The limitations of dermoscopy: false-positive and false-negative tumours.

Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumours, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically 'false-positive' and 'false-negative' tumours do exist. False-positive diagnosis usually leads to unnecessary excisions. False-negative diagnosis is much more dangerous, as it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false-negative tumours. The most frequent benign tumours that might acquire dermatoscopic characteristics suggestive of malignancy are seborrhoeic keratosis (SK), including solar lentigo, melanoacanthoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumours and naevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumours are the following: solar lentigo - broad network; melanoacanthoma - sharp border; irritated SK - regularly distributed white perivascular halos; clonal SK - classic SK criteria; regressive SK - remnants of SK; targetoid haemosiderotic haemangioma - dark centre and reddish periphery; thrombosed angioma - sharp demarcation; angiokeratoma - dark lacunae; atypical dermatofibromas - palpation; follicular tumours - white colour; sebaceous tumours - yellow colour; Clark naevi - clinical context; Spitz/Reed naevi - age; combined naevi - blue central area; recurrent naevi - pigmentation within the scar; sclerosing naevi - age and location on the upper back; blue naevi - history. Malignant tumours that might mimic benign ones and escape detection are melanoma (in situ, nevoid, spitzoid, verrucous, regressive, amelanotic), squamous cell carcinoma (mainly well-differentiated variants) and rarely basal cell carcinoma (non-pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are as follows: melanoma in situ - irregular hyperpigmented areas; nevoid melanoma - history of growth; spitzoid melanoma - age; verrucous melanoma - blue-black sign; regressive melanoma - peppering or scar-like depigmentation; amelanotic melanoma - pink colour, linear irregular vessels, dotted vessels. In this article, we summarized the most frequent dermoscopic variations of common skin tumours that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses.

Metabolic profiling study of shikonin's cytotoxic activity in the Huh7 human hepatoma cell line.

Shikonin and its enantiomer alkannin, which are natural products, have been extensively studied in vitro and in vivo for, among others, their antitumor activity. The investigation of the molecular pathways involved in their action is of interest, since they are not yet clearly defined. Metabolic profiling in cells can provide a picture of a cell's phenotype upon intervention, assisting in the elucidation of the mechanism of action. In this study, the cytotoxic effect of shikonin on a human hepatocarcinoma cell line was studied. Huh7 cells were treated with shikonin at 5 µM, and it was found that shikonin markedly inhibited cell growth. Metabolic profiling indicated alterations in the metabolic content of the cells and the culture media upon treatment, detecting the metabolic response of the cells. This study demonstrates the potential of metabolomics to improve knowledge on the mechanisms involved in shikonin's antitumor action.

Sterically stabilized liposomes as a potent carrier for shikonin.

The ability of pegylated liposomes (sterically stabilized liposomes-SSL) to localize in solid tumors via the enhanced permeability and retention (EPR) effect, partly depends on their long circulating properties which can be achieved by grafting polyethylene glycol (PEG) to the liposomes' surface. Alkannin and shikonin (A/S) are naturally occurring hydroxynaphthoquinones with a well-established spectrum of wound healing, antimicrobial, anti-inflammatory, antioxidant, and recently established antitumor activity. The purpose of this work was to prepare and characterize shikonin-loaded pegylated liposomes as a new drug carrier for shikonin, as a continuation of authors' previous work on conventional shikonin-loaded liposomal formulations. Three new pegylated liposomal formulations of shikonin (DSPC-PEG2000, EPC-PEG2000, and DPPC-PEG2000) were prepared and characterized in terms of physicochemical characteristics, pharmacokinetics, and stability (at 4 °C, for 28 d) and compared with the corresponding conventional ones. Particle size distribution, ζ-potential, entrapment efficiency, and release profile of the entrapped drug were measured. Results indicated the successful incorporation of shikonin into liposomes alongside with their good physicochemical characteristics, high entrapment efficiency, satisfactory in vitro release profile, and good physical stability. The results are considered promising and could be used as a road map for designing further in vivo experiments.

Modeling of hyperbranched polyesters as hosts for the multifunctional bioactive agent Shikonin.

We employ fully atomistic molecular dynamics simulations to study in detail the mechanisms involved in the non-covalent association of the bioactive agent Shikonin with the commercially available hyperbranched polyesters (Boltorn®), in ethanol solutions. We examine effects of the (pseudo)generation of the hyperbranched polyester and mimic two different concentrations, under conditions corresponding to excess drug availability. The two mechanisms participating in the polymer/drug complexation are hydrogen bonding and spatial constriction of the drug molecules within the hyperbranched structure. Based on static, as well as on dynamic information obtained by the analysis performed, it is demonstrated that apart from the size of the polyester, factors like the degree of structural flexibility, the intrapolymer hydrogen bonding and the polymer concentration may affect decisively the polyester/shikonin associative behavior, as well as the behavior of the drug-molecules in the solution. The results from the present study offer a detailed picture of the relative importance of those parameters affecting the complexation, and may serve as a basis for the understanding of the behavior of more complex multi-polyester systems.

Solid-phase extraction for purification of alkannin/shikonin samples and isolation of monomeric and dimeric fractions.

Isohexenylnaphthazarins (IHN), commonly known as alkannins and shikonins (A/S), are potent pharmaceutical substances with a wide spectrum of wound healing, antimicrobial, anti-inflammatory, and antitumor activity. Purification of A/S is crucial for their use in pharmaceuticals and for biological experimentation. Dimeric and oligomeric A/S derivatives co-exist with the active monomeric ones in most of the samples produced either by (semi)-synthesis or biotechnologically or isolated from natural products. Oligomeric A/S derivatives have not been studied for biological activity hitherto and a method to isolate them is essential.In the present study, solid-phase extraction (SPE) was applied for purification of commercial samples and isolation of monomeric and oligomeric A/S fractions, testing several stationary phases. Sephadex LH-20 cartridges achieved efficient purification for commercial samples containing both monomeric and dimeric A/S derivatives and also separation and isolation of both pure monomeric and dimeric A/S fractions for biological experiments. A high-performance liquid chromatography-diode array detection method was applied for detection, identification and quantification of monomeric and oligomeric shikonin fractions.

Alkannins and shikonins: a new class of wound healing agents.

Alkannins and Shikonins (A/S) are chiral-pairs of naturally occurring isohexenylnaphthazarins. They are found in the external layer of the roots of at least a hundred and fifty species that belong mainly to the genera Alkanna, Lithospermum, Echium, Onosma and Arnebia of the Boraginaceae family. Their occurrence in Jatropha glandulifera, a member of the Euphorbiaceae, should be considered as an exception. Pharmaceutical formulations with wound healing properties based on A/S have been in the market for many years. Although their wound-healing, anti-inflammatory, antimicrobial, antioxidant, antithrombotic and antitumor properties have been extensively documented, significant insight into their specific molecular pathways and mechanisms was hindered until recently. With the establishment of viable synthetic and biosynthetic routes of A/S and the synthesis of specific derivatives that were discovered the last few years, the effects of those compounds in the molecular-cell biology of human tissues in health and disease have just started being explored in depth, revealing a new class of drugs that hold promise as the basis for many valuable therapeutic targets. In the recent years, a wealth of new information arising from research efforts, on the wound healing properties of A/S has been accumulated. In this paper we review the findings and advances on the molecular and biological properties of A/S that promote wound healing.

Detection of hereditary bisalbuminemia in a Greek family by capillary zone electrophoresis.

It is presented herein a case of a family, four members of which suffer from hereditary bisalbuminemia. The abnormality was initially detected in a 29-year old male, by serum protein electrophoresis (SPE), during the investigation for possible multiple sclerosis. SPE also revealed the presence of a double albumin band in sera of the patient's sister, father and grandmother, almost confirming the inherited (genetic) form of bisalbuminemia. Possible causes related with the acquired form of bisalbuminemia were excluded for all examined individuals. SPE was performed by both automatic capillary zone electrophoresis and agaroze gel electrophoresis. All tested samples were immunofixated with special antisera, in order to exclude the presence of monoclonal fractions. Total albumin, total proteins and immunoglobulins varied in normal ranges. The relative mobility of the albumin variant was determined by a simple mixing experiment, which gave evidence of the fast-type form of inherited bisalbuminemia. This is the first report of hereditary bisalbuminemia in Greece.

Unsuspected breast carcinoma presenting as orbital complication of rhinosinusitis.

We report a rare clinical presentation of breast carcinoma metastasis to the ethmoid sinuses, orbit and cavernous sinus in a 70-year-old lady with unsuspected breast carcinoma who presented with clinical features of acute ethmoiditis, orbital cellulitis and cavernous sinus thrombosis. The patient underwent endoscopic ethmoidectomy and histology of the necrotic tissue from the ethmoidal cells was positive for endovascular neoplastic emboli. Subsequent examination revealed a large mass in the left breast, tethered to the skin, which was histologically confirmed to be a carcinoma. The patient died 2 months post-diagnosis. To our knowledge, this is the third case manifesting with combined features of ethmoiditis, orbital cellulitis and cavernous sinus syndrome from an unsuspected breast carcinoma. This case highlights the importance of imaging and thorough physical examination when a dramatic clinical picture presents in the paranasal sinuses of an otherwise healthy individual. Such manifestation of breast carcinoma is difficult to diagnose, and therefore, a high index of suspicion should be maintained. Skull base metastases from breast carcinoma behave aggressively and if diagnosed early, treatment may prolong survival and improve quality of life.

Simultaneous determination of monomeric and oligomeric alkannins and shikonins by high-performance liquid chromatography-diode array detection-mass spectrometry.

Alkannin and shikonin (A/S) derivatives have been found in the roots of several Boraginaceous species and are produced through plant tissue cultures. The chiral compounds alkannins and shikonins are potent pharmaceutical substances with a wide spectrum of pharmacological activities such as wound healing, antimicrobial, anti-inflammatory, anticancer and antioxidant. Although oligomeric A/S derivatives have been detected in root extracts and commercial samples their detection and determination through high-performance liquid chromatography has not been reported. Therefore, in the present study a rapid, simple high-performance liquid chromatography-diode array detection-mass spectrometry (HPLC-DAD-MS) method was developed to detect, separate and determine monomeric and oligomeric/polymeric derivatives of alkannin/shikonin simultaneously for the first time. An optimization of HPLC-DAD parameters was performed. Both atmospheric pressure chemical ionization (APCI) and electrospray ionization (ESI) modes were applied, in order to compare detection of monomeric and oligomeric A/S. Additionally, oligomeric A/S constituents in several samples were identified and the mode of A/S polymerization was proposed.

Analysis of alkannin derivatives from Alkanna species by high-performance liquid chromatography/photodiode array/mass spectrometry.

Alkannin, shikonin (A/S) and their derivatives are enantiomeric hydroxynaphthoquinone red pigments found in the roots of almost 150 species of the Boraginaceae family. A/S have been shown to exhibit strong wound healing, antimicrobial, anti-inflammatory and antioxidant activities and recent extensive research has well established their antitumor properties. A/S and their derivatives comprise the active ingredients of several pharmaceutical and cosmetic preparations. Although A/S have been efficiently synthesized and have been produced by cell tissue cultures in high yield, most of the pharmaceutical preparations worldwide contain A/S extracted from the roots of Boraginaceous species, found in nature. In the present study, a high-performance liquid chromatography/photodiode array/mass spectrometry (HPLC/PDA/MS) method was established to identify monomeric hydroxynaphthoquinones of the alkannin series and other metabolites from Boraginaceous root extracts. This method can be applied for the identification of alkannin derivatives and other metabolites from Boraginaceous cell cultures, and also to determine active ingredients in pharmaceutical preparations containing A/S derivatives. A phytochemical investigation of the Alkanna genus grown in Greece was also performed. Fifty-three root samples belonging to 10 species of the genus Alkanna (A. calliensis, A. corcyrensis, A. graeca, A. methanaea, A. orientalis, A. pindicola, A. primuliflora, A. sieberi, A. stribrnyi and A. tinctoria) were collected from several regions of the Greek flora and analyzed for their constituent hydroxynaphthoquinones and other metabolites. In most of the above Alkanna samples tested, the main hydroxynaphthoquinones were determined to be beta,beta-dimethylacrylalkannin, isovalerylalkannin + alpha-methyl-n-butylalkannin and acetylalkannin. The hydroxynaphthoquinone constituents and their proportions were found to vary among Alkanna species. Unknown metabolites (not monomeric hydroxynaphthoquinones) were detected by HPLC-PDA-MS, while in several Alkanna species hydroxynaphthoquinones were detected for the first time.

Radical scavenging activity of Crocus sativus L. extract and its bioactive constituents.

Radical scavenging activity is involved in aging processes, antiinflammatory, anticancer and wound healing activity. Hence, in the present study the DPPH radical scavenging activity of a natural product that possesses biological properties, an extract of Crocus sativus L. (saffron), grown in Crocos, Kozani (Greece), and some of its bioactive constituents (crocin, safranal) was studied. It was shown that a methanol extract of Crocus sativus exhibited high antioxidant activity, although it contains several active and inactive constituents. In trying to approximate a structure-activity relationship, two bioactive constituents of saffron extract were tested, namely crocin and safranal. Crocin showed high radical scavenging activity (50% and 65% for 500 and 1,000 ppm solution in methanol, respectively), followed by safranal (34% for 500 ppm solution). All the tested samples showed high radical scavenging activity, probably due to the ability to donate a hydrogen atom to the DPPH radical.Thus, saffron grown in Greece can be used promisingly in functional foods, drinks with antioxidant activity, in pharmaceutical and cosmetic preparations for their antioxidant activity and probably for their antiaging activity. Saffron can also be used internally in the form of powder or other pharmacotechnical formulae as a food supplement with antioxidant properties.

Radical scavenging activity of Alkanna tinctoria root extracts and their main constituents, hydroxynaphthoquinones.

Alkannin and shikonin (A[sol ]S) are pharmaceutical substances with a wide spectrum of biological properties. Radical scavenging activity is involved in aging processes, antiinssammatory, anticancer and wound healing activities. Hence, in the present study the DPPH radical scavenging activity of alkannin and shikonin, both monomeric and oligomeric, and extracts of Alkanna tinctoria roots were studied and a structure-activity relationship was approximated. It was shown that both monomeric and oligomeric alkannin and shikonin and also A[sol ]S esters exhibited extremely high radical scavenging activity. The presence of the naphthoquinone moiety seems to be essential for that activity, while the side chain of A[sol ]S possibly plays a minor role. Esterification of A[sol ]S on the side chain hydroxyl group does not affect radical scavenging activity. Organic solvents and olive oil (extracted at room temperature) extracts of Alkanna tinctoria roots, which contain as active ingredients A[sol ]S esters, exhibited very good antiradical activity. Alkannin and shikonin and their esters and also extracts of Alkanna tinctoria roots could be used promisingly in pharmaceutical and cosmetic preparations for their radical scavenging activity and probably for their antiaging activity.

GC-MS analysis of penta- and tetra-cyclic triterpenes from resins of Pistacia species. Part II. Pistacia terebinthus var. Chia.

Pistacia species contain oleoresins with bioactive triterpenes. In this study triterpenes, including minor components, were identified and quantified in both neutral and acidic fractions of Pistacia terebinthus var. Chia resin, grown exclusively in Chios island (Greece), collected traditionally, as well as using stimulating agents (liquid collection). It was proved that these two resin samples were composed of several different minor triterpenes, while major constituents were similar but in different proportions. Compounds that differentiated two resin samples of P. lentiscus and P. terebinthus var. Chia, both traditionally collected, were detected, in order to identify the nature of resins present in archaeological materials. In the traditionally collected resin, 37 triterpenes were identified, 12 in the acidic and 25 in the neutral fraction. In the liquid collection resin 10 compounds were identified in the acidic and 23 in the neutral fraction, while 16 compounds were not contained in the traditionally collected resin. The main triterpenes in both resin samples collected traditionally and using stimulating agents were: isomasticadienonic acid (23.6 and 26.3% w[sol ]w of the triterpenic fraction, respectively), 28-norolean-17-en-3-one (16.3 and 17.5% w[sol ]w of the triterpenic fraction, respectively) and masticadienonic acid (5.8 and 6.0% w[sol ]w of the triterpenic fraction). In this study the qualitative and quantitative composition of triterpenes was compared in the Pistacia lentiscus and P. terebinthus var. Chia resin samples collected with the traditional and new liquid techniques, and also triterpenes in resins of P. terebinthus obtained by the traditional technique and using stimulating agents. The aim of the study was also to examine whether the collection technique influenced the triterpenes contained in P. terebinthus var. Chia resin samples.

GC-MS analysis of penta- and tetra-cyclic triterpenes from resins of Pistacia species. Part I. Pistacia lentiscus var. Chia.

Pistacia species contain oleoresins with bioactive triterpenes. In this study triterpenes, including minor components, were identified and quantified in both neutral and acidic fraction of Pistacia lentiscus var. Chia resin, grown exclusively in Chios island (Greece), collected traditionally, as well as by the use of stimulating agents (liquid collection). It was proved that these two resin samples were composed of several different minor triterpenes. In the traditional collection of the resin, 36 triterpenes were identified, 23 of which are new minor compounds (five in the acidic and eighteen in the neutral fraction). In the liquid collection resin eight compounds were identified in the acidic and 11 in the neutral fraction, while seven compounds were not contained in resin traditionally collected. The main triterpenes in both resin samples collected traditionally and by use of stimulating agents were in the following order: isomasticadienonic acid (24 and 22.5% w/w of triterpenic fraction respectively), masticadienonic acid (9.3 and 14.7% w/w of triterpenic fraction) and 28-norolean-17-en-3-one (19 and 36% w/w of triterpenic fraction respectively). The aim of this study was to compare the qualitative and quantitative composition of triterpenes in the resin samples collected using the traditional and new liquid techniques, and examine whether the collection technique influences the contained triterpenes in P. lentiscus var. Chia resin samples. Finally, since there is confusion on interpreting mass spectra of triterpenes we present an analytical review on the base peaks, main fragments and fragmentation mechanism/pattern of several skeleton penta- and tetra- cyclic triterpenes reported in P. lentiscus resin. Also, a biosynthetic route for triterpene skeletons contained in P. lentiscus resin was approached.

Study on isohexenylnaphthazarins polymerization in alkaline media.

The chiral pair alkannin and shikonin (A/S) and their isohexenylnaphthazarin (IHN) esters, which are naturally occurring hydroxynaphthoquinones (HNQ), are potent pharmaceutical substances with a wide spectrum of biological activity. The stability of A/S and their derivatives during process and storage is crucial to their use as drugs, cosmetics and food additives. The influence of alkaline media and of IHN esters hydrolysis was experimentally investigated on IHN polymerization by size exclusion chromatography (SEC). It was proved that during IHN esters hydrolysis, polymeric A/S and IHN are formed. An optimization of the hydrolysis conditions of IHN esters was also approached in terms of polymerization. Hydrolysis of IHN from a pure mixture of pigments proved preferable to that of preliminary root extracts by means of IHN polymerization, even for analytical determination; non-polar solvents are proposed for the extraction of IHN from roots, followed by hydrolysis, aiming to minimize the polymeric IHN and A/S formed. It was also proved that polymerization of IHN in alkaline media and during hydrolysis of IHN esters proceeds through the intermediate formation of semiquinones; after acidification, coupling of semiquinones with phenoxyl radicals results in polymeric IHN structures.

Study on polymerization of the pharmaceutical substances isohexenylnaphthazarins.

Polymerization of naturally occurring isohexenylnaphthazarins (IHN), such as alkannin, shikonin (A/S) and their derivatives, which are potent pharmaceutical substances, significantly affects their use in pharmaceuticals, cosmetics and as food colorants, because it leads to reduction of the lustre of their red coloration, a decrease in their solubility and reduces the active monomeric IHN derivatives. In the present study, the influence of several crucial variables (processing and storage) was experimentally investigated on IHN polymerization by size exclusion chromatography (SEC). Temperature and solvent polarity increased significantly the concentration of hydroxynaphthoquinone (HNQ) polymers, while air and light exposure conditions did not significantly affect IHN polymerization. Low temperatures are proposed for all processes of industrial production of pharmaceutical preparations containing IHN and HNQ. An optimization of the industrial conditions used for the preparation of pharmaceutical and cosmetic preparations containing IHN, maximizing the active monomeric IHN fraction, was performed.

Study on the enantiomeric ratio of the pharmaceutical substances alkannin and shikonin.

The chiral pair alkannin and shikonin (A/S) are potent pharmaceutical substances with a wide spectrum of biological activity; their enantiomeric ratio does not influence the major biological activity studied hitherto. Nevertheless, in pharmaceutical development and approval of chiral drugs from the Health and Regulatory Authorities, full documentation of methods of analysis of enantiomeric drugs, is required in order to evaluate the enantiomeric purity of starting materials and final products and to control the stability of enantiomers in pharmaceutical formulations under several experimental conditions. In the present study, the enantiomeric ratio of A/S was determined in several commercial samples of alkannin and shikonin and also the proportion of A/S derivatives in several Alkanna root samples, which are all used as active ingredients in pharmaceuticals. Light and air proved not to influence the enantiomeric ratio of A/S on a shikonin commercial sample, and temperature also did not alter the A/S ratio on shikonin and alkannin commercial samples. Microencapsulation of alkannin and shikonin commercial samples in ethylcellulose microspheres and also molecular inclusion of a shikonin commercial sample in beta-hydroxypropyl-cyclodextrin, which are used as drug delivery systems, did not alter the A/S enantiomeric ratio.

Preparation and release studies of alkannin-containing microcapsules.

Microcapsules containing the pharmaceutical substance alkannin were prepared by the solvent evaporation method to enhance alkannin stability (reduce photo-oxidation, polymerization), to decrease its hydrophobicity and to control its release rate. The effect of various parameters, such as the type of polymeric matrix, the type of surfactant used for microcapsules preparation and the addition of Pistacia lentiscus resin in the core, on the characteristics of the produced microcapsules and the release rate of alkannin were investigated experimentally. Among the polymers tested for matrix, ethylcellulose of viscosity 46cp was the most successful, while ethylcellulose 10cp gave microcapsules with good morphological characteristics but high release rate. Beeswax resulted in flocculation and P. lentiscus resin with or without colophony as the matrix resulted in compact particles with no pores and much slower release, but did not allow alkannin to release easily from the matrix. Sodium dodecyl sulfate resulted in microcapsules with desirable morphological and physicochemical characteristics, while acacia and tragacanth gums were not indicated as surfactants in alkannin microencapsulation since they gave a high release rate and a great extent of particle size, respectively. The incorporation of Pistacia lentiscus resin in the capsule core increased loading and microencapsulation efficiency. Ethylcellulose of 46cp viscosity with sodium dodecyl sulfate as surfactant had the best characteristics studied for alkannin microencapsulation. Finally, the dissolution rate of alkannin from microcapsules was studied in a simulated intestinal and gastric environment and an external environment. Alkannin-containing microcapsules with improved properties can be used internally and externally as a new drug-delivery system.

Encapsulation of isohexenylnaphthazarins in cyclodextrins.

Naturally occurring isohexenylnaphthazarins (IHN), such as Alkannin, Shikonin (A/S) and their derivatives, are potent pharmaceutical substances with a wide spectrum of biological activity. In the present study, inclusion complexes of alkannin and shikonin commercial samples and IHN derivatives in the form of an oily extract of Alkanna tinctoria roots were formed with beta-cyclodextrin (CD) and beta-HPCD. These complexes were investigated to evaluate the effect of complexation on their aqueous solubility, decoloration, and also the percentage of polymeric A/S and IHN derivatives enclosed in the CDs cavity, since these decrease the active monomeric IHN. Both beta-CD and beta-HPCD increased the aqueous solubility of A/S and IHN derivatives and thus inclusion complexes can be used as drug delivery systems for A/S in both internal (capsules, tablets) and external hydrophilic pharmaceutical and cosmetic preparations (creams, gels, sprays) with enhanced bioavailability. The inclusion complexes formed had a pale purple colour, contributing to the partial decoloration of the A/S and thus of the fi nal pharmaceutical preparations. Finally, CDs selectively included more monomeric and less polymeric IHN, compared with the initial each time sample that is encapsulated; thus inclusion complexes may present enhanced biological activity.