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Posts Tagged ‘Biotechnology and Pharmaceuticals’

Natural Products Chemistry

Writer and Curator: Larry H. Bernstein, MD, FCAP 

 

 

Natural products chemistry or pharmacognosy, the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs

or drug substances of natural origin as well as the search for new drugs from natural
sources, is an a tradition in medicine that reaches to a tradition thousands of years
old.  It has to some extent been supplanted by structural organic chemistry, metallo-organic chemistry, and synthetic organic chemistry of families of drugs.  In some
cases, drug failures may be attributed to the inherent failure in a family, and in others
there has been substitution of a drug compound by another with eaqual or greater
potency and less toxicity. A serious confounder has been that medications intended
for a specific effect has either an unfavorable interaction with another class of drugs,
or it has a metabolic reaction with another organ or pathway than the use intended.
That has been the huge impediment to pharmaceutical development.

However, it is important to remember that many of the medications in common use
were originally plant or natural derivatives, e.g., digoxin, Warfarin.

Thymoquinone, an extract of nigella sativa seed oil, blocked pancreatic cancer cell
growth and killed the cells by enhancing the process of programmed cell death
Steve Benowitz  steven.benowitz@jefferson.edu

Researchers at the Kimmel Cancer at Jefferson in Philadelphia have found that
thymoquinone, an extract of nigella sativa seed oil, blocked pancreatic cancer cell
growth and killed the cells by enhancing the process of programmed cell death.
According to Hwyda Arafat, M.D., Ph.D., associate professor of Surgery at
Jefferson Medical College of Thomas Jefferson University, nigella sativa helps treat
a broad array of diseases, including some immune and inflammatory disorders.
Previous studies also have shown anticancer activity in prostate and colon cancers,
as well as antioxidant and anti-inflammatory effects.

Using a human pancreatic cancer cell line, she and her team found that adding
thymoquinone killed approximately 80 percent of the cancer cells. They demonstrated
that thymoquinone triggered programmed cell death in the cells, and that a number of
important genes, including p53, Bax, bcl-2 and p21, were affected. The researchers
found that expression of p53, a tumor suppressor gene, and Bax, a gene that promotes
programmed cell death, was increased, while bcl-2, which blocks such cell death,
was decreased. The p21 gene, which is involved in the regulation of different phases
of the cell cycle, was substantially increased.

In addition, adding thymoquinone to pancreatic cancer cells reduced the production
and activity of enzymes called histone deacetylases (HDACs), which remove the
acetyl groups from the histone proteins, halting the gene transcription process.
Dr. Arafat notes that HDAC inhibitors are a “hot” new class of drugs that interfere
with the function of histone deacetylases, and is being studied as a treatment for
cancer and neurodegenerative diseases.

Extra Virgin Olive Oil Improves Learning and Memory in SAMP8 Mice
SA Farra, TO Price, LJ Dominguez, A Motisi, F Saianoe, et al.
Journal of Alzheimer’s Disease 28 (2012) 81–92
http://dx.doi.org/10.3233/JAD-2011-110662

Polyphenols are potent antioxidants found in extra virgin olive oil (EVOO);
antioxidants have been shown to reverse age- and disease-related learning and
memory deficits. We examined the effects of EVOO on learning and memory
in SAMP8 mice, an age-related learning/memory impairment model
associated with increased amyloid- protein and brain oxidative damage.
We administered EVOO, coconut oil, or butter to 11 month old SAMP8
mice for 6 weeks. Mice were tested in T-maze foot shock avoidance
and one-trial novel object recognition with a 24 h delay. Mice which
received EVOO had improved acquisition in the T-maze and spent
more time with the novel object in one-trial novel object recognition
versus mice which received coconut oil or butter. Mice that received
EVOO had improve T-maze retention compared to the mice that received
butter. EVOO increased brain glutathione levels suggesting reduced
oxidative stress as a possible mechanism. These effects plus increased
glutathione reductase activity, superoxide dismutase activity, and
decreased tissue levels of 4-hydroxynoneal and 3-nitrotyrosine were
enhanced with enriched EVOO (3× and 5× polyphenols concentration).
Our findings suggest that EVOO has beneficial effects on learning
and memory deficits found in aging and diseases, such as those related
to the overproduction of amyloid- protein, by reversing oxidative damage
in the brain, effectsthat are augmented with increasing concentrations
of polyphenols in EVOO.

Synthetic analogues of flavonoids with improved activity against platelet activation
and aggregation as novel prototypes of food supplements
S Del Turco, S Sartini, G Cigni, C Sentieri, S Sbrana, et al.
Food Chemistry 175 (2015) 494–499 http://dx.doi.org/10.1016/j.foodchem.2014.12.005

We investigated the ability of quercetin and apigenin to modulate platelet activation
and aggregation, and compared the observed efficacy with that displayed by their
synthetic analogues 2-phenyl-4H-pyrido[1,2-a]pyrimidin-4-ones, 1–4, and 2,3-
diphenyl-4H-pyrido[1,2-a]pyrimidin-4-ones, 5–7. Platelet aggregation was
explored through a spectrophotometric assay on platelet-rich plasma (PRP)
treated with the thromboxane A2 mimetic U46619, collagen and thrombin in
presence/absence of various bioisosteres of flavonoids (12.5–25–50–100 lM).
The platelet density, (mean platelet component, MPC), was measured by the
Advia 120 Hematology System as a marker surrogate of platelet activation. The
induced P-selectin expression, which reflects platelet degranulation/activation,
was quantified by flow cytometry on PRP. Our synthetic compounds modulated
significantly both platelet activation and aggregation, thus turning out to be more
effective than the analogues quercetin and apigenin when tested at a
concentration fully consistent with their use in vivo. Accordingly, they might
be used as food supplements to increase the efficacy of natural flavonoids.

Polysaccharide Extracts From Sargassum Siliquosum J.G. Agardh Modulates
Production Of Pro-Inflammatory Cytokines In Lps-Induced Pbmc And Delays
Coagulation Time In-Vitro
RD Vasquez, RSP Garcia-Meim and JDA Ramos
Jour. Harmo. Res. Pharm., 2014, 3(3), 101-112  www.johronline.com

Sulfated polysaccharides from brown seaweeds exhibit various biological activities,
structural diversity, and are potential reagents for the development of therapeutic
drugs. This study aimed to determine the effect of aqueous and fucoidan extracts from
Sargassum siliquosum J. G. Agardh on viability of peripheral blood mononuclear
cells, production of pro-inflammatory cytokines and plasma coagulation using
in vitro
assays. Sulfate contents of the polysaccharides were quantified using Acid-Ashing Digestion Ion chromatography. Effect on viability of the extracts on
peripheral blood mononuclear cells was determined by MTT Assay. Estimation
of pro-inflammatory cytokines concentrations was done through Enzyme-Linked
Immunosorbent Assay, while anticoagulant activity was measured by Prothrombin
Time and Activated Partial Thromboplastin Time. Results revealed that both
extracts were non-cytotoxic to PBMCs, reduced significantly the production of
IL-1, IL-6,TNF-α and exhibited normal anticoagulant activity in PT assays and
prolonged APTT remarkably in dose-dependent manner. In conclusion, extracts
of the Sargassum siliquosum J.G. Agardh is a potential alternative source in
producing anti-inflammatory and anticoagulant substances in the future.

Purple corn anthocyanins inhibit diabetes-associated glomerular monocyte
activation and macrophage infiltration
Min-Kyung Kang, J Li, Jung-Lye Kim, Ju-Hyun Gong, Su-Nam Kwak, JHY Park, et al.
Am J Physiol Renal Physiol 303: F1060–F1069
http://dx.doi.org:/10.1152/ajprenal.00106.2012

Purple corn anthocyanins inhibit diabetes-associated glomerular monocyte activation
and macrophage infiltration. Diabetic nephropathy  (DN) is one of the major diabetic
complications and the leading cause of end- stage renal disease. In early DN, renal
injury and macrophage accumulation take place in the pathological environment
of glomerular vessels adjacent to renal mesangial cells expressing proinflammatory
mediators. Purple corn utilized as a daily food is rich in anthocyanins exerting
disease-preventive activities as a functional food. This study elucidated whether
anthocyanin-rich purple corn extract (PCA) could suppress monocyte activation and
macrophage infiltration. In the in vitro study, human endothelial cells and THP-1 monocytes were cultured in conditioned media of human mesangial cells exposed
to 33 mM glucose (HG-HRMC). PCA decreased the HG-HRMC-conditioned, media-induced expression of endothelial vascular cell adhesion molecule-1, E-selectin,
and monocyte integrins- and -2 through blocking the mesangial Tyk2 pathway. In the
in vivo animal study, db/db mice were treated with 10 mg/kg PCA daily for 8 wk. PCA
attenuated CXCR2 induction and the activation of Tyk2 and STAT1/3 in db/db mice.
Periodic acid-Schiff staining showed that PCA alleviated mesangial expansion-elicited renal injury in diabetic kidneys. In glomeruli, PCA attenuated the induction
of intracellular cell adhesion molecule-1 and CD11b. PCA diminished monocyte
chemoattractant protein-1 expression and macrophage inflammatory protein 2
transcription in the diabetic kidney, inhibiting the induction of the macrophage
markers CD68 and F4/80. These results demonstrate that PCA antagonized
the infiltration and accumulation of macrophages in diabetic kidneys through
disturbing the mesangial IL-8-Tyk-STAT signaling pathway. Therefore, PCA may
be a potential renoprotective agent treating diabetes-associated glomerulosclerosis.

Proximate analysis, phytochemical screening, and total phenolic and flavonoid
contentof Philippine bamboo Schizostachyum lumampao
JVV Tongco, RM Aguda and RA Razal.
Journal of Chemical and Pharmaceutical Research, 2014, 6(1):709-713
www.jocpr.com

In Asia, bamboo has been widely cultivated as a fast growing non-timber forest
species. Flavonoids and phenolics were shown to reduce inflammation, promote
overall cardiovascular health and circulation, and even protect against certain kinds
of cancer. These studies necessitate the chemical characterization (e.g., proximate
analysis) and qualitative identification of phenolics.

The chemical composition of the leaves of Schizostachyum lumampao, known as
“buho” in the Philippines, was determined for its potential use as herbal tea with
potential health benefits, such as antioxidant properties. Proximate analysis using
standard AOAC methods showed that the air-dried leaves contain 10 % moisture, 30.5 % ash, 22.1 % crude protein, 1.6 % crude
fat, 28.7 % crude fiber, and 7.2 % total sugar (by difference). Using a variety of
reagents for qualitative phytochemical screening, saponins, diterpenes, triterpenes,
phenols, tannins, and flavonoids were detected in both the ethanolic and aqueous
leaf extracts, while phytosterols were only detected in the ethanolic extract. Using
UV-Vis spectrophotometry, the total phenolic content (in GAE) were 76.7 and
13.5 gallic acid equivalents per 100 g air-dried sample for the ethanolic and
aqueous extracts, respectively. The total flavonoid content were 70.2 and 17.86 mg
quercetin equivalents per 100 g air-dried sample for the ethanolic and aqueous
extracts, respectively. This preliminary study showed the total amount of phenolics
and flavonoids present in buho, the phytochemicals present, and its proximate
analysis.

Ophiopogonin D: A new herbal agent against osteoporosis
Q Huang, B Gao, L Wang, Hong-Yang Zhang, Xiao-Jie Li, J Shi, Z Wang, et al.
Bone 74 (2015) 18–28
http://dx.doi.org/10.1016/j.bone.2015.01.002

Excessive reactive oxygen species (ROS) play an important role in the development
of osteoporosis. Ophiopogonin D (OP-D), isolated from the traditional Chinese
herbal agent Radix Ophiopogon japonicus, is a potent anti-oxidative agent. We
hypothesized that OP-D demonstrates anti-osteoporosis effects via decreasing
ROS generation in mouse pre-osteoblast cell line MC3T3-E1 subclone 4 cells
and a macrophage cell line RAW264.7 cells. We investigated OP-D on osteogenic
and osteoclastic differentiation under oxidative status. Hydrogen peroxide (H2O2)
was used to establish an oxidative damage model. In vivo, we established a murine
ovariectomized (OVX) osteoporosis model. Then, we searched the molecular
mechanism of OP-D against osteoporosis. Our results revealed that OP-D
significantly promoted the proliferation of MC3T3-E1 cells and improved some
osteogenic markers. Moreover, OP-D reduced TRAP activity and the mRNA
expressions of osteoclastic genes in RAW264.7 cells. OP-D suppressed ROS
generation in both MC3T3-E1 and RAW264.7 cells. OP-D treatment reduced
the activity of serum bone degradation markers, including CTX-1 and TRAP.
Further research showed that OP-D displayed anti-osteoporosis effects via
reducing ROS through the FoxO3a-β-catenin signaling pathway. In summary,
our results indicated that the protective effects of OP-D against osteoporosis
are linked to a reduction in oxidative stress via the FoxO3a-β-catenin signaling
pathway, suggesting that OP-D may be a beneficial herbal agent in bone-related
disorders, such as osteoporosis.

Revealing the macromolecular targets of complex natural products
D Reker, AM Perna, T Rodrigues, P Schneider, M Reutlinger, et al.
Nature Chemistry Dec  2014; 6: 1072 – 1078
http://dx.doi.org:/10.1038/NCHEM.2095

Natural products have long been a source of useful biological activity for the
development of new drugs. Their macromolecular targets are, however, largely
unknown, which hampers rational drug design and optimization. Here we present
the development and experimental validation of a computational method for the
discovery of such targets. The technique does not require three-dimensional
target models and may be applied to structurally complex natural products. The
algorithm dissects the natural products into fragments and infers potential
pharmacological targets by comparing the fragments to synthetic reference drugs
with known targets. We demonstrate that this approach results in confident
predictions. In a prospective validation, we show that fragments of the potent
antitumour agent archazolid A, a macrolide from the myxobacterium Archangium
gephyra, contain relevant information regarding its polypharmacology.
Biochemical and biophysical evaluation confirmed the predictions. The results
obtained corroborate the practical applicability of the computational approach to
natural product ‘de-orphaning’.

In vitro activity of Inula helenium against clinical Staphylococcus aureus strains
including MRSA
O’Shea S, Lucey B, Cotter L.
Br J Biomed Sci. 2009;66(4):186-9.

The present study aims to investigate the bactericidal activity (specifically
antistaphylococcal) of Inula helenium. The antimicrobial activity of the extract is
tested against 200 clinically significant Irish Staphylococcus aureus isolates
consisting of methicillin-resistant (MRSA) and -sensitive (MSSA) S. aureus
using a drop test method and a microbroth dilution method. The antibacterial
effect is evaluated by measuring the area of the inhibition zone against the
isolates. Results proved I. helenium to be 100% effective against the 200
staphylococci tested, with 93% of isolates falling within the ++ and +++ groups.
The minimum bactericidal concentration of I. helenium was examined on a subset
of isolates and values ranged from 0.9 mg/mL to 9.0 mg/mL. The extract was
equally effective against antibiotic-resistant and -sensitive strains. This plant
therefore possesses compounds with potent antistaphylococcal properties, which
in the future could be used to complement infection control policies and prevent
staphylococcal infection and carriage. This research supports other studies
wherein herbal plants exhibiting medicinal properties are being examined to
overcome the problems of antibiotic resistance and to offer alternatives in the
treatment and control of infectious diseases.

Inhibition of Proliferation of Breast Cancer Cells MCF7 and MDA-MB-231 by Lipophilic Extracts of Papaya (Carica papaya L. var. Maradol) Fruit
LE Gayosso-García Sancho, EM Yahia, P García-Solís, GA González-Aguilar
Food and Nutrition Sciences, 2014, 5, 2097-2103
http://dx.doi.org/10.4236/fns.2014.521222

Several epidemiological studies have suggested that carotenoids have
antineoplasic activities. The objective of this study was to determine the
antiproliferative effect of rich carotenoid lipophilic extracts of papaya fruit
pulp (Carica papaya L., cv Maradol) in breast cancer cells, MCF-7 (estrogen
receptor positive) and MDA-MB-231 (estrogen receptor negative), and in
non-tumoral mammary epithelial cells MCF-12F. Antiproliferative effect
was evaluated using the methyl-thiazolydiphenyl-tetrazolium bromide
(MTT) assay and testing lipophilic extracts from different papaya fruit
ripening stages (RS1, RS2, RS3, RS4), at different times (24, 48 and
72 h). Papaya lipophilic extracts do not inhibit cell proliferation of MCF-12F
and MDA-MB-231 cells. However, MCF-7 cells showed a significant
reduction in proliferation at 72 h with the RS4 papaya extract. Results
suggested that lipophilic extracts had different action mechanisms on
each type of cells and therefore, more studies were required to elucidate
such mechanisms.

In vitro cytotoxic activity of silver nano particle biosynthesized from Colpomenia
sinuosa and Halymenia poryphyroides using DLA and EAC cell lines
Vishnu Kiran M and Murugesan S
World J Pharm Sci 2014; 2(9): 926-930.

This study was conducted to investigate the invitro cytotoxic activity of silver
nanoparticles biosynthesized

from Colpomenia sinuosa and Halymenia poryphyroides using DLA and EAC
cell lines by tryphan blue dye  exclusion technique and MTT assay using Mouse L929 cell lines (Lungs fibroblast). The results of the trypan blue dye exclusion assay indicates that the silver nano particles biosynthesized from
Colpomenia sinuosa and Halymenia poryphyroides inhibits the growth of DLA
and EAC cell lines in a dose dependent manner against the standard drug
Curcumin where the silver nano particle biosynthesized from Colpomenia sinuosa
showed 61.57 % and silver nano particle biosynthesized from Halymenia poryphyroides showed 89.36 % in DLA cell line similarly the silver nanoparticle biosynthesized
from Colpomenia sinuosa showed 81.96 % and silver nanoparticle biosynthesized
from Halymenia poryphyroides 91.45 % in EAC cell line. The results of the MTT
assay indicated the silver nanoparticles biosynthesized from Colpomenia sinuosa
and Halymenia poryphyroides significantly inhibited the proliferation of L929 cells
in dose dependent manner where the silver nanoparticle biosynthesized from
Colpomenia sinuosa showed 37.06 % and silver nanoparticle biosynthesized from
Halymenia poryphyroides showed 100 % against the standard drug Curcumin.

Garlic compound fights source of food-borne illness better than antibiotics
·Better than antibiotics: Garlic compound fights source of food-borne illness
(http://www.wsunews.wsu.edu)

Researchers at Washington State University have found that a compound in garlic
is 100 times more effective than two popular antibiotics at fighting the Campylobacter
bacterium, one of the most common causes of intestinal illness. Their work was
recently published in the Journal of Antimicrobial Chemotherapy.  The discovery
opens the door to new treatments for raw and processed meats and food preparation
surfaces. Most infections stem from eating raw or undercooked poultry or foods
that have been cross-contaminated via surfaces or utensils used to prepare poultry.

Lu and his colleagues looked at the ability of the garlic-derived compound, diallyl
sulfide, to kill the bacterium when it is protected by a slimy biofilm that makes it
,000 times more resistant to antibiotics than the free floating bacterial cell. They
found the compound can easily penetrate the protective biofilm and kill bacterial
cells by combining with a sulfur-containing enzyme, subsequently changing
the enzyme’s function and effectively shutting down cell metabolism. The
researchers found the diallyl sulfide was as effective as 100 times as much
of the antibiotics erythromycin and ciprofloxacin and would often work in a
fraction of the time.

Two previous works published last year by Lu and WSU colleagues in Applied
and Environmental Microbiology and Analytical Chemistry found diallyl sulfide
and other organosulfur compounds effectively kill important foodborne pathogens,
such as Listeria monocytogenes and Escherichia coli O157:H7.

“Diallyl sulfide could make many foods safer to eat”, says Barbara Rasco, a
co-author on all three recent papers and Lu’s advisor for his doctorate in food
science. “It can be used to clean food preparation surfaces and as a preservative
in packaged foods like potato and pasta salads, coleslaw and deli meats”.

Effect of tree nuts on metabolic syndrome criteria: a systematic review and
meta-analysis of randomized controlled trials

SB Mejia, CWC Kendall, E Viguiliouk, LS Augustin, V Ha, AI Cozma, A Mirrahimi, et al.
BMJ Open 2014;4:e004660.  http://dx.doi.org:/10.1136/bmjopen-2013-004660

Objective: To provide a broader evidence summary to inform dietary guidelines of the
effect of tree nuts on criteria of the metabolic syndrome (MetS).
Design: We conducted a systematic review and metaanalysis of the effect of
tree nuts on criteria of the MetS.
Data sources: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library
(through 4 April 2014).
Eligibility criteria for selecting studies: We included relevant randomized controlled
trials (RCTs) of ≥3 weeks reporting at least one criterion of the MetS.
Data extraction: Two or more independent reviewers extracted all relevant data. Data
were pooled using the generic inverse variance method using random effects models
and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed
by the Cochran Q statistic and quantified by the I2 statistic. Study quality and risk of
bias were assessed.
Results: Eligibility criteria were met by 49 RCTs including 2226 participants who
were otherwise healthy or had dyslipidemia, MetS or type 2 diabetes mellitus.
Tree nut interventions lowered triglycerides (MD=−0.06 mmol/L (95% CI −0.09
to −0.03 mmol/L)) and fasting blood glucose (MD=−0.08 mmol/L (95% CI −0.16
to −0.01 mmol/L)) compared with control diet interventions. There was no effect
on waist circumference, high-density lipoprotein cholesterol or blood pressure with
the direction of effect favoring tree nuts for waist circumference. There was
evidence of significant unexplained heterogeneity in all analyses (p<0.05).
Conclusions: Pooled analyses show a MetS benefit of tree nuts through modest
decreases in triglycerides and fasting blood glucose with no adverse effects
on other criteria across nut types. As our conclusions are limited by the short
duration and poor quality of the majority of trials, as well as significant
unexplained between-study heterogeneity, there remains a need for larger,
longer, high-quality trials.

DPPH free radical scavenging activity of phenolics and flavonoids in some medicinal
plants of India
R Patel, Y Patel, P Kunjadia and A Kunjadia
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 773-780 http://www.ijcmas.com

Methanolic extracts of Gymnema sylvestre (leaf), Holarrhena antidysenterica (bark),
Vernonia anthelmintica(seeds) Enicostemma littorale (leaf), Momordica charantia
(fruit), Swertia chirata (leaf), Azadirachta indica (leaf), Caesalpinia bonducella (leaf)
used in Ayurvedic medicines for number of ailments were evaluated for their
antioxidant activity.The free radical-scavenging activity of the extracts was measured
as decolorizing activity followed by the trapping of the unpaired electron by 1, 1-
diphenyl-2-picryl hydrazyl radical (DPPH). The percentage decrease of DPPH
was recorded maximum in A. indica followed by M. charantia, C. bonducella,
E.littorale, V. anthelmintica, S.chirata, H.antidysenterica, G.sylvestre. The
antioxidant activity of medicinal plants was at par with the commercial antioxidant
like L-Ascorbic acid. Phytochemical analysis revealed the presence of major
phytocompounds like terpenoids, alkaloids, glycosides, phenolics and tannins.
Moreover, total flavonoid concentration equivalents to gallic acid was found in
the range of 326 μg to 1481μg/g of plant extracts and that of total phenolic
concentration equivalents to phenol was found in the range of 23.50 μg to
89.82 μg/g of plant extracts. The findings indicated promising antioxidant
activity of crude extracts of the above plants and needs further exploration
for their effective use in both modern and traditional system of medicines.

Cyanobacterial natural products as antimicrobial agents
V.D. Pandey
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 310-317 http://www.ijcmas.com

Cyanobacteria (blue-green algae) constitute a morphologically diverse and
widely distributed group of Gram-negative photosynthetic prokaryotes. Possessing
tremendous adaptability to varying environmental conditions, effective protective
mechanisms against various abiotic stresses and metabolic versatility, they colonize
and grow in different types of terrestrial and aquatic habitats. In addition to
the potential applications of cyanobacteria in various fields, such as agriculture,
aquaculture, pollution control, bioenergy and nutraceuticals, they produce chemically
diverse and pharmacologically important novel bioactive compounds, including
antimicrobial compounds (antibacterial, antifungal and antiviral). The emergence
and spread of antibiotic resistance in pathogenic microbes against commonly used
antibiotics necessitated the search for new antimicrobial agents from sources other
than the traditional microbial sources (streptomycetes and fungi). Various features
of cyanobacteria, including their capability of producing antimicrobial compounds,
make them suitable candidates for their exploitation as a natural source
of antimicrobial agents.
Determination of nutritional value and antioxidant from bulbs of different onion
(Allium cepa) variety: A comparative study
Kandoliya, U.K.*, Bodar, N.P., Bajaniya, V.K., Bhadja N.V. and Golakiya, B.A.
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 635-641 http://www.ijcmas.com

Onion (Allium cepa) is one of the most economically important vegetable crops
consumed for their ability to enhance the added flavor and typical taste in other
foods. It is a good source of antioxidants as well as some phytonutrients.
So the experiment was conducted to study the nutritional quality along with
various parameters contributing antioxidant activity from onion of different red and
white type local varieties. The findings revealed from all the variety studied,
shows 58.14 to 77.67 % DPPH value, comparable amount of flavanoids
(0.422 to 1.232 mg.g-1) and anthocyanine content along with total phenol
(8.96-18.23 mg.100 g-1), Pyruvic acid (1.09 to 1.33 mg.g-1), ascorbic acid
(1.18 to 3.89 mg.100g-1) , protein (0.79 to 1.27%) and titrable acidity
(0.34 0.75%).These results reveal that JDRO-07-13 of Red variety and
GWO-1 of white nutritionally found better due to its higher antioxidant
property, proteins, carbohydrates, reducing sugar and should be included in diets to supplement our daily allowance needed by the body.

Curcumin: New Weapon against Cancer
Fayez Hamam
Food and Nutrition Sciences, 2014, 5, 2257-2264
http://dx.doi.org/10.4236/fns.2014.522239

All the evidences point out to the fact that the incidence, mortality and number of
persons living with cancer are on the rise and, thus, this will impose a significant
burden on health care resources. The considerable number of deaths from cancer
necessitates the need to developing novel alternative cures that are efficient, safe,
cheap and easy to use. In the search for new therapies for tumors, naturally-derived compounds have been considered as a good source of novel anticancer
drugs. The challenge here is to find products that are pharmacologically active
against tumor cells with suitable toxicity profile and least damage to normal cells.
Curcumin is a spice widely used in many countries especially in South Asia and
it has gained importance for its anticancer function and low toxicity toward normal
tissues in a range of biological systems. In spite of significant research works, many
difficulties hinder its oral use in the therapy of different kind of tumors, such as
extreme low solubility in water, quick break down and excretion after being absorbed
in the human body. Low bioavailability due to enhanced metabolism and rapid
system elimination is another problem that hinders oral use of curcumin as
anticancer agent. Therefore, the previously mentioned poor pharmacokinetics
characteristics inhibit curcumin from reaching its site of action and, thus,
lessen its effectiveness against tumors. This article reviews the latest global
cancer statistics with special attention to be directed toward ovarian cancer.
It sheds light on many research works that investigated the protective and
therapeutic functions of different curcumin preparations against different
sites of cancer using animal models. It also summarizes recent
research works concerning the antitumor effects of curcumin alone and/or
loaded into a range of delivery devices in many types of ovarian cancer cell lines.

Cinnamon is lethal weapon against E. coli O157:H7

When cinnamon is in, Escherichia coli O157:H7 is out.  That’s what researchers
at Kansas State University discovered in laboratory tests with cinnamon and
apple juice heavily tainted with the bacteria.  Presented at the Institute of Food
Technologists’ 1999 Annual Meeting in Chicago on July 27, the study findings
revealed that cinnamon is a lethal weapon against  E. coli O157:H7 and may be
able to help control it in unpasteurized juices.

Lead researcher Erdogan Ceylan, M.S., reported that in apple juice samples
inoculated with about one million E. coli O157:H7 bacteria, about one teaspoon
(0.3 percent) of cinnamon killed 99.5 percent of the bacteria in three days at room
temperature (25 C).  When the same amount of cinnamon was combined with
either 0.1 percent sodium benzoate or potassium sorbate, preservatives approved
by the Food and Drug Administration, the E. coli were knocked out to an
undetectable level.  The number of bacteria added to the test samples was
100 times the number typically found in contaminated food.

“If cinnamon can knock out E. coli O157:H7, one of the most virulent foodborne
microorganisms that exists today, it will certainly have antimicrobial effects on other
common foodborne bacteria, such as Salmonella and Campylobacter,” noted Daniel
Y.C. Fung, Ph.D., professor of Food Science in the Department of Animal Sciences
and Industry at K-State, who oversaw the research.

Last year, Fung and Ceylan researched the antimicrobial effects of various spices
on  E. coli O157:H7 in raw ground beef and sausage and found that cinnamon,
clove, and garlic were the most powerful.  This research led to their recent studies
on cinnamon in apple juice, which proved to be a more effective medium than meat
for the spice to kill the bacteria.

“In liquid, the E. coli have nowhere to hide,” Fung noted, “whereas in a solid structure,
such as ground meat, the bacteria can get trapped in the fat or other cells and
avoid contact with the cinnamon.  But this cannot happen in a free-moving environment.”

For a copy of the study presented at IFT’s Annual Meeting, contact Angela Dansby at
312-82-8424 x127 or via e-mail at aldansby@ift.org
Anti-inflammatory, anti-proliferative and anti-atherosclerotic effects of quercetin in
human in vitro and in vivo models
R Kleemann, Lars Verschuren, M Morrison, S Zadelaar, MJ van Erk, PY Wielinga, & T  Kooistra
Atherosclerosis 218 (2011) 44– 52
http://dx.doi.org:/10.1016/j.atherosclerosis.2011.04.023

Objective: Polyphenols such as quercetin may exert several beneficial effects,
including those resulting from anti-inflammatory activities, but their impact on
cardiovascular health is debated. We investigated the effect of quercetin on
cardiovascular risk markers including human C-reactive protein (CRP) and on
atherosclerosis using transgenic humanized models of cardiovascular disease.
Methods: After evaluating its anti-oxidative and anti-inflammatory effects in
cultured human cells, quercetin (0.1%, w/w in diet) was given to human CRP
transgenic mice, a humanized inflammation model, and ApoE*3Leiden transgenic
mice, a humanized atherosclerosis model. Sodium salicylate was used as an
anti-inflammatory reference. Results: In cultured human endothelial cells,
quercetin protected against H2O2-induced lipid peroxidation and reduced the
cytokine-induced cell-surface expression of VCAM-1 and E-selectin. Quercetin
also reduced the transcriptional activity of NFB in human hepatocytes. In human
CRP transgenic mice (quercetin plasma concentration: 12.9 ± 1.3 M), quercetin
quenched IL1-induced CRP expression, as did sodium salicylate. In ApoE*3 Leiden mice, quercetin (plasma concentration: 19.3 ± 8.3 M) significantly attenuated
atherosclerosis by 40% (sodium salicylate by 86%). Quercetin did not affect
atherogenic plasma lipids or lipoproteins but it significantly lowered the circulating
inflammatory risk factors SAA and fibrinogen. Combined histological and microarray
analysis of aortas revealed that quercetin affected vascular cell proliferation thereby
reducing atherosclerotic lesion growth. Quercetin also reduced the gene expression
of specific factors implicated in local vascular inflammation including IL-1R, Ccl8, IKK,
and STAT3.
Conclusion: Quercetin reduces the expression of human CRP and cardiovascular risk
factors (SAA, fibrinogen) in mice in vivo. These systemic effects together with local
anti-proliferative and anti-inflammatory effects in the aorta may contribute to the
attenuation of atherosclerosis.
Natural products to drugs: natural product derived compounds in clinical trials
Mark S. Butler
Nat  Prod  Rep  2005; 22 : 162 – 195 http://dx.doi.org:/10.1039/b402985m

Natural product and natural product-derived compounds that are being
evaluated in clinical trials or in registration (current 31 December 2004)
have been reviewed. Natural product derived drugs launched in the
United States of America, Europe and Japan since 1998 and new
natural product templates discovered since 1990 are discussed.

Natural Products (NPs) traditionally have played an important role in drug discovery
and were the basis of most early medicines. Over the last 10 to 15 years advances
in X-ray crystallography and NMR, and alternative drug discovery methods such as
rational drug design and combinatorial chemistry have placed great pressure upon
NP drug discovery programs and during this period most major pharmaceutical
companies have terminated or considerably scaled down their NP operations.
However, despite the promise of these alternative drug discovery methods, there is
still a shortage of lead compounds progressing into clinical trials. This is especially
the case in therapeutic areas such as oncology, immunosuppression and metabolic
diseases where NPs have played a central role in lead discovery. In a recent review,
Newman,Cragg and Snader analysed the number of NP-derived drugs present in
the total drug launches from 1981 to 2002 and found that NPs were a significant
source of these new drugs, especially in the oncological and antihypertensive
therapeutic areas. In addition to providing many new drug leads, NPs and NP-derived drugs were well represented in the top 35 worldwide selling ethical drugs
in 2000, 2001 and 2002.

Antibacterial activity of green tea (Camellia sinensis) Extract against dental
caries and other pathogens
P. Lavanya and M. Sri priya
Int.J.Adv. Res.Biol.Sci.2014; 1(5):58-70

The present study has however, revealed that the herbal plant Camellia sinensis (green tea) possess antimicrobial properties. The isolated strains were confirmed by performing staining and biochemical techniques. Aqueous extract of green tea were taken and used for the study of inhibition effect against dental caries and
other pathogens. The zone of inhibition was performed using agar well diffusion techniques different concentration of green tea extracts were studied for their
antibacterial activity. The overall results showed that the microorganisms
were susceptible to different concentration of aqueous extracts of Camellia
sinensis which is a function of their antimicrobial properties. The effectiveness of active principle was studied and compared with the previous one. The nature
of the chemicals present as active principle of the extract was studied using
Paper chromatography and Thin layer chromatography. The chemicals involved in
antimicrobial activity are commonly belonging to any one of the group such as flavanoids, alkaloids, saponins and polyphenols. It could be concluded
that flavonoid in a potential natural, antimicrobial agent against dental
caries and other pathogens.

Antibacterial activity of Mangrove Medicinal Plants against Gram positive
Bacterial pathogens
K. A. Selvam* and K. Kolanjinathan
Int. J. Adv. Res. Biol.Sci. 1(8): (2014): 234–241

Ten mangrove medicinal plants viz., Avicennia marina, Rhizophora mucuronata, Rhizophora mangle, Asparagus officinalis, Ceriops decandra, Aegiceras
corniculatum, Acanthus ilicifolius, Bruguiera cylindrica, Rhizophora apiculata and Xylocarpus grantum were collected from mangrove forest of Pichavaram, Tamil
Nadu, India. The antibacterial activity of mangrove plant extracts (150 mg/ml and
300 mg/ml) were determined by Disc diffusion method. The zone of inhibition was more at 300 mg/ml of extracts when compared to 150 mg/ml of extracts. The
antibacterial activity of selected mangrove plant leaf extracts was determined
against pathogenic bacterial isolates. The methanol extract of Ceriops decandra showed maximum zone of inhibition against all the bacterial isolates followed
by Avicennia marina, Rhizophora mucronata, Aegiceras corniculatum, Rhizophora apiculata, Rhizophora mangle, Acanthus ilicifolius, Asparagus officinalis, Xylocarpus grantum and Bruguiera cylindrica at 300 mg/ml. The hexane extract of mangrove plants showed minimum inhibition zone against bacterial pathogens
when compared to the other solvent extracts. The DMSO was used as a blind
control and the antibiotic Ampicillin (300 mg/ml) was used as a positive control. Minimum inhibitory concentration (MIC) of the mangrove plant extracts against bacterial isolates was tested in Mueller Hinton broth by Broth macro dilution
method. The MIC of mangrove plants against bacterial pathogens was ranged
between 20 mg/ml to 640 mg/ml.

Antioxidant and antibacterial activity of Berberis tinctoria root
Karthikkumar Va, Sharanya R , Allegendiran R, Sasikumar J.M
Int. J. Adv. Res. Biol.Sci. 1(9): (2014): 292–297
Herbs have always been the principle form of medicine in developing nations
and presently they are becoming popular throughout the developed world as
people strive to stay healthy in the face of chronic stress and to treat illness with medicines that work in concert with body’s own defences. The aim of the present study was to evaluate the antioxidant and antibacterial potential of Bereris
tinctoria root. Plant material collected and extracted with various solvents. Different concentrations of extracts were used to evaluate the potential. Bereberis tinctoria
root at a concentration of 1000μg/ml shows high antioxidant activity and relatively
all extracts possessing strong to moderate antibacterial activity. In addition, during phytochemical screening, we got saponins and sterols from its root, when extracting with organic solvents. Thus, root extract of Berberis tinctoria might be good
candidate for the synthesis of antibacterial drugs in the future.

Biological Activities of Soybean Galactomannan Oligosaccharides and
Their Sulfated Derivatives
MMI Helal, SA Ismail, MOI Ghobashy, SS Elgazar, et al.
Int.J.Adv. Res.Biol.Sci.2014; 1(6):113-121

Galactomanno-oligosaccharieds (GMO) and their sulfated derivatives
(SGMO) were prepared from soybean hulls and evaluated for their biological
activities as anticoagulant; antimicrobial; antitumor; fibrinolytic and prebiotics.
The results indicated that the sulfating process has positive effect on the
anticoagulation and fibrinolytic activities of the galactomanno-oligosaccharides.
The SGMO have prolonged clotting time more than 24h at concentration resemble that of the standard heparin. It was also found that the SGMO have fibrinolytic
activity as that of the standard hemoclar and 3 times higher than that of the native GMO oligosaccharides. The prepared oligosaccharides also preformed anti-tumor
activity against human colon carcinoma cell line and the percentage of the dead cells increase from 28% to 72% by increase the concentration of the oligosaccharides from 0.005 to 0.02 mg/ml. The tested galactomanno-oligosaccharides also act as good source for prebiotic as they have the ability to grow the beneficial bacteria
4 to 8 times higher than the pathogenic one. To our knowledge this is the first
time someone report anticoagulation; fibrinolytic and direct antitumor activities for galactomanno-oligosaccharides not to mention soybean galactomanno-oligosaccharides.

Biotechnological Application of Production β-Lactamase Inhibitory Protein
(BLIP) By Actinomycetes Isolates from Al-Khurmah Governorate
HM Atta;  RA Bayoumi and  MH El-Sehrawi
Int. J. Adv. Res. Biol.Sci. 1(7): (2014): 144–154

Many pathogenic bacteria secrete β-lactamase enzymes as a mechanism of
defense against β-lactam antibiotics. Sixty-nine unrepeated actinomycetes
isolates were isolated from different localities in Al-Khurmah governorate, Saudi Arabia kingdom. Actinomycetes isolates were screened for producing β-lactamase inhibitory effect against amoxicillin –resistant bacteria. There were eleven isolates (15.94 %) which had β-lactamase inhibitory protein (BLIP) effect against amoxicillin –resistant Staphylococcus aureus, pseudomonas aeruginosa and Klebsiella
pneumonia. The KH-3201-144 isolate has been considered the most potent, this
was identified by biochemical, chemotaxonomic, morphological and physiological properties consistent with classification in the genus Streptomyces, with the
nearest species being Streptomyces rimosus. Furthermore, a phylogenetic
analysis of the 16S rDNA gene sequence and ribosomal database project
consistent with conventional taxonomy confirmed that strain KH-3201-144
was most similar to Streptomyces rimosus (96%). The highest amount of
β-lactamase inhibitory protein was precipitated at 40% of saturated ammonium sulphate. The purification was carried out by using both diethyl-aminoethyl-cellulose G-25 and sephadex G-200 column chromatography, respectively.
The β-lactamase inhibitory protein was separated at 40 KDa. The minimum
inhibition concentrations “MICs” of the purified β-lactamase inhibitory protein
(BLIP) effect against amoxicillin –resistant Staphylococcus aureus, pseudomonas aeruginosa and Klebsiella pneumonia were also determined.

Bioactive compounds from marine Microbes
P.Sudhasupriya and M.Rajalakshmi
Int.J.Adv. Res.Biol.Sci.2014; 1(6):232-236

Natural compounds isolated from marine organisms have been found to be
a very rich source of bioactive molecules. Reported biological effects of these compounds include anti‐tumor, anti-inflammatory and anti‐viral activities as
well as immunomodulatory and analgesic properties. Pharmaceutical market is growing rapidly and continuously. But, still the demand for new drug discovery
is encouraged. The reason behind this motivation can be the growing number
of drug–resistant infectious diseases and more and more upcoming disorders. Pharmaceutical market is growing rapidly and continuously. But, still the demand
for new drug discovery is encouraged. The reason behind this motivation can
be the growing number of drug–resistant infectious diseases and more and more upcoming disorders.

The Discovery and Properties of Avemar – Fermented Wheat Germ
Extract: Carcinogenesis Suppressor
Larry H Bernstein, MD, FCAP, Contributor
http://pharmaceuticalintelligence.com/2014/06/07/the-discovery-
and-properties-of-avemar-fermented-wheat-germ-extract-
carcinogenesis-suppressor/

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Prefacing the e-Book Epilogue: Metabolic Genomics and Pharmaceutics

Author and Curator: Larry H. Bernstein, MD, FCAP

 

Adieu, adieu, adieu …

Sound of Music

Snoopy - Charlie happiness

Snoopy – Charlie happiness

This work has been a coming to terms with my scientific and medical end of career balancing in a difficult time after retiring, but it has been rewarding.  In the clinical laboratories, radiology, anesthesiology, and in pharmacy, there has been some significant progress in support of surgical, gynecological, developmental, medical practices, and even neuroscience directed disciplines, as well as epidemiology over a period of half a century.  Even then, cancer and neurological diseases have been most difficult because the scientific basic research has either not yet uncovered a framework, or because that framework has proved to be multidimensional.  In the clinical laboratory sciences, there has been enormous progress in instrumental analysis, with the recent opening of molecular methods not yet prepared for routine clinical use, which will be a very great challenge to the profession, which has seen the development of large sample volume, multianalite, high-throughput, low-cost support emerging for decades.  The capabilities now underway will also enrrich the the capabilities of the anatomic pathology suite and the capabilities of 3-dimensional radiological examination.  In both pathology and radiology, we have seen the division of the fields into major subspecialties.  The development of the electronic health record had to take lessons from the first developments in the separate developments of laboratory, radiology, and pharmacy health record systems, to which were added, full cardiology monitoring systems.  These have been unintegrated.  This made it difficult to bring forth a suitable patient health record because the information needed to support decision-making by practitioners was in separate “silos”.  The mathematical methods that are being applied to the -OMICS sciences, can be brought to bear on the simplification and amplification of the clinicians’ ability to make decisions with near “errorless” discrimination, still allowing for an element of “art” in carrying out the history, physical examination, and knowledge unique to every patient.

We are at this time opening a very large, complex, study of biology in relationship to the human condition.  This will require sufficient resources to be invested in the development of these for a better society, which I suspect, will go on beyond the life of my grandchildren.  Hopefully, the long-term dangers of climate change will be controlled in that time.  As a society, or as a group of interdependent societies, we have no long term interest in continuing self-destructive behaviors that have predominated in the history of mankind.  I now top off these discussions with some further elucidation of what lies before us.

Metabolomics and systems pharmacology: why and how to model the human metabolic network for drug discovery

Douglas B. Kell and Royston Goodacre
School of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
Drug Discovery Today Feb 2014;19(2)  http://dx.doi.org/10.1016/j.drudis.2013.07.014

Metabolism represents the ‘sharp end’ of systems biology,

  • because changes in metabolite concentrations
  • are necessarily amplified relative to
  • changes in the transcriptome, proteome and enzyme activities,
  • which can be modulated by drugs.

To understand such behaviour, we therefore need
(and increasingly have)

  • reliable consensus (community) models of the human metabolic network
  • that include the important transporters.

Small molecule ‘drug’ transporters are in fact metabolite transporters,

  • because drugs bear structural similarities to metabolites known
  • from the network reconstructions and from measurements of the metabolome.

Recon2 represents the present state-of-the-art human metabolic
network reconstruction; it can predict inter alia:

  1. the effects of inborn errors of metabolism;
  2. which metabolites are exometabolites, and
  3. how metabolism varies between tissues and cellular compartments.

Even these qualitative network models are not yet complete. As our
understanding improves so do we recognize more clearly the need for a systems (poly)pharmacology.

Modelling biochemical networks – why we do so
There are at least four types of reasons as to why one would wish to model a biochemical network:

  1. Assessing whether the model is accurate, in the sense that it
    reflects – or can be made to reflect – known experimental facts.
  2. Establishing what changes in the model would improve the
    consistency of its behaviour with experimental observations
    and improved predictability, such as with respect to metabolite
    concentrations or fluxes.
  3. Analyzing the model, typically by some form of sensitivity
    analysis, to understand which parts of the system contribute
    most to some desired functional properties of interest.
  4. Hypothesis generation and testing, enabling one to analyse
    rapidly the effects of manipulating experimental conditions in
    the model without having to perform complex and costly
    experiments (or to restrict the number that are performed).

In particular, it is normally considerably cheaper to perform
studies of metabolic networks in silico before trying a smaller
number of possibilities experimentally; indeed for combinatorial
reasons it is often the only approach possible. Although
our focus here is on drug discovery, similar principles apply to the
modification of biochemical networks for purposes of ‘industrial’
or ‘white’ biotechnology.
Why we choose to model metabolic networks more than

  • transcriptomic or proteomic networks

comes from the recognition – made particularly clear

  • by workers in the field of metabolic control analysis

– that, although changes in the activities of individual enzymes tend to have

  • rather small effects on metabolic fluxes,
  • they can and do have very large effects on metabolite concentrations (i.e. the metabolome).

Modelling biochemical networks – how we do so

Although one could seek to understand the

  1. time-dependent spatial distribution of signalling and metabolic substances within indivi
    dual cellular compartments and
  2. while spatially discriminating analytical methods such as Raman spectroscopy and
    mass spectrometry do exist for the analysis of drugs in situ,
  • the commonest type of modelling, as in the spread of substances in
    ecosystems,
  • assumes ‘fully mixed’ compartments and thus ‘pools’ of metabolites.

Although an approximation, this ‘bulk’ modelling will be necessary for complex ecosystems such as humans where, in addition to the need for tissue- and cell-specific models, microbial communities inhabit this superorganism and the
gut serves as a source for nutrients courtesy of these symbionts.

Topology and stoichiometry of metabolic networks as major constraints on fluxes
Given their topology, which admits a wide range of parameters for
delivering the same output effects and thereby reflects biological
robustness,

  • metabolic networks have two especially important constraints that assist their accurate modelling:

(i) the conservation of mass and charge, and
(ii) stoichiometric and thermodynamic constraints.

These are tighter constraints than apply to signalling networks.

New developments in modelling the human metabolic network
Since 2007, several groups have been developing improved but nonidentical models of the human metabolic network at a generalised level and in tissue-specific forms. Following a similar community-driven strategy in Saccharomyces cerevisiae, surprisingly similar to humans, and in Salmonella typhimurium,

we focus in particular on a recent consensus paper that provides a highly curated and semantically annotated model of the human metabolic network, termed

In this work, a substantial number of the major groups active in this area came together to provide a carefully and manually constructed/curated network, consisting of some 1789 enzyme-encoding genes, 7440 reactions and 2626 unique metabolites distributed over eight cellular compartments.  A variety of dead-end metabolites and blocked reactions remain (essentially orphans and widows). But Recon2 was able to

  • account for some 235 inborn errors of metabolism,
  • a variety of metabolic ‘tasks’ (defined as a non-zero flux through a reaction or through a pathway leading to the production of a metabolite Q from a metabolite P).
  • filtering based on expression profiling allowed the construction of 65 cell-type-specific models.
  • Excreted or exometabolites are an interesting set of metabolites,
  • and Recon2 could predict successfully a substantial fraction of those

Role of transporters in metabolic fluxes

The uptake and excretion of metabolites between cells and their macrocompartments

  • requires specific transporters and in the order of one third of ‘metabolic’ enzymes,
  • and indeed of membrane proteins, are in fact transporters or equivalent.

What is of particular interest (to drug discovery), based on their structural similarities, is the increasing recognition (Fig. 3) that pharmaceutical drugs also

  • get into and out of cells by ‘hitchhiking’ on such transporters, and not –

to any significant extent –

  • by passing through phospholipid bilayer portions
    of cellular membranes.

This makes drug discovery even more a problem of systems biology than of biophysics.

role of solute carriers and other transporters in cellular drug uptake

role of solute carriers and other transporters in cellular drug uptake

Two views of the role of solute carriers and other transporters in cellular drug uptake. (a) A more traditional view in which all so-called ‘passive’drug uptake occurs through any unperturbed bilayer portion of membrane that might be present.
(b) A view in which the overwhelming fraction of drug is taken up via solute transporters or other carriers that are normally used for the uptake of intermediary metabolites. Noting that the protein:lipid ratio of biomembranes is typically 3:1 to 1:1 and that proteins vary in mass and density (a typical density is 1.37 g/ml) as does their extension, for example, normal to the ca. 4.5 nm lipid bilayer region, the figure attempts to portray a section of a membrane with realistic or typical sizes and amounts of proteins and lipids. Typical protein areas when viewed normal to the membrane are 30%, membranes are rather more ‘mosaic’ than ‘fluid’ and there is some evidence that there might be no genuinely ‘free’ bulk lipids (typical phospholipid masses are 750 Da) in biomembranes that are uninfluenced by proteins. Also shown is a typical drug: atorvastatin (LipitorW) – with a molecular mass of 558.64 Da – for size comparison purposes. If proteins are modelled as
cylinders, a cylinder with a diameter of 3.6 nm and a length of 6 nm has a molecular mass of ca. 50 kDa. Note of course that in a ‘static’ picture we cannot show the dynamics of either phospholipid chains or lipid or protein diffusion.

‘Newly discovered’ metabolites and/or their roles

To illustrate the ‘unfinished’ nature even of Recon2, which concentrates on the metabolites created via enzymes encoded in the human genome, and leaving aside the more exotic metabolites of drugs and foodstuffs and the ‘secondary’ metabolites of microorganisms, there are several examples of interesting ‘new’ (i.e. more or less recently recognised) human metabolites or roles thereof that are worth highlighting, often from studies seeking biomarkers of various diseases – for caveats of biomarker discovery, which is not a topic that we are covering here, and the need for appropriate experimental design. In addition, classes of metabolites not well represented in Recon2 are oxidised molecules such as those caused by nonenzymatic reaction of metabolites with free radicals such as the hydroxyl radical generated by unliganded iron. There is also significant interest in using methods of determining small molecules such as those in the
metabolome (inter alia) for assessing the ‘exposome’, in other words all the potentially polluting agents to which an
individual has been exposed.

Recently discovered effects of metabolites on enzymes 

Another combinatorial problem reflects the fact that in molecular enzymology it is not normally realistic to assess every possible metabolite to determine whether it is an effector (i.e.activator or inhibitor) of the enzyme under study. Typical proteins are highly promiscuous and there is increasing evidence for the comparative promiscuity of metabolites
and pharmaceutical drugs. Certainly the contribution of individual small effects of multiple parameter changes can have substantial effects on the potential flux through an overall pathway, which makes ‘bottom up’ modelling an inexact science. Even merely mimicking the vivo (in Escherichia coli) concentrations of K+, Na+, Mg2+, phosphate, glutamate, sulphate and Cl significantly modulated the activities of several enzymes tested relative to the ‘usual’ assay conditions. Consequently, we need to be alive to the possibility of many (potentially major) interactions of which we are as yet ignorant. One class of example relates to the effects of the very widespread post-translational modification on metabolic
enzyme activities.

A recent and important discovery (Fig. 4) is that a single transcriptome experiment, serving as a surrogate for fluxes through individual steps, provides a huge constraint on possible models, and predicts in a numerically tractable way and
with much improved accuracy the fluxes to exometabolites without the need for such a variable ‘biomass’ term. Other recent and related strategies that exploit modern advances in ‘omics and network biology to limit the search space in constraint-based metabolic modelling.

Fig 4. Workflow for expression-profile-constrained metabolic flux estimation

  1. Genome-scale metabolic model with gene-protein-reaction relationships
  2. Map absolute gene expression levels to reactions
  3. Maximise correlation between absolute gene expression and metabolic flux
  4. Predict fluxes to exometabolites
  5. Compare predicted with experimental fluxes to exometabolites

Drug Discovery Today

The steps in a workflow that uses constraints based on (i) metabolic network stoichiometry and chemical reaction properties (both encoded in the model) plus, and (ii) absolute (RNA-Seq) transcript expression profiles to enable the
accurate modelling of pathway and exometabolite fluxes. .

Concluding remarks – the role of metabolomics in systems pharmacology

What is becoming increasingly clear, as we recognize that to understand living organisms in health and disease we must treat them as systems, is that we must bring together our knowledge of the topologies and kinetics of metabolic networks with our knowledge of the metabolite concentrations (i.e. metabolomes) and fluxes. Because of the huge constraints imposed on metabolism by reaction stoichiometries, mass conservation and thermodynamics, comparatively few well-chosen ‘omics measurements might be needed to do this reliably (Fig. 4). Indeed, a similar approach exploiting constraints has come to the fore in denovo protein folding and interaction studies.

What this leads us to in drug discovery is the need to develop and exploit a ‘systems pharmacology’ where multiple binding targets are chosen purposely and simultaneously. Along with other measures such as phenotypic screening, and the integrating of the full suite of e-science approaches, one can anticipate considerable improvements in the rate of discovery of safe and effective drugs.

Metabolomics: the apogee of the omics trilogy
Gary J.!Patti, Oscar Yanes and Gary Siuzdak

Metabolites, the chemical entities that are transformed during metabolism, provide a functional readout of cellular biochemistry. With emerging technologies in mass spectrometry, thousands of metabolites can now be
quantitatively measured from minimal amounts of biological material, which has thereby enabled systems-level analyses. By performing global metabolite profiling, also known as untargeted metabolomics, new discoveries linking cellular pathways to biological mechanism are being revealed and are shaping our understanding of cell biology, physiology and medicine.

Metabolites are small molecules that are chemically transformed during metabolism and, as such, they provide a functional readout of cellular state. Unlike genes and proteins, the functions of which are subject to epigenetic regulation and posttranslational modifications, respectively, metabolites serve as direct signatures of biochemical activity and are therefore easier to correlate with phenotype. In this context, metabolite profiling, or metabolomics, has become a powerful approach that has been widely adopted for clinical diagnostics.

The field of metabolomics has made remarkable progress within the past decade and has implemented new tools that have offered mechanistic insights by allowing for the correlation of biochemical changes with phenotype.

In this Innovation article, we first define and differentiate between the targeted and untargeted approaches to metabolomics. We then highlight the value of untargeted metabolomics in particular and outline a guide to performing such studies. Finally, we describe selected applications of un targeted metabolomics and discuss their potential in cell biology.

  • metabolites serve as direct signatures of biochemical activity
  1. In some instances, it may be of interest to examine a defined set of metabolites by using a targeted approach.
  2. In other cases, an untargeted or global approach may be taken in which as many metabolites as possible are measured and compared between samples without bias.
  3. Ultimately, the number and chemical composition of metabolites to be studied is a defining attribute of any metabolomic experiment and shapes experimental design with respect to sample preparation and choice of instrumentation.

The targeted and untargeted workflow for LC/MS-based metabolomics.

a | In the triple quadrupole (QqQ)-based targeted metabolomic workflow, standard compounds for the metabolites of interest are first used to set up selected reaction monitoring methods. Here, optimal instrument voltages are determined and response curves are generated for absolute quantification. After the targeted methods have been established
on the basis of standard metabolites, metabolites are extracted from tissues, biofluids or cell cultures and analysed. The data output provides quantification only of those metabolites for which standard methods have been built.

b | In the untargeted metabolomic workflow, metabolites are first isolated from biological samples and subsequently analysed by liquid chromatography followed by mass spectrometry (LC/MS). After data acquisition, the results are processed by using bioinformatic software such as XCMS to perform nonlinear retention time alignment and identify peaks that are changing between the groups of samples measured. The m/z value s for the peaks of interest are searched in metabolite databases to obtain putative identifications. Putative identifications are then confirmed
by comparing tandem mass spectrometry (MS/MS) data and retention time data to that of standard compounds. The untargeted workflow is global in scope and outputs data related to comprehensive cellular metabolism.

Metabolic Biomarker and Kinase Drug Target Discovery in Cancer Using Stable Isotope-Based Dynamic Metabolic Profiling (SIDMAP)

László G. Boros1*, Daniel J. Brackett2 and George G. Harrigan3
1UCLA School of Medicine, Harbor-UCLA Research and Education Institute, Torrance, CA. 2Department of Surgery, University of Oklahoma Health Sciences Center & VA Medical Center, Oklahoma City, OK, 3Global High Throughput
Screening (HTS), Pharmacia Corporation, Chesterfield, MO.
Current Cancer Drug Targets, 2003, 3, 447-455.

Tumor cells respond to growth signals by the activation of protein kinases, altered gene expression and significant modifications in substrate flow and redistribution among biosynthetic pathways. This results in a proliferating phenotype
with altered cellular function. These transformed cells exhibit unique anabolic characteristics, which includes increased and preferential utilization of glucose through the non-oxidative steps of the pentose cycle for nucleic acid synthesis but limited denovo fatty acid synthesis and TCA cycle glucose oxidation. This primarily nonoxidative anabolic profile reflects an undifferentiated highly proliferative aneuploid cell phenotype and serves as a reliable metabolic biomarker to determine cell proliferation rate and the level of cell transformation/differentiation in response to drug treatment. Novel drugs effective in particular cancers exert their anti-proliferative effects by inducing significant reversions of a few specific non-oxidative anabolic pathways. Here we present evidence that cell transformation of various mechanisms is sustained by a unique
disproportional substrate distribution between the two branches of the pentose cycle for nucleic acid synthesis, glycolysis and the TCA cycle for fatty acid synthesis and glucose oxidation. This can be demonstrated by the broad labeling and unique specificity of [1,2-13C2]glucose to trace a large number of metabolites in the metabolome. Stable isotope-based dynamic metabolic profiles (SIDMAP) serve the drug discovery process by providing a powerful new tool that integrates the metabolome into a functional genomics approach to developing new drugs. It can be used in screening kinases and their metabolic targets, which can therefore be more efficiently characterized, speeding up and improving drug testing, approval and labeling processes by saving trial and error type study costs in drug testing.

Navigating the HumanMetabolome for Biomarker Identification and Design of Pharmaceutical Molecules

Irene Kouskoumvekaki and Gianni Panagiotou
Department of Systems Biology, Center for Biological Sequence Analysis, Building 208, Technical University of Denmark, Lyngby, Denmark
Hindawi Publishing Corporation  Journal of Biomedicine and Biotechnology 2011, Article ID 525497, 19 pages
http://dx.doi.org:/10.1155/2011/525497

Metabolomics is a rapidly evolving discipline that involves the systematic study of endogenous small molecules that characterize the metabolic pathways of biological systems. The study of metabolism at a global level has the potential to contribute significantly to biomedical research, clinical medical practice, as well as drug discovery. In this paper, we present the most up-to-date metabolite and metabolic pathway resources, and we summarize the statistical, and machine-learning tools used for the analysis of data from clinical metabolomics.

Through specific applications on cancer, diabetes, neurological and other diseases, we demonstrate how these tools can facilitate diagnosis and identification of potential biomarkers for use within disease diagnosis. Additionally, we
discuss the increasing importance of the integration of metabolomics data in drug discovery. On a case-study based on the Human Metabolome Database (HMDB) and the Chinese Natural Product Database (CNPD), we demonstrate the close relatedness of the two data sets of compounds, and we further illustrate how structural similarity with human metabolites could assist in the design of novel pharmaceuticals and the elucidation of the molecular mechanisms of medicinal plants.

Metabolites are the byproducts of metabolism, which is itself the process of converting food energy to mechanical energy
or heat. Experts believe there are at least 3,000 metabolites that are essential for normal growth and development (primary metabolites) and thousands more unidentified (around 20,000, compared to an estimated 30,000 genes and 100,000 proteins) that are not essential for growth and development (secondary metabolites) but could represent prognostic, diagnostic, and surrogate markers for a disease state and a deeper understanding of mechanisms of disease.

Metabolomics, the study of metabolism at the global level, has the potential to contribute significantly to biomedical
research, and ultimately to clinical medical practice. It is a close counterpart to the genome, the transcriptome and the proteome. Metabolomics, genomics, proteomics, and other “-omics” grew out of the Human Genome Project, a massive research effort that began in the mid-1990s and culminated in 2003 with a complete mapping of all the genes in the human body. When discussing the clinical advantages of metabolomics, scientists point to the “real-world” assessment
of patient physiology that the metabolome provides since it can be regarded as the end-point of the “-omics” cascade. Other functional genomics technologies do not necessarily predict drug effects, toxicological response, or disease states at the phenotype but merely indicate the potential cause for phenotypical response. Metabolomics can bridge this information gap. The identification and measurement of metabolite profile dynamics of host changes provides the closest link to the various phenotypic responses. Thus it is clear that the global mapping of metabolic signatures pre- and postdrug treatment is a promising approach to identify possible functional relationships between medication and medical phenotype.

Human Metabolome Database (HMDB). Focusing on quantitative, analytic, or molecular scale information about
metabolites, the enzymes and transporters associated with them, as well as disease related properties the HMDB represents the most complete bioinformatics and chemoinformatics medical information database. It contains records for
thousands of endogenous metabolites identified by literature surveys (PubMed, OMIM, OMMBID, text books), data
mining (KEGG, Metlin, BioCyc) or experimental analyses performed on urine, blood, and cerebrospinal fluid samples.
The annotation effort is aided by chemical parameter calculators and protein annotation tools originally developed for
DrugBank.

A key feature that distinguishes the HMDB from other metabolic resources is its extensive support for higher level database searching and selecting functions. More than 175 hand-drawn-zoomable, fully hyperlinked human
metabolic pathway maps can be found in HMDB and all these maps are quite specific to human metabolism and
explicitly show the subcellular compartments where specific reactions are known to take place. As an equivalent to
BLAST the HMDB contains a structure similarity search tool for chemical structures and users may sketch or
paste a SMILES string of a query compound into the Chem-Query window. Submitting the query launches a
structure similarity search tool that looks for common substructures from the query compound that match the
HMDB’s metabolite database. The wealth of information and especially the extensive linkage to metabolic diseases
to normal and abnormal metabolite concentration ranges, to mutation/SNP data and to the genes, enzymes, reactions
and pathways associated with many diseases of interest makes the HMDB one the most valuable tool in the hands
of clinical chemists, nutritionists, physicians and medical geneticists.

Metabolomics in Drug Discovery and Polypharmacology Studies

Drug molecules generally act on specific targets at the cellular level, and upon binding to the receptors, they exert
a desirable alteration of the cellular activities, regarded as the pharmaceutical effect. Current drug discovery depends
largely on ransom screening, either high-throughput screening (HTS) in vitro, or virtual screening (VS) in silico. Because
the number of available compounds is huge, several druglikeness filters are proposed to reduce the number of compounds that need to be evaluated. The ability to effectively predict if a chemical compound is “drug-like” or “nondruglike” is, thus, a valuable tool in the design, optimization, and selection of drug candidates for development. Druglikeness is a general descriptor of the potential of a small molecule to become a drug. It is not a unified descriptor
but a global property of a compound processing many specific characteristics such as good solubility, membrane
permeability, half-life, and having a pharmacophore pattern to interact specifically with a target protein. These
characteristics can be reflected as molecular descriptors such as molecular weight, log P, the number of hydrogen bond
donors, the number of hydrogen-bond acceptors, the number of rotatable bonds, the number of rigid bonds, the
number of rings in a molecule, and so forth.

Metabolomics for the Study of Polypharmacology of Natural Compounds

Internationally, there is a growing and sustained interest from both pharmaceutical companies and public in medicine
from natural sources. For the public, natural medicine represent a holistic approach to disease treatment, with
potentially less side effects than conventional medicine. For the pharmaceutical companies, bioactive natural products
constitute attractive drug leads, as they have been optimized in a long-term natural selection process for optimal interaction with biomolecules. To promote the ecological survival of plants, structures of secondary products have evolved to interact with molecular targets affecting the cells, tissues and physiological functions in competing microorganisms,
plants, and animals. In this, respect, some plant secondary products may exert their action by resembling endogenous
metabolites, ligands, hormones, signal transduction molecules, or neurotransmitters and thus have beneficial
effects on humans.

Future Perspectives

Metabolomics, the study of metabolism at the global level, is moving to exciting directions.With the development ofmore
sensitive and advanced instrumentation and computational tools for data interpretation in the physiological context,
metabolomics have the potential to impact our understanding of molecular mechanisms of diseases. A state-of-theart
metabolomics study requires knowledge in many areas and especially at the interface of chemistry, biology, and
computer science. High-quality samples, improvements in automated metabolite identification, complete coverage of
the human metabolome, establishment of spectral databases of metabolites and associated biochemical identities, innovative experimental designs to best address a hypothesis, as well as novel computational tools to handle metabolomics data are critical hurdles that must be overcome to drive the inclusion of metabolomics in all steps of drug discovery and drug development. The examples presented above demonstrated that metabolite profiles reflect both environmental and genetic influences in patients and reveal new links between metabolites and diseases providing needed prognostic,diagnostic, and surrogate biomarkers. The integration of these signatures with other omic technologies is of utmost importance to characterize the entire spectrum of malignant phenotype.

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Preface to Metabolomics as a Discipline in Medicine

Author: Larry H. Bernstein, MD, FCAP

 

The family of ‘omics fields has rapidly outpaced its siblings over the decade since
the completion of the Human Genome Project.  It has derived much benefit from
the development of Proteomics, which has recently completed a first draft of the
human proteome.  Since genomics, transcriptomics, and proteomics, have matured
considerably, it has become apparent that the search for a driver or drivers of cellular signaling and metabolic pathways could not depend on a full clarity of the genome. There have been unresolved issues, that are not solely comprehended from assumptions about mutations.

The most common diseases affecting mankind are derangements in metabolic
pathways, develop at specific ages periods, and often in adulthood or in the
geriatric period, and are at the intersection of signaling pathways.  Moreover,
the organs involved and systemic features are heavily influenced by physical
activity, and by the air we breathe and the water we drink.

The emergence of the new science is also driven by a large body of work
on protein structure, mechanisms of enzyme action, the modulation of gene
expression, the pH dependent effects on protein binding and conformation.
Beyond what has just been said, a significant portion of DNA has been
designated as “dark matter”. It turns out to have enormous importance in
gene regulation, even though it is not transcriptional, effected in a
modulatory way by “noncoding RNAs.  Metabolomics is the comprehensive
analysis of small molecule metabolites. These might be substrates of
sequenced enzyme reactions, or they might be “inhibiting” RNAs just
mentioned.  In either case, they occur in the substructures of the cell
called organelles, the cytoplasm, and in the cytoskeleton.

The reactions are orchestrated, and they can be modified with respect to
the flow of metabolites based on pH, temperature, membrane structural
modifications, and modulators.  Since most metabolites are generated by
enzymatic proteins that result from gene expression, and metabolites give
organisms their biochemical characteristics, the metabolome links
genotype with phenotype.

Metabolomics is still developing, and the continued development has
relied on two major events. The first is chromatographic separation and
mass  spectroscopy (MS), MS/MS, as well as advances in fluorescence
ultrasensitive optical photonic methods, and the second, as crucial,
is the developments in computational biology. The continuation of
this trend brings expectations of an impact on pharmaceutical and
on neutraceutical developments, which will have an impact on medical
practice. What has lagged behind, and may continue to contribute to the
lag is the failure to develop a suitable electronic medical record to
assist the physician in decisions confronted with so much as yet,
hidden data, the ready availability of which could guide more effective
diagnosis and management of the patient. Put all of this together, and
we can meet series challenges as the research community
interprets and integrates the complex data they are acquiring.

.

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Pfizer Cambridge Collaborative Innovation Events: ‘The Role of Innovation Districts in Metropolitan Areas to Drive the Global an | Basecamp Business.

Reporter: Stephen J. Williams, Ph.D.

Monday, September 8 2014 5:30pm – 7:00pm Other Time Presented by:

Event Details:
Date/Time:
Monday, September 8, 2014, 5:30-7PM EDT
Venue: Pfizer Cambridge Seminar Room (ground floor)
Location: Pfizer Inc., 610 Main Street, Cambridge, MA 02139 . Click here for a map to the location
(Corner of Portland and Albany street, Cambridge, MA 02139)
RSVP: To confirm your attendance please RSVP online through this website. This is an ONLINE REGISTRATION-ONLY event (there will not be registration at the door).

The Role of Innovation Districts in Metropolitan Areas to Drive the Global and Local Economy: Cambridge/Boston Case Study

Join Pfizer Cambridge at our new residence for a fascinating evening led by Vise-President and Founding Director, Bruce Katz of Brookings Institution, followed by a networking reception with key partners in our new Cambridge residence; Boston-Cambridge big pharma and biotech, members of the venture capital community, renowned researchers, advocacy groups and Pfizer Cambridge scientists and clinicians.

Boston/Cambridge is one of most prominent biomedical hubs in the world and known for its thriving economy. Recent advances in biomedical innovation and cutting-edge technologies have been a major factor in stimulating growth for the city. The close proximity of big pharma, biotech, academia and venture capital in Boston/Cambridge has particularly been crucial in fostering a culture ripe for such innovation.

Bruce Katz will shed light on the state of the local and global economy and the role innovation districts can play in accelerating therapies to patients. Katz will focus on the success Boston/Cambridge has had thus far in advancing biomedical discoveries as well as offer insights on the city’s future outlook.

The Brookings Institution is a nonprofit public policy organization based in Washington, D.C. Mr. Katz is Founding Director of the Brookings Metropolitan Policy Program, which aims to provide decision makers in the public, corporate, and civic sectors with policy ideas for improving the health and prosperity of cities and metropolitan areas.

Agenda:

5:30-6PM      Registration/Gathering (please arrive by no later than 5:45PM EDT with a
                       government issued ID to allow sufficient time for security check)

6-7PM            Welcoming remarks by Cambridge/Boston Site Head and Group Senior 
                       Vice-President WorldWide R&D, Dr. Jose-Carlos Gutierrez-Ramos

                        Keynote speaker: Bruce Katz, 
                        Founding Director Metropolitan Policy Program
                        Vice-president, The Brookings Institution

7-8PM             Open reception and Networking

8PM                 Event ends

This May, Pfizer Cambridge sites are integrating and relocating our research and development teams into our new local headquarters at 610 Main Street, Cambridge, MA 02139. The unified Cambridge presence represents the opportunity to interlace Pfizer’s R&D capability in the densest biomedical community in the world, to potentially expand our already existing collaborations and to embark on forging possible new connections. These events will further drive our collective mission and passion to deliver new medicines to patients in need. Our distinguished invited guests will include leaders in the Boston-Cambridge venture capital and biotech community, renowned researchers, advocacy groups and Pfizer Cambridge scientists and clinicians.  

Online registration:
If you are experiencing issues with online registration, please contact: Cambridge_site_head@pfizer.com  



Hashtags: #bcnet-PCCIE

Monday, September 8 2014 5:30pm – 7:00pm Other Time

Location: Pfizer Inc.
610 Main St
Cambridge, MA 02139
Contact:
 

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Plant-based Nutrition, Neutraceuticals and Alternative Medicine: Article Compilation the Journal PharmaceuticalIntelligence.com

Curator: Larry H. Bernstein, MD, FCAP

 

  1. Green tea polyphenols alleviate early BBB damage
    http://pharmaceuticalintelligence.com/2013/07/31/green-tea-polyphenols-alleviate-early-bbb-damage-during/
  2. What do you know about Plants and Neutraceuticals?

Author and Curator, Larry H. Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2014/07/30/what-do-you-know-about-plants-and-neutraceuticals/

  1. The Final Considerations of the Role of Platelets and Platelet Endothelial Reactions in Atherosclerosis and Novel Treatments

Author and Curator: Larry H Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2013/10/15/the-final-considerations-of-the-role-of-platelets-and-platelet-endothelial-reactions-in-atherosclerosis-and-novel-treatments/

  1. Endothelial Function and Cardiovascular Disease

Author and Curator: Larry H Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2012/10/25/endothelial-function-and-cardiovascular-disease/

  1. NO Nutritional remedies for hypertension and atherosclerosis. It’s 12 am: do you know where your electrons are?

Author and Reporter: Meg Baker, Ph.D., Registered Patent Agent

http://pharmaceuticalintelligence.com/2012/10/07/no-nutritional-remedies-for-hypertension-and-atherosclerosis-its-12-am-do-you-know-where-your-electrons-are/

  1. Cocoa and Heart Health

Reporter: Larry H Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2013/11/17/cocoa-and-heart-health/

  1. Metabolomics: its applications in food and nutrition research

Reporter and Curator: Dr. Sudipta Saha, Ph.D.

http://pharmaceuticalintelligence.com/2013/05/12/metabolomics-its-applications-in-food-and-nutrition-research/

  1. Japanese knotweed extract (Polygonum cuspidatum) Resveratrol 98%

Reporter: Larry H Bernstein, MD, FCAP   Stanford Lee, Shanghai Natural Bio-engineering Co., Ltd
Key products: resveratrol, curcumin,artemisinin,artemether,artesunate,dihydroartemisinin,Lumefantrine,etc
https://www.linkedin.com/today/post/article/20140805055958-283555965-japanese-knotweed-extract-polygonum-cuspidatum-resveratrol-98?/

http://pharmaceuticalintelligence.com/2014/08/20/japanese-knotweed-extract-polygonum-cuspidatum-resveratrol-98/

  1. Antimicrobial resistance
    Reporter: Larry H Bernstein, MD, FCAP   
    http://pharmaceuticalintelligence.com/2014/08/18/antimicrobial-resistance/
  2. Macrocycles in new drug discovery
    Reporter: Larry H Bernstein, MD, FCAP     Jamie MallinsonIan Collins
    Future Medicinal Chemistry, Jul 2012, Vol. 4, No. 11, Pages 1409-1438.

Natural product macrocycles and their synthetic derivatives

http://pharmaceuticalintelligence.com/2014/08/16/macrocycles-in-new-drug-discovery/

  1. Lipid Metabolism

ALA and LA, LCPUFAs (EPA, DHA, and AA), eicosanoids, delta-3-desaturase, prostaglandins, leukotrienes

Ginseng fights fatigue in cancer patients, Mayo Clinic-led study finds http://pharmaceuticalintelligence.com/2014/08/15/lipid-metabolism/

  1. Ginseng fights fatigue in cancer patients, Mayo Clinic-led study finds

Reporter: Larry H Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2014/08/10/ginseng-fights-fatigue-in-cancer-patients-mayo-clinic-led-study-finds/

  1. Scientists develop new cancer-killing compound from salad plant / 1,200 times more specific in killing certain kinds of cancer cells than currently available drugs
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/17/scientists-develop-new-cancer-killing-compound-from-salad-plant-1200-times-more-specific-in-killing-certain-kinds-of-cancer-cells-than-currently-available-drugs/
  2. Protein heals wounds, boosts immunity and protects from cancer – Lactoferrin
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/17/protein-heals-wounds-boosts-immunity-and-protects-from-cancer-lactoferrin/
  3. Inula helenium ( elecampane ) 100% Effective against MRSA in vitro, 200 Strains
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/15/inula-helenium-elecampane-100-effective-against-mrsa-in-vitro-200-strains/
  4. Thymoquinone, an extract of nigella sativa seed oil, blocked pancreatic cancer cell growth and killed the cells by enhancing the process of programmed cell death.
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/15/thymoquinone-an-extract-of-nigella-sativa-seed-oil-blocked-pancreatic-cancer-cell-growth-and-killed-the-cells-by-enhancing-the-process-of-programmed-cell-death/
  5. Cinnamon is lethal weapon against E. coli O157:H7
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/15/cinnamon-is-lethal-weapon-against-e-coli-o157h7/
  6. Garlic compound fights source of food-borne illness better than antibiotics (100 times more effective than two popular antibiotics )

Reporter: Larry H Bernstein, MD, FCAP

http://pharmaceuticalintelligence.com/2014/07/15/garlic-compound-fights-source-of-food-borne-illness-better-than-antibiotics-100-times-more-effective-than-two-popular-antibiotics/

  1. Reference Genes in the Human Gut Microbiome: The BGI Catalogue

Reporter: Aviva Lev-Ari, PhD, RN

http://pharmaceuticalintelligence.com/2014/07/14/reference-genes-in-the-human-gut-microbiome-the-bgi-catalogue/

  1. Study suggests consuming whey protein before meals could help improve blood glucose control in people with diabetes
    Reporter: Larry H Bernstein, MD, FCAP
    http://pharmaceuticalintelligence.com/2014/07/12/study-suggests-consuming-whey-protein-before-meals-could-help-improve-blood-glucose-control-in-people-with-diabetes/
  2. Omega-3 fatty acids, depleting the source, and protein insufficiency in renal disease
    Larry H. Bernstein, MD, FCAP, Curator
    http://pharmaceuticalintelligence.com/2014/07/06/omega-3-fatty-acids-depleting-the-source-and-protein-insufficiency-in-renal-disease/
  3. Health benefit of anthocyanins from apples and berries noted for men
    Larry H. Bernstein, MD, FCAP, Curator
    http://pharmaceuticalintelligence.com/2014/07/06/health-benefit-of-anthocyanins-from-apples-and-berries-noted-for-men/
  4. Carrots Cut Men’s Prostate Cancer Risk by 50%
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/07/03/carrots-cut-mens-prostate-cancer-risk-by-50/
  5. A Recipe To Make Cannabis Oil For A Chemotherapy Alternative
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/07/02/a-recipe-to-make-cannabis-oil-for-a-chemotherapy-alternative/
  6. Plant flavonoid found to reduce inflammatory response in the brain: luteolin
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/29/plant-flavonoid-found-to-reduce-inflammatory-response-in-the-brain-luteolin/
  7. Omega-3 fatty acids protect eyes against retinopathy, study finds
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/28/omega-3-fatty-acids-protect-eyes-against-retinopathy-study-finds/
  8. Scientists identify new pathogenic and protective microbes associated with severe diarrhea
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/28/scientists-identify-new-pathogenic-and-protective-microbes-associated-with-severe-diarrhea/
  9. 2,000-year-old herb regulates autoimmunity and inflammation / Chang Shan, from a type of hydrangea that grows in Tibet and Nepal
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/27/2000-year-old-herb-regulates-autoimmunity-and-inflammation-chang-shan-from-a-type-of-hydrangea-that-grows-in-tibet-and-nepal/
  10. Turmeric-based drug effective on Alzheimer flies
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/27/turmeric-based-drug-effective-on-alzheimer-flies/
  11. Plant flavonoid luteolin blocks cell signaling pathways in colon cancer cells
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/26/plant-flavonoid-luteolin-blocks-cell-signaling-pathways-in-colon-cancer-cells/
  12. Study Finds Shu Gan Liang Xue Herbal Formula Has Breast Cancer Anti Tumor Effect
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/25/study-finds-shu-gan-liang-xue-herbal-formula-has-breast-cancer-anti-tumor-effect/
  13. HMPC Q&A Documents on Herbal Medicinal Products published
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/25/hmpc-qa-documents-on-herbal-medicinal-products-published/
  14. Garden Cress Extract Kills 97% of Breast Cancer Cells in Vitro
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/21/garden-cress-extract-kills-97-of-breast-cancer-cells-in-vitro/
  15. Moringa Oleifera Kills 97% of Pancreatic Cancer Cells in Vitro
    Larry H. Bernstein, MD, FCAP, Reporter
    http://pharmaceuticalintelligence.com/2014/06/21/moringa-oleifera-kills-97-of-pancreatic-cancer-cells-in-vitro/

16. The Discovery and Properties of Avemar – Fermented Wheat Germ Extract: Carcinogenesis Suppressor
Larry H. Bernstein, MD, FCAP, Author and Curator
http://pharmaceuticalintelligence.com/2014/06/09/the-discovery-and-properties-of-avemar-fermented-wheat-germ-extract-carcinogenesis-suppressor-2/

 


 

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Third Annual TCGC: The Clinical Genome Conference, San Francisco, June 10-12, 2014 by Bio-IT World and Cambridge Healthtech Institute

Reporter: Aviva Lev-Ari, PhD, RN

 

UPDATED on 5/1/2014

Register by May 2 for

Hotel Kabuki, San Francisco, CA

June 10 – 12, 2014

FINAL AGENDA

CLINICAL GENOME

conference

THE 3rd ANNUAL

Mining the Genome for Medicine Clinical Genome Conference.com

TCGC

The unstoppable march of genomics into clinical practice continues. In an ideal world, the expanding use of genomic tools will identify disease before the onset of clinical symptoms and determine individualized drug treatment leading to precision medicine. However, many challenges remain or the successful translation of genomic knowledge and technologies into health advances and actionable patient care. Join vital discussions of the applications, questions and solutions surrounding clinical genome analysis.

KEYNOTE SPEAKERS

Atul Butte, M.D., Ph.D.

Division Chief and Associate Professor, Stanford University School of Medicine; Director, Center for Pediatric Bioinformatics, Lucile Packard Children’s Hospital

David Galas, Ph.D.

Principal Scientist, Pacific Northwest Diabetes Research Institute

Gail P. Jarvik, M.D., Ph.D.

Head, Division of Medical Genetics, Arno G. Motulsky Endowed Chair in Medicine and Professor, Medicine and Genome Sciences, University of Washington Medical Center

John Pfeifer, M.D., Ph.D.

Vice Chair, Clinical Affairs, Pathology and Immunology; Professor, Pathology and Immunology, Washington University

John Quackenbush, Ph.D.

Professor, Dana-Farber Cancer Institute and Harvard School of Public Health; Co-Founder and CEO, GenoSpace

Topics Include:

• Working with the Payer Process

• Genome Variation and Clinical Utility

• NGS Is Guiding Therapies

• NGS Is Redefining Genomics

• Interpretation and Translation to the Client

• Integrating Genomic Data into the Clinic

ClinicalGenomeConference.com

Cambridge Healthtech Institute

250 First Avenue, Suite 300

Needham, MA 02494

www.healthtech.com

 

TUESDAY, JUNE 10

7:30 am Conference Registration and Morning Coffee

Working with the Payer Process

8:30 Chairperson’s Opening Remarks

»»KEYNOTE PRESENTATION

8:45 Case Study on Working through the Payer Process

John Pfeifer, M.D., Ph.D., Vice Chair, Clinical Affairs, Pathology; Professor,

Pathology and Immunology; Professor, Obstetrics and Gynecology, Washington

University School of Medicine

If next-generation sequencing (NGS) is to become a part of patient care in routine clinical practice (whether in the setting of oncology or in the setting of inherited genetic disorders), labs that perform clinical NGS must be reimbursed for the testing they provide. Genomics and Pathology Services at Washington University in St. Louis (GPS@WUSTL) will be used as a case study of a national reference lab that has been successful in achieving high levels of reimbursement for the clinical NGS testing it performs, including from private payers. The reasons for GPS’s success will be discussed, including NGS test design, clinical focus of testing, use of different models for reimbursement and payer education.

9:30 Implementation of Clinical Cancer Genomics within an Integrated

Healthcare System

Lincoln D. Nadauld, M.D., Ph.D., Director, Cancer Genomics, Intermountain Healthcare

Precision cancer medicine involves the detection of tumor-specific DNA alterations followed by treatment with therapeutics that specifically target the actionable mutations. Significant advances in genomic technologies have now rendered extended genomic analyses of human malignancies technologically and financially feasible for clinical adoption. Intermountain Healthcare, an integrated healthcare delivery system, is taking advantage of these advances to programmatically implement genomics into the regular treatment of cancer patients to improve clinical outcomes and reduce treatment costs.

10:00 PANEL DISCUSSION:

Payer’s Dilemma: Evolution vs. Revolution

As falling genome sequencing costs help clinicians refine patient diagnoses and therapeutic approaches, new complexities arise over insurance coverage of such tests, classification by CPT codes and other reimbursement issues. Experts on this panel will discuss payer challenges and changes—both rapid and gradual—occurring alongside these advances in clinical genomics.

Moderator: Katherine Tynan, Ph.D., Business Development & Strategic Consulting for Diagnostics

Companies, Tynan Consulting LLC

Panelists:

Tonya Dowd, MPH, Director, Reimbursement Policy and Market Access, Quorum Consulting

Mike M. Moradian, Ph.D., Director of Operations and Molecular Genetics Scientist, Kaiser

Permanente Southern California Regional Genetics Laboratory

Rina Wolf, Vice President of Commercialization Strategies, Consulting and Industry Affairs, XIFIN

Additional Panelists to be Announced

10:45 Networking Coffee Break

11:15 Beyond Genomics: Preparing for the Avalanche of Post-Genomic

Clinical Findings

Jimmy Lin, M.D., Ph.D., President, Rare Genomics Institute

Whole genomic and exomics sequencing applied clinically is revealing newly discovered genes and syndromes at an astonishing rate. While clinical databases and variant annotation continue to grow, much of the effort needed is functional analysis and clinical correlation. At RGI, we are building a comprehensive functional genomics platform that includes electronic health records, biobanking, data management, scientific idea crowdsourcing and contract research sourcing.

11:45 The MMRF CoMMpass Clinical Trial: A Longitudinal Observational

Trial to Identify Genomic Predictors of Outcome in Multiple Myeloma

Jonathan J. Keats, Ph.D., Assistant Professor, Integrated Cancer Genomics Division, Translational

Genomics Research Institute

12:15 pm Luncheon Presentation: Sponsored by

Big Data & Little Data – From Patient Stratification

to Precision Medicine

Colin Williams, Ph.D., Director, Product Strategy, Thomson Reuters

Molecular data has the power, when unlocked, to transform our understanding of disease to support drug discovery and patient care. The key to unlocking this potential is ‘humanising’ the data, through tools and techniques, to a level that supports interpretation by Life Science professionals. This talk will focus on strategies for extracting insight from ‘big data’ by shrinking it to ‘little data’, with a focus on applications to support patient stratification in drug discovery and for practising precision medicine in a clinical setting.

Genome Variation and Clinical Utility

1:45 Chairperson’s Remarks

»»KEYNOTE PRESENTATION

1:50 Lessons from the Clinical Sequencing Exploratory

Research (CSER) Consortium: Genomic Medicine

Implementation

Gail P. Jarvik, M.D., Ph.D., Head, Division of Medical Genetics, Arno G. Motulsky Endowed Chair in Medicine and Professor, Medicine and Genome

Sciences, University of Washington Medical Center

Recent technologies have led to affordable genomic testing. However, implementation of genomic medicine faces many hurdles. The Clinical Sequencing Exploratory Research (CSER) Consortium, which includes nine genomic medicine projects, was formed to explore these challenges and opportunities. Dr. Jarvik is the PI of a CSER genomic medicine project and of the CSER coordinating center. She will focus on the frequency of exomic incidental findings, including those of the 56 genes recommended for incidental finding return by the ACMG. The CSER group has annotated the putatively pathogenic and novel variants of the Exome Variant Server (EVS) to estimate the rate of these in individuals of European and African ancestry. Experience with consenting and returning incidental findings will also be reviewed.

2:35 Decoding the Patient’s Genome: Clinical Use of Genome-Wide

Sequencing Data

Elizabeth Worthey, Ph.D., Assistant Professor, Pediatrics & Bioinformatics Program, Human & Molecular Genetics Center, Medical College of Wisconsin

Despite significant advances in our understanding of the genetic basis of disease, genomewide identification and subsequent interpretation of the molecular changes that lead to human disease represent the most significant challenges in modern human genetics.

Starting in 2009 at MCW, we have performed clinical WGS and WES to diagnose patients coming from across all clinical specialties. I will discuss findings, pros and cons in approach, challenges remaining and where we go next.

3:05 Analyzing Variants with a DTC Genetics Database

Brian Naughton, Ph.D., Founding Scientist, 23andMe, Inc.

Sequencing a genome results in dozens of potentially disease-causing variants (VUS). I describe some examples of using the 23andMe database, including quick recontact of participants, to determine if a variant is disease-causing.

3:35 Refreshment Break in the Exhibit Hall with Poster Viewing

 

Genome Interpretation Software Solutions: Software Spotlights

(Sponsorship Opportunities Available)

Obtaining clinical genome data is rapidly becoming a reality, but analyzing and interpreting the data remains a bottleneck. While there are many commercial software solutions and pipelines for managing raw genome sequence data, providing the medical interpretation and delivering a clinical diagnosis will be the critical step in fulfilling the promise of genomic medicine. This session will showcase how genome data analysis companies are streamlining the genomic diagnostic pipeline through:

• Transferring raw sequencing data

• Interpreting genetic variations

• Building new software and cloud-based analysis pipelines

• Investigating the genetic basis of disease or drug response

• Integrating with other clinical data systems

• Creating new medical-grade databases

• Reporting relevant clinical information in a physician-friendly manner

• Continuous learning feedback

4:15 Software Spotlight #1

4:30 Copy Number Variant Detection Using Sponsored by

Next-Generation Sequencing: State of the Art

Alexander Kaplun, Ph.D., Field Applications Scientist, BIOBASE

This talk will provide a short review about the current state of the art in detection of larger variants that have an important role in many diseases such as haplotypes, indels, repeats, copy number variants (CNVs), structural variants (SVs) and fusion genes using NGS methods, and an outlook to their use for pharmacogenomic genotyping.

4:45 Software Spotlight #3

5:00 Software Spotlight #4

5:15 Software Spotlight #5

5:30 Pertinence Metric Enables Hypothesis-Independent Sponsored by

Genome-Phenome Analysis in Seconds

Michael M. Segal, M.D., Ph.D., Chief Scientist, SimulConsult

Genome-phenome analysis combines processing of a genomic variant table and comparison of the patient’s findings to those of known diseases (“phenome”). In a study of 20 trios, accuracy was 100% when using trios with family-aware calling, and close to that if only probands were used. The gene pertinence metric calculated in the analysis was 99.9% for the causal genes. The analysis took seconds and was hypothesis-independent as to form of inheritance or number of causal genes. Similar benefits were found in gene discovery situations.

6:00 Welcome Reception in the Exhibit Hall with Poster Viewing

7:00 Close of Day

WEDNESDAY, JUNE 11

7:30 am Breakfast Presentation (Sponsorship Opportunity Available) or Morning Coffee

NGS Is Guiding Therapies

8:30 Chairperson’s Opening Remarks

8:35 Next-Generation Sequencing Approaches for Identifying Patients

Who May Benefit from PARP Inhibitor Therapy

Mitch Raponi, Ph.D., Senior Director and Head, Molecular Diagnostics, Clovis Oncology

The following questions will be addressed: What biomarkers should we be focusing on to identify appropriate patients who will likely benefit from PARP inhibitors? How can we apply next-generation sequencing technologies to identify all patients who will respond to the PARP inhibitor rucaparib? What regulatory challenges are we faced with for approval of NGS companion diagnostics?

9:05 Whole-Genome and Whole-Transcriptome Sequencing to Guide

Therapy for Patients with Advanced Cancer

Glen J. Weiss, M.D., MBA, Director, Clinical Research, Cancer Treatment Centers of America

Treating advanced cancer with agents that target a single-cell surface receptor, up-regulated or amplified gene product or mutated gene has met with some success; however, eventually the cancer progresses. We used next-generation sequencing technologies (NGS) including whole-genome sequencing (WGS), and where feasible, whole-transcriptome sequencing (WTS) to identify genomic events and associated expression changes in advanced cancer patients. While the initial effort was a slower process than anticipated due to a variety of issues, we demonstrated the feasibility of using NGS in advanced cancer patients so that treatments for patients with progressing tumors may be improved. This lecture will highlight some of these challenges and where we are today in bringing NGS to patients.

9:35 The SmartChip TE™ Target Enrichment System for Sponsored by

Clinical Next-Gen Sequencing

Gianluca Roma, MS MBA, Director, Product Management, WaferGen Biosystems

10:05 Coffee Break in the Exhibit Hall with Poster Viewing

Data Mining

»»KEYNOTE PRESENTATION

10:45 Translating a Trillion Points of Data into

Therapies, Diagnostics and New Insights into Disease

Atul Butte, M.D., Ph.D., Division Chief and Associate Professor, Stanford University School of Medicine; Director, Center for Pediatric Bioinformatics,

Lucile Packard Children’s Hospital; Co-Founder, Personalis and Numedii

There is an urgent need to translate genome-era discoveries into clinical utility, but the difficulties in making bench-to-bedside translations have been well described. The nascent field of translational bioinformatics may help. Dr. Butte’s lab at Stanford builds and applies tools that convert more than a trillion points of molecular, clinical and epidemiological data— measured by researchers and clinicians over the past decade—into diagnostics, therapeutics and new insights into disease. Dr. Butte, a bioinformatician and pediatric endocrinologist, will highlight his lab’s work on using publicly available molecular measurements to find new uses for drugs, including drug repositioning for inflammatory bowel disease, discovering new treatable inflammatory mechanisms of disease in type 2 diabetes and the evaluation of patients presenting with whole genomes sequenced.

11:30 DGIdb – Mining the Druggable Genome

Malachi Griffith, Ph.D., Research Faculty, Genetics, The Genome Institute, Washington University School of Medicine

In the era of high-throughput genomics, investigators are frequently presented with lists of mutated or otherwise altered genes implicated in human disease. Numerous resources exist to generate hypotheses about how such genomic events might be targeted therapeutically or prioritized for drug development. The Drug-Gene Interaction database (DGIdb) mines these resources and provides an interface for searching lists of genes against a compendium of drug-gene interactions and potentially druggable genes. DGIdb can be accessed at dgidb.org.

12:00 pm Sponsored Presentation (Opportunity Available)

12:30 Luncheon Presentation (Sponsorship Opportunity Available)

 

The unstoppable march of genomics into clinical practice continues. In an ideal world, the expanding use of genomic tools will identify disease before the onset of clinical symptoms and determine individualized drug treatment leading to precision medicine. However, many challenges remain for the successful translation of genomic knowledge and technologies into health advances and clinical practice.

Bio-IT World and Cambridge Healthtech Institute are again proud to host the Third Annual TCGC: The Clinical Genome Conference, inviting stakeholders from all arenas impacting clinical genomics to share new findings and solutions for advancing the application of clinical genome medicine.

TCGC brings together many constituencies for frank and vital discussion of the applications, questions and solutions surrounding clinical genome analysis, including scientists, physicians, diagnosticians, genetic counselors, bioinformaticists, ethicists, regulators, insurers, lawyers and administrators.

Topics addressing successful translation of genomic knowledge and technologies into advancement of clinical utility (medicines and diagnostics) include but are not limited to:

Scientific Investigation and Interpretation

  • Technologies/Platforms
  • WGS/Exome/Single-Cell Sequencing
  • Drug and Diagnostic Targets
  • Interpretation and Analysis Pipelines
  • Case Studies

Clinical Integration and Implementation

  • Mechanisms to Monitor Genomic Medicine
  • Determining Clinical Utility
  • Standardization/Regulation/Certification
  • Reimbursement
  • Data Management
  • Diagnostic Lab Infrastructure
  • HIT/Data Integration
  • Reporting Results to Patients/Physicians

Call for Speakers
For a limited time, we are inviting researchers and clinicians applying genome analysis tools in clinical settings, as well as regulators and administrators implementing genomics into the clinic, to submit proposals for platform presentations. Please note that due to limited speaking slots, preference is given to abstracts from those within pharmaceutical and biopharmaceutical companies, regulators and those from academic centers. Additionally, as per CHI policy, a select number of vendors/consultants who provide products and services to these genomic researchers are offered opportunities for podium presentation slots based on a variety of Corporate Sponsorships.

All proposals are subject to review by the organizers and Scientific Advisory Committee.

Please click here to submit a proposal.

Submission deadline for priority consideration: November 15, 2013

For more details on the conference, please contact:
Mary Ann Brown
Executive Director, Conferences
Cambridge Healthtech Institute
250 First Avenue, Suite 300
Needham, MA 02494
T:  781-972-5497
E:  mabrown@healthtech.com

For exhibit and sponsorship opportunities, please contact:
Jay Mulhern
Manager, Business Development, Conferences & Media
Cambridge Healthtech Institute
250 First Avenue, Suite 300
Needham, MA 02494
T: 781-972-1359
E: jmulhern@healthtech.com

SOURCE

http://www.clinicalgenomeconference.com/

 

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The Delicate Connection:  IDO (Indolamine 2, 3 dehydrogenase) and Cancer Immunology

Author and Curator: Demet Sag, PhD, CRA, GCP      

Table of Contents:

  1. Abstract
  2. Dual role for IDO
  3. Immune System and IDO
  4. Autoimmune disorders and IDO
  5. Cancer and Ido
  6. Clinical Interventions
  7. Clinical Trials
  8. Future Actions for Molecular Dx and Targeted Therapies:
  9. Conclusion
  10. References

TABLE 1- IDO Clinical Trials

TABLE 2- Kyn induced Genes

TABLE 3 Possible biomarkers and molecular diagnostics targets

TABLE 4: Current Interventions ______________________________________________________________________________________________________________

ABSTRACT:

Overall purpose is to find a method to manipulate IDO for clinical applications, mainly the focus of this review is is cancer prevention and treatment.  The first study proving the connection between IDO and immune response came from, a very natural event, a protection of pregnancy in human. This led to discover that high IDO expression is a common factor in cancer tumors. Thus, attention promoted investigations on IDO’s role in various disease states, immune disorders, transplantation, inflammation, women health, mood disorders.
Many approaches, vaccines and adjuvants are underway to find new immunotherapies by combining the power of DCs in immune response regulation and specific direction of siRNA.  As a result, with this unique qualities of IDO, DCs and siRNA, we orchestrated a novel intervention for immunomodulation of IDO by inhibiting with small interference RNA, called siRNA-IDO-DCvax.  Proven that our DCvax created a delay and regression of tumor growth without changing the natural structure and characterization of DCs in melanoma and breast cancers in vivo. (** The shRNA IDO- DCvax is developed by Regen BioPhrama, San Diego, CA ,  Thomas Ichim, Ph.D, CSO. and David Koos, CEO)

______________________________________________________________________________________________________________

Double-Edged Sword of IDO: The Good and The Bad for Clinical intervention and Developments

IDO almost has a dual role. There is a positive side of high expression of IDO during pregnancy (29; 28; 114), transplants (115; 116; 117; 118; 119), infectious diseases (96) and but this tolerance is negative during autoimmune-disorders (120; 121; 122), tumors of cancer (123; 124; 117; 121; 125; 126; 127) (127), and mood disorders (46). The increased IDO expression has a double-edged sword in human physiology provides a positive role during protection of fetus and grafts after transplantations but becomes a negative factor during autoimmune disorders, cancer, sepsis and mood disorders.

Prevention of allogeneic fetal rejection is possible by tryptophan metabolism (26) rejecting with lack of IDO but allocating if IDO present (29; 28; 114). These studies lead to find “the natural regulation mechanism” for protecting the transplants from graft versus host disease GVHD (128) and getting rid of tumors.

The plasticity of  mammary and uterus during reproduction may hold some more answers to prevent GVHD and tumors of cancer with good understanding of IDO and tryptophan mechanism (129; 130). After allogeneic bone marrow transplants the risk of solid tumor development increased about 80% among 19,229 patients even with a greater risk among patients under 18 years old (117).  The adaptation of tolerance against host mechanism is connected to the IDO expression (131). During implantation and early pregnancy IDO has a role by making CD4+CD25+Foxp3+ regulatory T cells (Tregs) and expressing in DCs and  MQs  (114; 132; 133).

Clonal deletion mechanism prevents mother to react with paternal products since female mice accepted the paternal MHC antigen-expressing tumor graft during pregnancy and rejected three weeks after delivery (134). CTLA-4Ig gene therapy alleviates abortion through regulation of apoptosis and inhibition of spleen lymphocytes (135).  

 Immune System and IDO DCs are the orchestrator of the immune response (56; 57; 58) with list of functions in uptake, processing, and presentation of antigens; activation of effector cells, such as T-cells and NK-cells; and secretion of cytokines and other immune-modulating molecules to direct the immune response. The differential regulation of IDO in distinct DC subsets is widely studied to delineate and correct immune homeostasis during autoimmunity, infection and cancer and the associated immunological outcomes. Genesis of antigen presenting cells (APCs), eventually the immune system, require migration of monocytes (MOs), which is originated in bone marrow. Then, these MOs move from bloodstream to other tissues to become macrophages and DCs (59; 60).

Initiation of immune response requires APCs to link resting helper T-cell with the matching antigen to protect body. DCs are superior to MQs and MOs in their immune action model. When DCs are first described (61) and classified, their role is determined as a highly potent antigen-presenting cell (APC) subset with 100 to 1000-times more effective than macrophages and B-cells in priming T-cells. Both MQs and monocytes phagocytize the pathogen, and their cell structure contains very large nucleus and many internal vesicles. However, there is a nuance between MQ and DCs, since DCs has a wider capacity of stimulation, because MQs activates only memory T cells, yet DCs can activate both naïve and memory T cells.

DCs are potent activators of T cells and they also have well controlled regulatory roles. DC properties determine the regulation regardless of their origin or the subset of the DCs. DCs reacts after identification of the signals or influencers for their inhibitory, stimulatory or regulatory roles, before they express a complex repertoire of positive and negative cytokines, transmembrane proteins and other molecules. Thus, “two signal theory” gains support with a defined rule.  The combination of two signals, their interaction with types of cells and time are critical.

In short, specificity and time are matter for a proper response. When IDO mRNA expression is activated with CTL40 ligand and IFNgamma, IDO results inhibition of T cell production (4).  However, if DCs are inhibited by 1MT, an inhibitor of IDO, the response stop but IgG has no affect (10).  In addition, if the stimulation is started by a tryptophan metabolite, which is downstream of IDO, such as 3-hydroxyantranilic or quinolinic acids, it only inhibits Th1 but not Th2 subset of T cells (62).

Furthermore, inclusion of signal molecules, such as Fas Ligand, cytochrome c, and pathways also differ in the T cell differentiation mechanisms due to combination, time and specificity of two-signals.  The co-culture experiments are great tool to identify specific stimuli in disease specific microenvironment (63; 12; 64) for discovering the mechanism and interactions between molecules in gene regulation, biochemical mechanism and physiological function during cell differentiation.

As a result, the simplest differential cell development from the early development of DCs impact the outcome of the data. For example, collection of MOs from peripheral blood mononuclear cells (PBMCs) with IL4 and GM-CSF leads to immature DCs (iDCs). On next step, treatment of iDCs with tumor necrosis factor (TNF) or other plausible cytokines (TGFb1, IFNgamma, IFNalpha,  IFNbeta, IL6 etc.) based on the desired outcome differentiate iDCs  into mature DCs (mDCs). DCs live only up to a week but MOs and generated MQs can live up to a month in the given tissue. B cells inhibit T cell dependent immune responses in tumors (65).

AutoImmune Disorders:

The Circadian Clock Circuitry and the AHR

The balance of IDO expression becomes necessary to prevent overactive immune response self-destruction, so modulation in tryptophan and NDA metabolisms maybe essential.  When splenic IDO-expressing CD11b (+) DCs from tolerized animals applied, they suppressed the development of arthritis, increased the Treg/Th17 cell ratio, and decreased the production of inflammatory cytokines in the spleen (136).

The role of Nicotinamide prevention on type 1 diabetes and ameliorates multiple sclerosis in animal model presented with activities of  NDAs stimulating GPCR109a to produce prostaglandins to induce IDO expression, then these PGEs and PGDs converted to the anti-inflammatory prostaglandin, 15d-PGJ(2) (137; 138; 139).  Thus, these events promotes endogenous signaling mechanisms involving the GPCRs EP2, EP4, and DP1 along with PPARgamma. (137).

Modulating the immune response at non-canonical at canonocal pathway while keeping the non-canonical Nf-KB intact may help to mend immune disorders. As a result, the targeted blocking in canonical at associated kinase IKKβ and leaving non-canonocal Nf-kB pathway intact, DCs tips the balance towards immune supression. Hence, noncanonical NF-κB pathway for regulatory functions in DCs required effective IDO induction, directly or indirectly by endogenous ligand Kyn and negative regulation of proinflammatory cytokine production. As a result, this may help to treat autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, inflammatory bowel disease, and multiple sclerosis, or allergy or transplant rejection.

While the opposite action needs to be taken during prevention of tumors, that is inhibition of non-canonical pathway.  Inflammation induces not only relaxation of veins and lowering blood pressure but also stimulate coagulopathies that worsen the microenvironment and decrease survival rate of patients after radio or chemotherapies.Cancer Generating tumor vaccines and using adjuvants underway (140).

Clinical correlation and genetic responses also compared in several studies to diagnose and target the system for cancer therapies (127; 141; 131).  The recent surveys on IDO expression and human cancers showed that IDO targeting is a candidate for cancer therapy since IDO expression recruiting Tregs, downregulates MHC class I and creating negative immune microenvironment for protection of development of tumors (125; 27; 142).  Inhibition of IDO expression can make advances in immunotherapy and chemotherapy fields (143; 125; 131; 144).

IDO has a great importance on prevention of cancer development (126). There are many approaches to create the homeostasis of immune response by Immunotherapy.  However, given the complexity of immune regulations, immunomodulation is a better approach to correct and relieve the system from the disease.  Some of the current IDO targeted immunotherapy or immmunomodulations with RNA technology for cancer prevention (145; 146; 147; 148; 149; 150) or applied on human or animals  (75; 151; 12; 115; 152; 9; 125) or chemical, (153; 154) or  radiological (155).  The targeted cell type in immune system generally DCs, monocytes (94)T cells (110; 156)and neutrophils (146; 157). On this paper, we will concentrate on DCvax on cancer treatments.

 T-reg, regulatory T cells; Th, T helper; CTLA-4, cytotoxic T lymphocyte-associated antigen 4; TCR, T cell receptor; IDO, indoleamine 2,3-dioxygenase. (refernece: http://www.pnas.org/content/101/28/10398/suppl/DC)

T-reg, regulatory T cells; Th, T helper; CTLA-4, cytotoxic T lymphocyte-associated antigen 4; TCR, T cell receptor; IDO, indoleamine 2,3-dioxygenase. (refernece: http://www.pnas.org/content/101/28/10398/suppl/DC)

IDO and the downstream enzymes in tryptophan pathway produce a series of immunosuppressive tryptophan metabolites that may lead into Tregs proliferation or increase in T cell apoptosis (62; 16; 27; 158), and some can affect NK cell function (159).

The interesting part of the mechanism is even without presence of IDO itself, downstream enzymes of IDO in the kynurenine tryptophan degradation still show immunosuppressive outcome (160; 73) due to not only Kyn but also TGFbeta stimulated long term responses. DC vaccination with IDO plausible (161) due to its power in immune response changes and longevity in the bloodstream for reversing the system for Th17 production (162).

Clinical Interventions are taking advantage of the DC’s central role and combining with enhancing molecules for induction of immunity may overcome tolerogenic DCs in tumors of cancers (163; 164).

The first successful application of DC vaccine used against advanced melanoma after loading DCs with tumor peptides or autologous cell lysate in presence of adjuvants keyhole limpet hematocyanin (KLH) (165).  Previous animal and clinical studies show use of DCs against tumors created success (165; 166; 167) as well as some problems due to heterogeneity of DC populations in one study supporting tumor growth rather than diminishing (168).

DC vaccination applied onto over four thousand clinical trial but none of them used siRNA-IDO DC vaccination method. Clinical trials evaluating DCs loaded ex vivo with purified TAAs as an anticancer immunotherapeutic interventions also did not include IDO (Table from (169). This table presented the data from 30 clinical trials, 3 of which discontinued, evaluating DCs loaded ex vivo with TAAs as an anticancer immunotherapy for 12 types of cancer [(AML(1), Breast cancer (4), glioblastoma (1), glioma (2), hepatocellular carcinoma (1), hematological malignancies (1), melanoma (6), neuroblastoma sarcoma (2), NSCLC (1), ovarian cancer (3), pancreatic cancer (3), prostate cancer (10)] at phase I, II or I/II.

Tipping the balance between Treg and Th17 ratio has a therapeutic advantage for restoring the health that is also shown in ovarian cancer by DC vaccination with adjuvants (161).  This rebalancing of the immune system towards immunogenicity may restore Treg/Th17 ratio (162; 170) but it is complicated. The stimulation of IL10 and IL12 induce Treg produce less Th17 and inhibiting CTL activation and its function (76; 171; 172) while animals treated with anti-TGFb before vaccination increase the plasma levels of IL-15 for tumor specific T cell survival in vivo (173; 174) ovarian cancer studies after human papilloma virus infection present an increase of IL12 (175).

Opposing signal mechanism downregulates the TGFb to activate CTL and Th1 population with IL12 and IL15 expression (162; 173).  The effects of IL17 on antitumor properties observed by unique subset of CD4+ T cells (176) called also CD8+ T cells secrete even more IL17 (177).

Using cytokines as adjuvants during vaccination may improve the efficacy of vaccination since cancer vaccines unlike infections vaccines applied after the infection or disease started against the established adoptive immune response.  Adjuvants are used to improve the responses of the given therapies commonly in immunotherapy applications as a combination therapy (178).

Enhancing cancer vaccine efficacy via modulation of the microenvironment is a plausible solution if only know who are the players.  Several molecules can be used to initiate and lengthen the activity of intervention to stimulate IDO expression without compromising the mechanism (179).  The system is complicated so generally induction is completed ex-vivo stimulation of DCs in cell lysates, whole tumor lysates, to create the microenvironment and natural stimulatory agents. Introduction of molecules as an adjuvants on genetic regulation on modulation of DCs are critical, because order and time of the signals, specific location/ tissue, and heterogeneity of personal needs (174; 138; 180). These studies demonstrated that IL15 with low TGFb stimulates CTL and Th1, whereas elevated TGFb with IL10 increases Th17 and Tregs in cancer microenvironments.

IDO and signaling gene regulation

For example Ret-peptide antitumor vaccine contains an extracellular fragment of Ret protein and Th1 polarized immunoregulator CpG oligonucleotide (1826), with 1MT, a potent inhibitor of IDO, brought a powerful as well as specific cellular and humoral immune responses in mice (152).

The main idea of choosing Ret to produce vaccine in ret related carcinomas fall in two criterion, first choosing patients self-antigens for cancer therapy with a non-mutated gene, second, there is no evidence of genetic mutations in Ret amino acids 64-269. Demonstration of proliferating hemangiomas, benign endothelial tumors and often referred as hemangiomas of infancy appearing at head or neck, express IDO and slowly regressed as a result of immune mediated process.

After large scale of genomic analysis show insulin like growth factor 2 as the key regulator of hematoma growth (Ritter et al. 2003). We set out to develop new technology with our previous expertise in immunotherapy and immunomodulation (181; 182; 183; 184), correcting Th17/Th1 ratio (185), and siRNA technology (186; 187).  We developed siRNA-IDO-DCvax. Patented two technologies “Immunomodulation using Altered DCs (Patent No: US2006/0165665 A1) and Method of Cancer Treatments using siRNA Silencing (Patent No: US2009/0220582 A1).

In melanoma cancer DCs were preconditioned with whole tumor lysate but in breast cancer model pretreatment completed with tumor cell lysate before siRNA-IDO-DCvax applied. Both of these studies was a success without modifying the autanticity of DCs but decreasing the IDO expression to restore immunegenity by delaying tumor growth in breast cancer (147) and in melanoma (188).  Thus, our DCvax specifically interfere with Ido without disturbing natural structure and content of the DCs in vivo showed that it is possible to carry on this technology to clinical applications.

Furthermore, our method of intervention is more sophisticated since it has a direct interaction mechanism with ex-vivo DC modulation without creating long term metabolism imbalance in Trp/Kyn metabolite mechanisms since the action is corrective and non-invasive.

There were several reasons.

First, prevention of tumor development studies targeting non-enzymatic pathway initiated by pDCs conditioned with TGFbeta is specific to IDO1 (189).

Second, IDO upregulation in antigen presenting cells allowing metastasis show that most human tumors express IDO at high levels (123; 124).

Third, tolerogenic DCs secretes several molecules some of them are transforming growth factor beta (TGFb), interleukin IL10), human leukocyte antigen G (HLA-G), and leukemia inhibitory factor (LIF), and non-secreted program cell death ligand 1 (PD-1 L) and IDO, indolamine 2.3-dioxygenase, which promote tumor tolerance. Thus, we took advantage of DCs properties and Ido specificity to prevent the tolerogenicity with siRNA-IDO DC vaccine in both melanoma and breast cancer.

Fourth, IDO expression in DCs make them even more potent against tumor antigens and create more T cells against tumors. IDOs are expressed at different levels by both in broad range of tumor cells and many subtypes of DCs including monocyte-derived DCs (10), plasmacytoid DCs (142), CD8a+ DCs (190), IDO compotent DCs (17), IFNgamma-activated DCs used in DC vaccination.  These DCs suppress immune responses through several mechanisms for induction of apoptosis towards activated T cells (156) to mediate antigen-specific T cell anergy in vivo (142) and for enhancement of Treg cells production at sites of vaccination with IDO-positive DCs+ in human patients (142; 191; 192; 168; 193; 194). If DCs are preconditioned with tumor lysate with 1MT vaccination they increase DCvax effectiveness unlike DCs originated from “normal”, healthy lysate with 1MT in pancreatic cancer (195).  As a result, we concluded that the immunesupressive effect of IDO can be reversed by siRNA because Treg cells enhances DC vaccine-mediated anti-tumor-immunity in cancer patients.

Gene silencing is a promising technology regardless of advantages simplicity for finding gene interaction mechanisms in vitro and disadvantages of the technology is utilizing the system with specificity in vivo (186; 196).  siRNA technology is one of the newest solution for the treatment of diseases as human genomics is only producing about 25,000 genes by representing 1% of its genome. Thus, utilizing the RNA open the doors for more comprehensive and less invasive effects on interventions. Thus this technology is still improving and using adjuvants. Silencing of K-Ras inhibit the growth of tumors in human pancreatic cancers (197), silencing of beta-catenin in colon cancers causes tumor regression in mouse models (198), silencing of vascular endothelial growth factor (VGEF) decreased angiogenesis and inhibit tumor growth (199).

Combining siRNA IDO and DCvax from adult stem cell is a novel technology for regression of tumors in melanoma and breast cancers in vivo. Our data showed that IDO-siRNA reduced tumor derived T cell apoptosis and tumor derived inhibition of T cell proliferation.  In addition, silencing IDO made DCs more potent against tumors since treated or pretreated animals showed a delay or decreased the tumor growth (188; 147)

 

Clinical Trials:

First FDA approved DC-based cancer therapies for treatment of hormone-refractory prostate cancer as autologous cellular immunotherapy (163; 164).  However, there are many probabilities to iron out for a predictive outcome in patients.

Table 2 demonstrates the current summary of clinical trials report.  This table shows 38 total studies specifically Ido related function on cancer (16), eye (3), surgery (2), women health (4), obesity (1), Cardiovascular (2), brain (1), kidney (1), bladder (1), sepsis shock (1), transplant (1),  nervous system and behavioral studies (4), HIV (1) (Table 4).  Among these only 22 of which active, recruiting or not yet started to recruit, and 17 completed and one terminated.

Most of these studies concentrated on cancer by the industry, Teva GTC ( Phase I traumatic brain injury) Astra Zeneca (Phase IV on efficacy of CRESTOR 5mg for cardiovascular health concern), Incyte corporation (Phase II ovarian cancer) NewLink Genetics Corporation Phase I breast/lung/melanoma/pancreatic solid tumors that is terminated; Phase II malignant melanoma recruiting, Phase II active, not recruiting metastatic breast cancer, Phase I/II metastatic melanoma, Phase I advanced malignancies) , HIV (Phase IV enrolling by invitation supported by Salix Corp-UC, San Francisco and HIV/AIDS Research Programs).

Many studies based on chemotherapy but there are few that use biological methods completed study with  IDO vaccine peptide vaccination for Stage III-IV non-small-cell lung cancer patients (NCT01219348), observational study on effect of biological therapy on biomarkers in patients with untreated hepatitis C, metastasis melanoma, or Crohn disease by IFNalpha and chemical (ribavirin, ticilimumab (NCT00897312), polymorphisms of patients after 1MT drug application in treating patients with metastatic or unmovable refractory solid tumors by surgery (NCT00758537), IDO expression analysis on MSCs (NCT01668576), and not yet recruiting intervention with adenovirus-p53 transduced dendric cell vaccine , 1MT , radiation, Carbon C 11 aplha-methyltryptophan- (NCT01302821).

Among the registered clinical trials some of them are not interventional but  observational and evaluation studies on Trp/Kyn ratio (NCT01042847), Kyn/Trp ratio (NCT01219348), Kyn levels (NCT00897312, NCT00573300),  RT-PCR analysis for Kyn metabolism (NCT00573300, NCT00684736, NCT00758537), and intrinsic IDO expression of mesenchymal stem cells in lung transplant with percent inhibition of CD4+ and CD8+ T cell proliferation toward donor cells (NCT01668576), determining polymorphisms (NCT00426894). These clinical trials/studies are immensely valuable to understand the mechanism and route of intervention development with the data collected from human populations   

Future Actions for Molecular Dx and Targeted Therapies:

Viable tumor environment. Tumor survival is dependent upon an exquisite interplay between the critical functions of stromal development and angiogenesis, local immune suppression and tumor tolerance, and paradoxical inflammation. TEMs: TIE-2 expressing monocytes; “M2” TAMs: tolerogenic tumor-associated macrophages; MDSCs: myeloid-derived suppressor cells; pDCs: plasmacytoid dendritic cells; co-stim.: co-stimulation; IDO: indoleamine 2,3-dioxygenase; VEGF: vascular endothelial growth factor; EGF: epidermal growth factor; MMP: matrix metaloprotease; IL: interleukin; TGF-β: transforming growth factor-beta; TLRs: toll-like receptors.  (reference: http://www.hindawi.com/journals/cdi/2012/937253/fig1/)

Viable tumor environment. Tumor survival is dependent upon an exquisite interplay between the critical functions of stromal development and angiogenesis, local immune suppression and tumor tolerance, and paradoxical inflammation. TEMs: TIE-2 expressing monocytes; “M2” TAMs: tolerogenic tumor-associated macrophages; MDSCs: myeloid-derived suppressor cells; pDCs: plasmacytoid dendritic cells; co-stim.: co-stimulation; IDO: indoleamine 2,3-dioxygenase; VEGF: vascular endothelial growth factor; EGF: epidermal growth factor; MMP: matrix metaloprotease; IL: interleukin; TGF-β: transforming growth factor-beta; TLRs: toll-like receptors. (reference: http://www.hindawi.com/journals/cdi/2012/937253/fig1/)

Current survival or response rate is around 40 to 50 % range.  By using specific cell type, selected inhibition/activation sequence based on patient’s genomic profile may improve the efficacy of clinical interventions on cancer treatments. Targeted therapies for specific gene regulation through signal transduction is necessary but there are few studies with genomics based approach.

On the other hand, there are surveys, observational or evaluations (listed in clinical trials section) registered with www.clinicaltrials.gov that will provide a valuable short-list of molecules.  Preventing stimulation of Ido1 as well as Tgfb-1gene expression by modulating receptor mediated phosphorylation between TGFb/SMAD either at Mad-Homology 1 (MH1) or Mad-Homology 1 (MH2) domains maybe possible (79; 82; 80). Within Smads are the conserved Mad-Homology 1 (MH1) domain, which is a DNA binding module contains tightly bound Zinc atom.

Smad MH2 domain is well conserved and one the most diverse protein-signal interacting molecule during signal transduction due to two important Serine residues located extreme distal C-termini at Ser-Val-Ser in Smad 2 or at pSer-X-PSer in RSmads (80). Kyn activated orphan G protein–coupled receptor, GPR35 with unknown function with a distinct expression pattern that collides with IDO sites since its expression at high levels of the immune system and the gut (63) (200; 63).  

The first study to connect IDO with cancer shows that group (75).  The directly targeting to regulate IDO expression is another method through modulating ISREs in its promoter with RNA-peptide combination technology. Indirectly, IDO can be regulated through Bin1 gene expression control over IDO since Bin1 is a negative regulator of IDO and prevents IDO expression.  IDO is under negative genetic control of Bin1, BAR adapter–encoding gene Bin1 (also known as Amphiphysin2). Bin1 functions in cancer suppression since attenuation of Bin1 observed in many human malignancies (141; 201; 202; 203; 204; 205; 206) .  Null Bin-/- mice showed that when there is lack of Bin1, upregulation of IDO through STAT1- and NF-kB-dependent expression of IDO makes tumor cells to escape from T cell–dependent antitumor immunity.

This pathway lies in non-enzymatic signal transducer function of IDO after stimulation of DCs by TGFb1.  The detail study on Bin1 gene by alternative spicing also provided that Bin1 is a tumor suppressor.  Its activities also depends on these spliced outcome, such as  Exon 10, in muscle, in turn Exon 13 in mice has importance in role for regulating growth when Bin1 is deleted or mutated C2C12 myoblasts interrupted due to its missing Myc, cyclinD1, or growth factor inhibiting genes like p21WAF1 (207; 208).

On the other hand alternative spliced Exon12A contributing brain cell differentiation (209; 210). Myc as a target at the junction between IDO gene interaction and Trp metabolism.  Bin1 interacts with Myc either early-dependent on Myc or late-independent on Myc, when Myc is not present. This gene regulation also interfered by the long term signaling mechanism related to Kynurenine (Kyn) acting as an endogenous ligand to AHR in Trp metabolite and TGFb1 and/or IFNalpha and IFNbeta up regulation of DCs to induce IDO in noncanonical pathway for NF-kB and myc gene activations (73; 74).  Hence, Trp/Kyn, Kyn/Trp, Th1/Th17 ratios are important to be observed in patients peripheral blood. These direct and indirect gene interactions place Bin1 to function in cell differentiation (211; 212; 205).

Regulatory T-cel generation via reverse and non-canonical signaliing to pDCs

Table 3 contains the microarray analysis for Kyn affect showed that there are 25 genes affected by Kyn, two of which are upregulated and 23 of them downregulated (100). This list of genes and additional knowledge based on studies creating the diagnostics panel with these genes as a biomarker may help to analyze the outcomes of given interventions and therapies. Some of these molecules are great candidate to seek as an adjuvant or co-stimulation agents.  These are myc, NfKB at IKKA, C2CD2, CREB3L2, GPR115, IL2, IL8, IL6, and IL1B, mir-376 RNA, NFKB3, TGFb, RelA, and SH3RF1. In addition, Lip, Fox3P, CTLA-4, Bin1, and IMPACT should be monitored.

In addition, Table 4 presents the other possible mechanisms. The highlights of possible target/biomarkers are specific TLRs, conserved sequences of IDO across its homologous structures, CCR6, CCR5, RORgammat, ISREs of IDO, Jak, STAT, IRFs, MH1 and MH2 domains of Smads. Endothelial cell coagulation activation mechanism and pDC maturation or immigration from lymph nodes to bloodstream should marry to control not only IDO expression but also genesis of preferred DC subsets. Stromal mesenchymal cells are also activated by these modulation at vascular system and interferes with metastasis of cancer. First, thrombin (human factor II) is a well regulated protein in coagulation hemostasis has a role in cell differentiation and angiogenesis.

Protein kinase activated receptors (PARs), type of GPCRs, moderate the actions. Second, during hematopoietic response endothelial cells produce hematopoietic growth factors (213; 214). Third, components of bone marrow stroma cells include monocytes, adipocytes, and mesenchymal stem cells (215). As a result, addressing this issue will prevent occurrence of coagulapathologies, namely DIC, bleeding, thrombosis, so that patients may also improve response rate towards therapies. Personal genomic profiles are powerful tool to improve efficacy in immunotherapies since there is an influence of age (young vs. adult), state of immune system (innate vs. adopted or acquired immunity). Table 5 includes some of the current studies directly with IDO and indirectly effecting its mechanisms via gene therapy, DNA vaccine, gene silencing and adjuvant applications as an intervention method to prevent various cancer types.

CONCLUSION

IDO has a confined function in immune system through complex interactions to maintain hemostasis of immune responses. The genesis of IDO stem from duplication of bacterial IDO-like genes.  Inhibition of microbial infection and invasion by depleting tryptophan limits and kills the invader but during starvation of trp the host may pass the twilight zone since trp required by host’s T cells.  Thus, the host cells in these small pockets adopt to new microenvironment with depleted trp and oxygen poor conditions. Hence, the cell metabolism differentiate to generate new cellular structure like nodules and tumors under the protection of constitutively expressed IDO in tumors, DCs and inhibited T cell proliferation.

On the other hand, having a dichotomy in IDO function can be a potential limiting factor that means is that IDOs impact on biological system could be variable based on several issues such as target cells, IDO’s capacity, pathologic state of the disease and conditions of the microenvironment. Thus, close monitoring is necessary to analyze the outcome to prevent conspiracies since previous studies generated paradoxical results.

Current therapies through chemotherapies, radiotherapies are costly and effectiveness shown that the clinical interventions require immunotherapies as well as coagulation and vascular biology manipulations for a higher efficacy and survival rate in cancer patients. Our siRNA and DC technologies based on stem cell modulation will provide at least prevention of cancer development and hopefully prevention in cancer.

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Imaging Biomarker for Arterial Stiffness: Pathways in Pharmacotherapy for Hypertension and Hypercholesterolemia Management

Author, and Content Consultant to e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC

and

Article Curator: Aviva Lev-Ari, PhD, RN

This article has Four Parts:

Part 1:

Quantification of Arterial Stiffness selected for its Predictive Value for Cardiovascular (CV) Events.

Arterial stiffness can predict cardiovascular adverse events such as stroke and heart attack. While there are various ways to define and estimate arterial stiffness, relatively simple surrogates have clinical advantages and favorable reports regarding predictive accuracy. This article will review in particular carotid-femoral pulse wave velocity (cfPWV) as an imaging-based biomarker of arterial stiffness.

Part II:

Results for Advances and Recent Clinical Trials in Hypertension Management

Caution is required in the interpretation of trial results, due to the Hawthorne Effect: participation in a trial confers benefits to all groups. Usually the Hawthorne effect is attributed to the close attention and is considered transient, but it can have lasting impact. In a retrospective cohort study, the benefits of participation in clinical trials irrespective of the treatment allocation were illustrated by better persistence and adherence to prescribed medication long term.

  • Participation in a clinical trial enhances adherence and persistence to treatment: a retrospective cohort study.

Hypertension . 2011 ; 58 : 573 – 578 .

  • It is proving more and more difficult to show incremental benefit of new therapies over standard therapy in control groups that are on background therapy marked by high statin, antiplatelet, and other antihypertensive therapy rates, as well as more overweight and obesity and less tobacco use than in the past.

Participation in a Clinical Trial Enhances Adherence and Persistence to Treatment, A Retrospective Cohort Study Chronobiol Int . 2011 ; 28 : 601 – 610.

 Cardiorenal end points in a trial of Aliskiren for type 2 diabetes. N Engl J Med . 2012 ; 367 : 2204 – 2213.

Part III:

Pharmacotherapy for Hypertension and Hypercholesterolemia Management: Mechanism of Action of Top 10 Cardio Drugs 2012, published on May 16, 2013. FiercePharma reports the top 10 drugs from expenditure standpoint:

Part IV: Management Aspects of the Global Pharmaceutical Industry

The 20 Highest-Paid Biopharma CEOs of 2012 are also reported by FiersePharma.

Part 1:

Quantification of Arterial Stiffness selected for its Predictive Value for Cardiovascular (CV) Events.

based on

Stéphane Laurent, Elie Mousseaux and Pierre Boutouyrie, Arterial Stiffness as an Imaging Biomarker : Are All Pathways Equal?

http://hyper.ahajournals.org/content/early/2013/05/20/HYPERTENSIONAHA.113.01372.citation

In a recent meta-analysis,2 Seventeen longitudinal studies totalizing 15,877 subjects with a mean follow-up of 7.7 years showed, for 1 SD increase in PWV, a risk ratio of 1.47 (1.31–1.64) for total mortality, 1.47 (1.29–1.66) for CV mortality, and 1.42 (1.29–1.58) for all-cause mortality.

Aortic stiffness, measured through cfPWV, can thus be considered as a novel imaging biomarker for predicting CV events, although its value as a true surrogate end point requires a large intervention trial to demonstrate that the reduction in arterial stiffness translates into a reduction in CV events.

Prediction of Occurrence of Cardiovascular Events Independently of Left Ventricular Mass in Hypertensive Patients: Monitoring of Timing of Korotkoff Sounds as Indicator of Arterial Stiffness

In this article by Gosse et al7 published in the present issue of Hypertension, the Authors provides an important contribution with regard to the predictive value of arterial stiffness for CV events for the following reasons:

  • First, the authors reported that arterial stiffness, measured in a population of 793 patients with hypertension with a mean follow-up of 97 months, was independently related to all CV events, major CV events, and total mortality. Interestingly, the predictive value was significant in all subgroups of CV risk, defined by a low, medium, or high SCORE risk. These findings confirmed those of previous studies.
  • Second, the authors took advantage of the simultaneous measurement of 24-hour blood pressure (BP) to include 24-hour mean BP in the multivariate Cox analysis, and this is a novelty. Thus, they were able to provide the demonstration that the predictive value of arterial stiffness is not only independent of office BP, as shown in most epidemiological studies, but also of 24-hour mean BP and pulse pressure (or alternatively 24-hour systolic and diastolic BPs) simultaneously measured.
  • Third, among the 793 patients, 519 patients had baseline measurements of arterial stiffness before any antihypertensive treatment, and the remaining 274 patients had measurement during the follow- up period. The independent predictive value of arterial stiffness was significant whether measured before or after the administration of antihypertensive treatment.
  • Finally, Gosse et al 7 showed, in a subgroup of 523 patients who had a measurement of left ventricular mass index, that the predictive value of arterial stiffness for major CV events was independent of left ventricular mass index. The authors thus confirmed the very few epidemiological studies which analyzed the predictive value of biomarkers of target organ damages (ie, left ventricular mass index, urinary albumin excretion rate, carotid intimamedia thickness, and arterial stiffness) and found that arterial stiffness retained a significant predictive value when adjusted either to left ventricular mass index6 or carotid intima-media thickness.5
  • The method which has been used to determine arterial stiffness. Indeed, Gosse et al 8 proposed, 2 decades ago, to take advantage of an ambulatory measurement of BP and continuous monitoring of ECG >24 hours, to calculate the QKD interval. QKD is the time between the onset of the QRS on the ECG and the detection of the last Korotkoff sound by the microphone placed on the brachial artery. It has 2 components:
  1. the pre-ejection time, which is influenced by heart rate and
  2. the pulse transmission time, which is inversely related to PWV, and arterial stiffness.
  • BP and QKD are measured repeatedly, and a stiffness parameter is derived from the linear regression of all the measurements of QKD, heart rate, and systolic BP >24 hours. The QKD interval is calculated for a 100-mm Hg BP, thus it gives an isobaric value of arterial stiffness, and for a 60-beats/min heart rate to reduce the influence of the pre-ejection time.
  • Most importantly, the arterial pathway of pulse wave transmission includes the ascending aorta, the aortic arch, and muscular arteries (subclavian and brachial), and thus,
  • differs from the carotid-femoral pathway of the cfPWV measurement, considered as gold standard for arterial stiffness.9
  • cfPWV is calculated as the ratio of the transit time between the feet of the carotid and femoral pressure waveforms, and the carotid-femoral distance, a ratio which is undisputedly recognized as a stiffness parameter. Several studies and a consensus statement have determined the correction factor, which should be applied to the carotid-femoral distance, to take into account the fact that, when the pressure wave is recorded at the carotid level, it has already reached the descending thoracic aorta.
  • The pressure wave travels mostly along an aortic segment, including the thoracic descending aorta and the abdominal aorta, and ultimately travels along the iliac and common femoral arteries. This is well exemplified by the Figure, which superimposes the trajectory of the pressure pulse wave on a normal angiogram obtained by magnetic resonance imaging.

VIEW FIGURE

The trajectories of the pressure pulse waves along the arterial segments are superimposed onto an angiogram obtained by computed tomography scan (left anterior oblique). The carotid-femoral pathway is described as dotted line, and the QKD pathway is described as dashed line.

pap62

FIGURE SOURCE:

http://hyper.ahajournals.org/content/early/2013/05/20/HYPERTENSIONAHA.113.01372.citation

The method developed by Gosse et al 7,8 measures the time delay between the onset of the QRS on the ECG and the detection of the last Korotkoff sound by the microphone placed on the brachial artery. Thus, the pressure pulse wave travels first along the ascending aorta and the aortic arch (ie, a short pathway of elastic arteries) and then along the subclavian and brachial arteries (ie, a much longer pathway of muscular arteries).

Because the stiffness of muscular arteries is little influenced by age and hypertension, Gosse et al8 attributed the difference in QKD duration to ascending aorta and aortic arch. However, a closer look at the Figure shows that the length of the ascending and aortic arch pathway represents a very small part of the total pathway and casts doubt about this statement.

Furthermore, in magnetic resonance imaging studies, the transit time of flow wave along the aortic arch (average 120 mm length) is often found ≈35 ms in young healthy subjects,10 a value which is far from the mean 206 ms QKD duration found in the present study. Thus, part of that QFD duration has to be further explained by both the preejection period and the transit time within muscular arteries.

Alternative Devices

  • 2008 – The arteriograph system estimates PWV from a single-site determination of the suprasystolic waveform at the brachial artery site, and measures the time elapsed between the first wave ejected from the left ventricle to the aortic root, and its reflection from the bifurcation as the second systolic wave, with subtraction of the brachial artery transit time.
  • 2010 – The Mobil-O-Graph system uses oscillometric recording of brachial artery pressure waveform and reconstructs the central pulse wave by applying a transfer function. Central pulse wave is then decomposed into forward and backward waves, and PWV isestimated from their time difference.
  • Device |Method |Arterial Pathway |Predictive Value for CV Events | (Year of First Publication)

1984 Complior Mechanotransducer Carotid-femoral Yes (1999)

1990 Sphygmocor Tonometer Carotid-femoral Yes (2011)

1994 QKD ECG + Korotkoff sounds Aorta + brachial Yes (2005)

1997 Cardiov. Eng. Inc Tonometer Carotid-femoral Yes (2010)

2002 Doppler probes Doppler probe Aortic arch + descending aorta Yes (2002)

2002 VP-1000 Omron Brachial and ankle pressure cuffs Aorta + brachial + lower limbs Yes (2005)

2004 PulsePen Tonometer Carotid-femoral No

2006 CAVI-VaSera ECG + Brachial and ankle pressure cuffs Aorta + brachial + lower limbs No

2008 Arteriograph Arm pressure cuff Aorta + brachial No

2009 MRI-ArtFun MRI Aortic arch No

2009 Vicorder Cuffs Carotid-femoral No

2010 Mobil-O-Graph Arm pressure cuff Aorta No

Conclusions

The measurement of arterial stiffness is increasingly popular among physicians and researchers mainly because its predictive value for cardiovascular (CV) events has been well demonstrated. The largest amount of evidence has been given for aortic stiffness, measured through carotid-femoral pulse wave velocity (cfPWV). This has been initially reported in the late 1990s or early 2000s.1

Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patientsHypertension. 2001;37:1236–1241.

European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applicationsEur Heart J. 2006;27:2588–2605.

Arterial Stiffness as an Imaging Biomarker : Are All Pathways Equal? http://hyper.ahajournals.org/content/early/2013/05/20/HYPERTENSIONAHA.113.01372.citation

References for Imaging Biomarker for Arterial Stiffness, at the end of the paper

Part II:

Results for Advances and Recent Clinical Trials in Hypertension Management

Based on

Garry L.R. Jennings, Recent Advances in Hypertension:Recent Clinical Trials of Hypertension Management http://hyper.ahajournals.org/content/early/2013/05/20/HYPERTENSIONAHA.113.00863.citation

Trends: tended to drive interest toward equivalence rather than efficacy studies (ie, trials designed to show an investigational agent is as good as, not better than, existing treatment), surrogate end points, including new blood pressure (BP) variables, and studies of combinations and algorithms rather than single interventions. Population studies around the world, however, continue to show that large numbers of people have hypertension that is not treated satisfactorily and are not achieving the goals set by the major national guidelines. These guidelines themselves are under continual scrutiny on the basis of recent data casting doubt on the validity of present BP goals. Guideline committees also face the issue that evidence based on expensive large-scale clinical trials is more often funded by the pharmaceutical or device industries than by government, leaving large evidence gaps in areas of public importance but no direct interest to industry funders. The purpose of the present article is to briefly review clinical trials of interventions in hypertension during the past 2 years.

Subject categories of Last Decade Clinical Trials on Hypertension

  • Resistant Hypertension
  • Resistant Hypertension and the Sympathetic
  • Nervous System
  • Trials of Pharmacotherapy
  • Old Ground, New Findings
  • Are Chlorthalidone and Nonthiazides the Best Diuretics for Treatment of Hypertension?
  • BP Targets and Treatment
  • Lifestyle and Nonpharmacological Approaches to Hypertension
  1.  Sodium
  2. Trials of Nutrition and BP
  • Resistance Exercise and BP

What Can Be Learned From Clinical Trials Reported in the Present Decade?

  • Systems for blood pressure management in the community can be improved because a large treatment gap remains.
  • Drug combinations from different classes with different modes of action are useful.
  • Drug combinations that include drugs with similar mode of action do not generally enhance efficacy and come at a cost in adverse events.
  • Small but important nutritional effects on blood pressure demand further examination.
  • The sympathetic nervous system has returned as an important target for therapy of hypertension.
  • Blood pressure targets and goals need refining, preferably on the basis of specifically designed clinical trials.

The scene for clinical trials of hypertension management is in transition. The era of mega trials may not be over but is certainly in decline, and in the past 2 years there have been no studies reporting primary outcome data the scale of the

  • Antihypertensive and
  • Lipid-Lowering Treatment
  1. Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT),
  2. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET),
  3. Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), and other
  4. major studies that marked clinical trial activity and informed guideline committees during the past 2 to 3 decades.

This reflects in part the view that the

  • present benchmark pharmacological agents for treating hypertension are difficult to improve,
  • some systemic issues affecting the pharmaceutical industry influencing the ability to make the large investment required to perform mega trials and
  • the quality of the antihypertensive drug pipeline.

http://hyper.ahajournals.org/content/early/2013/05/20/HYPERTENSIONAHA.113.00863.citation

References for Clinical Trial on Hypertension, at the end of the paper

Part III:

Mechanism of Action of Top 10 Cardio Drugs 2012, published on May 16, 2013

The top 10 Cardio Drugs in 2012 belong to two drug classes

  • Antihypertensive and
  • Lipid-Lowering Treatment

Sales % Change 2012 vs 2011 by Drug Class

MOA

By

Drug Class

Drug Name

2011 Sales billion

2012 Sales billion

% change

Statins

Crestor

6.622

6.253

-6%

Lipitor

9.577

3.948

-59%

Zetia

2.428

2.567

+6%

Vytorin

1.882

1.747

-7%

Total Sales and % change Statins

 20,509  14,515  -29.2%

ARB

Diovan

5.665

4.417

-22%

ACEII

Benicar

2.602

2.446

-6%

ACEI

Micardis

2.217

2.098

-5%

ARB

Avapro

1.797

1.422

-30% (BMS)

ARB

Blopress

1.808

1.643

-9%

PAH

Tracleer

1.721

1.6

-7%

Total Sales and % change AntiHTN

 15,810  13,626  -13.8%

Data Source:

http://www.fiercepharma.com/special-reports/top-10-cardio-drugs-2012#ixzz2U9Axh8X4 

1 Crestor

Crestor (AstraZeneca)
Patent expiry: July 2016

2012 sales: $6.253 billion
2011 sales: $6.622 billion
Change: (6%)

Crestor – FiercePharma http://www.fiercepharma.com/special-reports/crestor-0#ixzz2UACLZyaa 

(rosuvastatin calcium) is indicated as an adjunct to diet to reduce elevated Total-C, LDL-C, ApoB, non-HDL-C, and triglycerides, and to increase HDL-C in adult patients with primary hyperlipidemia or mixed dyslipidemia and to slow the progression of atherosclerosis in adult patients as part of a treatment strategy to lower Total-C and LDL-C to target levels.1

Diovan

Diovan (Novartis)
Patent expiry: September 2012

2012 sales: $4.417 billion
2011 sales: $5.665 billion
Change: (22%)

Diovan – FiercePharma http://www.fiercepharma.com/special-reports/diovan#ixzz2UACdBCtZ 

Valsartan (Angiotan or Diovan) is an angiotensin II receptor antagonist (more commonly called an “ARB”, or angiotensin receptor blocker), with particularly high affinity for the type I (AT1) angiotensin receptor. By blocking the action of angiotensin, valsartan dilates blood vessels and reduces blood pressure.[1] In the U.S., valsartan is indicated for treatment of high blood pressurecongestive heart failure (CHF), or post-myocardial infarction (MI).[2]

3 Lipitor

Lipitor (Pfizer)
Patent expiry: November 2011

2012 sales: $3.948 billion
2011 sales: $9.577 billion
Change: (59%)

Lipitor – FiercePharma http://www.fiercepharma.com/special-reports/lipitor-2#ixzz2UACsJ2Y2 

(atorvastatin calcium) tablets are a prescription medicine that is used along with a low-fat diet. It lowers the LDL (“bad”) cholesterol and triglycerides in your blood. It can raise your HDL (“good”) cholesterol as well. LIPITOR can lower the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL, or family history of early heart disease. LIPITOR can lower the risk for heart attack or stroke in patients with diabetes and risk factors such as diabetic eye or kidney problems, smoking, or high blood pressure.

LIPITOR is a member of the drug class known as statins, used for lowering blood cholesterol. It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms. Like all statins, atorvastatin works by inhibiting HMG-CoA reductase, an enzyme found in liver tissue that plays a key role in production of cholesterol in the body.

Atorvastatin was first synthesized in 1985 by Bruce Roth of Parke-Davis Warner-Lambert Company (now Pfizer). The best selling drug in pharmaceutical history, sales of Lipitor since it was approved in 1996 exceed US$125 billion, and the drug has topped the list of best-selling branded pharmaceuticals in the world for nearly a decade

4 Zetia

Zetia (Merck)
Patent expiry: December 2016

2012 sales: $2.567 billion
2011 sales: $2.428 billion
Change: 6%

Zetia – FiercePharma http://www.fiercepharma.com/special-reports/zetia#ixzz2UADFaGJ0 

Ezetimibe (pron.: /ɛˈzɛtɨmɪb/) is a drug that lowers plasma cholesterol levels. It acts by decreasing cholesterol absorption in the intestine. It may be used alone (marketed as Zetia or Ezetrol), when other cholesterol-lowering medications are not tolerated, or together withstatins (e.g., ezetimibe/simvastatin, marketed as Vytorin and Inegy) when statins alone do not control cholesterol.

Ezetimibe decreases cholesterol levels, but has not been shown to improve outcomes in cardiovascular disease patients by decreasing atherosclerotic or vascular events compared to placebo. Ezetimibe is endorsed in the Canadian Lipid Guidelines and is considered a well-tolerated option for an add-on agent to statin, to help patients achieve their LDL (or bad cholesterol) targets. [1] Ezetimibe is the only add-on to statin therapy that has successfully shown cardiovascular benefit when combined with statin, but has not been proven to have an incremental benefit compared to statins alone. [2] Britain’s NICE statement, published in 2007, endorses its use for monotherapy if statins are not tolerated or as add-on therapy.[3]

5 Benicar

Benicar (Daiichi Sankyo)
Patent expiry: October 2016

2012 sales: $2.446 billion
2011 sales: $2.602 billion
Change: (6%)

Benicar – FiercePharma http://www.fiercepharma.com/special-reports/benicar#ixzz2UADYvld5 

BENICAR and BENICAR HCT are prescription medicines used to lower high blood pressure (hypertension). They may be used alone or with other medicines used to treat high blood pressure. BENICAR HCT is not for use as the first medicine to treat high blood pressure.

 Olmesartan medoxomil is an angiotensin II receptor antagonistused to treat high blood pressure.

Olmesartan is a prodrug that works by blocking the binding of angiotensin II to the AT1 receptors in vascular muscle; it is therefore independent of angiotensin II synthesis pathways, unlike ACE inhibitors. By blocking the binding rather than the synthesis of angiotensin II, olmesartan inhibits the negative regulatory feedback on renin secretion. As a result of this blockage, olmesartan reduces vasoconstriction and the secretion of aldosterone. This lowers blood pressure by producing vasodilation, and decreasing peripheral resistance.

6 Micardis

Micardis (Boehringer Ingelheim)
Patent Expiry: January 2014

2012 Sales: $2.098 billion
2011 Sales: $2.217 billion
Change: (5%)

Micardis – FiercePharma http://www.fiercepharma.com/special-reports/micardis#ixzz2UADpDZeO 

Micardis® (telmisartan) tablets are a prescription medicine used to treat high blood pressure (hypertension). Additionally, MICARDIS 80 mg tablets are used in certain high-risk people aged 55 years and older who are unable to take a medicine called an angiotensin converting enzyme inhibitor (ACE-I) to help lower their risk of having certain cardiovascular problems such as stroke, heart attack, or death.

Micardis® (telmisartan) tablets are a prescription medicine used to treat high blood pressure (hypertension).

Telmisartan (INN) (pron.: /tɛlmɪˈsɑrtən/) is an angiotensin II receptor antagonist (angiotensin receptor blocker, ARB) used in the management of hypertension. It is marketed under thetrade name Micardis (by Boehringer Ingelheim), among others.

Telmisartan is an angiotensin II receptor blocker that shows high affinity for the angiotensin II receptor type 1 (AT1), with a binding affinity 3000 times greater for AT1 than AT2. It has the longest half-life of any ARB (24 hours)[1][4] and the largest volume of distribution.

In addition to blocking the RAs, telmisartan acts as a selective modulator of peroxisome proliferator-activated receptor gamma (PPAR-γ), a central regulator of insulin and glucose metabolism. It is believed that telmisartan’s dual mode of action may provide protective benefits against the vascular and renal damage caused by diabetes and cardiovascular disease (CVD).[4]

Telmisartan’s activity at the PPAR-γ receptor has prompted speculation around its potential as a sport doping agent as an alternative to GW 501516.[5] Telmisartan activates PPARδ receptors in several tissues. [6][7][8][9]

7 Avapro

Avapro (Sanofi)
Patent expiry: March 2012

Total 2012 sales: $1.925 billion
2012 sales Sanofi: $1.422 billion
2012 sales BMS: $503 million

Total 2011 sales: $2.749 billion
2011 sales Sanofi: $1.797 billion
2011 sales BMS: $952 million
Total Change: (30%)

Avapro – FiercePharma http://www.fiercepharma.com/special-reports/avapro#ixzz2UAE9iB2E 

rbesartan (INN) (pron.: /ɜrbəˈsɑrtən/) is an angiotensin II receptor antagonist used mainly for the treatment of hypertension. Irbesartan was developed by Sanofi Research (now part ofsanofi-aventis). It is jointly marketed by sanofi-aventis and Bristol-Myers Squibb under the trade names AprovelKarvea, and Avapro.

As with all angiotensin II receptor antagonists, irbesartan is indicated for the treatment ofhypertension. Irbesartan may also delay progression of diabetic nephropathy and is also indicated for the reduction of renal disease progression in patients with type 2 diabetes,[1]hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (>900 mg/24 hours).[2]

 A large randomized trial following 4100+ men and women with heart failure and normal ejection fraction (>=45%) over 4+ years found no improvement in study outcomes or survival with irbesartan as compared to placebo.[3]

8 Vytorin

Vytorin (Merck)
Patent Expiry: April 2017

2012 sales: $1.747 billion
2011 sales: $1.882 billion
Change: (7%)

Vytorin – FiercePharma http://www.fiercepharma.com/special-reports/vytorin#ixzz2UAEQVcQr 

Ezetimibe/simvastatin (pron.: /ɛˈzɛtɨmɪb ˌsɪmvəˈstætɨn/) is a drug combination used for the treatment of dyslipidemia. It is a combination of ezetimibe (best known as Zetia in the United States and Ezetrol elsewhere) and the statin drug simvastatin (best known as Zocor in the U.S.). The combination preparation is marketed by Merck & Co./Schering-PloughPharmaceuticals (joint venture) under the trade names Vytorin and Inegy.

Ezetimibe reduces blood cholesterol by inhibiting absorption of cholesterol by the small intestine by acting at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver.

Simvastatin is an HMG-CoA reductase inhibitor or statin. It works by blocking an enzymethat is necessary for the body to make cholesterol.

Even though ezetimibe decreases cholesterol levels, as of 2009 it has not been found to lead to improvement in real world outcomes.[1] The combination of simvastatin and ezetimibe has not been found to be any better than simvastatin alone. A panel of experts thus concluded in 2008 that it should “only be used as a last resort”.[2]

9 Blopress

Blopress (Takeda Pharmaceutical)
Patent expiry: June 2012

2012 sales: $1.643 billion
2011 sales: $1.808 billion
Change: (9%)

Blopress – FiercePharma http://www.fiercepharma.com/special-reports/blopress#ixzz2UAEnxyWy

Candesartan (rINN) (pron.: /ˌkændɨˈsɑrtən/) is an angiotensin II receptor antagonist used mainly for the treatment of hypertension. The prodrug candesartan cilexetil is marketed by AstraZeneca and Takeda Pharmaceuticals, commonly under the trade names Blopress,AtacandAmias, and Ratacand

As all angiotensin II receptor antagonists, candesartan is indicated for the treatment of hypertension. Results from the CHARM study in the early 2000s demonstrated the morbidity and mortality reduction benefits of candesartan therapy in congestive heart failure.[1] Thus, while ACE inhibitors are still considered first-line therapy in heart failure, candesartan can be used in combination with an ACE to achieve improved mortality and morbidity vs. an ACE alone and additionally is an alternative in patients intolerant of ACE inhibitor therapy.

Prehypertension

In a four-year randomized controlled trial, candesartan was compared to placebo to see whether it could prevent or postpone the development of full-blown hypertension in people with so-called prehypertension. During the first two years of the trial, half of participants were given candesartan, and the others received placebo; candesartan reduced the risk of developing hypertension by nearly two-thirds during this period. In the last two years of the study, all participants were switched to placebo. By the end of the study, candesartan hadsignificantly reduced the risk of hypertension, by more than 15%. Serious side effects were actually more common among participants receiving placebo than in those given candesartan.[2]

Candesartan is also available in a combination formulation with a low dose thiazide diuretic, invariably hydrochlorothiazide, to achieve an additive antihypertensive effect. Candesartan/hydrochlorothiazide combination preparations are marketed under various trade names including Atacand HCTHytacandBlopress Plus, Advantec and Ratacand Plus.

10 Tracleer

Tracleer (Actelion)
Patent expiry: November 2015   

2012 sales: $1.600 billion
2011 sales: $1.721 billion
Change: (7%)

Tracleer – FiercePharma http://www.fiercepharma.com/special-reports/tracleer#ixzz2UAF2iIJB 

Bosentan is a dual endothelin receptor antagonist used in the treatment of pulmonary artery hypertension (PAH). It is licensed in the United States, the European Union and other countries by Actelion Pharmaceuticals for the management of PAH under the trade name Tracleer.

Bosentan is a competitive antagonist of endothelin-1 at the endothelin-A (ET-A) and endothelin-B (ET-B) receptors. Under normal conditions, endothelin-1 binding of ET-A or ET-B receptors causes pulmonary vasoconstriction. By blocking this interaction, bosentan decreases pulmonary vascular resistance. Bosentan has a slightly higher affinity for ET-A than ET-B.

Clinical uses 

Bosentan is indicated mainly for the treatment of pulmonary hypertension. In 2007, bosentan was approved in the European Union also for reducing the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcer disease.

In the United States, bosentan is indicated for the treatment of pulmonary arterial hypertension (WHO Group I) in patients with WHO Class II-IV symptoms, to improve exercise capacity and decrease the rate of clinical worsening.[1]

http://www.fiercepharma.com/special-reports/top-10-cardio-drugs-2012

For years, cardio was king. The world’s all-time best-selling drug, Pfizer’s ($PFELipitor, after all, is an antihyperlipidemic drug. Cardio drugs have traditionally made up one of the largest categories of therapeutic treatment in the drug universe.

According to EvaluatePharma‘s World Preview 2018 report, combined sales of antihypertensive drugs and antihyperlipidemics were more than $70 billion in 2011. That would put them at the top of the heap. Sales of antihypertensive drugs alone were more than $40 billion that year, making them the second-largest therapy area defined by the report, behind oncology drugs at $64.4 billion. The list, compiled by EvaluatePharma, includes the theraputic areas categorized as cardio, so it does not include some products sometimes used for heart disease but not in that therapeutic area, including blood thinners like Plavix.

But many of the top cardio drugs are long in the tooth, and generics are now eating their lunch. Did I mention Lipitor? Sales cratered last year, falling nearly 60%. Despite that, the drug placed third among the top 10 cardio drugs of 2012, a reminder of the stature it had achieved. Four of the top 10 have lost patent protection in the last two years, and most will be off patent by 2016, with only Merck’s ($MRKVytorin protected until 2017.

Last year, the top 10 cardio drugs racked up sales of $28.644 billion, down 23% from the $37.271 billion they sold in 2011. Still, the group has made a lot of money for its companies for years and, in some cases, completely changed the treatment of heart disease.

It is an interesting list. Only Merck has two drugs in the top 10. The other drugmakers make up a broad swath of the pharma industry. Read our report below, and if you have some insights you would like to share, please do.

Top 10 Cardio Drugs 2012 – FiercePharma http://www.fiercepharma.com/special-reports/top-10-cardio-drugs-2012#ixzz2UAByWR7s 

Part IV:

20 Highest-Paid Biopharma CEOs of 2012

Call it a rite of spring. Every year about this timeFiercePharma takes a look at executive compensation in the industry, and we rank the highest-paid CEOs. If you’re a regular reader, you’ll notice that this year’s list is longer than previous editions. And there’s a reason for that: curiosity.

As we were beginning to gather numbers from biopharma companies’ proxy statements and annual reports, news surfaced that Valeant Pharmaceuticals ($VRX) and Actavis ($ACT) had been in merger talks. The former CEO of Mylan ($MYL), one of Actavis’ rivals, regularly appeared on our highest-paid executives list, so we looked up the numbers on Actavis. No dice; CEO Paul Bisaro may have pulled off his biggest merger ever last year, but $8.66 million in compensation still didn’t qualify him for our ranking.

Then, we pulled out Valeant’s proxy statement. And while CEO Michael Pearson didn’t earn enough in 2012 to make the cutoff–his compensation just surpassed $6 million–he should have been at the top of the list last year. Pearson’s 2011 pay package broke $36 million. He collected more than $18 million in stock and option awards, plus a special $13.7 million dividend payment, stemming from agreements negotiated years before.

We hate to miss a scoop. Naturally. So, we vowed to avoid making the same mistake this time around. Rather than limit our executive-pay search to the biggest pharma companies and biotechs, plus the usual suspects who often make CEO-pay rankings, we used a bigger net. We collected compensation information from 50 companies, including numbers for CEOs, CFOs, R&D chiefs and other top executives.

Partly because of this search, but mostly because of big bonuses and awards at fast-growing Regeneron ($REGN), we have a brand-new No. 1 on our list. That’s Regeneron CEO Leonard Schleifer, whose 2012 compensation totaled $30.047 million. You’ll notice some other newbies, such as Leonard Bell from Alexion ($ALXN), whose pay bump put him in 12th place. And then there are familiar faces, such as Pfizer ($PFE) CEO Ian Read; Johnson & Johnson’s ($JNJ) former chairman and CEO, William Weldon; and Eli Lilly ($LLY) CEO John Lechleiter, who hung on in 10th place.

Many of the companies we researched pay their top people far less than the $10 million that served as our cutoff figure. Novo Nordisk ($NVO) CEO Lars Sorensen, who has presided over double-digit growth there for several years, collected a package of cash and stock awards worth about $5 million for 2012. GlaxoSmithKline ($GSK) CEO Andrew Witty made less than $6 million himself; he took a pay cut for the year because of Glaxo’s shortfall on certain performance targets.

And then there are others who would have made the list, had their titles been different. There’s Regeneron R&D chief George Yancopoulos, whose extraordinary $81 million in compensation shows how much the company appreciates its newly minted blockbuster, Eylea. There’s Mylan Chairman Robert Coury, who used to be a fixture on our list until Heather Bresch took over as CEO; he made more than $28 million last year. Novartis’ ($NVS) former chairman Daniel Vasella could have qualified for 12th place with his $13.98 million in compensation.

Vasella, then, gives us a quick segue to the ongoing debate over executive pay. In Switzerland, populist dismay at some high-profile compensation figures led to a public vote earlier this year. Citizens voted in new restrictions on common bonuses, such as golden parachutes, and gave shareholders a binding vote on executive pay. And local analysts figure that late-breaking news of Vasella’s behind-the-scenes noncompete agreement–worth some $78 million over 5 years–helped pay activists to get out the vote. (Vasella ended up refusing the deal, by the way.)

In the U.S., where executives are paid more than anywhere else in the world, shareholders at some companies have successfully lobbied for a greater emphasis on performance pay and against extraordinary bonuses, such as change-in-control payments that send top executives on their way with tens of millions after a merger. Other companies have instituted “say-on-pay” advisory votes for shareholders, but those often end up as rubber stamps for the status quo.

Now, we’re interested in what you have to say about executive compensation. Are the CEOs on this list worth their price? What’s a supersuccessful new drug worth? Should CEO pay be docked for R&D failures? What about failed launches? Should other, lower-paid executives earn more? Tweet your opinions to @FiercePharma using the hashtag #FPexecpay, leave your comments below or email us. We’ll collect your thoughts in a future article.

As always, feel free to send us your thoughts on our coverage. And if we missed a well-paid CEO, be sure to let us know.

— Tracy Staton (email | Twitter)

For more:
Top 10 Biotech CEO Pay Packages of 2012
Top 10 Pharma CEO salaries of 2010
Top 10 Pharma CEO salaries of 2009
2012’s 10 highest-paid Med Tech CEOs
Top 10 Medical Device Industry CEO Salaries for 2011


20 Highest-Paid Biopharma CEOs of 2012 – FiercePharma http://www.fiercepharma.com/special-reports/20-highest-paid-biopharma-ceos-2012#ixzz2UAGAlHay 

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Okin PM , Dahl ö f B , Kjeldsen SE , Wachtell K . Association of pulse pressure

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K . Combined Effect of Angiotensin II Receptor Blocker and Either a

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Blood Pressure: The Japan Combined Treatment With Olmesartan and a

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Devereux RB . Differential impacts of blood pressure and lipid lowering

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37. Hummel SL , Seymour EM , Brook RD , Kolias TJ , Sheth SS , Rosenblum

HR , Wells JM , Weder AB . Low-sodium dietary approaches to stop

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Hypertension . 2012 ; 60 : 1200 – 1206 .

38. Soedamah-Muthu SS , Verberne LD , Ding EL , Engberink MF , Geleijnse JM .

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of prospective cohort studies. Hypertension . 2012 ; 60 : 1131 – 1137 .

39. West SG , Gebauer SK , Kay CD , Bagshaw DM , Savastano DM ,

Diefenbach C , Kris-Etherton PM . Diets containing pistachios reduce systolic

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40. Zhang X , Qi Q , Liang J , Hu FB , Sacks FM , Qi L . Neuropeptide Y promoter

polymorphism modifi es effects of a weight-loss diet on 2-year

changes of blood pressure: the preventing overweight using novel dietary

strategies trial. Hypertension . 2012 ; 60 : 1169 – 1175 .

41. Meredith IT , Friberg P , Jennings GL , Dewar EM , Fazio VA , Lambert GW ,

Esler MD . Exercise training lowers resting renal but not cardiac sympathetic

activity in humans. Hypertension . 1991 ; 18 : 575 – 582 .

42. Cornelissen VA , Fagard RH , Coeckelberghs E , Vanhees L . Impact of resistance

training on blood pressure and other cardiovascular risk factors: a metaanalysis

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RELATED SOURCES:

Aortic pulse pressure is associated with the localization of coronary artery disease based on coronary flow lateralization. American journal of hypertension, 25(10), 1055-1063.

  1. Georges Khoueiry1,
  2. Basem Azab2,
  3. Estelle Torbey2,
  4. Nidal Abi Rafeh1,
  5. Jean-Paul Atallah2,
  6. Kathleen Ahern2,
  7. James Malpeso1,
  8. Donald McCord1 and
  9. Elie R. Chemaly3

Author Affiliations


  1. 1Department of Cardiology, Staten Island University Hospital, Staten Island, New York, USA

  2. 2Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA

  3. 3Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA

Elie R. Chemaly (elie.chemaly@mssm.edu)

Abstract

Background Aortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (CAD). Besides, the left coronary artery (LCA) has a predominantly diastolic flow while the right coronary artery (RCA) receives systolic and diastolic flow. Thus, we hypothesized that increased systolic–diastolic pressure difference had a greater atherogenic effect on the RCA than on the LCA.

Methods A random sample of 433 CAD patients (145 females, 288 males, mean age 65.0 ± 11.1 years) undergoing coronary angiography at Staten Island University Hospital between January 2005 and May 2008 was studied. Coronary lesion was defined as a ≥50% luminal stenosis. Patients were divided into three groups, with isolated LCA lesions (n = 154), isolated RCA lesions (n = 36) or mixed LCA and RCA lesions (n = 243).

Results APP differed significantly between groups, being highest when the RCA alone was affected (67.6 ± 20.3 mm Hg for LCA vs. 78.8 ± 22.0 for RCA vs. 72.7 ± 22.6 for mixed, P = 0.008 for analysis of variance (ANOVA)). Age and gender were not associated with CAD location. Heart rate was associated with CAD location, lowest in RCA group, and negatively correlated with APP. However, left ventricular ejection fraction (LVEF) was lower in the mixed CAD group and positively correlated with APP. The association between APP and right-sided CAD persisted in multivariate logistic regression adjusting for confounders, including heart rate, LVEF and medication use. A similar but less significant pattern was seen with brachial arterial pressures.

Conclusions Aortic pulse pressure may affect CAD along with coronary flow phasic patterns.

American Journal of Hypertension, advance online publication 28 June 2012; doi:10.1038/ajh.2012.87

The Relationship Between Diastolic Pressure and Coronary Collateral Circulation in Patients With Stable Angina Pectoris and Chronic Total OcclusionAm J Hypertens (2013)doi: 10.1093/ajh/hps096 

First published online: February 7, 2013

  1. Wang Shu1,
  2. Jing jing1,
  3. Liu Chang Fu1,
  4. Jiang Tie Min2,
  5. Yang Xiao Bo1,
  6. Zhou Ying1and
  7. Chen Yun Dai1,*
  1. 1 The Cardiovascular Medical Department of the General Hospital of the Chinese People’s Liberation Army, Beijing, China;

  2. 2 The Cardiovascular Medical Department of the Affiliated Hospital of the Chinese People’s Armed Police Logistics College, Tianjin, China.
  1. Correspondence: Chen Yun Dai (chenyundai2002@163.com).

Abstract

BACKGROUND The most important biomechanical source of activation of the coronary collateral circulation (CCC) is increased tangential fluid shear stress at the arterial endothelial surface. The coronary circulation is unique in that most coronary blood flow occurs in diastole. Consequently, the diastolic blood pressure (DBP) may influence the tangential fluid shear stress on the arterial endothelial surface in diastole, therebyaffecting development of the CCC.

METHODS To investigate this, we conducted a study of 222 patients with stable angina pectoris and chronic total occlusion of coronary arteries. All of the patients had no history of coronary artery interventional therapy, coronary artery bypass surgery, cardiomyopathy, or congenital heart disease. The extent of the collateral vasculature of the area perfused by the artery affected by chronic total occlusion was graded as poor or well-developed according to Rentrop’s classification.

RESULTS Univariate analysis showed a significant difference between the study subgroup with poorly developed collaterals and that with well-developed collaterals in terms of high diastolic blood pressure (DBP) and mean DBP. Multivariate analysis revealed high DBP as the only independent positive predictor of a well-developed collateral circulation.

CONCLUSIONS High DBP is positively related to a well-developed CCC. Differences in development of the CCC may be one of the pathophysiologic mechanisms responsible for the J-curve phenomenon in the relationship between DBP and cardiovascular risk.

http://ajh.oxfordjournals.org/content/early/2013/02/06/ajh.hps096.abstract

Other related articles that were published on this Open Access Online Scientific Journal, include the following:

Synthetic Biology: On Advanced Genome Interpretation for Gene Variants and Pathways: What is the Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

Aviva Lev-Ari, PhD, RN May 17, 2013

http://pharmaceuticalintelligence.com/2013/05/17/synthetic-biology-on-advanced-genome-interpretation-for-gene-variants-and-pathways-what-is-the-genetic-base-of-atherosclerosis-and-loss-of-arterial-elasticity-with-aging/

Artherogenesis: Predictor of CVD – the Smaller and Denser LDL Particles

Aviva Lev-Ari, PhD, RN 11/15/2012

http://pharmaceuticalintelligence.com/2012/11/15/artherogenesis-predictor-of-cvd-the-smaller-and-denser-ldl-particles/

Cardiovascular Diseases: Causes, Risks and Management, Volume Two, Risks of Cardiovascular Diseases

Justin D. Pearlman MD ME PhD MA FACC, Editor

http://pharmaceuticalintelligence.com/biomed-e-books/cardiovascular-diseases-risks-and-management/cvd-2-risk-assessment-of-cardiovascular-diseases/

Genetics of Conduction Disease: Atrioventricular (AV) Conduction Disease (block): Gene Mutations – Transcription, Excitability, and Energy Homeostasis

Aviva Lev-Ari, PhD, RN 4/28/2013

http://pharmaceuticalintelligence.com/2013/04/28/genetics-of-conduction-disease-atrioventricular-av-conduction-disease-block-gene-mutations-transcription-excitability-and-energy-homeostasis/

Genomics & Genetics of Cardiovascular Disease Diagnoses: A Literature Survey of AHA’s Circulation Cardiovascular Genetics, 3/2010 – 3/2013

Aviva Lev-Ari, PhD, RN and Larry H. Bernstein, MD, FCAP 3/7/2013

http://pharmaceuticalintelligence.com/2013/03/07/genomics-genetics-of-cardiovascular-disease-diagnoses-a-literature-survey-of-ahas-circulation-cardiovascular-genetics-32010-32013/

Hypertriglyceridemia concurrent Hyperlipidemia: Vertical Density Gradient Ultracentrifugation a Better Test to Prevent Undertreatment of High-Risk Cardiac Patients

Aviva Lev-Ari, PhD, RN 4/4/2013

http://pharmaceuticalintelligence.com/2013/04/04/hypertriglyceridemia-concurrent-hyperlipidemia-vertical-density-gradient-ultracentrifugation-a-better-test-to-prevent-undertreatment-of-high-risk-cardiac-patients/

Hypertension and Vascular Compliance: 2013 Thought Frontier – An Arterial Elasticity Focus

Justin D. Pearlman, MD, PhD and Aviva Lev-Ari, PhD, RN 5/11/2013

http://pharmaceuticalintelligence.com/2013/05/11/arterial-elasticity-in-quest-for-a-drug-stabilizer-isolated-systolic-hypertension-caused-by-arterial-stiffening-ineffectively-treated-by-vasodilatation-antihypertensives/

Read Full Post »

Cardio-Metabolic Drug Targets, Inaugural, September 25 – 26, 2013, Westin Waterfront | Boston, Massachusetts  

 

Reporter: Aviva Lev-Ari, PhD, RN

Article ID #57:Cardio-Metabolic Drug Targets, Inaugural, September 25 – 26, 2013, Westin Waterfront | Boston, Massachusetts. Published on 5/23/2013

WordCloud Image Produced by Adam Tubman

                                 

ABOUT THIS CONFERENCE

Cardiovascular disease, diabetes, obesity and dyslipidemia, though traditionally treated as separate entities, are often conditions that appear together in individuals because of defects in underlying metabolic processes. Researchers are therefore now seeking compounds that target biological points of intersection of these related diseases in the hopes of ‘killing more birds with one stone.’ Or they are approaching drug development of a compound for a specific disease with a greater awareness of the backdrop of related conditions.

Join fellow biomedical researchers from academia and industry at our day and a half conference, Cardio-Metabolic Drug Targets to discuss the impact of this paradigm change in the way drugs are discovered and developed in the cardio-metabolic arena and to stay abreast of the latest targets and drug development candidates in the pipeline.

SUGGESTED EVENT PACKAGE:

September 23: Allosteric Modulators of GPCRs Short Course 
September 24 – 25: Novel Strategies for Kinase Inhibitors Conference
September 25: Setting Up Effective Functional Screens Using 3D Cell Cultures Dinner Short Course
September 25 – 26: Cardio-Metabolic Drug Targets Conference

Scientific Advisory Board:

Jerome J. Schentag, Pharm.D., Professor of Pharmaceutical Sciences, University at Buffalo

Rebecca Taub, M.D., Ph.D., CEO, Madrigal Pharmaceuticals

Preliminary Agenda

BEYOND STATINS: NEW APPROACHES FOR REGULATING LIPID METABOLISM AND ATHEROSCLEROSIS

Macrophage ABC Transporters: Novel Targets to Promote Atherosclerotic Plaque Regression by Inducing Reverse Cholesterol Transport (RCT) Mechanism

Eralp “Al” Bellibas, M.D., Senior Director, Head, Clinical Pharmacology, The Medicines Company

Targeting PCSK9 for Hypercholesterolemia and Atherosclerosis

Hong Liang, Ph.D., Associate Research Fellow, Rinat Research Unit, Pfizer

Novel Treatment for Dyslipidemia: Liver-Directed Thyroid Hormone Receptor-ß Agonist

Rebecca Taub, M.D., Ph.D., CEO, Madrigal Pharmaceuticals

CARDIO-METABOLIC THERAPEUTIC CANDIDATES

Oral Mimetics of RYGB and GLP-1 in Metabolic Syndromes

Jerome J. Schentag, Pharm.D., Professor of Pharmaceutical Sciences, University at Buffalo

FGF21-Mimetic Antibodies for Type 2 Diabetes

Jun Sonoda, Ph.D., Group Leader, Scientist, Molecular Biology, Genentech

NEW CARDIO-METABOLIC TARGETS

Blockade of Delta-Like Ligand 4 (Dll4)-Notch Signaling Reduces Macrophage Activation and Attenuates Atherosclerotic Vascular Diseases and Metabolic Disorders

Masanori Aikawa, Ph.D., Assistant Professor, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical

Modulating Glycerolipid Metabolism in Myeloid Cells for Cardiometabolic Benefit

Suneil K. Koliwad, M.D., Ph.D., Assistant Professor, Diabetes Center/Department of Medicine, University of California San Francisco

AMPK as a Target in Lipid and Carbohydrate Metabolism

Ajit Srivastava, Ph.D., Adjunct Professor, Pharmacology, Drexel University; Independent Consultant, Integrated Pharma Solutions, LLC

 http://www.discoveryontarget.com/Cardio-Drug-Targets

Inaugural n September 25 – 26, 2013

Cardio-Metabolic Drug Targets

Targeting One, Treating More

»»Suggested Event Package

September 23: Allosteric Modulators of GPCRs Short Course 4

September 24-25: Novel Strategies for Kinase Inhibitors

Conference

September 25: Setting Up Effective Functional Screens Using 3D

Cell Cultures Dinner Short Course 9

September 25-26: Cardio-Metabolic Drug Targets Conference

Wednesday, September 25

11:50 am Registration

BEYOND STATINS: NEW APPRO ACHES FOR

REGULATING LIPID METABOLISM AND

ATHERO SCLERO SIS

1:30 pm Chairperson’s Opening Remarks

1:40 PLENARY KEYNOTE PRESENTATION: Towards a Patient-

Based Drug Discovery

Stuart L. Schreiber, Ph.D., Director, Chemical Biology and Founding Member, Broad

Institute of Harvard and MIT; Howard Hughes Medical Institute Investigator; Morris

Loeb Professor of Chemistry and Chemical Biology, Harvard University

3:10 Refreshment Break in the Exhibit Hall with Poster Viewing

4:00 FEATURED SPEAKER: Atherosclerosis and Cardio-

Metabolism Research Overview: Promising Targets

Margrit Schwarz, Ph.D., MBA, formerly Director of Research, Dyslipidemia and

Atherosclerosis, Amgen; currently President, MS Consulting, LLC

4:30 Sponsored Presentations (Opportunities Available)

5:00 Novel Treatment for Dyslipidemia: Liver-Directed Thyroid

Hormone Receptor-ß Agonist

Rebecca Taub, M.D., Ph.D., CEO, Madrigal Pharmaceuticals

5:30 Modulating Glycerolipid Metabolism in Myeloid Cells for

Cardiometabolic Benefit

Suneil K. Koliwad, MD., Ph.D. Assistant Professor, Diabetes Center/Department

of Medicine, University of California San Francisco (UCSF)

6:00 Targeting PCSK9 for Hypercholesterolemia and

Atherosclerosis

Hong Liang, Ph.D., Associate Research Fellow, Rinat Research Unit, Pfizer

6:30 Close of Day

Thursday, September 26

7:30 am Registration

NEW ARTHERO /LIPID/CARDIO-METABOLIC

DRUG TARGETS

8:00 Breakfast Interactive Breakout Discussion Groups

9:05 Chairperson’s Opening Remarks

9:10 ApoE derived ABCA1 agonists for the Treatment of

Cardiovascular Disease

Jan Johansson, M.D., Ph.D., CEO, Artery Therapeutics, Inc.

9:40 Blockade of Delta-Like Ligand 4 (Dll4)-Notch Signaling

Reduces Macrophage Activation and Attenuates Atherosclerotic

Vascular Diseases and Metabolic Disorders

Masanori Aikawa, Ph.D., Assistant Professor, Department of Medicine,

Brigham and Women’s Hospital and Harvard Medical

10:10 Coffee Break in the Exhibit Hall with Poster Viewing

10:55 AMPK as a Target in Lipid and Carbohydrate Metabolism

Ajit Srivastava, Ph.D., Adjunct Professor, Department of Pharmacology, Drexel

University; Independent Consultant, Integrated Pharma Solutions, LLC

11:25 Macrophage ABC Transporters: Novel Targets to Promote

Atherosclerotic Plaque Regression by Inducing Reverse

Cholesterol Transport (RCT) Mechanism

Eralp “Al” Bellibas, M.D., Senior Director, Head, Clinical Pharmacology, The

Medicines Company

11:55 Targeting Ubiquitin Signaling Mediated Disease Pathology

of LDL Receptors

Udo Maier, Ph.D., Head of Target Discovery Research, Boehringer Ingelheim

Pharma

12:25 pm Sponsored Presentation (Opportunity Available)

12:55 Luncheon Presentation (Sponsorship Opportunity Available) or

Lunch on Your Own

Cardio-Metab olic Mimetics

2:25 Chairperson’s Opening Remarks

2:30 Oral Mimetics of RYGB and GLP-1 in Metabolic Syndromes

Jerome J. Schentag, PharmD, Professor of Pharmaceutical Sciences, University

at Buffalo

3:00 FGF21-Mimetic Antibodies for Type 2 Diabetes

Jun Sonoda, Ph.D., Group Leader, Scientist, Molecular Biology, Genentech

3:30 Ice Cream Refreshment Break in the Exhibit Hall with Poster

Viewing

gpCrS IN METABOLIC DISEASES

4:00 Targeting the Ghrelin Receptor with an Oral, Macrocyclic

Agonist

Helmut Thomas, Ph.D., Senior Vice President, Research and Preclinical

Development, Tranzyme Pharma

4:30 Presentation to be Announced

5:00 Lactate Receptor, GPR81/HCA1, as a Novel Target for

Metabolic Disorders

Changlu Liu, Ph.D., Scientific Director, Janssen Fellow, Head of Molecular

Innovation, Neuroscience, Janssen Research & Development, LLC

5:30 Targeting GPR55 in Cancer and Diabetes

Marco Falasca, Ph.D., Professor of Molecular Pharmacology, Queen Mary

University of London

6:00 Close of Conference

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