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Banjan B, Krishnan D, Koshy AJ, Soman S, Leelamma A, Raju R, Revikumar A. In-silico screening and identification of potential drug-like compounds for dengue-associated thrombocytopenia from Carica papaya leaf extracts. J Biomol Struct Dyn 2024; 42:5963-5981. [PMID: 37394810 DOI: 10.1080/07391102.2023.2230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
Dengue virus is a mosquito-borne pathogen that causes a variety of illnesses ranging from mild fever to severe and fatal dengue haemorrhagic fever or dengue shock syndrome. One of the major clinical manifestations of severe dengue infection is thrombocytopenia. The dengue non-structural protein 1 (NS1) is the primary protein that stimulates immune cells via toll-like receptor 4 (TLR4), induces platelets, and promotes aggregation, which could result in thrombocytopenia. The leaf extracts of Carica papaya seem to have therapeutic benefits in managing thrombocytopenia associated with dengue. The present study focuses on understanding the underlying mechanism of the use of papaya leaf extracts in treating thrombocytopenia. We have identified 124 phytocompounds that are present in the papaya leaf extract. The pharmacokinetics, molecular docking, binding free energy calculations, and molecular dynamic simulations were performed to investigate the drug-like properties, binding affinities, and interaction of phytocompounds with NS1 protein as well as the interactions of NS1 with TLR4. Three phytocompounds were found to bind with the ASN130, a crucial amino acid residue in the active site of the NS1 protein. Thus, we conclude that Rutin, Myricetin 3-rhamnoside, or Kaempferol 3-(2''-rhamnosylrutinoside) may serve as promising molecules by ameliorating thrombocytopenia in dengue-infected patients by interfering the interaction of NS1 with TLR4. These molecules can serve as drugs in the management of dengue-associated thrombocytopenia after verifying their effectiveness and assessing the drug potency, through additional in-vitro assays.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Bhavya Banjan
- Centre for Integrative Omics Data Science, Yenepoya (Deemed to be University), Mangalore, India
| | - Deepak Krishnan
- Centre for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to Be University), Mangalore, India
| | - Abel John Koshy
- Centre for Integrative Omics Data Science, Yenepoya (Deemed to be University), Mangalore, India
| | - Sowmya Soman
- Centre for Integrative Omics Data Science, Yenepoya (Deemed to be University), Mangalore, India
| | - Anila Leelamma
- Department of Biochemistry, NSS College, Nilamel, Kollam, Kerala, India
| | - Rajesh Raju
- Centre for Integrative Omics Data Science, Yenepoya (Deemed to be University), Mangalore, India
| | - Amjesh Revikumar
- Centre for Integrative Omics Data Science, Yenepoya (Deemed to be University), Mangalore, India
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Tan SM, AbouAssi R, Dianita R, Murugaiyah V, SiokYee C. An Insight into Viscosity and Conductivity in the Formulation of Co-axial Electrospun Carica papaya Leaf Extract. Drug Dev Ind Pharm 2024:1-21. [PMID: 38530403 DOI: 10.1080/03639045.2024.2335527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Objective: This research aimed to investigate the application of the coaxial electrospun method for the production of natural extracts (papaya leaf extract) fibre films. This was achieved through utilising different polymers and with a focus on the conductivity and the viscosity of polymer solutions as critical parameters to generate successful fibres. Significance: Electrospinning is a promising trending manufacturing method for incorporating thermolabile herbal extracts using coaxial electrospun features. However, the complexity of the electrospinning process and the feasibility of the product required precise scrutiny. Methods: The electrospinning solution parameters (conductivity and viscosity) were evaluated by employing various ratios of Eudragit L100 (EL100) and Eudragit L100-55 (EL100-55) pre-spinning polymeric blend solutions. The electrospinning process and ambient parameters were optimised. Following that, the in-silico physicochemical properties of phytochemical marker, rutin, were illustrated using SwissADME web tool. Both freeze-dried Carica papaya leaf extract and its produced films were characterised using Scanning Electron Microscopy (SEM), Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR), polarised light microscopy, and X-Ray Powder Diffraction (XRPD). Results: The optimal values of conductivity (≈40-44 × 10-4 S/m) and viscosity (≈32-42 × 10-3 Pa·s) were determined for producing evenly distributed and small fibre diameters in SEM images. These parameters significance was highlighted in acquiring and maintaining adequate tangential stress for fibre elongation, which would consequently affect the morphology and diameter of the fibres formed. Conclusion: In conclusion, the solution, process, and ambient parameters are significant in developing natural extracts into films via electrospinning technology, and this includes the promising Carica papaya leaf extract films produced by coaxial electrospinning.
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Affiliation(s)
- Siew Mei Tan
- Thoughts Formulation Lab, Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Reem AbouAssi
- Thoughts Formulation Lab, Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- EDEN Research Group, Discipline of Pharmaceutical Technology, College of Pharmacy, Al-Kitab University, Altun Kupri, Kirkuk, 36001, Iraq
| | - Roza Dianita
- Discipline of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Vikneswaran Murugaiyah
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Chan SiokYee
- Thoughts Formulation Lab, Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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Patil P, Alagarasu K, Chowdhury D, Kakade M, Cherian S, Kaushik S, Yadav J, Kaushik S, Parashar D. In-vitro antiviral activity of Carica papaya formulations against dengue virus type 2 and chikungunya viruses. Heliyon 2022; 8:e11879. [PMCID: PMC9723942 DOI: 10.1016/j.heliyon.2022.e11879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/12/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022] Open
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Carica papaya L. Leaves: Deciphering Its Antioxidant Bioactives, Biological Activities, Innovative Products, and Safety Aspects. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2451733. [PMID: 35720184 PMCID: PMC9203216 DOI: 10.1155/2022/2451733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 01/02/2023]
Abstract
The prevalence of viral infections, cancer, and diabetes is increasing at an alarming rate around the world, and these diseases are now considered to be the most serious risks to human well-being in the modern period. There is a widespread practice in Asian countries of using papaya leaves (C. papaya L.) as herbal medicine, either alone or in combination with prescribed medications, to treat a variety of ailments. The importance of conducting the necessary descriptive studies in order to determine the safety of papaya leaf consumption is also emphasized in the context of their application in the healthcare sector. Electronic databases such as Google Scholar, Scopus, and PubMed were used to gather information on papaya leaves, their therapeutic potential, and clinical evidence-based studies. The literature was gathered from publications on papaya leaves, their therapeutic potential, and clinical evidence-based studies. The antidengue, anticancer, antidiabetic, neuroprotective, and anti-inflammatory effects of papaya leaves discussed in this article are supported by evidence from preclinical, in vivo, in vitro, and clinical trial studies, as well as from other sources. Leaves have been investigated for their mechanism of action as well as their potential to be used in the development of novel herbal products for the health business. According to the reports gathered, only a small number of research demonstrated that leaf extract at high concentrations was hazardous to certain organs. The collective literature reviewed in this review provides insights into the use of papaya leaves as a cure for epidemic diseases, highlighting the phytochemical composition and pharmacological attributes of papaya leaves, as well as the results of various preclinical and clinical studies that have been conducted so far on the subject. The review clearly demonstrates the successful medical evidence for the use of papaya leaf extracts in the healthcare system as a supplemental herbal medication in a variety of clinical settings.
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Delving into the Therapeutic Potential of Carica papaya Leaf against Thrombocytopenia. Molecules 2022; 27:molecules27092760. [PMID: 35566112 PMCID: PMC9104069 DOI: 10.3390/molecules27092760] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
Thrombocytopenia is a clinical manifestation that refers to the low platelet count, i.e., <150 × 103/μL, of blood, resulting in imbalanced hemostasis, which leads to several fatal complications. The causative factors vary greatly, but, as a consequence, they interfere with platelet production and promote destruction, leading to death. Carica papaya leaf has unique therapeutic and medicinal characteristics against thrombocytopenia, and this is supported by scientific studies. Secondary metabolites and minerals in the leaf, such as carpaine and quercetin, promote platelet production, inhibit platelet destruction, and maintain platelet membrane through gene expression activity and the ceasing of viral proteases, respectively. This review explores the scientific studies that support the role of papaya leaf in the form of juice, extract, or powder against thrombocytopenia through animal modeling and clinical trials. Phytochemical profiles of C. papaya leaf revealed the presence of flavonoids, alkaloids, phenols, cardiac glycosides, tannins, terpenes, and saponins, which impart therapeutic potential to the leaf. The therapeutic benefits of the leaf include immunomodulatory, antiviral, antidiabetic, anticancer, antimalarial, antiangiogenic, antibacterial, and antioxidant activities. Several conducted scientific research studies have proved the efficacy of C. papaya leaf against thrombocytopenia, expanding the implication of natural sources to eradicate numerous ailments.
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Carica papaya Leaf Juice for Dengue: A Scoping Review. Nutrients 2022; 14:nu14081584. [PMID: 35458146 PMCID: PMC9030784 DOI: 10.3390/nu14081584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
The potential therapeutic effect of Carica papaya leaf juice has attracted wide interest from the public and scientists in relieving dengue related manifestations. Currently, there is a lack of evaluated evidence on its juice form. Therefore, this scoping review aims to critically appraise the available scientific evidence related to the efficacy of C. papaya leaf juice in dengue. A systematic search was performed using predetermined keywords on two electronic databases (PubMed and Google Scholar). Searched results were identified, screened and appraised to establish the association between C. papaya and alleviating dengue associated conditions. A total of 28 articles (ethnobotanical information: three, in vitro studies: three, ex vivo studies: one, in vivo study: 13, clinical studies: 10) were included for descriptive analysis, which covered study characteristics, juice preparation/formulations, study outcomes, and toxicity findings. Other than larvicidal activity, this review also reveals two medicinal potentials of C. papaya leaf juice on dengue infection, namely anti-thrombocytopenic and immunomodulatory effects. C. papaya leaf juice has the potential to be a new drug candidate against dengue disease safely and effectively.
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Phytoconstituents as Lead Compounds for Anti-Dengue Drug Discovery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1322:159-193. [PMID: 34258741 DOI: 10.1007/978-981-16-0267-2_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dengue is an arthropod-borne viral disease common in subtropical and tropical regions. The widespread use of traditional medicines in these regions for dengue fever (DF) has encouraged researchers to explore the therapeutic effect of herbs and their phytochemicals in dengue infection. Phytochemicals such as quercetin, baicalein, luteolin, oxindole alkaloids, celastrol and geraniin have shown significant inhibition of dengue virus in vitro. Many phytoconstituents have better selectivity index supporting their safety profile for future development. However, in vivo studies supporting therapeutic potency for these active phytoconstituents are limited. There is a need for studies translating anti-dengue profile of active phytoconstituents to find successful anti-dengue compounds.
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Sarker MMR, Khan F, Mohamed IN. Dengue Fever: Therapeutic Potential of Carica papaya L. Leaves. Front Pharmacol 2021; 12:610912. [PMID: 33981215 PMCID: PMC8109180 DOI: 10.3389/fphar.2021.610912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Dengue, a very widespread mosquito-borne infectious disease caused by Aedes aegypti virus, has been occurring during the monsoons every year. The prevalence and incidence of dengue fever and death due to its complications have been increased drastically in these recent years in Bangladesh, Philippines, Thailand, Brazil, and India. Recently, dengue had spread in an epidemic form in Bangladesh, Thailand, and Philippines. Although the infection affected a large number of people around the world, there is no established specific and effective treatment by synthetic medicines. In this subcontinent, Malaysia could effectively control its incidences and death of patients using alternative medication treatment mainly prepared from Carica papaya L. leaves along with proper care and hospitalization. Papaya leaves, their juice or extract, as well as their different forms of preparation have long been used traditionally for treating dengue fever and its complications to save patients’ lives. Although it is recommended by traditional healers, and the general public use Papaya leaves juice or their other preparations in dengue fever, this treatment option is strictly denied by the physicians offering treatment in hospitals in Bangladesh as they do not believe in the effectiveness of papaya leaves, thus suggesting to patients that they should not use them. In Bangladesh, 1,01,354 dengue patients have been hospitalized, with 179 deaths in the year 2019 according to information from the Institute of Epidemiology, Disease Control, and Research as well as the Directorate General of Health Services of Bangladesh. Most of the patients died because of the falling down of platelets to dangerous levels and hemorrhage or serious bleeding. Therefore, this paper aims to critically review the scientific basis and effectiveness of Carica papaya L. leaves in treating dengue fever based on preclinical and clinical reports. Thrombocytopenia is one of the major conditions that is typical in cases of dengue infection. Besides, the infection and impairment of immunity are concerned with dengue patients. This review summarizes all the scientific reports on Carica papaya L. for its ability on three aspects of dengue: antiviral activities, prevention of thrombocytopenia and improvement of immunity during dengue fever.
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Affiliation(s)
- Md Moklesur Rahman Sarker
- Department of Pharmacy, State University of Bangladesh, Dhanmondi, Dhaka, Bangladesh.,Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Farzana Khan
- Department of Pharmacy, State University of Bangladesh, Dhanmondi, Dhaka, Bangladesh.,Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia (The National University of Malaysia), Cheras, Malaysia
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Mohd Abd Razak MR, Norahmad NA, Md Jelas NH, Afzan A, Mohmad Misnan N, Mat Ripen A, Thayan R, Zainol M, Syed Mohamed AF. Immunomodulatory Activities of Carica papaya L. Leaf Juice in a Non-Lethal, Symptomatic Dengue Mouse Model. Pathogens 2021; 10:pathogens10050501. [PMID: 33919457 PMCID: PMC8170887 DOI: 10.3390/pathogens10050501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
The role of Carica papaya L. leaf juice in immune dysregulation caused by dengue virus infection remains unclear. This study aimed to investigate the immunomodulatory activities of the freeze-dried C. papaya leaf juice (FCPLJ) on AG129 mice infected with a clinical DENV-2 (DMOF015) isolate. The infected AG129 mice were orally treated with 500 and 1000 mg/kg/day of FCPLJ, for three days. Platelet, leukocyte, lymphocyte and neutrophil counts were microscopically determined. The level of plasma proinflammatory cytokines was measured by multiplex immunoassay. The levels of intracellular cytokines and viral RNA were determined by RT-qPCR technique. The results showed that the FCPLJ treatment increased the total white blood cell and neutrophil counts in the infected mice. The FCPLJ treatment decreased the level of GM-CSF, GRO-alpha, IL-1 beta, IL-6, MCP-1 and MIP-1 beta in the plasma of the infected mice. The intracellular IL-6 and viral RNA levels in the liver of infected mice were decreased by the FCPLJ treatment. In conclusion, this study supports the potential immunomodulatory role of the FCPLJ in a non-lethal, symptomatic dengue mouse model. Further studies on the action mechanism of the C. papaya leaf juice and its possible use as adjunctive dengue immunotherapy are warranted.
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Affiliation(s)
- Mohd Ridzuan Mohd Abd Razak
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
- Correspondence:
| | - Nor Azrina Norahmad
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Nur Hana Md Jelas
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Adlin Afzan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Norazlan Mohmad Misnan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Adiratna Mat Ripen
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Ravindran Thayan
- Infectious Disease Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Murizal Zainol
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Ami Fazlin Syed Mohamed
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
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Masri MFB, Rathore APS, St. John AL. Therapeutics for Dengue. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Mohd Abd Razak MR, Norahmad NA, Md Jelas NH, Jusoh B, Muhammad A, Mohmad Misnan N, Zainol M, Thayan R, Syed Mohamed AF. Preliminary study on the expression of endothelial cell biology related genes in the liver of dengue virus infected mice treated with Carica papaya leaf juice. BMC Res Notes 2019; 12:206. [PMID: 30944031 PMCID: PMC6448258 DOI: 10.1186/s13104-019-4242-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
Objective The purpose of this study was to profile and identify the endothelial cell biology related genes that are affected by dengue virus infection in the liver tissue of AG129 mice, with and without Carica papaya leaf juice treatment. Results The dengue fever mouse model was established by intraperitoneal inoculation of dengue virus, New Guinea C strain at 2 × 106 PFU. Daily oral administration of 1000 mg/kg freeze-dried C. papaya leaf juice (FCPLJ) was done starting from day 1 to day 3 post infection. The RNA was extracted from liver tissues harvested on day 4 post infection. The expression levels of 84 genes related to mouse endothelial cell biology were determined by qRT-PCR technique. Dengue virus infection upregulated 15 genes and downregulated two genes in the liver of AG129 mice. The FCPLJ treatment upregulated monocyte chemoattractant protein 1 and downregulated intercellular adhesion molecule 1, integrin beta 3 and fibronectin 1 genes during dengue virus infection. The data showed the potential effect of FCPLJ treatment on the expression profile of endothelial cell biology related genes in the liver of dengue virus infected-AG129 mice. Further proteomic studies are needed to determine the functional roles of the genes affected by FCPLJ treatment. Electronic supplementary material The online version of this article (10.1186/s13104-019-4242-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Nor Azrina Norahmad
- Herbal Medicine Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Nur Hana Md Jelas
- Herbal Medicine Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Bazilah Jusoh
- Herbal Medicine Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Amirrudin Muhammad
- Herbal Medicine Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | | | - Murizal Zainol
- Herbal Medicine Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Ravindran Thayan
- Infectious Disease Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
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