The anti-staphylococcal fusidic acid as an efflux pump inhibitor combined with fluconazole against vaginal candidiasis in mouse model.

BACKGROUND: Candida albicans is the most common fungus that causes vaginal candidiasis in immunocompetent women and catastrophic infections in immunocompromised patients. The treatment of such infections is hindered due to the increasing emergence of resistance to azoles in C. albicans. New treatment approaches are needed to combat candidiasis especially in the dwindled supply of new effective and safe antifungals. The resistance to azoles is mainly attributed to export of azoles outside the cells by means of the efflux pump that confers cross resistance to all azoles including fluconazole (FLC). OBJECTIVES: This study aimed to investigate the possible efflux pump inhibiting activity of fusidic acid (FA) in C. albicans resistant isolates and the potential use of Fusidic acid in combination with fluconazole to potentiate the antifungal activity of fluconazole to restore its activity in the resistant C. albicans isolates. METHODS: The resistance of C. albicans isolates was assessed by determination of minimum inhibitory concentration. The effect of Fusidic acid at sub-inhibitory concentration on efflux activity was assayed by rhodamine 6G efflux assay and intracellular accumulation. Mice model studies were conducted to evaluate the anti-efflux activity of Fusidic acid and its synergistic effects in combination with fluconazole. Impact of Fusidic acid on ergosterol biosynthesis was quantified. The synergy of fluconazole when combined with Fusidic acid was investigated by determination of minimum inhibitory concentration. The cytotoxicity of Fusidic acid was tested against erythrocytes. The effect of Fusidic acid on efflux pumps was tested at the molecular level by real-time PCR and in silico study. In vivo vulvovaginitis mice model was used to confirm the activity of the combination in treating vulvovaginal candidiasis. RESULTS: Fusidic acid showed efflux inhibiting activity as it increased the accumulation of rhodamine 6G, a substrate for ABC-efflux transporter, and decreased its efflux in C. albicans cells. The antifungal activity of fluconazole was synergized when combined with Fusidic acid. Fusidic acid exerted only minimal cytotoxicity on human erythrocytes indicating its safety. The FA efflux inhibitory activity could be owed to its ability to interfere with efflux protein transporters as revealed by docking studies and downregulation of the efflux-encoding genes of both ABC transporters and MFS superfamily. Moreover, in vivo mice model showed that using fluconazole-fusidic acid combination by vaginal route enhanced fluconazole antifungal activity as shown by lowered fungal burden and a negligible histopathological change in vaginal tissue. CONCLUSION: The current findings highlight FA's potential as a potential adjuvant to FLC in the treatment of vulvovaginal candidiasis.

New pyrrolidine-carboxamide derivatives as dual antiproliferative EGFR/CDK2 inhibitors.

Cancer is one of the leading causes of mortality worldwide, making it a public health concern. A novel series of pyrrolidine-carboxamide derivatives 7a-q were developed and examined in a cell viability assay utilizing a human mammary gland epithelial cell line (MCF-10A), where all the compounds exhibited no cytotoxic effects and more than 85% cell viability at a concentration of 50 µM. Antiproliferative activity was evaluated in vitro against four panels of cancer cell lines A-549, MCF-7, Panc-1, and HT-29. Compounds 7e, 7g, 7k, 7n, and 7o were the most active as antiproliferative agents capable of triggering apoptosis. Compound 7g was the most potent of all the derivatives, with a mean IC50 of 0.90 µM compared to IC50 of 1.10 µM for doxorubicin. Compound 7g inhibited A-549 (epithelial cancer cell line), MCF-7 (breast cancer cell line), and HT-29 (colon cancer cell line) more efficiently than doxorubicin. EGFR inhibitory assay results of 7e, 7g, 7k, 7n, and 7o demonstrated that the tested compounds inhibited EGFR with IC50 values ranging from 87 to 107 nM in comparison with the reference drug erlotinib (IC50 = 80 nM). 7e, 7g, 7k, 7n, and 7o inhibited CDK2 efficiently in comparison to the reference dinaciclib (IC50 = 20 nM), with IC50 values ranging from 15 to 31 nM. The results of inhibitory activity assay against different CDK isoforms revealed that the tested compounds had preferential inhibitory activity against the CDK2 isoform.

Free Salt Dyeing by Treatment of Cotton Fabric Using Carboxyethyl Chitosan and Synthesized Direct Dyes to Enhance Dyeing Properties and Antibacterial Activity.

AIM: The purpose of this paper is to synthesize and characterize two new direct dyes based on chromenes derivatives. BACKGROUND: The synthesis of carboxyethyl chitosan (CECS) by the reaction of chitosan and acrylic acid via Michael's addition reaction was conducted. Cotton fabrics were treated with CECS to enhance the exhaustion of dye, fastness properties, and antimicrobial activity of dyed fabric. METHODS: Chitosan (CS) and acrylic acid were combined in Michael's addition process to successfully produce N-carboxyethylchitosan (CECS). Then, the cotton was treated with different concentrations of carboxyethyl chitosan (0.5-5 wt.%) and then dyed by synthesized mono azo and diazo direct dyes based on chromene derivatives. RESULTS AND DISCUSSION: The results regarding dyeing and antibacterial activity indicated highquality dyeing properties, However, direct dyes showed higher exhaustion and fixation values, fastness properties, and the colorimetric CIE L*a*b* C*h° data of the dyed cotton fabric. CONCLUSION: Cotton fabrics treated with carboxyethyl chitosan and dyed with direct dyes were found to have higher antibacterial activity upon a concentration of 2.5 wt.%. In addition, the antibacterial activity towards Gram-positive bacteria was reported to be more than Gram-negative bacteria.

Discovery of new 5-substituted-indole-2-carboxamides as dual epidermal growth factor receptor (EGFR)/cyclin dependent kinase-2 (CDK2) inhibitors with potent antiproliferative action.

A new series of 5-substituted-3-ethylindole-2-carboxamides 5a-k and 6a-c was designed and synthesised in an attempt to develop a dual targeted antiproliferative agent. Various spectroscopic methods of analysis were used to confirm the structures of the new compounds. The antiproliferative effect of compounds 5a-k and 6a-c against four cancer cell lines was investigated. Compounds 5a-k and 6a-c had significant antiproliferative activity against the four cancer cell lines tested, with mean GI50 values ranging from 37 nM to 193 nM. The most powerful derivatives were compounds 5g, 5i, and 5j, with GI50 values of 55 nM, 49 nM, and 37 nM, respectively, in comparison to the reference erlotinib, which had a GI50 of 33 nM. The four most potent compounds, 5c, 5g, 5i, and 5j, were then investigated for their efficacy as EGFR inhibitors, and the findings showed that the tested compounds inhibited EGFR with IC50 values ranging from 85 nM to 124 nM when compared to the reference erlotinib (IC50 = 80 nM). Moreover, compounds 5c and 5g inhibited CDK2 with IC50 values of 46 ± 05 nM and 33 ± 04 nM, respectively. The EGFR and CDK2 assays revealed that compounds 5i and 5j displayed potent antiproliferative activity and can be considered as potential dual EGFR and CDK2 inhibitors.

Toxicity bioassay and sub-lethal effects of profenofos-based insecticide on behavior, biochemical, hematological, and histopathological responses in Grass carp (Ctenopharyngodon idella).

Profenofos (organophosphate) is among the major toxicant polluting freshwater bodies, exerting a significant effect on fish health. The LC50 value of Profenofos (PRO) was resolved in Grass carp (Ctenopharyngodon idella) with average body weight (55.82 ± 5.42 g) and determined the 96 h LC50 value as 7.2 µg/L for the assay. Twenty-one-day exposures to 1.8 µg/ L and 3.6 µg/ L doses were conducted to evaluate the sub-lethal effects, and various toxicological endpoints were assessed on the 1st, 7th, 15th and 21st days of exposure. Acute toxic stress was observed with fish displaying behavioral toxicity. The most hematological change was extreme microcytic hypochromic anemia. Leucocyte count increased in experimented fish. Moderate neutrophilia, monocytosis and lymphocytosis were observed. Serum total protein, albumin, and globulin concentrations were significantly diminished. Overall, increments over control were recognized in serum urea, creatinine and acid phosphatase. However, serum glucose, total lipid, cholesterol, serum ALT and AST activity showed a significant decrease in fish exposed to both concentrations of PRO. Serum IgM concentrations insignificantly changed in treated fish except for on the 21st day of exposure to 3.6 µg/ L of PRO, while serum lysozyme significantly decreased. Furthermore, total protein, lipid and glycogen concentrations in muscles and the liver exhibited a decreasing trend at all concentrations. Moreover, histopathological alterations in the liver, kidney, and muscles occurred exclusively after treatment. From the obtained results, it is assumed that profenofos induced general toxic impacts under field conditions and might disturb ecologically relevant processes.

Synthesis, Application and Antimicrobial Activity of New Acid Dyes Based on 3-Amino-2-thioxo-4-thiazolidinone Nucleus on Wool and Silk Fabrics.

The dyes are synthesized by 3-Amino-2-thioxo-4thiazolidinone (N-Amino rhodanine) with glutaraldehyde or terephthalaldehyde by 2:1 mole to form a and b then coupled with diazonium salts p- Amino benzenesulfonic acid and 4-Amino 3,4-disulfoazobenzeneazobenzene by 2:1 to form new different bis-mono-azo a1 and b1 and diazo a2 and b2 acid dyes. Therefore, the synthesized dyes were applied to both silk and wool fabric materials. We also evaluated the antimicrobial susceptivity of these dyed fabrics to two model gram-negative and gram-positive bacteria. Further, the chemical composition of these dyes is emphasized by an elemental analysis. AIMS: This paper aims to synthesize and apply dye and antimicrobial to four new acid dyes based on derivatives of N-Amino rhodanine as a chromophoric group. Then, these dyes are used in dyeing silk and wool which have good lightfastness, and are also excellent for washing, rubbing and sweating fastness. Also, we measure antimicrobial susceptivity of silk and wool fabrics to Gram-negative and Gram-positive bacteria. BACKGROUND: The new synthetic acid dyes, which have antimicrobial susceptivity to gram-negative and gram-positive bacteria, are mostly used on silk and wool fabrics which are excellent for lightfastness, washing, rubbing and sweating fastness. OBJECTIVES: The present studies aimed at synthesis, characterization and antimicrobial susceptivity to gramnegative and gram-positive bacteria. METHODS: The infra-red spectrum was recorded using an Infra-red spectrometer, Perkin Elmer/1650 FTIR. The 1H-NMR spectra were recorded using a Varian 400MHz spectrometer. The absorbance of the dyes was measured in the ultraviolet-visible region between 300 and 700 nm by a UNICAM UV spectrophotometer. The dye uptake by wool and silk fabrics was measured using a Shimadzu UV-2401PC (UV/V is spectrophotometer at λmax) before and after dyeing. The produced dyes were found to have a good antimicrobial susceptivity to a variety of bacteria. RESULTS AND DISCUSSION: The compounds a1, b1, a2 &b2 show good antimicrobial activity toward gramnegative (E. coli), gram-positive (S. aurous) bacteria. The data showed that exhaustion and fastness activities of silk and wool dyed fabrics were both very high. CONCLUSION: In this work, we prepared newly synthesized acid dyes based on 3-Amino-2-thioxo-4- thiazolidinone derivatives and used them for dyeing wool and silk fabrics. Both synthetic dyes have shown good lightfastness and fastness properties. Also, all dyes have shown a good antimicrobial effect.

Optimization and SAR investigation of novel 2,3-dihydropyrazino[1,2-a]indole-1,4-dione derivatives as EGFR and BRAFV600E dual inhibitors with potent antiproliferative and antioxidant activities.

Using a single drug to treat cancer with dual-targeting is an unusual approach when compared to other drug combinations. Dual-targeting agents were developed as a result of insufficient efficacy and drug resistance when single-targeting agents were used. As a result, the 2,3-dihydropyrazino[1,2-a]indole-1,4-dione derivatives 13-22 have been developed as dual EGFR and BRAFV600E inhibitors. The target compounds were synthesized and tested in vitro against four cancer cell lines, with compounds 15, and 19-22 demonstrating potent antiproliferative activity. In vitro studies revealed that these compounds have dual inhibitory effect on EGFR and BRAFV600E. Compounds 15, and 19-22 exhibited inhibitions of EGFR with IC50 ranging from 32 nM to 63 nM which were superior to erlotinib (IC50 = 80 ± 10 nM). Compounds 20, 21 and 22 showed promising inhibitory activity of BRAFV600E (IC50 = 55, 45 and 51 nM, respectively) and were found to be potent inhibitors of cancer cell proliferation (GI50 = 51, 35 and 44 nM, respectively). Compounds 20, 21 and 22 showed good antioxidant activity comparable to the reference Trolox. Lastly, the best active dual inhibitors were docked inside EGFR and BRAFV600E active sites to clarify their binding modes.

Synthesis, Application, and Antibacterial Activity of New Direct Dyes based on Chromene Derivatives.

AIMS: This study aimed at synthesizing, analyzing, and utilizing two new direct dyes based on chromene derivatives as the chromophoric moiety in dyeing wool, silk, and cotton, with good color strength, light fastness, and other desirable features. BACKGROUND: New direct dyes with antimicrobial activities for Gram-positive, Gram-negative bacteria, and fungus are being developed. These dyes are used on cotton, silk, and wool materials, which have excellent light fastness, washing, rubbing, and perspiration fastness. METHODS: All dyeing fabrics were tested for antibacterial activity. As a part of the experiment, parent structure 1 was previously synthesized. Then, diazotization and coupling reactions were used to prepare these dyes. RESULTS AND DISCUSSION: P-Aminobenzenesulfonic acid (C1) and 4-Aminoazobenzene-3,4'-disulfonic acid (C2) were diazotized in hydrochloric acid with sodium nitrite and then coupled with compound 1 in a molar ratio of 1:1 at 25 °C until the pH was fixed at 5. Finally, the monoazo and diazo direct dyes (D1 and D2) were prepared. CONCLUSION: Wool, silk, and cotton materials benefit from the increased antibacterial activities and dyeing qualities (exhaustion and fixing) of synthetic dyes. Furthermore, they offer excellent fastness qualities (light, rubbing, and perspiration).

Discovery of novel oxazole-based macrocycles as anti-coronaviral agents targeting SARS-CoV-2 main protease.

We have discovered a family of synthetic oxazole-based macrocycles to be active against SARS-CoV-2. The synthesis, pharmacological properties, and docking studies of the compounds are reported in this study. The structure of the new macrocycles was confirmed by NMR spectroscopy and mass spectrometry. Compounds 13, 14, and 15a-c were evaluated for their anti-SARS-CoV-2 activity on SARS-COV-2 (NRC-03-nhCoV) virus in Vero-E6 cells. Isopropyl triester 13 and triacid 14 demonstrated superior inhibitory activities against SARS-CoV-2 compared to carboxamides 15a-c. MTT cytotoxicity assays showed that the CC50 (50% cytotoxicity concentration) of 13, 14, and 15a-c ranged from 159.1 to 741.8 µM and their safety indices ranged from 2.50 to 39.1. Study of the viral inhibition via different mechanisms of action (viral adsorption, replication, or virucidal property) showed that 14 had mild virucidal (60%) and inhibitory effects on virus adsorption (66%) at 20 µM concentrations. Compound 13 displayed several inhibitory effects at three levels, but the potency of its action is primarily virucidal. The inhibitory activity of compounds 13, 14, and 15a-c against the enzyme SARS-CoV-2 Mpro was evaluated. Isopropyl triester 13 had a significant inhibition activity against SARS-CoV-2 Mpro with an IC50 of 2.58 µM. Large substituents on the macrocyclic template significantly reduced the inhibitory effects of the compounds. Study of the docking of the compounds in the SARS CoV-2-Mpro active site showed that the most potent macrocycles 13 and 14 exhibited the best fit and highest affinity for the active site binding pocket. Taken together, the present study shows that the new macrocyclic compounds constitute a new family of SARS CoV-2-Mpro inhibitors that are worth being further optimized and developed.

Novel 1,5-diaryl pyrazole-3-carboxamides as selective COX-2/sEH inhibitors with analgesic, anti-inflammatory, and lower cardiotoxicity effects.

COX-2 selective drugs have been withdrawn from the market due to cardiovascular side effects, just a few years after their discovery. As a result, a new series of 1,5-diaryl pyrazole carboxamides 19-31 was synthesized as selective COX-2/sEH inhibitors with analgesic, anti-inflammatory, and lower cardiotoxic properties. The target compounds were synthesized and tested in vitro against COX-1, COX-2, and sEH enzymes. Compounds 20, 22 and 29 exhibited the most substantial COX-2 inhibitory activity (IC50 values: 0.82-1.12 µM) and had SIs of 13, 18, and 16, respectively, (c.f. celecoxib; SI = 8). Moreover, compounds 20, 22, and 29 were the most potent dual COX-2/sEH inhibitors, with IC50 values of 0.95, 0.80, and 0.85 nM against sEH, respectively, and were more potent than the standard AUDA (IC50 = 1.2 nM). Furthermore, in vivo studies revealed that these compounds were the most active as analgesic/anti-inflammatory derivatives with a good cardioprotective profile against cardiac biomarkers and inflammatory cytokines. Finally, the most active dual inhibitors were docked inside COX-2/sEH active sites to explain their binding modes.

Design, synthesis, and biological evaluation of novel EGFR inhibitors containing 5-chloro-3-hydroxymethyl-indole-2-carboxamide scaffold with apoptotic antiproliferative activity.

New EGFR inhibitor series of fifteen 5-chloro-3-hydroxymethyl-indole-2-carboxamide derivatives has been designed, synthesized, and tested for antiproliferative activity against a panel of cancer cell lines. The results showed that p-substituted phenethyl derivatives 10, 11, 13, 15 and 17-19 showed superior antiproliferative activity compared to their m-substituted counterparts 12, 14, 16 and 20. Compounds 15, 16, 19 and 20 displayed promising EGFR inhibitory activity as well as an increase in caspase 3 levels. Compounds 15 and 19 increased caspase-8 and 9 levels, as well as inducing Bax and decreasing Bcl-2 protein levels. Compound 19 demonstrated cell cycle arrest at pre-G1 and G2/M phases. The results of the docking study into the active site of EGFR revealed strong fitting of the new compounds with higher binding affinities compared to erlotinib.

Oxidative Stress Influences Pseudomonas aeruginosa Susceptibility to Antibiotics and Reduces Its Pathogenesis in Host.

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes serious infections in humans, notably cystic fibrosis. P. aeruginosa faces various stresses such as oxidative stress either in the environment or within the host during infection. In the present study, the influence of oxidative stress on both Pseudomonas antibiotic susceptibility and host pathogenesis was characterized. Prior exposure to H2O2 significantly altered P. aeruginosa susceptibility to tested antibiotics; colistin, ciprofloxacin, tobramycin, and ceftazidime. The minimum inhibitory concentrations (MICs) of tested antibiotics either increased or decreased following H2O2 exposure. Importantly, RT-qPCR revealed that expression of quorum sensing genes, that regulate virulence factors production in P. aeruginosa, was significantly higher in unstressed relative to H2O2-stressed cells. The impact of P. aeruginosa exposure to oxidative stress by H2O2 on bacterial pathogenesis was investigated using in vivo mice infection model. Interestingly, exposure to oxidative stress markedly reduces P. aeruginosa pathogenesis in mice. Unstressed P. aeruginosa was able to kill more mice as compared to H2O2-stressed bacteria. In addition, body weight of mice infected with unstressed P. aeruginosa was lower than that of mice inoculated with stressed bacteria. Isolated organs (spleen, liver, and kidney) from mice infected with unstressed bacteria exhibited increased weight as well as bacterial load in comparison with mice infected with stressed bacteria. In summary, current data highlight the impact of oxidative stress on P. aeruginosa antibiotic susceptibility as well as host pathogenesis. These findings could be helpful in treatment of infections caused by this important pathogen.

Impaired metabolic and hepatic functions following subcutaneous lipectomy in adult obese rats.

NEW FINDINGS: What is the central question of this study? What is the impact and drawbacks of subcutaneous lipectomy on body metabolism? What is the main finding and its importance? Subcutaneous lipectomy resulted in deterioration of hepatic functions, atherosclerotic lipid profile and disturbed redox state. While the results support lipectomy as an effective treatment for obesity, lipectomy induces unfavourable changes in health. ABSTRACT: The number of obese older adults is on the rise, but data about proper treatment of obesity in the elderly is controversial. The present study was designed to investigate the effectiveness and consequences of partial subcutaneous lipectomy, as a rapid medical intervention against increased accumulation of body fat, in adult obese rats. The study was conducted on adult (9-12 months) female rats, in which obesity was induced by bilateral surgical ovariectomy. They were randomized into two main groups: short term (5 weeks) and long term (10 weeks). Both groups were subdivided into control, ovariectomized (OVX) and ovariectomized lipectomized groups. Body weight (BW) was measured and body mass index (BMI) calculated. Fasting blood glucose, lipid profile and plasma levels of total proteins, albumin, liver enzymes, malondialdehyde (MDA), leptin and adiponectin were determined. The content of both blood and hepatic tissue of reduced glutathione was estimated. In addition, histological study of the liver, aorta and peri-renal fat was performed. Compared to controls, OVX rats showed significant increase in BW, BMI and plasma levels of liver enzymes, MDA and leptin. Histological study revealed vacuolated ballooned hepatocytes and enlarged irregular visceral adipocytes with atherosclerotic changes in the wall of aorta. Following subcutaneous lipectomy, rats exhibited significant fasting hyperglycaemia, dyslipidaemia, lowered plasma albumin and disturbed redox state with aggravation of the histological changes. The findings indicate that although subcutaneous lipectomy appears to be effective in combating obesity in older females, it has unfavourable effects on both metabolic and hepatic functions.

Ultrasound-guided insulin injection for carpal tunnel syndrome in type 2 diabetes mellitus patients.

OBJECTIVE: To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM). METHOD: Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. All injections were performed with ultrasonographic guidance. All patients were assessed by modified Boston Carpal Tunnel Questionnaire (FD score), CTS severity score (SS score), and neurophysiological and ultrasonographic assessments at baseline and 10 weeks after treatment. RESULTS: A significant improvement in mean FD score, SS score, DML (distal motor latency), SNCV (sensory nerve conduction velocity), PSL (peak sensory latency), Samp (sensory amplitude), and CSA (cross-sectional area of median nerve) observed in all groups (with exception of mean DML and Samp in the second group and mean Samp in the third group). Group III showed significant improvement in CSA especially when compared to group II by post hoc analysis (P = 0.005). CONCLUSIONS: Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 DM and is a safer alternative. Adding insulin injections after steroid shows more sonographic improvement than steroid alone. Key Points • Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 diabetic patients. • Measuring CSA of median nerve at CT inlet by US is a better tool for monitoring median nerve changes after treatment. • Adding insulin injections after steroid has more sonographic improvement than steroid alone.

Urinary angiostatin, CXCL4 and VCAM-1 as biomarkers of lupus nephritis.

BACKGROUND: The aim was to study urinary angiostatin, CXC chemokine ligand 4 (CXCL4) and vascular cell adhesion molecule-1 (VCAM-1) as biomarkers of renal disease in systemic lupus erythematosus (SLE). METHOD: Patients who fulfilled ≥ 4 American College of Rheumatology (ACR) criteria for SLE with active renal, active non-renal or inactive disease, and a group of healthy controls were studied. Urine samples were assayed for angiostatin, CXCL4 and VCAM-1 by ELISA, and normalized by creatinine. Receiver operating characteristic analysis was performed to obtain the best cutoff values to calculate the performance of these markers in differentiating the different groups of patients as compared to anti-double-stranded DNA (anti-dsDNA) and complement C3. Correlation between these urinary biomarkers and various renal parameters was also tested. RESULTS: Patients with SLE (n = 227; 80 with inactive SLE, 67 with active non-renal disease and 80 with active renal disease; 94% women; age 39.2 ± 13.8 years) and 53 controls (96% women) were studied. All were ethnic Chinese. Urinary angiostatin, CXCL4 and VCAM-1 (normalized for creatinine) were significantly higher in patients with active renal disease than in patients with active non-renal disease, patients with inactive SLE and controls. These markers correlated significantly with total SLE disease activity index (SLEDAI) and renal SLEDAI scores, and with the urinary protein-to-creatinine ratio. Urine angiostatin exhibited higher specificity and sensitivity in differentiating active renal from active non-renal SLE (area under the curve (AUC) 0.87) than serum anti-dsDNA/C3. Urine CXCL4 (AUC 0.64) and VCAM-1 (AUC 0.73), on the other hand, performed similarly to anti-dsDNA/C3. All three markers performed comparably to anti-dsDNA/C3 in distinguishing active from inactive SLE. In a subgroup of 68 patients with paired renal biopsy, the urinary levels of these proteins did not differ significantly between the proliferative and non-proliferative types of lupus nephritis. Urinary CXCL4 and VCAM-1 correlated significantly with the histologic activity score, and urinary angiostatin correlated significantly with proteinuria in this subgroup. CONCLUSIONS: Urinary angiostatin, CXCL4 and VCAM-1 are potential biomarkers for SLE, in particular lupus nephritis. Further longitudinal studies are necessary to delineate the performance of these markers in predicting renal flares and prognosis in SLE patients.

Urine angiostatin and VCAM-1 surpass conventional metrics in predicting elevated renal pathology activity indices in lupus nephritis.

AIM: The goal of this study is to investigate how urinary angiostatin, vascular cell adhesion molecule 1 (VCAM-1) and established measures of renal function relate to specific histologic findings in paired kidney biopsy samples from patients with lupus nephritis (LN). METHOD: Urine samples were collected from 54 LN patients together with paired kidney biopsy samples and examined for urinary angiostatin and VCAM-1 protein levels. Nonparametric tests were used to examine the association of both urinary biomarkers and established traditional laboratory markers of renal function with nine specific renal histologic features seen in LN, including glomerular leukocyte infiltration, endocapillary proliferation, cellular crescents, fibrinoid necrosis, wire loops, interstitial inflammation, glomerulosclerosis, fibrous crescents, tubular atrophy and interstitial fibrosis. RESULTS: Compared to traditional renal disease metrics, both urinary angiostatin and VCAM-1 exhibited outstanding potential (area under the curve 0.97, 0.98, respectively) to predict renal biopsy activity index score ≥ 7, which is associated with poor long-term prognosis. Whereas urine VCAM-1 was most significantly associated with fibrous crescents, urine angiostatin was most significantly associated with endocapillary proliferation, cellular crescents, fibrinoid necrosis and fibrous crescents in concurrent renal biopsies. CONCLUSION: Urinary angiostatin and VCAM-1 are predictive of specific histological changes in concurrent LN renal biopsies. Both urinary biomarkers are good candidates for use as noninvasive measures of renal pathology activity changes in LN.

Sickle cell disease in western Sudan: genetic epidemiology and predictors of knowledge attitude and practices.

OBJECTIVE: To investigate the epidemiology of sickle cell disease (SCD) and determinants of knowledge, attitudes and practices (KAP) towards SCD in western Kordofan State, Sudan. METHODS: A community-based, descriptive, cross-sectional study was conducted in three towns. Three hundred and seventy-two households were polled, and blood samples for haemoglobin phenotyping were collected from 1116 individuals. Sociodemographic, socio-economic and KAP data were collected using investigator-administered questionnaires. Descriptive, frequency distribution and multiple regression analyses were performed. RESULTS: About 50.9% of the study population were Misseriya tribes. Consanguineous marriages were reported by 67.5% of the households. The highest percentage of homozygous SCD was 2.8% among children under 5 years of age. About 24.9% were carriers of HbS allele (HbAS). HbS allele frequency was highest in children aged 5-11 years (18.3%, CI: 13.7-22.9%) and lowest in males >15 years old (12.0%, CI: 6.1-17.9%). The average HbS frequency across all age groups was 14.5% (95% CI: 12.2-16.8%). The most frequent ß-globin gene cluster haplotype was the Cameroon (30.8%), followed by the Benin (21.8%), the Senegal (12.8%) and the Bantu (2.2%) haplotypes. About 17.0% of all-cause child deaths were due to SCD. The estimated change in log odds of having the SS genotype per year increase in age was (-) 0.0058 (95% CI -0.0359, 0.0242). This represents a non-statistically significant 2.9% increase in 5-year mortality for individuals with the SS genotype relative to those with AS and AA genotypes. About 46.9% of the households had poor knowledge, 26.1% had satisfactory knowledge, and 26.9% had good knowledge about sickle cell disease. Mothers' and fathers' educational levels were significant predictors of good knowledge about SCD (P < 0.05). About 48.0% had a satisfactory attitude towards sickle cell disease while 30.7% had poor attitude and only 21.3 showed good attitudes. Poor knowledge about SCD and low socio-economic status were the strongest positive predictors of poor attitude and practices towards SCD (P < 0.01). CONCLUSIONS: Sickle cell disease is a major health problem in West Kordofan, Sudan. Knowledge, attitude and practices towards the disease are not satisfactory. The development of public health programs is highly recommended to control and manage SCD in western parts of Sudan.