Therapeutic Activity of Type 3 Streptococcus pneumoniae Capsule Degrading Enzyme Pn3Pase.

PURPOSE: Streptococcus pneumoniae (Spn) serotype 3 (Spn3) is considered one of the most virulent serotypes with resistance to conventional vaccine and treatment regimens. Pn3Pase is a glycoside hydrolase that we have previously shown to be highly effective in degrading the capsular polysaccharide of type 3 Spn, sensitizing it to host immune clearance. To begin assessing the value and safety of this enzyme for future clinical studies, we investigated the effects of high doses of Pn3Pase on host cells and immune system. METHODS: We assessed the enzyme's catalytic activity following administration in mice, and performed septic infection models to determine if prior administration of the enzyme inhibited repeat treatments of Spn3-challenged mice. We assessed immune populations in mouse tissues following administration of the enzyme, and tested Pn3Pase toxicity on other mammalian cell types in vitro. RESULTS: Repeated administration of the enzyme in vivo does not prevent efficacy of the enzyme in promoting bacterial clearance following bacterial challenge, with insignificant antibody response generated against the enzyme. Immune homeostasis is maintained following high-dose treatment with Pn3Pase, and no cytotoxic effects were observed against mammalian cells. CONCLUSIONS: These data indicate that Pn3Pase has potential as a therapy against Spn3. Further development as a drug product could overcome a great hurdle of pneumococcal infections.

[Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study].

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

Alfa-alglicosidase como terapia de reposição enzimática na doença de pompe / Alpha-Alglicosidase as Enzyme Replacement Therapy in Pompe Disease

INTRODUÇÃO: a DP, ou glicogenose tipo II, pode ser classificada em DP precoce (idade de início dos sintomas ≤ 12 meses) e DP tardia (idade de início dos sintomas ≥ 12 meses). A DP é uma doença rara, grave, associada à alta morbimortalidade, e que não está incluída no Programa Nacional de Triagem Neonatal. Seu acometimento neuromuscular progressivo - frequentemente fatal nas formas mais graves ­ decorre de mutações patogênicas bialélicas no gene GAA, localizado no cromossomo 17q25.2-q25.3. A DP é uma glicogenose muscular, não associada à ocorrência de hipoglicemia, causada pela atividade deficiente da alfa glicosidase ácida (sinônimo: maltase ácida), enzima lisossômica que libera glicose a partir do glicogênio, conforme a demanda de energia celular. A atividade deficiente desta enzima leva ao acúmulo de glicogênio dentro dos lisossomos e do citoplasma das células da musculatura lisa, esquelética e cardíaca. Este acúmulo acaba danificando o funcionamento celular e destruindo as células, por hipertrofia e ruptura dos lisossomos. A prevenção das manifestações clínicas e o tratamento das manifestações já estabelecidas da DP pode ser realizada, quando indicado, com a terapia de reposição enzimática (TRE) com maltase ácida recombinante humana (alfaalglicosidase), produzida em células de ovário de hamster chinês. TECNOLOGIA: alfa-alglicosidase (myozyme®). PERGUNTA: O uso da alfa-alglicosidase é eficaz e seguro em pacientes com DP? EVIDÊNCIAS CIENTÍFICAS: Dada a existência de menos de 5 ensaios clínicos randomizados (ECR) incluindo uma, outra ou ambas as formas da doença, foram avaliados também ensaios clínicos abertos prospectivos que avaliaram os desfechos de interesse e cujo tamanho amostral era igual ou superior a 5. Assim, trinta e seis estudos foram incluídos, sendo que 13/36 avaliaram DP precoce (entre eles, uma revisão sistemática e um ECR) e 23/36 que avaliaram DP tardia (entre eles, duas revisões sistemáticas e um ECR). DP Precoce: Foi encontrada evidência de benefício da TRE para cardiomiopatia, tempo para início de ventilação mecânica, sobrevida, e segurança. Ressalta-se, contudo, que a maioria dos estudos incluiu pacientes que iniciaram TRE até um ano de idade e que não estavam em ventilação mecânica invasiva, sendo esta a população para a qual este tratamento deve ser indicado. DP Tardio: Foi encontrada evidência de benefício da TRE para capacidade vital forçada (CVF), teste de caminhada em 6 minutos, sobrevida/mortalidade, tempo de ventilação e segurança. AVALIAÇÃO ECONÔMICA: As análises de custo-efetividade resultaram em uma razão de custo efetividade incremental (RCEI) de R$ 1.521.942,46 por ano de vida livre de ventilação para o tratamento da DP precoce com alfa-alglicosidase mais cuidados de suporte em comparação a somente cuidados de suporte; e uma RCEI de R$ 5.306.919,17 por ano de vida ganho (AVG) no tratamento da DP tardia com alfa-alglicosidase mais cuidados de suporte em comparação a somente cuidados de suporte. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: A estimativa dos gastos com a incorporação da alfaalglicosidase na perspectiva do SUS, dentro dos cenários propostos para o tratamento dos pacientes com DP precoce, variou de R$ 2,87 milhões a R$ 10,98 milhões no primeiro ano e entre R$ 15,7 milhões e R$ 78,9 milhões após transcorridos cinco anos. Para o tratamento dos pacientes com DP tardia, o impacto orçamentário variou de R$ 102,4 milhões a R$ 156,87 milhões no primeiro ano e entre R$ 613,78 milhões e R$ 1,02 bilhões após transcorridos cinco anos. Finalmente, para o tratamento de todos os pacientes com DP (precoce e tardia), o impacto orçamentário estimado variou de R$ 110,66 milhões a R$ 167,86 milhões no primeiro ano e entre R$ 663,34 milhões e R$ 1,1 bilhões após transcorridos cinco anos de incorporação no SUS. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Reveglucosidase alfa: há 3 ensaios clínicos concluídos, de fase 2, fase 3 e sua extensão, cuja intervenção é intitulada como BMN 701, GAA humana recombinante GILT-tagged, avaliada apenas para DP tardio, sem resultados disponíveis. RECOMENDAÇÃO INICIAL: A Conitec, em sua 76ª reunião ordinária, no dia 3 de abril de 2019, considerando o alto custo da terapia e o elevado impacto orçamentário, o Plenário da Conitec recomendou de forma preliminar a incorporação da alfa-aglicosidade para a forma precoce da doença devido aos ganhos nos desfechos de tempo para início de ventilação mecânica e sobrevida. CONSULTA PÚBLICA: A Consulta Pública nº 33 foi realizada entre os dias 05/06 e 24/06/2019. Foram recebidas 389 contribuições, 61 pelo formulário técnico-científico e 328 pelo formulário de experiência ou opinião sendo 52% concordando totalmente com a recomendação preliminar da Conitec. Foram levantadas questões sobre a utilização da TRE em pacientes com DP tardia, porém os estudos incluídos na CP não trouxeram novas evidências de benefício no tratamento da DP tardia e a proposta de risco compartilhado submetida pela empresa, nas condições apresentadas, não apresentava elementos suficientes para justifica-la. Assim, o plenário da Conitec entendeu que não houve argumentação suficiente para alterar a recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 81ª reunião ordinária, no dia 5 de setembro de 2019, deliberaram, por unanimidade, por recomendar a incorporação no SUS da alfa-alglicosidase para o tratamento da forma precoce da doença de Pompe, conforme Protocolo Clínico do Ministério da Saúde. Foi assinado o Registro de Deliberação nº 470/2019. DECISÃO: Incorporar a alfa-alglicosidase para a forma precoce da doença de Pompe, conforme Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde, no âmbito do Sistema Único de Saúde ­ SUS. Dada pela Portaria nº 48, seção 1, página 65, em 17 de outubro de 2019.

Protective and therapeutic application of the depolymerase derived from a novel KN1 genotype of Klebsiella pneumoniae bacteriophage in mice.

Klebsiella pneumoniae is one of the major Gram-negative bacterial pathogens causing hospital-acquired multidrug-resistant infections, and the antimicrobial treatment options are scarce. The lack of available antimicrobials has prompted the development of alternative strategies for the treatment of these infections. In this study, a K. pneumoniae bacteriophage (vB_KpnP_IME321) targeting a KN1 capsular type strain, Kp409, was isolated, characterized and sequenced. This bacteriophage has a latent period of 20 min and a burst size of approximately 410 pfu/cell. It contained 49 predicted open reading frames, of which ORF42 was identified as encoding the putative capsule depolymerase. The enzyme expressed and purified in the Escherichia coli BL21 system, namely Dp42, could depolymerize the capsular polysaccharide of Kp409 and form translucent halos on the plates. The phage-encoded depolymerase could increase the inhibitory effect of serum on the growth of bacteria in vitro. Pre-treated with Dp42 rescued 100% of mice following lethal Kp409 challenge, and administration of this enzyme after infection significantly increased survival rates of infected mice in the animal experiment. In conclusion, the phage-encoded depolymerase Dp42 represents a potential alternative strategy for controlling infections mediated by K. pneumoniae expressing the KN1 capsular polysaccharide.

Imiglucerasa para el tratamiento de la enfermedad de Gaucher / Imiglucerase for the treatment of Gaucher's disease

INTRODUCCIÓN: Este documento técnico se realiza a solicitud de la Dirección de Cobertura y Evaluación de Prestaciones de Alto Costo del Fondo Intangible Solidario de Salud (FISSAL) del Seguro Integral de Salud (SIS); el cual motivó la realización de la pregunta PICO por parte de médicos y especialistas de la siguiente manera, P: pacientes naïve con diagnóstico de enfermedad de Gaucher tipo 1 o 3; I: imiglucerasa 400 U; C: velaglucerasa alfa 400 U; O: concentración de hemoglobina, recuento de plaquetas, hepatoesplenomegalia, cambio en los niveles de biomarcadores (quitotriosidasa, CCL18-PARC, enzima convertidora de angiotensina y fosfatasa ácida tartrato-resistente), desenlaces esqueléticos (frecuencia de dolor óseo, frecuencia de eventos de crisis ósea, y densidad ósea), eventos adversos y calidad de vida. OBJETIVO: Describir la evidencia científica disponible sobre la eficacia y seguridad de imiglucerasa 400 U en la enfermedad de Gaucher. METODOLOGÍA: Se realizó una búsqueda sistemática en Medline (Pubmed), The Cochrane Library y LILACS utilizando la estrategia de búsqueda descrita en el Anexo 01. Ésta se complementó con la búsqueda de evidencia en páginas institucionales de agencias gubernamentales y buscadores genéricos. Se priorizó la identificación y selección de revisiones sistemáticas (RS) con o sin meta-análisis (MA), ensayos clínicos aleatorizados (ECA) o cuasi-experimentales, guías de práctica clínica (GPC), evaluaciones de tecnologías sanitarias (ETS) y evaluaciones económicas de América Latina. La calidad de la evidencia identificada se valoró usando las siguientes herramientas: AMSTAR 2 para la valoración de la calidad de revisiones sistemáticas, la herramienta propuesta por la colaboración Cochrane para la valoración del riesgo de sesgo de ensayos clínicos, y el instrumento AGREE II para valorar el rigor metodológico de las GPC. RESULTADOS: Se identificó una RS y dos GPC que respondieron a la pregunta PICO de interés. Los hallazgos de la RS no mostraron diferencias significativas entre imiglucerasa y velaglucerasa alfa sobre diferentes desenlaces, tales como concentración de hemoglobina, recuento de plaquetas, hepato-esplenomegalia, niveles de biomarcadores como quitotriosidasa o CCL18-PARC, o eventos adversos. No se halló evidencia sobre desenlaces esqueléticos ni calidad de vida. La RS incluyó solamente un ECA con un número pequeño de participantes y periodo de seguimiento corto. Las dos GPC incluidas procedieron de Ecuador y México, y recomendaron indistintamente el uso de imiglucerasa o velaglucerasa alfa, condicionado a la confirmación del diagnóstico de EG, presencia de manifestaciones hematológicas, óseas, pulmonares, hepáticas o esplénicas; y a la evaluación anual del cumplimiento de metas terapéuticas. La evidencia hallada, tanto en la RS como en las dos GPC, correspondió únicamente a pacientes con EG-1. No se encontró evaluaciones económicas en América Latina que comparen imiglucerasa y velaglucerasa alfa. La RS presentó un nivel de confianza alto, mientras las dos GPC obtuvieron un puntaje superior al 70% en el rigor metodológico. CONCLUSIONES: Imiglucerasa y velaglucerasa alfa mostraron similar perfil de eficacia y seguridad para el tratamiento de pacientes con EG-1. Estos resultados proceden de un solo ensayo clínico con un número pequeño de participantes y periodo de seguimiento corto; Dos GPC publicadas en países de América Latina recomiendan indistintamente el uso de imiglucerasa y velaglucerasa alfa en pacientes con EG-1; No se halló evidencia respecto al uso de estos medicamentos en manifestaciones no neurológicas de pacientes con EG-3.

Marine Enzymes in Cancer: A New Paradigm.

Over the last decades, the vast chemical and biodiversity of marine environment has been identified as an important source of new anticancer drugs. The evolution of marine life is a result of competition among microorganisms for space and nutrients in the marine environment, which drives marine microorganisms to generate diverse enzyme systems with unique properties to adapt to harsh conditions of ocean. Therefore, marine-derived sources offer novel enzymes endowed with extraordinary properties. Recent advances in cancer therapy have facilitated enzyme therapy as a promising tool. But, the available information on the use of enzymes derived from marine sources as therapeutic agents for cancer therapy is scanty. The potential utility of marine enzymes in cancer therapy will be discussed in this chapter.

Toward Clinical use of the IgG Specific Enzymes IdeS and EndoS against Antibody-Mediated Diseases.

The endoglycosidase EndoS and the protease IdeS from the human pathogen Streptococcus pyogenes are immunomodulating enzymes hydrolyzing human IgG. IdeS cleaves IgG in the lower hinge region, while EndoS hydrolyzes the conserved N-linked glycan in the Fc region. Both enzymes are remarkably specific for human IgG that after hydrolysis loses most of its effector functions, such as binding to leukocytes and complement activation, all contributing to bacterial evasion of adaptive immunity. However, taken out of their infectious context, we and others have shown that IdeS and EndoS can alleviate autoimmune disease in a number of animal models of antibody-mediated disorders. In this chapter, we will briefly describe the discovery and characterization of these unique enzymes, present the findings from a number of animal models of autoimmunity where the enzymes have been tested, and outline the ongoing clinical testing of IdeS. Furthermore, we will discuss the rationale for further development of IdeS and EndoS into novel pharmaceuticals against diseases where IgG antibodies contribute to the pathology, including, but not restricted to, chronic and acute autoimmunity, transplant rejection, and antidrug antibody reactions.

In vivo enzymatic modulation of IgG antibodies prevents immune complex-dependent skin injury.

IgG antibodies are potent inducers of proinflammatory responses by cross-linking Fc receptors on innate immune effector cells resulting in tissue injury. The recently discovered enzymes endoglycosidase S (EndoS) and IgG-degrading enzyme (IdeS) of Streptococcus pyogenes are able to modulate the interaction between IgG antibodies and the Fc receptors, by hydrolysis of the glycan associated with the heavy chain of the IgG molecule (EndoS), or cleavage in the hinge region of the heavy IgG chain (IdeS). In this work, we investigated their ability to inhibit damage mediated by skin-bound antibodies in vivo in two different experimental models, the Arthus reaction, and epidermolysis bullosa acquisita, an autoimmune blistering skin disease associated with autoantibodies against type VII collagen. We demonstrate that both enzymes efficiently interfere with IgG-mediated proinflammatory processes, offering a great asset to specifically target pathological IgG antibodies in the skin and holding great promise for future applications in human therapy.

Enzymes in therapy of biofilm-related oral diseases.

Biofilm-related infections of the oral cavity, including dental caries and periodontitis, represent the most prevalent health problems. For years, the treatment thereof was largely based on antibacterial chemical agents. Recently, however, there has been growing interest in the application of more preventive and minimally invasive biotechnological methods. This review focuses on the potential applications of enzymes in the treatment and prevention of oral diseases. Dental plaque is a microbial community that develops on the tooth surface, embedded in a matrix of extracellular polymeric substances of bacterial and host origin. Both cariogenic microorganisms and the key components of oral biofilm matrix may be the targets of the enzymes. Oxidative salivary enzymes inhibit or limit the growth of oral pathogens, thereby supporting the natural host defense system; polysaccharide hydrolases (mutanases and dextranases) degrade important carbohydrate components of the biofilm matrix, whereas proteases disrupt bacterial adhesion to oral surfaces or affect cell-cell interactions. The efficiency of the enzymes in in vitro and in vivo studies, advantages and limitations, as well as future perspectives for improving the enzymatic strategy are discussed.

Capsule-Targeting Depolymerase, Derived from Klebsiella KP36 Phage, as a Tool for the Development of Anti-Virulent Strategy.

The rise of antibiotic-resistant Klebsiella pneumoniae, a leading nosocomial pathogen, prompts the need for alternative therapies. We have identified and characterized a novel depolymerase enzyme encoded by Klebsiella phage KP36 (depoKP36), from the Siphoviridae family. To gain insights into the catalytic and structural features of depoKP36, we have recombinantly produced this protein of 93.4 kDa and showed that it is able to hydrolyze a crude exopolysaccharide of a K. pneumoniae host. Using in vitro and in vivo assays, we found that depoKP36 was also effective against a native capsule of clinical K. pneumoniae strains, representing the K63 type, and significantly inhibited Klebsiella-induced mortality of Galleria mellonella larvae in a time-dependent manner. DepoKP36 did not affect the antibiotic susceptibility of Klebsiella strains. The activity of this enzyme was retained in a broad range of pH values (4.0-7.0) and temperatures (up to 45 °C). Consistently, the circular dichroism (CD) spectroscopy revealed a highly stability with melting transition temperature (Tm) = 65 °C. In contrast to other phage tailspike proteins, this enzyme was susceptible to sodium dodecyl sulfate (SDS) denaturation and proteolytic cleavage. The structural studies in solution showed a trimeric arrangement with a high ß-sheet content. Our findings identify depoKP36 as a suitable candidate for the development of new treatments for K. pneumoniae infections.

(1→3)-α-D-Glucan hydrolases in dental biofilm prevention and control: A review.

Dental plaque is a highly diverse biofilm, which has an important function in maintenance of oral and systemic health but in some conditions becomes a cause of oral diseases. In addition to mechanical plaque removal, current methods of dental plaque control involve the use of chemical agents against biofilm pathogens, which however, given the complexity of the oral microbiome, is not sufficiently effective. Hence, there is a need for development of new anti-biofilm approaches. Polysaccharides, especially (1→3),(1→6)-α-D-glucans, which are key structural and functional constituents of the biofilm matrix, seem to be a good target for future therapeutic strategies. In this review, we have focused on (1→3)-α-glucanases, which can limit the cariogenic properties of the dental plaque extracellular polysaccharides. These enzymes are not widely known and have not been exhaustively described in literature.

Non-conventional therapeutics for oral infections.

As our knowledge of host-microbial interactions within the oral cavity increases, future treatments are likely to be more targeted. For example, efforts to target a single species or key virulence factors that they produce, while maintaining the natural balance of the resident oral microbiota that acts to modulate the host immune response would be an advantage. Targeted approaches may be directed at the black-pigmented anaerobes, Porphyromonas gingivalis and Prevotella intermedia, associated with periodontitis. Such pigments provide an opportunity for targeted phototherapy with high-intensity monochromatic light. Functional inhibition approaches, including the use of enzyme inhibitors, are also being explored to control periodontitis. More general disruption of dental plaque through the use of enzymes and detergents, alone and in combination, shows much promise. The use of probiotics and prebiotics to improve gastrointestinal health has now led to an interest in using these approaches to control oral disease. More recently the potential of antimicrobial peptides and nanotechnology, through the application of nanoparticles with biocidal, anti-adhesive and delivery capabilities, has been explored. The aim of this review is to consider the current status as regards non-conventional treatment approaches for oral infections with particular emphasis on the plaque-related diseases.

Informe de evaluación rápida de tecnología sobre seguridad y efectividad de laronidasa para mucopolisacaridosis tipo I / Rapid evaluation report of technology on safety and effectiveness of laronidase for mucopolysaccharidosis type I

La MPS I es una enfermedad pan-étnica con una incidencia estimada en 1:100 000 nacidos vivos. Aproximadamente, 50% a 80% de los pacientes presenta el fenotipo grave de la enfermedad (o Síndrome de Hurler). Un estudio poblacional mostró que el fenotipo atenuado representa 26% de la población total de pacientes con MPS I. Sin embargo, esos datos pueden estar subestimados, una vez que el diagnóstico de casos graves parece ser más fácil que el de casos atenuados. Según el MPS I Registry (patrocinado por la Genzyme Corporation), hasta el 2009 existían 845 pacientes con MPS I identificados en todo el mundo. (2) De ellos 118 fueron de cinco países de Latinoamérica (60% Brasil, 14% Argentina, 17% México, 3% Chile, y 5% Colombia). El resto del mundo (ROW, por sus siglas en inglés) tenía 727 pacientes distribuidos en 27 países: 56% Europa, 41% América del Norte y 3% de Asia Pacífico. Al respecto de la distribución de fenotipos del total de latinoamericanos reportados, el 31% reportaron tener Síndrome de Hurler; mientras que el resto del mundo mostró un 62%. Sin embargo hubo una gran proporción de pacientes en Latinoamérica sin determinar o reportar fenotipo (22 frente 6% del resto del mundo). De acuerdo a la revisión de la literatura, se tienen estos datos de incidencia y de supervivencia de acuerdo al fenotipo de MPS I. Como resultado de la utilización de laronidasa en pacientes con mucopolisacaridosis tipo I se observó mejoras en el porcentaje de capacidad vital forzada, hepato/esplenomegalia, excreción urinaria de los GAG, índice de apnea/hipoapnea del sueño (IAH), amplitud de flexión de la espalda, agudeza visual, índice de discapacidad CHAQ/HAQ, test de Marcha de los 6 Minutos (TM6M). Se recomienda cubrir con generación de evidencia.(AU)

Bacteriophage polysaccharide depolymerases and biomedical applications.

Polysaccharide depolymerase, a polysaccharide hydrolase encoded by bacteriophages (or 'phages'), can specifically degrade the macromolecule carbohydrates of the host bacterial envelope. This enzyme assists the bacteriophage in adsorbing, invading, and disintegrating the host bacteria. Polysaccharide depolymerase activity continues even within biofilms. This effectiveness means phages are promising candidates for novel antibiotic scaffolds. A comprehensive compendium of bacteriophage polysaccharide depolymerases has been compiled, together with their potential biomedical applications, such as novel antibiotics, adjuvants for antibiotics, bacterial biofilm disruptants, and diagnostic kits.

RS-Glucoraphanin bioactivated with myrosinase treatment counteracts proinflammatory cascade and apoptosis associated to spinal cord injury in an experimental mouse model.

Spinal cord injury (SCI) is a highly debilitating pathology. Although innovative medical care has been improved, drug therapies to counteract neuronal damage and promote regeneration are limited. An experimental mouse model of SCI was designed to examine the possible neuroprotective role of the glucosinolate (RS)-glucoraphanin (RS-GRA), bioactivated with myrosinase enzyme (MYR-activated RS-GRA). Methodologically, the injury was induced by application of an aneurysm clip (force of 24 g) for 1 min via four-level T5-T8 after laminectomy. MYR-activated RS-GRA was administered in mice (10mg/kg i.p.) 1 and 6h after the trauma, identified as the therapeutic intervention window. The treatment with MYR-activated RS-GRA significantly decreased histological damage resulted by proinflammatory events as well as by apoptosis cascade. Overall, by quantitative analysis of immunohistochemical images, the neuroprotection has been quite evident. MYR-activated RS-GRA has given a histological quantification around zero in all determinations. Particularly, looking at the strongest data obtained, regarding the glial fibrillary acidic protein (GFAP), result the high tissue localization of this damage marker mediated by astrocyte activity, estimated as about 80% of positive staining, was shot down by MYR-activated RS-GRA treatment. Taken together, our results show that MYR-activated RS-GRA could represent an interesting approach for the management of secondary damage following SCI.

Anti-inflammatory and anti-apoptotic effects of (RS)-glucoraphanin bioactivated with myrosinase in murine sub-acute and acute MPTP-induced Parkinson's disease.

This study was focused on the possible neuroprotective role of (RS)-glucoraphanin, bioactivated with myrosinase enzyme (bioactive RS-GRA), in an experimental mouse model of Parkinson's disease (PD). RS-GRA is one of the most important glucosinolates, a thiosaccharidic compound found in Brassicaceae, notably in Tuscan black kale seeds. RS-GRA was extracted by one-step anion exchange chromatography, further purified by gel-filtration and analyzed by HPLC. Following, pure RS-GRA was characterized by (1)H and (13)C NMR spectrometry and the purity was assayed by HPLC analysis of the desulfo-derivative according to the ISO 9167-1 method. The obtained purity has been of 99%. To evaluate the possible pharmacological efficacy of bioactive RS-GRA (administrated at the dose of 10mg/kg, ip +5µl/mouse myrosinase enzyme), C57BL/6 mice were used in two different sets of experiment (in order to evaluate the neuroprotective effects in different phases of the disease), according to an acute (2 injections·40mg/kg MPTP) and a sub-acute (5 injections·20mg/kg MPTP) model of PD. Behavioural test, body weight changes measures and immunohistochemical localization of the main PD markers were performed and post-hoc analysis has shown as bioactive RS-GRA is able to reduce dopamine transporter degradation, tyrosine hydroxylase expression, IL-1ß release, as well as the triggering of neuronal apoptotic death pathway (data about Bax/Bcl-2 balance and dendrite spines loss) and the generation of radicalic species by oxidative stress (results focused on nitrotyrosine, Nrf2 and GFAP immunolocalization). These effects have been correlated with the release of neurotrophic factors, such as GAP-43, NGF and BDNF, that, probably, play a supporting role in the neuroprotective action of bioactive RS-GRA. Moreover, after PD-induction mice treated with bioactive RS-GRA are appeared more in health than animals that did not received the treatment both for phenotypic behaviour and for general condition (movement coordination, presence of tremors, nutrition). Overall, our results suggest that bioactive RS-GRA can protect neurons against the neurotoxicity involved in PD via an anti-apoptotic/anti-inflammatory action.

Protective role of (RS )-glucoraphanin bioactivated with myrosinase in an experimental model of multiple sclerosis.

AIM: The discovery of new natural compounds with pharmacological properties is a field of interest widely growing. Recent literature shows that Brassica vegetables (Cruciferae) possess therapeutic effects particularly ascribed due to their content in glucosinolates, which upon myrosinase hydrolysis release the corresponding isothiocyanates. This study examines the potential neuroprotective and immunomodulatory effects of (RS )-glucoraphanin from Tuscan black kale (Brassica oleracea L. var. acephala sabellica) bioactivated with myrosinase (bioactive RS -GRA) (10 mg/kg/day intraperitoneally), in an experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. METHODS: EAE was induced by immunization with myelin oligodendroglial glycoprotein peptide (MOG35-55 ) in mice. After immunization, mice were observed daily for signs of EAE and weight loss. Clinical score was evaluated using a standardized scoring system. RESULTS: By Western blot analysis of spinal cord tissues, we have demonstrated that treatment with bioactive RS -GRA significantly decreased nuclear factor (NF)-kB translocation, pro-inflammatory cytokine production such as interleukin-1ß (IL-1ß), and apoptosis (Bax and caspase 3 expression). CONCLUSION: Our results clearly demonstrate that bioactive RS -GRA treatment may represent a useful therapeutic perspective in the treatment of this disease.

Selective deactivation of serum IgG: a general strategy for the enhancement of monoclonal antibody receptor interactions.

Serum IgG is a potent inhibitor of monoclonal antibody (mAb) binding to the cell-surface Fcγ receptors (FcγRs), which mediate cytotoxic and phagocytic effector functions. Here, we show that this competition can be eliminated, selectively, by the introduction to serum of (i) an enzyme that displaces Fc from FcγRs and (ii) a modification present in the therapeutic mAb that renders it resistant to that enzyme. Specifically, we show that (i) EndoS (endoglycosidase S) cleaves only complex-type glycans of the type found on IgG but (ii) is inactive against an engineered IgG Fc with oligomannose-type glycans. EndoS thus reduces FcγR binding of serum IgG, but not that of engineered mAb. Introduction of both the engineered mAb and endoglycosidase in serum leads to a dramatic increase in FcγR binding compared to the introduction of mAb in serum alone. Antibody receptor refocusing is a general technique for boosting the effector signal of therapeutic antibodies.

Successful treatment of experimental glomerulonephritis with IdeS and EndoS, IgG-degrading streptococcal enzymes.

BACKGROUND: Anti-glomerular basement membrane (anti-GBM) disease often results in end-stage renal failure despite therapy with plasma exchange and immunosuppressive drugs. The newly discovered streptococcal enzymes IgG-degrading enzyme of S.pyogenes (IdeS) and endoglycosidase S (EndoS) act with remarkable specificity on circulating IgG. In this study, we investigate their ability in vivo to prevent damage mediated by kidney-bound antibodies in a mouse model of anti-GBM disease. METHODS: Anti-GBM disease was induced in mice by injection of subnephritogenic doses of rabbit anti-mouse GBM, followed a week later by injection of monoclonal mouse anti-rabbit IgG antibodies. By administrating IdeS or EndoS as fusion partners with GST between these antibody injections, we tested their ability to prevent damage by acting on kidney-bound rabbit anti-GBM. Control animals received placebo injections. RESULTS: All animals in the positive control groups developed severe albuminuria immediately after the second antibody injection (mean, 2.51 mg/24 h; range, 0.13-8.20). This was significantly diminished by EndoS (1.3 +/- 1.3 mg/24 h) and completely prevented by IdeS (0.017 +/- 0.014 mg/24 h). Immunofluorescence studies showed that IdeS treatment effectively removed the Fc fragments of the rabbit IgG. This was accompanied by a significant reduction of the deposition of the complement components C3 and C1q, and this diminished the recruitment of leukocytes to the glomeruli. CONCLUSION: IdeS degrades IgG bound to the GBM in vivo, thereby preventing renal damage in this animal model. Most likely, IdeS would degrade both circulating and kidney-bound anti-GBM in patients with Goodpasture's disease. Whether this would lead to a halt in disease progression and a better prognosis remains to be determined.

Therapeutic potential of biofilm-dispersing enzymes.

Surface-attached colonies of bacteria known as biofilms play a major role in the pathogenesis of medical device infections. Biofilm colonies are notorious for their resistance to antibiotics and host defenses, which makes most device infections difficult or impossible to eradicate. Bacterial cells in a biofilm are held together by an extracellular polymeric matrix that is synthesized by the bacteria themselves. Enzymes that degrade biofilm matrix polymers have been shown to inhibit biofilm formation, detach established biofilm colonies, and render biofilm cells sensitive to killing by antimicrobial agents. This review discusses the potential use of biofilm matrix-degrading enzymes as anti-biofilm agents for the treatment and prevention of device infections. Two enzymes, deoxyribonuclease I and the glycoside hydrolase dispersin B, will be reviewed in detail. In vitro and in vivo studies demonstrating the anti-biofilm activities of these two enzymes will be summarized, and the therapeutic potential and possible drawbacks of using these enzymes as clinical agents will be discussed.