Flubendazole Plays an Important Anti-Tumor Role in Different Types of Cancers.

Flubendazole, belonging to benzimidazole, is a broad-spectrum insect repellent and has been repurposed as a promising anticancer drug. In recent years, many studies have shown that flubendazole plays an anti-tumor role in different types of cancers, including breast cancer, melanoma, prostate cancer, colorectal cancer, and lung cancer. Although the anti-tumor mechanism of flubendazole has been studied, it has not been fully understood. In this review, we summarized the recent studies regarding the anti-tumor effects of flubendazole in different types of cancers and analyzed the related mechanisms, in order to provide the theoretical reference for further studies in the future.

Pharmacologic activation of autophagy without direct mTOR inhibition as a therapeutic strategy for treating dry macular degeneration.

Dry age-related macular degeneration (AMD) is marked by the accumulation of extracellular and intracellular lipid-rich deposits within and around the retinal pigment epithelium (RPE). Inducing autophagy, a conserved, intracellular degradative pathway, is a potential treatment strategy to prevent disease by clearing these deposits. However, mTOR inhibition, the major mechanism for inducing autophagy, disrupts core RPE functions. Here, we screened autophagy inducers that do not directly inhibit mTOR for their potential as an AMD therapeutic in primary human RPE culture. Only two out of more than thirty autophagy inducers tested reliably increased autophagy flux in RPE, emphasizing that autophagy induction mechanistically differs across distinct tissues. In contrast to mTOR inhibitors, these compounds preserved RPE health, and one inducer, the FDA-approved compound flubendazole (FLBZ), reduced the secretion of apolipoprotein that contributes to extracellular deposits termed drusen. Simultaneously, FLBZ increased production of the lipid-degradation product ß-hydroxybutyrate, which is used by photoreceptor cells as an energy source. FLBZ also reduced the accumulation of intracellular deposits, termed lipofuscin, and alleviated lipofuscin-induced cellular senescence and tight-junction disruption. FLBZ triggered compaction of lipofuscin-like granules into a potentially less toxic form. Thus, induction of RPE autophagy without direct mTOR inhibition is a promising therapeutic approach for dry AMD.

Antimicrobial and anticancer properties of Carica papaya leaves derived di-methyl flubendazole mediated silver nanoparticles.

BACKGROUND: In this study, a biologically active molecule, di-methyl flubendazole isolated from the extract of Carica papaya leaves confirmed by using GC-MS, 1H NMR, and 13C NMR analysis was applied to synthesize silver nanoparticles (AgNPs). The AgNPs with plant sources an alternative therapeutic agent for synthetic compound used in cancer chemotherapy. METHODS: The AgNPs were characterized using UV, FT-IR, XRD, FESEM with EDX and TEM. The antibacterial effects of AgNPs were determined with agar well diffusion method. The MTT assay used to evaluate the inhibitory effect cell lines. The acridine orange and ethidium bromide and DAPI have used cell morphological effects. RESULTS: The AgNPs were mono-crystalline and their size ranged from 7 to 22 nm. AgNPs showed good antibacterial activity against both Gram-positive and Gram-negative bacteria. Studies on the antiproliferative potential of bioinspired AgNPs in cancer cell lines revealed that the antiproliferative effect was much stronger in HepG2 than in MCF-7 and A549 cell lines. Similarly, AgNPs exerted less cytotoxic activity in Vero cells (normal cells). AgNPs-treated cells showed necrosis, apoptotic morphology evidenced by cell shrinkage, membrane blebbing, cell decay, and necrosis. HepG2 cells treated with biosynthesized AgNPs exhibited a G0/G1 phase (52-53.37%) blockage. Compared to the control, AgNP-treated HepG2 cells showed elevated ®-actin levels; however, Bcl-2 was significantly down regulated in AgNP-treated cells, indicating the involvement of Bcl-2 in apoptosis. CONCLUSION: Overall, the fact that di-methyl flubendazole-based silver nanoparticles showed a novel and cost-effective natural antitumor and antibacterial agent.

Development and validation of an Onchocerca ochengi adult male worm gerbil model for macrofilaricidal drug screening.

BACKGROUND: Onchocerciasis currently afflicts an estimated 15 million people and is the second leading infectious cause of blindness world-wide. The development of a macrofilaricide to cure the disease has been hindered by the lack of appropriate small laboratory animal models. This study therefore, was aimed at developing and validating the Mongolian gerbil, as an Onchocerca ochengi (the closest in phylogeny to O. volvulus) adult male worm model. METHODOLOGY/PRINCIPAL FINDINGS: Mongolian gerbils (Meriones unguiculatus) were each implanted with 20 O. ochengi male worms (collected from infected cattle), in the peritoneum. Following drug or placebo treatments, the implanted worms were recovered from the animals and analyzed for burden, motility and viability. Worm recovery in control gerbils was on average 35%, with 89% of the worms being 100% motile. Treatment of the gerbils implanted with male worms with flubendazole (FBZ) resulted in a significant reduction (p = 0.0021) in worm burden (6.0% versus 27.8% in the control animals); all recovered worms from the treated group had 0% worm motility versus 91.1% motility in control animals. FBZ treatment had similar results even after four different experiments. Using this model, we tested a related drug, oxfendazole (OFZ), and found it to also significantly (p = 0.0097) affect worm motility (22.7% versus 95.0% in the control group). CONCLUSIONS/SIGNIFICANCE: We have developed and validated a novel gerbil O. ochengi adult male worm model for testing new macrofilaricidal drugs in vivo. It was also used to determine the efficacy of oxfendazole in vivo.

Preclinical toxicity and pharmacokinetics of a new orally bioavailable flubendazole formulation and the impact for clinical trials and risk/benefit to patients.

BACKGROUND: Flubendazole, originally developed to treat infections with intestinal nematodes, has been shown to be efficacious in animal models of filarial infections. For treatment of filarial nematodes, systemic exposure is needed. For this purpose, an orally bioavailable amorphous solid dispersion (ASD) formulation of flubendazole was developed. As this formulation results in improved systemic absorption, the pharmacokinetic and toxicological profile of the flubendazole ASD formulation have been assessed to ensure human safety before clinical trials could be initiated. METHODS & FINDINGS: Safety pharmacology, toxicity and genotoxicity studies have been conducted with the flubendazole ASD formulation. In animals, flubendazole has good oral bioavailability from an ASD formulation ranging from 15% in dogs, 27% in rats to more than 100% in jirds. In in vivo toxicity studies with the ASD formulation, high systemic exposure to flubendazole and its main metabolites was reached. Flubendazole, up to high peak plasma concentrations, does not induce Cmax related effects in CNS or cardiovascular system. In repeated dose toxicity studies in rats and dogs, flubendazole-induced changes were observed in haematological, lymphoid and gastrointestinal systems and in testes. In dogs, the liver was an additional target organ. Upon treatment cessation, at least partial recovery was observed for these changes in dogs. In rats, the No Observed Adverse Effect Level (NOAEL) was 5 mg (as base)/kg body weight/day (mg eq./kg/day) in males and 2.5 mg eq./kg/day in females. In dogs, the NOAEL was lower than 20 mg eq./kg/day. Regarding genotoxicity, flubendazole was negative in the Ames test, but positive in the in vivo micronucleus test. CONCLUSIONS: Based on these results, in combination with previously described genotoxicity and reproductive toxicity data and the outcome of the preclinical efficacy studies, it was concluded that no flubendazole treatment regimen can be selected that would provide efficacy in humans at safe exposure.

The influence of Farmatan® and Flimabend® on the mucosal immunity of broiler chicken1.

The aim of the present study was to monitor selected parameters of mucosal immunity in jejunum and ileum (immunoglobulin A [IgA], mucin 2 [MUC-2], and pro-inflammatory cytokines) in commercial broiler farm chicken after treatment with flubendazole (Flimabend®) and natural extract from chestnut wood (Farmatan®). A total of 24 forty-day-old Kalimero-Super Master hybrid chickens were divided into 4 groups (n = 6): the Fli group received Flimabend® per os, 100 mg/g suspension in 1.43 mg of active substance/kg body weight during 7 d of experiment; the Far group received Farmatan®per os at 0.2% concentration for 6 h/d during 5 d (experimental d 3 to 7); the Far + Fli group received a combination of doses administered in the same way as for the first two groups; and the C group represented control with no active substance administration. The concentrations of secretory IgA (sIgA) and MUC-2 and relative expression of selected immune parameters were evaluated. Our results show strong suppressive effect of the Farmatan® and Flimabend® combination on relative expression of IL-1ß and IL-18 in selected parts of the intestine. On the other hand, administration of natural extract from selected chestnut wood (Farmatan®) increased expression of total IgA as well as concentration of sIgA in the studied parts of the chicken intestine. Moreover, expression and concentration of MUC-2 was positively affected by addition of Farmatan®. In contrast, 7-d administration of Flimabend® resulted in upregulation of pro-inflammatory cytokines and decrease in IgA and MUC-2 gene expression. In conclusion, for maintenance of mucosal immunity via activation of IgA and mucin production, the long-term preventive use of Farmatan® is a suitable choice.

Repurposing and Reformulation of the Antiparasitic Agent Flubendazole for Treatment of Cryptococcal Meningoencephalitis, a Neglected Fungal Disease.

Current therapeutic options for cryptococcal meningitis are limited by toxicity, global supply, and emergence of resistance. There is an urgent need to develop additional antifungal agents that are fungicidal within the central nervous system and preferably orally bioavailable. The benzimidazoles have broad-spectrum antiparasitic activity but also have in vitro antifungal activity that includes Cryptococcus neoformans Flubendazole (a benzimidazole) has been reformulated by Janssen Pharmaceutica as an amorphous solid drug nanodispersion to develop an orally bioavailable medicine for the treatment of neglected tropical diseases such as onchocerciasis. We investigated the in vitro activity, the structure-activity-relationships, and both in vitro and in vivo pharmacodynamics of flubendazole for cryptococcal meningitis. Flubendazole has potent in vitro activity against Cryptococcus neoformans, with a modal MIC of 0.125 mg/liter using European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. Computer models provided an insight into the residues responsible for the binding of flubendazole to cryptococcal ß-tubulin. Rapid fungicidal activity was evident in a hollow-fiber infection model of cryptococcal meningitis. The solid drug nanodispersion was orally bioavailable in mice with higher drug exposure in the cerebrum. The maximal dose of flubendazole (12 mg/kg of body weight/day) orally resulted in an ∼2 log10CFU/g reduction in fungal burden compared with that in vehicle-treated controls. Flubendazole was orally bioavailable in rabbits, but there were no quantifiable drug concentrations in the cerebrospinal fluid (CSF) or cerebrum and no antifungal activity was demonstrated in either CSF or cerebrum. These studies provide evidence for the further study and development of the benzimidazole scaffold for the treatment of cryptococcal meningitis.

Pharmaceutical screen identifies novel target processes for activation of autophagy with a broad translational potential.

Autophagy is a conserved homeostatic process active in all human cells and affecting a spectrum of diseases. Here we use a pharmaceutical screen to discover new mechanisms for activation of autophagy. We identify a subset of pharmaceuticals inducing autophagic flux with effects in diverse cellular systems modelling specific stages of several human diseases such as HIV transmission and hyperphosphorylated tau accumulation in Alzheimer's disease. One drug, flubendazole, is a potent inducer of autophagy initiation and flux by affecting acetylated and dynamic microtubules in a reciprocal way. Disruption of dynamic microtubules by flubendazole results in mTOR deactivation and dissociation from lysosomes leading to TFEB (transcription factor EB) nuclear translocation and activation of autophagy. By inducing microtubule acetylation, flubendazole activates JNK1 leading to Bcl-2 phosphorylation, causing release of Beclin1 from Bcl-2-Beclin1 complexes for autophagy induction, thus uncovering a new approach to inducing autophagic flux that may be applicable in disease treatment.

Statistical analysis of the effects of polyethylene glycol concentration and molecular weight on the sedimentation and resuspendability behavior of model aqueous dispersions.

This work investigates the flocculation effect of polyethylene glycol (PEG) on typical aqueous dispersions, such as O/W emulsions and solid/liquid suspensions. Hereby, sunflower oil and flubendazole were selected as model ingredients, whereas microfluidization at variable driving air pressure was used to enable particle size distribution variations for both systems. The molecular weight of PEG varied from 2000 to 12,000g/mol while its concentration ranged from 50 to 100mg/ml. Statistical analysis revealed that both PEG concentration and molecular weight showed a flocculation enhancing effect. Hereby the inhibiting effect of particle size toward the formation of voluminous and easily resuspendable sediment could at least partially be overcome by selecting appropriate PEG characteristics.

Comparative efficacy of flubendazole and a commercially available herbal wormer against natural infections of Ascaridia galli, Heterakis gallinarum and intestinal Capillaria spp. in chickens.

The efficacy of a commercially available flubendazole-based product and a commercially available herbal product were compared against three species of helminth parasites of chickens: Ascaridia galli, Heterakis gallinarum and Capillaria spp. A total of 48 naturally infected chickens were used in the study with 16 birds in each of three treatment groups (untreated control; flubendazole; and a herbal product). One bird from each treatment group was necropsied on Day 0 prior to first treatment to confirm the parasite species present in the birds. Treatments were administered as labelled and the 45 remaining birds were necropsied on Day 12 and worm counts performed. Average worm counts in the two treated groups were compared to the untreated controls to calculate efficacy. Flubendazole (Group A) achieved an overall efficacy of 99.4% for the three parasite species. The herbal product (Group B) achieved efficacies ranging from less than zero to 11.6% for the three parasites, with worm counts not significantly different to the untreated controls. At present, commercially available herbal products claiming anthelmintic properties do not require licencing as veterinary medicinal products (Directive 2004/28/EC: see Article 17 and 33-38) and thus are not required to meet specific efficacy thresholds. Products which do not appear to deliver acceptable anthelmintic efficacy, are obviously a concern from many aspects but specifically from an animal welfare perspective.

Efficacy of allicin from garlic against Ascaridia galli infection in chickens.

The use of garlic as a treatment against helminth infections is increasing in organic layer farms in several European countries. Its efficacy against these parasites, however, has not been demonstrated thus far. Therefore, a study was conducted to determine the efficacy of a commercially available garlic product consisting of a high concentration of allicin (i.e., the main active component of garlic) against experimentally induced Ascaridia galli infection in chickens. In total, 450 Lohmann LSL-Classic cockerels were used. Group 1, the uninfected, untreated group, consisted of 50 chickens. Groups 2 to 5, each consisting of approximately 100 chickens, were inoculated with 300 embryonated A. galli eggs/chicken at 6 wk of age. Group 2 was not treated, whereas groups 3 through 5 were given daily individual oral treatments from 13 wk of age onward. Group 3 received the recommended dose of allicin for 2 wk, whereas group 4 received a 10-fold dose of allicin. Group 5 was given 10 mg of flubendazole/kg of BW for 1 wk. Necropsy of 20 birds of all groups was performed weekly between 13 and 16 wk of age to determine adult worm loads. Group 1 remained free of A. galli. The experimental infection in the other groups resulted in a mean adult worm load of approximately 16 worms/bird. No significant differences were observed in worm counts of the allicin-treated groups (groups 3 and 4) compared with the infected, untreated group (group 2) at any week (P > 0.05). In contrast, no worms were found in chickens after flubendazole treatment (group 5). It was concluded that allicin does not represent an alternative to flubendazole for the treatment of A. galli infections in chickens.

Effect of chemotherapeutic treatment on cytokine (IFN-gamma, IL-2, IL-4, IL-5, IL-10) gene transcription in response to specific antigens in Brugia malayi-infected Mastomys coucha.

Cytokine (interferon (IFN)-gamma, interleukin (IL)-2, IL-4, IL-5, IL-10) gene transcription in response to filarial antigens was determined in peripheral blood mononuclear cells of Brugia malayi-infected Mastomys coucha in the course of untreated and chemotherapeutically abbreviated infections. Transcript levels in infected untreated animals suggest particular time courses for the various cytokines with ongoing parasite development and differing efficacies of female, male, microfilarial, and L3 antigens in inducing cytokine gene transcription. Gene transcription of both of Th1- and Th2-associated cytokines were initiated in the course of the infection in a manner that does not fit in a simple Th1-Th2 paradigm. IFN-gamma and IL-4 gene transcripts prevailed during prepatency. In case of the other cytokine genes considered in the study, transcription in general peaked around beginning of patency. During the phase of increasing microfilaremia (approximately 120-180 days p. i.) cytokine gene transcription was generally decreased. Later on, when the parasitemia had leveled off, except IFN-gamma, transcript levels often tended to increase. In chemotherapeutically treated animals, the outcome varied with the different efficacies of the drugs employed. The highly microfilaricidal cyclodepsipeptide BAY 44-4400 eliminated circulating microfilariae and partially sterilized adult worms without killing them. This kind of treatment hardly affected cytokine responses. In contrast, the therapy with Flubendazole, a selectively macrofilaricidal benzimidazole, and particularly the application of CGP 20376, a highly efficient microfilaricidal and macrofilaricidal benzthiazole, resulted in enhanced transcription of the Th1-associated IFN-gamma and IL-2 genes as well as of the Th2-associated IL-5 gene 2-3 months after treatment. IL-10 gene transcription seemed transiently increased after 1 month. There was no effect of any treatment on the IL-4 gene transcription.

Effect of oral dosing vehicles on the developmental toxicity of flubendazole in rats.

Flubendazole was suspended in deionized water or olive oil and administered by gavage once daily to pregnant rats on Days 8-15 of pregnancy to examine if the embryolethal and teratogenic doses were affected by the vehicles used. Flubendazole in olive oil caused a statistically significant increase in embryolethality at doses of 7.83 mg/kg per day and higher, with complete resorption in all dams at 31.33 mg/kg per day. When flubendazole was suspended in deionized water, a significant increase in embryolethality occurred only at a maternal dose of 125.32 mg/kg per day. The proportion of litters with anomalous fetuses was significantly increased at doses of 31.33 mg/kg per day and above when flubendazole was administered in deionized water, but increased at doses at four times lower when flubendazole was administered as in olive oil. Administered as a single dose in olive oil on any one of Days 6-12 of pregnancy, a flubendazole dose of 31.33 mg/kg caused significant increases in embryolethality and decreased fetal body weights on Days 7-9, with an 82.7% incidence of embryolethality on Day 8, with complete resorption in 5 of the 8 dams. The critical periods for teratogenic effects were between Days 8 and 11 of pregnancy, with Day 9 being the most critical. Fetuses with gross, skeletal, or internal anomalies were seen in dams given a single dose of as low as 7.83 mg/kg.

Basic studies on the laboratory assessment of macrofilaricides using Brugia malayi in the jird, Meriones unguiculatus. 2. Establishment and evaluation of a new method of macrofilaricide assessment.

Jird infected subcutaneously with infective stage larvae (L3) of Brugia malayi were evaluated as an animal model for assessing macrofilaricides using a method of observing the change in microfilaria (mf) density but not by recovering adult worms. The animals were treated with a test compound followed by diethylcarbamazine (DEC) at 50 mg/kg for 5 consecutive days for clearing the existing mf from the blood stream. A continuous decrease in mf density was observed when jirds were treated with flubendazole. Nevertheless, slow recovery of mf density was observed in the jirds which were given suramin or Mel W, indicating that mf productivity of female worms was continuing after DEC treatment. The results obtained by monitoring microfilaremia corresponded with those obtained by recovery of adult worms at autopsy, suggesting that the system of L3-induced B. malayi jird model is useful for testing macrofilaricides.

Effects of alcoholic extract from Ma-Klua (Diospyros mollis) on adults and larvae of the dwarf tapeworm, Hymenolepis nana in mice and on the infectivity of the eggs.

The anthelmintic effect of an alcoholic extract from a shrub, Diospyros mollis, popularly known as Ma-Klua in Thailand, on the adults and larvae of the dwarf tapeworm, Hymenolepis nana, in mice was studied in comparison with that of flubendazole. The experimentally infected mice were given a single oral dose of 10-1000 mg of Ma-Klua extract or flubendazole/kg body wt 1, 2, 3, 4, or 12 days post-infection and autopsied 14 days post-infection. Ma-Klua extract was effective in the elimination of adults (ED50 = 79 mg/kg) but not larvae. Drastic effects of Ma-Klua extract on the motility and structure of adults were observed and the number of the adults in mice decreased with time after administration of the drug 12 days post-infection. The small numbers of adults remaining in the host intestine 2 days after the drug administration showed severe damage in the gravid segments. These facts were thought to be responsible for the significant reduction in egg output observed 1 and 2 days after medication. Fresh eggs exposed to Ma-Klua extract in vitro and in vivo, or in vivo alone showed reduced infectivity. The effect of flubendazole on adults and larvae was minimal.

Clinical trials of broad spectrum anthelmintics against soil-transmitted helminthiasis.

Clinical trials on the three broad spectrum anthelmintics against trichuriasis, ascariasis and hookworm infection were carried out in a rural community in Irosin, Sorsogon. Flubendazole (Fluvermal) appears to be a promising drug against trichuriasis particularly when periodic mass treatment of a community is carried out. Mebendazole (Antiox) also appears to be promising given as single dose during mass treatment of soil-transmitted helminthiasis. As shown in previous studies, oxantel-pyrantel (Quantrel) should be given at 15 mg/kg body weight at 12-hour intervals or 20 mg/kg body weight single dose rather than 10 mg/kg body weight in a single dose when treating trichuriasis.