Safety and Mode of Action of Diabetes Medications in comparison with 5-Aminolevulinic Acid (5-ALA)

Application of in vitro bioassays to monitor pharmaceuticals in water: A synthesis of chronological analysis, mode of action, and practical insights

Pharmaceutical compounds in wastewater have emerged as a significant concern for the aquatic environment. The use of in vitro bioassays represents a sustainable and cost-effective approach for assessing the potential toxicological risks of these biologically active compounds in wastewater and aligns with ethical considerations in research. It facilitates high-throughput analysis, captures mixture effects, integrates impacts of both known and unknown chemicals, and reduces reliance on animal testing. The core aim of the current review was to explore the practical application of in vitro bioassays in evaluating the environmental impacts of pharmaceuticals in wastewater. This comprehensive review strives to achieve several key objectives. First, it provides a summary categorisation of pharmaceuticals based on their mode of action, providing a structured framework for understanding their ecological significance. Second, a chronological analysis of pharmaceutical research aims to document their prevalence and trends over time, shedding light on evolving environmental challenges. Third, the review critically analyses existing bioassay applications in wastewater, while also examining bioassay coverage of representative compounds within major pharmaceutical classes. Finally, it explores the potential for developing innovative bioassays tailored for water quality monitoring of pharmaceuticals, paving the way for more robust environmental monitoring and risk assessment. Overall, adopting effect-based methods for pharmaceutical monitoring in water holds significant promise. It encompasses a broad spectrum of biological impacts, promotes standardized protocols, and supports a bioassay test battery approach indicative of different endpoints, thereby enhancing the effectiveness of environmental risk assessment.

Anti-diabetic compounds from Uvaria dulcis Dunal

Medicinal plants have long been a source of lead compounds for drug discovery. Among these, the Annonaceae family has gained recognition for its potential to yield novel compounds, particularly those that can be used in the development of drugs targeting chronic diseases like diabetes mellitus (DM). We employed various chromatographic methods to isolate bioactive compounds from the roots, leaves, and twigs of Uvaria dulcis Dunal. We used spectroscopic methods to determine the chemical structures of these compounds. We successfully identified twelve known compounds from various parts of U. dulcis: patchoulenon, polygochalcone, 2'3'-dihydroxy-4',6'-dimethoxydihydrochalcone, 2',3'-dihydroxy-4',6'-dimethoxychalcone, chrysin, techochrysin, 8-hydroxy-5,7-dimethoxyflavanone, pinocembrin, 3-farnesylindole, onysilin, cinchonain la, and cinchonain lb. Interestingly, cinchonain la and cinchonain lb exhibited more potent anti-α-glucosidase activity than acarbose (standard drug), with IC50 values of 11.88 ± 1.41 μg/mL and 15.18 ± 1.19 μg/mL, respectively. Cinchonain la inhibited the DPP-IV enzyme, with IC50 value lower than the standard compound (diprotin A) at 81.78 ± 1.42 μg/mL. While 2',3'-dihydroxy-4',6'-dimethoxychalcone show more potent inhibitory effect than standard drug with IC50 value of 8.62 ± 1.19 μg/mL. Additionally, at a concentration of 10 μg/mL, cinchonain lb and 2',3'-dihydroxy-4',6'-dimethoxychalcone promoted glucose uptake in L6 myotubes cells to the same extent as 100 nM insulin. These findings suggest that cinchonain la, cinchonain lb, and 2',3'-dihydroxy-4',6'-dimethoxychalcone are the U. dulcis-derived bioactive compounds that hold promise as potential structures to use in the development of anti-diabetic drugs.

Safety and efficacy of 5-aminolevulinic acid phosphate/iron in mild-to-moderate coronavirus disease 2019: A randomized exploratory phase II trial

BACKGROUND

5-aminolevulinic acid (5-ALA), a natural amino acid that is marketed alongside sodium ferrous citrate (SFC) as a functional food, blocks severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proliferation in vitro and exerts anti-inflammatory effects. In this phase II open-label, prospective, parallel-group, randomized trial, we aimed to evaluate the safety and efficacy of 5-ALA in patients with mild-to-moderate coronavirus disease 2019.

METHODS

This trial was conducted in patients receiving 5-ALA/SFC (250/145 mg) orally thrice daily for 7 days, followed by 5-ALA/SFC (150/87 mg) orally thrice daily for 7 days. The primary endpoints were changes in SARS-CoV-2 viral load, clinical symptom scores, and 5-ALA/SFC safety (adverse events [AE] and changes in laboratory values and vital signs).

RESULTS

A total of 50 patients were enrolled from 8 institutions in Japan. The change in SARS-CoV-2 viral load from baseline was not significantly different between the 5-ALA/SFC (n = 24) and control (n = 26) groups. The duration to improvement was shorter in the 5-ALA/SFC group than in the control group, although the difference was not significant. The 5-ALA/SFC group exhibited faster improvement rates in "taste abnormality," "cough," "lethargy," and "no appetite" than the control group. Eight AEs were observed in the 5-ALA/SFC group, with 22.7% of patients experiencing gastrointestinal symptoms (decreased appetite, constipation, and vomiting). AEs occurred with 750/435 mg/day in 25.0% of patients in the first phase and with 450/261 mg/day of 5-ALA/SFC in 6.3% of patients in the second phase.

CONCLUSION

5-ALA/SFC improved some symptoms but did not influence the SARS-CoV-2 viral load or clinical symptom scores over 14 days. The safety of 5-ALA/SFC in this study was acceptable. Further evaluation using a larger sample size or modified method is warranted.

Amphibian Skin and Skin Secretion: An Exotic Source of Bioactive Peptides and Its Application

Amphibians have been consumed as an alternative protein source all around the world due to their delicacy. The skin of edible amphibians, particularly frogs and giant salamanders, always goes to waste without further utilization. However, these wastes can be utilized to extract protein and bioactive peptides (BPs). Various BPs have been extracted and reported for numerous biological activities such as antioxidant, antimicrobial, anticancer, antidiabetic, etc. The main BPs identified were brevinins, bombesins, dermaseptins, esculentins, magainin, temporins, tigerinins, and salamandrins. This review provides a comprehensive discussion on various BPs isolated and identified from different amphibian skins or skin secretion and their biological activities. The general nutritional composition and production statues of amphibians were described. Additionally, multiple constraints against the utilization of amphibian skin and secretions are reported. Finally, the prospective applications of BPs in food and biomedical industries are presented such as multifunctional food additives and/or supplements as well as drug delivery agents.

Pilot Trial on the Effect of 5-Aminolevulinic Acid on Glucose Tolerance in Patients with Maternally Inherited Diabetes and Deafness

INTRODUCTION

The amino acid 5-aminolevulinic acid (5-ALA) is the first heme biosynthetic precursor. The combination of 5-ALA with sodium ferrous citrate (SFC) enhances heme production, leading to increased adenosine triphosphate (ATP) production in mitochondria. We investigated whether administering 5-ALA/SFC improves glucose tolerance with an increase in insulin secretion in patients with maternally inherited diabetes and deafness (MIDD), which is characterized by an insulin secretory disorder due to impaired mitochondrial ATP production.

METHODS

This was a single-arm, open-label, interventional study. We prospectively administered the oral glucose tolerance test (OGTT) twice in five patients with MIDD who had received intensive insulin therapy: before and 24 weeks after an administration of 5-ALA/SFC (200/232 mg per day). We measured the concentrations of glucose, insulin, C-peptide, and proinsulin at fasting, and 30, 60, and 120 min after glucose load in each OGTT. The primary endpoint was the changes in the area under the curve (AUC) of serum insulin from 0 to 120 min during OGTT from baseline to 24 weeks.

RESULTS

The serum insulin AUC (µU/mL) during the 120-min OGTT tended to increase from baseline to 24 weeks but not significantly (17.1 ± 13.7 versus 22.3 ± 13.4, p = 0.077). The plasma glucose AUC (mg/dL) during the 120-min OGTT at 24 weeks was not significantly decreased; the late phase of glucose excursion from 60 to 120 min was significantly decreased compared with baseline (357 ± 42 versus 391 ± 50, p = 0.041). The mean level of glycated hemoglobin (HbA1c) decreased from 8.3 ± 1.2% at baseline to 7.9 ± 0.3% at 24 weeks (p = 0.36) without increasing the daily dose of insulin injections.

CONCLUSION

The 24-week administration of 5-ALA/SFC did not demonstrate a significant improvement in insulin secretion in patients with MIDD. Further investigations with a larger number of patients and a placebo control group are required to clarify the potential efficacy of 5-ALA/SFC for ameliorating mitochondrial dysfunctions in MIDD.

TRIAL REGISTRATION

UMIN-CTR000040581 and jRCT071200025.

Advances in the intraoperative delineation of malignant glioma margin

Surgery plays a critical role in the treatment of malignant glioma. However, due to the infiltrative growth and brain shift, it is difficult for neurosurgeons to distinguish malignant glioma margins with the naked eye and with preoperative examinations. Therefore, several technologies were developed to determine precise tumor margins intraoperatively. Here, we introduced four intraoperative technologies to delineate malignant glioma margin, namely, magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry. By tracing their detecting principles and developments, we reviewed their advantages and disadvantages respectively and imagined future trends.

Flavonoids and Phenols, the Potential Anti-Diabetic Compounds from Bauhinia strychnifolia Craib. Stem

Bioactive compounds from medicinal plants are good alternative treatments for T2DM. They are also sources of lead molecules that could lead to new drug discoveries. In this study, Bauhinia strychnifolia Craib. stem, a traditional Thai medicinal plant for detoxification, was extracted into five fractions, including crude extract, BsH, BsD, BsE, and BsW, by ethanolic maceration and sequential partition with hexane, dichloromethane, ethyl acetate, and water, respectively. Among these fractions, BsE contained the highest amounts of phenolics (620.67 mg GAE/g extract) and flavonoids (131.35 mg QE/g extract). BsE exhibited the maximum inhibitory activity against α-glucosidase (IC₅₀ 1.51 ± 0.01 µg/mL) and DPP-IV (IC₅₀ 2.62 ± 0.03 µg/mL), as well as dominantly promoting glucose uptake on 3T3-L1 adipocytes. Furthermore, the four compounds isolated from the BsE fraction, namely resveratrol, epicatechin, quercetin, and gallic acid, were identified. Quercetin demonstrated the highest inhibitory capacity against α-glucosidase (IC₅₀ 6.26 ± 0.36 µM) and DPP-IV (IC₅₀ 8.25 µM). In addition, quercetin prominently enhanced the glucose uptake stimulation effect on 3T3-L1 adipocytes. Altogether, we concluded that quercetin was probably the principal bioactive compound of the B. strychnifolia stem for anti-diabetic, and the flavonoid-rich fraction may be sufficiently potent to be an alternative treatment for blood sugar control.

Oakmoss Exhibits Antihyperglycemic Activity in Streptozotocin-Induced Diabetic Rats

AIMS

The study aimed to assess the antidiabetic effect of Oakmoss.

BACKGROUND

Lichens species are dual organisms consisting of a mycobiont (Fungi) and a photoautotrophic partner (Algae). They are widely used in traditional medicine as a treatment against diabetes.

OBJECTIVE

This study was designed to assess the antihyperglycemic activity as well as the antihyperlipidemic capacity of Oakmoss (Evernia prunastri (L.)) in normal and streptozotocin(STZ)-induced diabetic rats.

METHODS

This study has evaluated the effects of aqueous extract of Oakmoss at a dose of 60 mg/kg on blood glucose levels and lipid profile in normal and STZ-induced diabetic rats. Histopathological examination of liver, determination of glycogen content in liver and skeletal muscles (EDL and soleus), antioxidant activity, and phytochemical investigation were also performed.

RESULTS

Both single and repeated oral doses of Oakmoss (60 mg/kg) produced a significant reduction of blood glucose, triglycerides and very low-density lipoprotein (VLDL) levels in diabetic rats. Furthermore, repeated oral administration of Oakmoss during 7 days ameliorated the liver function by increasing its glycogen content and improving its histological architecture in treated diabetic rats. In addition, the aqueous extract of Oakmoss exhibited an antioxidant activity and showed richness in certain phytochemicals especially in phenolic acids and flavonoids.

CONCLUSION

Oakmoss, a lichen species, exhibits a potential effect on improving hyperglycemia and hypertriglyceridemia in diabetic rats.

Antiviral activity of 5-aminolevulinic acid against variants of severe acute respiratory syndrome coronavirus 2

BACKGROUND

Genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to emerge in 2020 and have been spreading globally during the coronavirus disease 2019 (COVID-19) pandemic. Despite the presence of different COVID-19 vaccines, the discovery of effective antiviral therapeutics for the treatment of patients infected with SARS-CoV-2 are still urgently needed. A natural amino acid, 5-aminolevulinic acid (5-ALA), has exhibited both antiviral and anti-inflammatory activities. In a previous study, we demonstrated an in vitro antiviral effect of 5-ALA against SARS-CoV-2 infection without significant cytotoxicity. In the present study, we sought to investigate whether 5-ALA with or without sodium ferrous citrate (SFC) can inhibit in vitro both the original SARS-CoV-2 Wuhan strain and its variants, including the Alpha, Beta, Gamma and Delta strains.

METHODS

The antiviral activity of ALA with or without SFC was determined in Vero-E6 cell. The virus inhibition was quantified by real time RT-PCR.

RESULTS

Co-administration of 5-ALA and SFC inhibited the Wuhan, Alpha and Delta variants of SARS-CoV-2 with IC50 values of 235, 173 and 397 µM, respectively, and the Beta and Gamma variants with IC50 values of 1311 and 1516 µM.

CONCLUSION

Our study suggests that 5-ALA with SFC warrants accelerated clinical evaluation as an antiviral drug candidate for treating patients infected with SARS-CoV-2 variants.

Antihyperglycemic Activity of Aqueous Extract of Euphorbia guyoniana in Streptozotocin-Induced Diabetic Rats

AIMS

This work assessed the antihyperglycemic effect of Euphorbia guyoniana.

BACKGROUND

Euphorbia guyoniana (Boss. and Reut.) is widely used in traditional medicine.

OBJECTIVE

This study was designed to confirm this traditional use by assessing its antihyperglycemic capacity in vivo.

METHODS

The effect of the aqueous extract of Euphorbia guyoniana (Boss. and Reut.) (60 mg/kg) on glycemia in both normal and diabetic rats was evaluated. The glycogen content in the liver and skeletal muscles (extensor digitorum longus and soleus) was measured. Furthermore, liver histopathological analysis was performed.

RESULTS

The findings showed that Euphorbia guyoniana (Boss. and Reut.) exhibited a significant decrease in glycaemia in diabetic rats (from 20±2 mmol/l to 5.5 mmol/l after 6 hours of oral administration; p<0.0001 and from 20±2 mmol/l to 4.5 mmol/l after 7 days of once-daily repeated oral administration of the aqueous Euphorbia guyoniana extract; p<0.0001). In addition, the extract increased the glycogen content in the liver (41±4 mg/g versus 70±5 mg/g in normal and diabetic rats respectively) and extensor digitorum longus (39±4 mg/g versus 60±1 mg/g in normal and diabetic rats, respectively), and partially restored corporal weight in diabetic rats. Furthermore, this aqueous extract has been shown to suppress hyperglycemia induced by glucose load in treated diabetic rats. Additionally, hepatic histology in diabetic rats has been improved. This plant revealed the presence of several phytochemical constituents and possessed antioxidant activity.

CONCLUSION

The current study evidenced that Euphorbia guyoniana (Boss. and Reut.) has a beneficial effect on improving hyperglycemia and glycogen depletion in the diabetic state.

Effects of vancomycin-induced gut microbiome alteration on the pharmacodynamics of metformin in healthy male subjects

Metformin is a major treatment for type 2 diabetes. This study was conducted to investigate the impact of gut microbiome dysbiosis on the pharmacokinetics and antihyperglycemic effects of metformin. Healthy adult males aged 19-45 years with no defecation abnormalities were recruited for this 4-period clinical study: baseline; post-metformin (i.e., multiple oral doses of 1000 mg metformin on days 1-4); post-vancomycin (i.e., multiple oral doses of 500 mg vancomycin on days 11-17 inducing gut microbiome changes); and post-metformin + vancomycin (i.e., multiple oral doses of 1000 mg metformin on days 16-19). In each period, serum glucose and insulin concentrations following an oral glucose tolerance test, fecal samples for gut microbiome composition, and safety data were obtained. Following metformin dosing, plasma and urine samples for pharmacokinetics were collected. Nine subjects completed the study. The pharmacokinetics of metformin remained unchanged, and the antihyperglycemic effect was significantly decreased after vancomycin administration (p value = 0.039), demonstrating the weak relationship between the pharmacokinetics and pharmacodynamics of metformin. Relative abundances of some genus were changed after vancomycin administration, and tended to correlate with the antihyperglycemic effects of metformin (p value = 0.062 for Erysipelatoclostridium; p value = 0.039 for Enterobacter; and p value = 0.086 for Faecalibacterium). Adverse events occurred in all subjects and were resolved without sequelae. In conclusion, a decrease in the antihyperglycemic effect of metformin was observed after concomitant administration with vancomycin, without changes in metformin pharmacokinetics. The antihyperglycemic effect was tended to correlate with the relative abundance of several genus, suggesting that the effect of metformin is partly attributable to the gut microbiome (ClinicalTrials.gov, NCT03809260).

Launaea acanthodes (Boiss) O. Kuntze mediates hepatic glucose metabolism and ameliorates impaired pancreatic function in streptozotocin-induced diabetic rats

ETHNOPHARMACOLOGICAL RELEVANCE

Launaea acanthodes (Boiss.) O. Kuntze is native to semiarid regions of central Iran, traditionally used in the treatment of numerous disorders including diabetes.

AIM OF THE STUDY

The current study aimed to explore hypoglycemic activity of Launaea acanthodes extract in streptozotocin-induced diabetic rats. Furthermore, gene expression study was carried out to examine expression levels of key glucose metabolism-related genes.

METHODS

For in vitro study, Folin-Ciocalteus, DPPH and aluminum chloride colorimetric assays were used to determine the total phenolic content, antioxidant capacity and total flavonoid content of extracts, respectively. For in vivo study, streptozotocin-induced diabetic Wistar rats were orally administered with metformin (50 mg/kg) and various doses of extracts (100, 200 and 400 mg/kg body weight) for 28 days. Fasting blood glucose, body weight, food and water intake were assessed during the course of treatment. At the end of the intervention, oral glucose tolerance test (OGTT), lipid profile and glycated hemoglobin (HbA1c) were evaluated. Furthermore, functional liver enzymes, oxidative stress markers and histopathology of pancreas were examined. Lastly, quantitative real time polymerase chain reaction (qRT-PCR) was applied to explore the mRNA levels of genes relevant to glucose metabolism in the pancreas and liver tissues of diabetic rats.

RESULTS

Based on the in vitro results, the hydroalcoholic extract revealed potential radical scavenging activity and contained highest amount of phenolic and flavonoid. The in vivo results demonstrated that the extract lowered fasting blood glucose level, increased the body weight, restored the alterations in the levels of water and food intake, attenuated HbA1c, improved lipid profile and ameliorated the OGTT in diabetic rats. The extract administration alleviated the histopathological changes in the pancreas, suppressed malondialdehyde (MDA) level and further restored attenuated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutathione peroxidase (GPx) and superoxide dismutase (SOD) in diabetic rats. Analysis of real time PCR data showed that extract administration reversed the expression levels of hepatic glucokinase (GK), phosphenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase). Meanwhile, the extract upregulated the expression level of glucose transporter-2 (GLUT-2) and pancreatic-duodenal homeobox (PDX-1) in diabetic rats.

CONCLUSION

Collectively, the results demonstrate that Launaea acanthodes hydroalcoholic extract exerts hypoglycemic effect possibly via regulating key enzymes of glucose metabolism and ameliorating pancreatic dysfunction through its antioxidant properties.

Pathological and Pharmacological Roles of Mitochondrial Reactive Oxygen Species in Malignant Neoplasms: Therapies Involving Chemical Compounds, Natural Products, and Photosensitizers

Oxidative stress plays an important role in cellular processes. Consequently, oxidative stress also affects etiology, progression, and response to therapeutics in various pathological conditions including malignant tumors. Oxidative stress and associated outcomes are often brought about by excessive generation of reactive oxygen species (ROS). Accumulation of ROS occurs due to dysregulation of homeostasis in an otherwise strictly controlled physiological condition. In fact, intracellular ROS levels are closely associated with the pathological status and outcome of numerous diseases. Notably, mitochondria are recognized as the critical regulator and primary source of ROS. Damage to mitochondria increases mitochondrial ROS (mROS) production, which leads to an increased level of total intracellular ROS. However, intracellular ROS level may not always reflect mROS levels, as ROS is not only produced by mitochondria but also by other organelles such as endoplasmic reticulum and peroxisomes. Thus, an evaluation of mROS would help us to recognize the biological and pathological characteristics and predictive markers of malignant tumors and develop efficient treatment strategies. In this review, we describe the pathological significance of mROS in malignant neoplasms. In particular, we show the association of mROS-related signaling in the molecular mechanisms of chemically synthesized and natural chemotherapeutic agents and photodynamic therapy.

In Vitro Determination of Antimicrobial and Hypoglycemic Activities of Mikania cordata (Asteraceae) Leaf Extracts

Infectious diseases and diabetes mellitus are counted responsible for a substantial amount of mortality among the human population. The current study was performed to detect the antimicrobial activities and hypoglycemic potential of Mikania cordata (Asteraceae) leaves extracted into aqueous media and several organic solvents (ethyl acetate and methanol). The ethyl acetate extract of Mikania cordata (MEA) leaves was observed to possess significantly ( $p\le 0.05$ ) greater antimicrobial capabilities (susceptible against Bacillus cereus ATCC 11778 and Staphylococcus aureus ATCC 25923) when compared with that of the methanol (MME) and aqueous extracts (MDW) which were assessed based on Kirby-Bauer disk diffusion assay. The minimum inhibitory concentration of MEA (against B. cereus, S. aureus, and Escherichia coli ATCC 25922) and MME (against B. cereus, S. aureus, E. coli, and Candida albicans ATCC 10231) lies in a similar range of 1.13 > MIC>0.56 mg/ml. In the present study, a single compound (from MEA) of Rf value 0.64 was isolated by thin-layer chromatography (TLC) that was responsible for the zone of inhibition against B. cereus (20.3 ± 0.3 mm). The results of this study also depicted the antihyperglycemic properties of M. cordata leaves which followed the same trend as the commercial drug Metformin in a glucose concentration-independent manner when tested in a glucose uptake assay by yeast cells. Therefore, it is evident that Mikania cordata is a reservoir of useful bioactive compounds which with further research will be paving the path for drug commercialization. This is the first record of TLC-based isolation of antimicrobial compounds of M. cordata and analysis of the hypoglycemic properties of M. cordata leaves.

Synergistic Fabrication of Dose-Response Chitosan/Dextran/β-Glycerophosphate Injectable Hydrogel as Cell Delivery Carrier for Cardiac Healing After Acute Myocardial Infarction

The human mesenchymal stem cells (hMSCs) therapy offering an encouraging the new methods to establish the conveying on the chitosan (C)/dextran (D)/β-glycerophosphate (β-GP) loaded with hMSCs to enhance the acute myocardial infarctions. The synthesized hMSCs-CD@β-GP system displayed the ratio of determination modules, size of the pore, absorbency, and the swellings ratio in the assortment of the 65 ka, 149 ± 39.8 µm, 92.2%, 42 ± 1.38, and 29 ± 1.9, respectively. The fabricated hMSCs-CD@β-GP was highly stable and physicochemical investigated and confirmed the suitability of the materials for cardiac regeneration applications. The in vitro examinations of the injectable hydrogels with hMSCs-CD@β-GP have recognized that the improved survival rate of the cells, increased the pro-inflammatory expressions factors, pro-angiogenic factors analysis confirmed the promising results of the ejection of fractions, fibrosis area, vessel density with decreased infractions size, with suggesting that the remarkable improvement of the heart regenerative function after myocardial infarctions. The new synergistic approach of the injectable hydrogels with hMSCs could able appropriate for the effective treatment of cardiac therapies after acute myocardial infarctions.