Drug Discoveries & Therapeutics Vol. 11(2017) No. 3

A series of novel sulfonyl phosphonic 1,4-dithia-7-azaspiro[4,4]nonane derivatives were designed, synthesized, and assayed for their activity against matrix metalloproteinase-2 (MMP-2). Results indicated that all of the compounds exhibited moderate inhibitory activity against MMP-2 compared to LY52 (the control) (IC50 = 0.95 ± 0.09 µM). Several selected compounds were also examined for their antiproliferative activity against SKOV3, HL60, and A549 cells. Notably, all of the tested compounds had slightly lower antiproliferative activity against SKOV3 cells than that of LY52. Compound 6d displayed the greatest inhibitory activity in an enzymatic assay and a cell-based assay, which means that this compound is a good candidate for further development of phosphonate-based MMP inhibitors.

We assessed the validity of using a sheet-shaped body vibrometer (SBV) as a portable monitoring device for obstructive sleep apnea (OSA) screening. Seventy consecutive patients with suspected OSA underwent simultaneous in-laboratory polysomnography (PSG) and SBV. We evaluated the screening accuracy of the respiratory event index (REI) obtained with the SBV, using the REI based on either the estimated total sleep time (REI_eTST) or time in bed (REI_TIB); these were compared to the apnea-hypopnea index (AHI) obtained via PSG. Bland-Altman plots indicated that the mean difference between REI_eTST and AHI was lower than that between REI_TIB and AHI (1.2 ± 19.8 vs. 6.5 ± 16.8). For AHI ≥ 15, the sensitivity and specificity at an optimal REI_eTST of 17.0 were 90.9% and 76.9%, whereas those at an optimal REI_TIB of 15.9 were 86.4% and 80.8%, respectively; moreover, for AHI ≥ 30, these values at an optimal REI_eTST of 26.0 were 89.5% and 88.2%, whereas those at an optimal REI_TIB of 23.8 were 84.2% and 92.2%, respectively. The optimal cutoff values of REIs for AHI of ≥ 5 were markedly different from those for AHI obtained via PSG (REI_eTST, 14.9; REI_TIB, 15.0), but close to those for AHI of ≥ 15; both had good sensitivities and specificities. REIs obtained via SBV performed well in moderate-to-severe, but not mild, OSA screening; REI_eTST showed a slightly higher sensitivity and a relatively closer value to the AHI obtained via PSG when compared to REI_TIB. We consider the SBV less acceptable for screening mild cases than more severe cases.

Tolvaptan (TLV) is an oral selective vasopressin type 2 receptor antagonist. Long-term use of TLV is not recommended in patients with heart failure (HF) if fluid retention disappears and/or body weight is within the target range. However, some patients require long-term use of TLV. The current study investigated the efficacy and safety of long-term use of TLV. Subjects were 258 consecutive patients with HF who received TLV during hospitalization from January 2011 to March 2015. The rate of continuing administration of TLV was evaluated. Moreover, the one-year mortality rate and rate of re-hospitalization either with or without TLV were investigated. Results at discharge and one year later were compared for patients who continued to receive TLV one year after discharge. Oral concomitant medications, blood pressures, heart rate, blood tests, chest X-ray and transthoracic echocardiography were investigated. In-hospital and one-year mortality rates were 15.9% and 27.8%, respectively. Moreover, the mortality rate and/or rate of re-hospitalization within one year was 54.4%. The rate of re-hospitalization for HF was significantly higher in patients who continued to receive TLV after discharge compared to patients who ceased receiving TLV after discharge (p < 0.001). However, the subjects who continued to receive TLV for up to one year after discharge tended to have a longer duration until re-hospitalization for HF and significantly decreased brain natriuretic peptide levels (577.6 ± 528.5 pg/mL to 397.3 ± 365.8 pg/mL, p = 0.015). Long-term use of TLV might delay re-hospitalization for HF in patients with severe HF. Large-scale clinical studies are necessary to verify these results.

The aim of this study was to investigate the effect of N-acetyl glucosamine and proteoglycan-containing supplement (NGPS) on knee pain and locomotor functions in middle-aged and elderly persons with knee pain. An open trial was conducted on 19 subjects suffering from knee pain. The subjects, aged (55.6 ± 6.9) years, were given the NGPS tablets, which they must take 3 times per day, that contain 526.5 mg of N-acetyl glucosamine (GlcNAc) and 33.6 mg of proteoglycan for 12 weeks. Subjective pain was evaluated using the Visual Analog Scale (VAS), while the function of the knee with regard to daily operation was evaluated using the Japanese Knee Osteoarthritis Score (JKOM). Walking, stair-climbing and swelling were evaluated using the Japanese Orthopedic Association Score (JOA). These items were evaluated at a baseline, and after 4, 8, and 12 weeks of NGPS treatment. The VAS scores at 8 (p = 0.004) and 12 (p < 0.001) weeks were significantly lower than that at the baseline. The JKOM total score was significantly lower at 8 and 12 weeks (p = 0.001) than that at the baseline. The JOA score in the more painful side of the leg was significantly higher at 12 weeks (p = 0.002) than that at the baseline. The present study reveals that intake of NGPS is effective for relieving knee pain and improving knee function when walking or climbing stairs, swelling and bending or stretching.

A potential association between type 1 diabetes mellitus and subsequent epilepsy emerged in recent studies. This study aimed to evaluate the possible relationship between type 1 diabetes mellitus and epilepsy using meta-analysis. Pubmed, ISI Web of Knowledge, Embase and Cochrane Library were searched for potential studies of the association between type 1 diabetes mellitus and epilepsy from inception to February 1, 2017. Two investigators independently screened studies for inclusion and extracted related data; discrepancies were solved by consensus. Random effects model of Hazard Ratio (HR) was used to estimate the strength of association. We identified 13 papers from potentially relevant articles of which 3 cohort studies met the inclusion criteria. Random effects meta-analysis showed that type 1 diabetes mellitus was associated with an increased risk of epilepsy with HR = 3.29 (95% CI: 2.61-4.14; I² = 0, p = 0.689). Similar results were observed in type 1 diabetes mellitus patents younger than 18-years-old with HR = 2.96 (95% CI: 2.28-3.84; I² = 0, p = 0.571). Meta-analysis of 2 studies that adjusted for potential confounders yielded an increased risk of epilepsy with HR = 2.89 (95% CI: 2.26-3.70; I² = 0, p = 0.831). The meta-analysis indicates that type 1 diabetes mellitus is associated with a statistically significant increased risk for epilepsy compared to those without type 1 diabetes mellitus.

S-1, a 5-fluorouracil (5-FU)-based anti-cancer agent, is an important drug for treating metastatic extramammary Paget's disease (EMPD). Although intratumor expression levels of 5-FU metabolism enzymes have been studied widely in many solid tumors, no studies have examined on the expression levels of thymidylate synthase (TS), orotate phosphoribosyl-transferase (OPRT) or dihydropyrimidine dehydrogenase (DPD) in skin cancers. The aim of this study was to estimate the intratumoral mRNA expression levels of these genes in EMPD by real time PCR. Intratumoral DPD mRNA levels were decreased in EMPD compared to those in normal skin, but its intratumoral DPD mRNA expression levels were not correlated with clinical manifestations. Intratumoral DPD mRNA levels were positively correlated with OPRT mRNA levels in EMPD. Based on these results, low expression of intratumoral DPD mRNA in EMPD may contribute to the pathogenesis of this disease.

Insects produce antimicrobial molecules that contribute to their innate immune responses to eliminate invading microorganisms. To explore the potential utility of these antimicrobial molecules, we focused on larvae of the house fly Musca domestica, which is an efficient processor of organic waste and a good resource of protein and oil for animal feeding. The induction of hemagglutinating activity, which is usually accompanied by activation of innate immune responses in fly larvae, was observed in the hemolymph following needle injury. Hemolymph collected from injured larvae demonstrated potent antimicrobial activities against both Gram-positive and Gram-negative bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa. Furthermore, the antimicrobial activity was significantly retained in hemolymph after heat-treatments, suggesting that pasteurization of animal feed prepared from fly larvae would be a useful sterilization method. These observations indicate that injured Musca domestica larvae are a source of antimicrobial agents, and highlight the utility of preparing animal feed from these larvae.

Infantile hepatic hemangioendothelioma (IHHE) is the most common benign vascular liver tumor and typically occurs during the first 6 months of life. A 4-month-old male patient presented with abdominal distention. A physical examination revealed massive hepatomegaly. Liver enzyme levels were normal. The alpha fetoprotein level was 1,323 mg/dL (6-1,000). Abdominal magnetic resonance imaging (MRI) showed multiple, well-defined and hyperintense nodular lesions in the liver. MRI findings suggested IHHE. The thyroid stimulating hormone (TSH) level was high (177.2 µU/mL). He was started on sodium levothyroxine 50 μg daily. The patient has hypoxemia due to abdominal distention during the follow-up period. Oral methylprednisolone therapy was started at a dose of 2.5 mg/kg/dose, and propranolol at a dose of 1 mg/kg/dose, bid. Fifteen days later his TSH level remained elevated at 212.3 μU/mL despite repeatedly increasing the dose of levothyroxine up to 200 μg/daily. One month after the initial presentation, his TSH level was reduced to 11.28 µU/mL. We observed a marked improvement in abdominal distention and respiratory distress within 15 days and an average reduction of 50% in the lesion diameters after a month. Despite its benign nature, IHHE may lead to development of complications. Steroid and propranolol treatment may be useful in in the management of emergency complications.

Chryseobacterium indolegenes is a rare pathogen that causes a variety of infections in inviduals who are mostly hospitalized with severe underlying diseases. Here we present a case of C. indolegenes in a 69-year-old male with chronic obstructive pulonary disease (COPD) who was admitted to the chest disease outpatient clinic with symptoms like cough, fever and sputum production and followed up on a suspicion of pneumonia. Despite the fact that our patient did not have any history of hospitalization for at least one year, pneumonia cause was due to C. indolegenes. Clinicians should pay attention to the rare pathogens such as C. indologenes while managing COPD patients without prior hospitalization history.

Hepatocellular carcinoma (HCC) remains a severe health threat in China. Early tumor detection is crucial for improving the prognosis of patients. Currently, ultrasound plus biomarker alpha fetoprotein (AFP) is recommended by Chinese Liver Cancer Diagnosis and Treatment Guidelines in China. However, most HCC continues to be diagnosed beyond an early stage due to insufficient sensitivity and specificity of current surveillance tools, highlighting the need for more accurate biomarkers to improve early HCC detection. In Japan, ultrasound plus triple biomarkers AFP, Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and prothrombin induced by vitamin K absence II (PIVKA II) has been routinely used for HCC surveillance and achieved increased early HCC detection rate. Very recently, the assay of triple biomarkers AFP, AFP-L3, and PIVKA II using μTASWako i30 immuno-analyzer was brought into China. The prospect of the modality of ultrasound plus triple biomarkers for early HCC detection in China is expected in the future.