against ABBV-8E12. Based on the acceptable safety and tolerability profile of single doses of ABBV-8E12, AbbVie is currently enrolling patients into two phase 2 clinical trials to assess efficacy and safety of multiple doses of ABBV-8E12 in patients with early Alzheimer's disease or PSP.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Fatores Imunológicos/uso terapêutico , Tauopatias/terapia , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/farmacocinética , Método Duplo-Cego , Avaliação Pré-Clínica de Medicamentos , Humanos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/farmacocinética , Imunoterapia , Modelos Biológicos , Tauopatias/sangue , Tauopatias/líquido cefalorraquidiano
9.
Immunopharmacol Immunotoxicol ; 39(2): 59-65, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28145788

RESUMO

CONTEXT: Therapeutic effects of α-l-guluronic acid with the greatest tolerability and efficacy (G2013) have been shown in experimental model of multiple sclerosis and other in vitro and in vivo examinations regarding α-l-guluronic acid; there are no toxicological researches on its safety although the pharmacological impacts have been recorded. OBJECTIVE: This study was designed to determine the acute and sub chronic toxicity of α-l-guluronic acid in healthy male and female BALB/c mice. MATERIALS AND METHODS: For the acute toxicity study, the animals orally received five different single doses of α-l-guluronic acid and were kept under observation for 14 d. In the sub-chronic study, 24 male and female BALB/c mice were divided into four groups and treated daily with test substance preparation at dose levels of 0, 50, 250, and 1250 mg/kg body weight for at least 90 consecutive days. The mortality, body weight changes, clinical signs, hematological and biochemical parameters, gross findings, histopathological, and organs weight determinants were monitored during this study. RESULTS: The results of acute toxicity indicated that the LD50 of α-l-guluronic acid is 4.8 g/kg. We found no mortality or abnormality in clinical signs, body weight, relative organs weight, or necropsy in any of the animals in the subchronic study. Additionally, the results showed no significant difference in hematological, biochemical, and histopathological parameters in rats. CONCLUSIONS: Our results suggest that α-l-guluronic acid has high safety when administered orally in animals.


Assuntos
Anti-Inflamatórios , Ácido Glucurônico , Fatores Imunológicos , Esclerose Múltipla/tratamento farmacológico , Ácidos Urônicos , Animais , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/farmacologia , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Feminino , Ácido Glucurônico/efeitos adversos , Ácido Glucurônico/imunologia , Ácido Glucurônico/farmacocinética , Ácido Glucurônico/farmacologia , Ácidos Hexurônicos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/imunologia , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Esclerose Múltipla/imunologia , Esclerose Múltipla/patologia , Ratos , Ácidos Urônicos/efeitos adversos , Ácidos Urônicos/imunologia , Ácidos Urônicos/farmacocinética , Ácidos Urônicos/farmacologia
10.
Mol Nutr Food Res ; 61(1)2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27396291

RESUMO

SCOPE: This study simulates the fermentation process of barley ß-glucan and sugar beet pectin in the human colon and monitors the degradation products formed. Additionally, immune effects of the degradation products were investigated. METHODS AND RESULTS: Immunostimulatory activity of fermentation digesta was investigated using bone marrow derived dendritic cells (BMDCs) from toll-like receptor 2/4 (TLR2/4) knockout mice, which were unresponsive to microbe-associated molecular patterns. Cytokine responses were elicited to dietary fibers and not to the SCFA and microbiota. The fermentation digesta were analyzed for their SCFA profiles and glycan metabolites over time. During fermentation the amount of insoluble precipitating fibers increased and induced as well as soluble molecules of lower molecular mass greater amounts of cytokines in BMDCs than the parental fiber. Additionally, high amounts of cytokines can be attributed to soluble galactose-rich beet pectin molecules. CONCLUSIONS: The fermentation of the two fibers led to fiber-specific amounts of SCFA, glycosidic metabolites, and different immunomodulatory properties. BMDC from TLR2/4 knockout mice did not respond to the digest microbiota and SCFA, making it a useful approach to study temporal effects of fermentation on the immunomodulatory effects of fibers.


Assuntos
Citocinas/metabolismo , Fezes/microbiologia , Pectinas/metabolismo , beta-Glucanas/metabolismo , Animais , Técnicas de Cultura Celular por Lotes , Beta vulgaris/química , Células Dendríticas/metabolismo , Fibras na Dieta/metabolismo , Fibras na Dieta/farmacologia , Fermentação , Hordeum/química , Humanos , Fatores Imunológicos/farmacocinética , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pectinas/farmacocinética , Receptor 2 Toll-Like/genética , beta-Glucanas/farmacocinética
11.
J Ethnopharmacol ; 195: 222-230, 2017 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-27856301

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Ginseng (Ginseng Radix et Rhizoma) is used worldwide for its miracle tonic effects, especially for its immunomodulatory activities. Sulfur fumigation, a fast and convenient method to prevent pesticidal and bacterial contamination in the food industry, has been recently employed during post-harvest processing of ginseng. Our previous studies demonstrated that sulfur fumigation significantly altered the chemical profile of the bioactive ingredients in ginseng. However, the effects of sulfur fumigation on the pharmacokinetics and bioactivities of ginseng remain unknown. AIM OF THE STUDY: To examine the effects of sulfur fumigation on the pharmacokinetics and immunomodulatory activities of ginseng. MATERIALS AND METHODS: For pharmacokinetic studies, male Sprague-Dawley rats exposed to single/multiple dosages of non-fumigated ginseng (NFG) and sulfur fumigated ginseng (SFG) were investigated using HPLC-MS/MS analysis. For bioactivity studies, male ICR mice were used to compare the immunomodulatory effects of NFG or SFG under both normal and cyclophosphamide (CY)-induced immunocompromised conditions using white blood cell counts, serum cytokine levels, and spleen and thymus weight indices. RESULTS: Sulfur fumigation significantly reduced the contents of the bioactive ginsenosides in ginseng, which resulted in drastically low systemic exposure of ginsenosides in SFG-treatment group compared to NFG-treatment group. This observation was consistent with the bioactivities obtained in NFG- and SFG-treatment groups. The bioactivity studies also demonstrated the immunomodulatory effects of NFG but not SFG in the CY-induced immunosuppressed mice. CONCLUSION: Sulfur fumigation significantly reduced contents of bioactive ginsenosides in ginseng, leading to dramatic decrease in the systemic exposure of these ginsenosides in the body and detrimental reduction of immunomodulatory effects of ginseng. Our results provided scientific evidences and laid a solid foundation for the needs of thorough evaluation of the significant impact of sulfur fumigation on ginseng and other medicinal herbs.


Assuntos
Fumigação , Ginsenosídeos/farmacologia , Sistema Imunitário/efeitos dos fármacos , Fatores Imunológicos/farmacologia , Panax/química , Extratos Vegetais/farmacologia , Enxofre/química , Animais , Cromatografia Líquida de Alta Pressão , Ciclofosfamida/farmacologia , Ginsenosídeos/isolamento & purificação , Ginsenosídeos/farmacocinética , Sistema Imunitário/imunologia , Sistema Imunitário/metabolismo , Hospedeiro Imunocomprometido , Fatores Imunológicos/isolamento & purificação , Fatores Imunológicos/farmacocinética , Imunossupressores/farmacologia , Interleucina-2/sangue , Leucócitos/efeitos dos fármacos , Leucócitos/imunologia , Masculino , Camundongos Endogâmicos ICR , Fitoterapia , Extratos Vegetais/isolamento & purificação , Extratos Vegetais/farmacocinética , Plantas Medicinais , Ratos Sprague-Dawley , Baço/efeitos dos fármacos , Baço/imunologia , Espectrometria de Massas em Tandem , Timo/efeitos dos fármacos , Timo/imunologia
12.
Molecules ; 22(1)2016 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-28025523

RESUMO

Haizao Yuhu Decoction (HYD) has been used for approximately 500 years and is well-known in Traditional Chinese Medicine for its efficacy in the treatment of thyroid-related diseases. In this study, a rapid liquid chromatography-tandem mass spectrometry method was developed for the determination of liquiritin, naringin, hesperidin, peimine, liquiritigenin, glycyrrhizic acid, bergapten, nobiletin, osthole, and glycyrrhetinic acid in rat plasma to investigate the pharmacokinetic profile of different HYD prescriptions in a rat model of hypothyroidism. The differences in pharmacokinetic parameters among the groups were compared by Student's t-test. The pharmacokinetic profile of liquiritin, naringin, hesperidin, peimine, liquiritigenin, glycyrrhizic acid, bergapten, nobiletin, osthole, and glycyrrhetinic acid showed significant differences between Haizao and Gancao anti-drug combination and other herbs in HYD. These results may contribute to the rational clinical use of HYD and reveal the compatibility profile of the Haizao and Gancao anti-drug combination.


Assuntos
Cumarínicos/farmacocinética , Medicamentos de Ervas Chinesas/farmacocinética , Flavanonas/farmacocinética , Hipotireoidismo/tratamento farmacológico , Fatores Imunológicos/farmacocinética , Triterpenos Pentacíclicos/farmacocinética , Administração Oral , Animais , Cromatografia Líquida de Alta Pressão/métodos , Cumarínicos/sangue , Modelos Animais de Doenças , Medicamentos de Ervas Chinesas/farmacologia , Flavanonas/sangue , Flavanonas/farmacologia , Humanos , Hipotireoidismo/imunologia , Hipotireoidismo/patologia , Fatores Imunológicos/sangue , Limite de Detecção , Masculino , Medicina Tradicional Chinesa , Triterpenos Pentacíclicos/sangue , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/imunologia , Glândula Tireoide/patologia
13.
Molecules ; 21(8)2016 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-27483229

RESUMO

Phenylethanoid glycosides (PhGs) are widely distributed in traditional Chinese medicines as well as in other medicinal plants, and they were characterized by a phenethyl alcohol (C6-C2) moiety attached to a ß-glucopyranose/ß-allopyranose via a glycosidic bond. The outstanding activity of PhGs in diverse diseases proves their importance in medicinal chemistry research. This review summarizes new findings on PhGs over the past 10 years, concerning the new structures, their bioactivities, including neuroprotective, anti-inflammatory, antioxidant, antibacterial and antivirus, cytotoxic, immunomodulatory, and enzyme inhibitory effects, and pharmacokinetic properties.


Assuntos
Medicamentos de Ervas Chinesas , Glicosídeos , Álcool Feniletílico , Plantas Medicinais/química , Antibacterianos/química , Antibacterianos/isolamento & purificação , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Anti-Inflamatórios/química , Anti-Inflamatórios/isolamento & purificação , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/uso terapêutico , Antioxidantes/química , Antioxidantes/isolamento & purificação , Antioxidantes/farmacocinética , Antioxidantes/uso terapêutico , Antivirais/química , Antivirais/isolamento & purificação , Antivirais/farmacocinética , Antivirais/uso terapêutico , Medicamentos de Ervas Chinesas/química , Medicamentos de Ervas Chinesas/farmacocinética , Medicamentos de Ervas Chinesas/uso terapêutico , Glicosídeos/química , Glicosídeos/isolamento & purificação , Glicosídeos/farmacocinética , Glicosídeos/uso terapêutico , Fatores Imunológicos/química , Fatores Imunológicos/isolamento & purificação , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/uso terapêutico , Fármacos Neuroprotetores/química , Fármacos Neuroprotetores/isolamento & purificação , Fármacos Neuroprotetores/farmacocinética , Fármacos Neuroprotetores/uso terapêutico , Álcool Feniletílico/química , Álcool Feniletílico/isolamento & purificação , Álcool Feniletílico/farmacocinética , Álcool Feniletílico/uso terapêutico
14.
Eur J Drug Metab Pharmacokinet ; 41(6): 845-853, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26470874

RESUMO

BACKGROUND AND OBJECTIVES: 20(S)-Ginsenoside Rg3 could significantly inhibit tumor growth and metastasis in animals and in in vitro tumor cell invasion. This first-in-human pharmacokinetic study investigated the pharmacokinetics of 20(S)-ginsenoside Rg3 (hip intramuscular injection) in healthy Chinese volunteers. METHODS: Study 1 investigated single, ascending intramuscular doses of 10-60 mg of 20(S)-ginsenoside Rg3 in 24 healthy adults; study 2 evaluated multiple intramuscular doses of 30 mg of 20(S)-ginsenoside Rg3 administered for 15 days in 9 healthy adults. RESULTS: In both studies, 20(S)-ginsenoside Rg3 was rapidly absorbed, with a time to reach maximum plasma concentration (T max) of 4 h. After single-dose administration, elimination half-life t ½ was 32.0 ± 26.7, 51.7 ± 15.4 and 53.9 ± 25.7 h; maximum plasma concentration (C max) was 135.4 ± 35.3, 162.1 ± 47.2 and 399.8 ± 217.0 ng/mL; area under the plasma concentration-time curve (AUC) from time zero to infinity (AUC0-∞) was 3474.1 ± 1312.3, 8156.5 ± 1782.7 and 25,666.8 ± 9401.1 ng·h/mL; clearance CL/F was 3.2 ± 0.9, 3.8 ± 0.7 and 2.7 ± 1.3 L/h; urine excretion percentage during 72 h was 0.5 ± 0.1, 0.4 ± 0.1 and 0.4 ± 0.2 % after 10, 30 and 60 mg 20(S)-ginsenoside Rg3, respectively. After multiple-dose administration, C max was 457.0 ± 165.7 and 770.2 ± 275.4 ng/mL; AUC0-48h was 10,530.0 ± 4073.9 and 16,871.3 ± 6939.3 ng·h/mL after the first and the last 20(S)-ginsenoside Rg3 doses, respectively; fluctuation percentage was 183.0 ± 46.3 %. Accumulation ratio was 1.7 ± 0.6 at steady state. CONCLUSIONS: 20(S)-ginsenoside Rg3 was generally well tolerated. In these studies, 20(S)-ginsenoside Rg3 exhibited a pharmacokinetic profile suitable for once-every-2-days dosing.


Assuntos
Antineoplásicos Fitogênicos/farmacocinética , Medicamentos de Ervas Chinesas/farmacocinética , Ginsenosídeos/farmacocinética , Fatores Imunológicos/farmacocinética , Absorção Fisiológica , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/metabolismo , Área Sob a Curva , Povo Asiático , Nádegas , China , Estudos de Coortes , Estudos Cross-Over , Relação Dose-Resposta a Droga , Esquema de Medicação , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/metabolismo , Feminino , Ginsenosídeos/administração & dosagem , Ginsenosídeos/efeitos adversos , Ginsenosídeos/metabolismo , Meia-Vida , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/metabolismo , Injeções Intramusculares , Masculino , Taxa de Depuração Metabólica , Eliminação Renal , Reprodutibilidade dos Testes , Urina/química
15.
Eur J Pharm Biopharm ; 97(Pt A): 8-14, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26455420

RESUMO

An attractive herbal product, softgel capsules containing 10 mg of Echinacea angustifolia lipophilic extract, was given in a single oral administration to 10 human volunteers to perform a pharmacokinetic and immunological study. The plasma concentration of the major constituent was monitored, quantifying at predetermined time points the dodeca-2E,4E,8Z,10E/Z-tetraenoic isobutylamides (tetraene). The plasmatic levels of IL-2, IL-6, IL-8, IL-10 and TNF-a in samples collected before and 24 h after drug administration were analyzed by cytokine assay. The total RNA was extracted from limpho-monocyte isolated from the same blood samples and the same cytokines in terms of gene expression were evaluated. With the help of proper statistical tests the differences between the values obtained at 0 and 24 h were evaluated. Results of pharmacokinetic studies attest an approximately 3.5-fold improvement of tetraene oral bioavailability compared with previously published studies. Dodeca-2E,4E-dienoic acid isobutylamide exerts immunomodulatory effects down-regulating the gene expression and reducing the protein plasmatic levels of pro-inflammatory cytokines such as IL-6, TNF-α and IL-8, and up-regulating the expression of anti-inflammatory molecules as IL-10. Student's two-sided paired t-test and non-parametric Wilcoxon-Mann-Whitney signed rank test agree in the conclusions about the differences between the ln values at 24 h and corresponding ln values at 0 h.


Assuntos
Citocinas/sangue , Echinacea/química , Fatores Imunológicos/administração & dosagem , Extratos Vegetais/administração & dosagem , Adulto , Disponibilidade Biológica , Cápsulas , Citocinas/genética , Feminino , Regulação da Expressão Gênica , Humanos , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Interleucinas/sangue , Interleucinas/genética , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/farmacocinética , Extratos Vegetais/farmacologia , Método Simples-Cego , Estatísticas não Paramétricas , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/genética
16.
J Pharmacol Exp Ther ; 353(1): 9-16, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25597308

RESUMO

Proanthocyanidins are among the most abundant constituents in pine bark extracts (PBEs). This review summarizes medical research on PBEs from Pinus pinaster, Pinus radiata, Pinus massoniana, and other less well characterized species. The precise mechanisms of the important physiologic functions of PBE components remain to be elucidated, but there is evidently great potential for the identification and development of novel antioxidant, anti-inflammatory, cardiovascular, neuroprotective, and anticancer medicines. Although toxicological data for PBEs are limited, no serious adverse effects have been reported. PBEs, therefore, may have potential as nutraceuticals and pharmaceuticals and should be safe for use as food ingredients.


Assuntos
Pinus/química , Casca de Planta/química , Extratos Vegetais/farmacologia , Animais , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/toxicidade , Anticarcinógenos/farmacocinética , Anticarcinógenos/farmacologia , Anticarcinógenos/toxicidade , Antineoplásicos/farmacocinética , Antineoplásicos/farmacologia , Antineoplásicos/toxicidade , Antioxidantes/farmacocinética , Antioxidantes/farmacologia , Antioxidantes/toxicidade , Cardiotônicos/farmacocinética , Cardiotônicos/farmacologia , Cardiotônicos/toxicidade , Humanos , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Fatores Imunológicos/toxicidade , Metabolismo dos Lipídeos/efeitos dos fármacos , Fármacos Neuroprotetores/farmacocinética , Fármacos Neuroprotetores/farmacologia , Fármacos Neuroprotetores/toxicidade , Extratos Vegetais/farmacocinética , Extratos Vegetais/toxicidade , Proantocianidinas/farmacocinética , Proantocianidinas/farmacologia , Proantocianidinas/toxicidade
17.
Int J Nanomedicine ; 9: 4533-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25288882

RESUMO

Magnetoliposomes are phospholipid vesicles encapsulating magnetic nanoparticles that can be used to encapsulate therapeutic drugs for delivery into specific organs. Herein, we developed magnetoliposomes containing recombinant human IFNα2b, designated as MIL, and evaluated this combination's biological safety and therapeutic effect on both cellular and animal hepatocellular carcinoma models. Our data showed that MIL neither hemolyzed erythrocytes nor affected platelet-aggregation rates in blood. Nitroblue tetrazolium-reducing testing showed that MIL did not change the absolute numbers or phagocytic activities of leukocytes. Acute-toxicity testing also showed that MIL had no devastating effect on mice behaviors. All the results indicated that the nanoparticles could be a safe biomaterial. Pharmacokinetic analysis and tissue-distribution studies showed that MIL maintained stable and sustained drug concentrations in target organs under a magnetic field, helped to increase bioavailability, and reduced administration time. MIL also dramatically inhibited the growth of hepatoma cells. Targeting of MIL in the livers of nude mice bearing human hepatocellular carcinoma showed that MIL significantly reduced the tumor size to 38% of that of the control group. Further studies proved that growth inhibition of cells or tumors was due to apoptosis-signaling pathway activation by human IFNα2b.


Assuntos
Portadores de Fármacos/química , Fatores Imunológicos/farmacologia , Interferon-alfa/farmacologia , Lipossomos/química , Neoplasias Hepáticas Experimentais/patologia , Nanopartículas de Magnetita/química , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Portadores de Fármacos/toxicidade , Avaliação Pré-Clínica de Medicamentos , Feminino , Humanos , Fatores Imunológicos/química , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/toxicidade , Interferon alfa-2 , Interferon-alfa/química , Interferon-alfa/farmacocinética , Interferon-alfa/toxicidade , Lipossomos/toxicidade , Nanopartículas de Magnetita/toxicidade , Masculino , Camundongos , Camundongos Endogâmicos ICR , Coelhos , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/química , Proteínas Recombinantes/farmacocinética , Proteínas Recombinantes/farmacologia , Proteínas Recombinantes/toxicidade , Distribuição Tecidual
18.
PLoS One ; 9(7): e100797, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25003344

RESUMO

Capsazepine, an antagonist of capsaicin, is discovered by the structure and activity relationship. In previous studies it has been found that capsazepine has potency for immunomodulation and anti-inflammatory activity and emerging as a favourable target in quest for efficacious and safe anti-inflammatory drug. Thus, a 2D quantitative structural activity relationship (QSAR) model against target tumor necrosis factor-α (TNF-α) was developed using multiple linear regression method (MLR) with good internal prediction (r2 = 0.8779) and external prediction (r2pred = 0.5865) using Discovery Studio v3.5 (Accelrys, USA). The predicted activity was further validated by in vitro experiment. Capsazepine was tested in lipopolysaccharide (LPS) induced inflammation in peritoneal mouse macrophages. Anti-inflammatory profile of capsazepine was assessed by its potency to inhibit the production of inflammatory mediator TNF-α. The in vitro experiment indicated that capsazepine is an efficient anti-inflammatory agent. Since, the developed QSAR model showed significant correlations between chemical structure and anti-inflammatory activity, it was successfully applied in the screening of forty-four virtual derivatives of capsazepine, which finally afforded six potent derivatives, CPZ-29, CPZ-30, CPZ-33, CPZ-34, CPZ-35 and CPZ-36. To gain more insights into the molecular mechanism of action of capsazepine and its derivatives, molecular docking and in silico absorption, distribution, metabolism, excretion and toxicity (ADMET) studies were performed. The results of QSAR, molecular docking, in silico ADMET screening and in vitro experimental studies provide guideline and mechanistic scope for the identification of more potent anti-inflammatory & immunomodulatory drug.


Assuntos
Capsaicina/análogos & derivados , Simulação de Acoplamento Molecular , Relação Quantitativa Estrutura-Atividade , Animais , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/farmacologia , Disponibilidade Biológica , Capsaicina/efeitos adversos , Capsaicina/química , Capsaicina/farmacocinética , Capsaicina/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Citocinas/metabolismo , Avaliação Pré-Clínica de Medicamentos , Feminino , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/química , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/farmacologia , Macrófagos/citologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Camundongos , Conformação Proteica , Medição de Risco , Fator de Necrose Tumoral alfa/química , Fator de Necrose Tumoral alfa/metabolismo
19.
Nucleic Acid Ther ; 24(4): 267-82, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24720569

RESUMO

IMT504 is a non-CpG 24-mer oligodeoxynucleotide (ODN) with immunomodulatory as well as tissue repair activity. IMT504 has been previously proven to be effective in animal models of vaccine potency, chronic lymphocytic leukemia, tissue regeneration, and sepsis. Here, we assessed the safety, including pharmacokinetics and toxicity studies in rats and monkeys, of IMT504 in a single- or repeated-dose administration by the subcutaneous (SC) or intravenous (IV) routes. In rats, the maximum tolerated dose was determined to be 50 mg/kg when administered SC. Adverse effects at 50 mg/kg were mild and reversible liver injury, revealed as lobular inflammation, focal necrosis, and small changes in the transaminase profile. Dose-dependent splenomegaly and lymphoid hyperplasia, most probably associated with immune stimulation, were commonly observed. Rats and monkeys were also IV injected with a single dose of 10 or 3.5 mg/kg, and no adverse effects were observed. Rats injected IV with 10 mg/kg showed a transient increase in spleen weight, together with a slight increase in the marginal zone of the white pulp and in leukocyte count 2 days post-administration. In monkeys, this dosage caused slight changes in total serum complement and leukocyte count on day 14. No adverse effects were observed at 3.5 mg/kg IV in rats or monkeys. Therefore, this dose was defined as the "no observed adverse effect level" for this route. Furthermore, repeated-dose toxicity studies were performed in these species using 3.5 or 0.35 mg/kg/day IV for 6 weeks. A transient increase in the spleen and liver weight was observed at 3.5 mg/kg/day only in female rats. No changes in clotting time and activation of the alternative complement pathway were observed. The toxicity profile of IMT504 herein reported suggests a dose range in which IMT504 can be used safely in clinical trials.


Assuntos
Fatores Imunológicos/toxicidade , Oligodesoxirribonucleotídeos/toxicidade , Animais , Cebus , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Avaliação Pré-Clínica de Medicamentos , Feminino , Fatores Imunológicos/farmacocinética , Inflamação/induzido quimicamente , Inflamação/patologia , Injeções Intravenosas , Injeções Subcutâneas , Masculino , Oligodesoxirribonucleotídeos/farmacocinética , Ratos , Fatores Sexuais , Esplenomegalia/induzido quimicamente , Esplenomegalia/patologia
20.
Actas Dermosifiliogr ; 105(1): 31-44, 2014.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23177976

RESUMO

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.


Assuntos
Inflamação/complicações , Obesidade/imunologia , Psoríase/imunologia , Adipócitos/metabolismo , Adipócitos/patologia , Adipocinas/metabolismo , Adipocinas/fisiologia , Tecido Adiposo/metabolismo , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/administração & dosagem , Antirreumáticos/economia , Antirreumáticos/farmacocinética , Antirreumáticos/uso terapêutico , Peso Corporal/efeitos dos fármacos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Causalidade , Moléculas de Adesão Celular/metabolismo , Comunicação Celular , Citocinas/metabolismo , Citocinas/fisiologia , Suscetibilidade a Doenças , Relação Dose-Resposta a Droga , Ácidos Graxos não Esterificados/metabolismo , Hormônios/fisiologia , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/economia , Fatores Imunológicos/farmacocinética , Fatores Imunológicos/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Linfócitos/patologia , Síndrome Metabólica/etiologia , Síndrome Metabólica/fisiopatologia , Modelos Biológicos , Obesidade/complicações , Obesidade/fisiopatologia , Terapia PUVA , Psoríase/complicações , Psoríase/tratamento farmacológico
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