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Understanding the Thalidomide Chirality in Biological Processes by the Self-disproportionation of Enantiomers. Sci Rep 2018; 8:17131. [PMID: 30459439 PMCID: PMC6244226 DOI: 10.1038/s41598-018-35457-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023] Open
Abstract
Twenty years after the thalidomide disaster in the late 1950s, Blaschke et al. reported that only the (S)-enantiomer of thalidomide is teratogenic. However, other work has shown that the enantiomers of thalidomide interconvert in vivo, which begs the question: why is teratogen activity not observed in animal experiments that use (R)-thalidomide given the ready in vivo racemization (“thalidomide paradox”)? Herein, we disclose a hypothesis to explain this “thalidomide paradox” through the in-vivo self-disproportionation of enantiomers. Upon stirring a 20% ee solution of thalidomide in a given solvent, significant enantiomeric enrichment of up to 98% ee was observed reproducibly in solution. We hypothesize that a fraction of thalidomide enantiomers epimerizes in vivo, followed by precipitation of racemic thalidomide in (R/S)-heterodimeric form. Thus, racemic thalidomide is most likely removed from biological processes upon racemic precipitation in (R/S)-heterodimeric form. On the other hand, enantiomerically pure thalidomide remains in solution, affording the observed biological experimental results: the (S)-enantiomer is teratogenic, while the (R)-enantiomer is not.
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Hijji Y, Benjamin E, Jasinski JP, Butcher RJ. Crystal structure of the thalidomide analog (3a R*,7a S*)-2-(2,6-dioxopiperidin-3-yl)hexa-hydro-1 H-iso-indole-1,3(2 H)-dione. Acta Crystallogr E Crystallogr Commun 2018; 74:1595-1598. [PMID: 30443388 PMCID: PMC6218906 DOI: 10.1107/s2056989018014317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
Abstract
The title compound, C13H16N2O4, crystallizes in the monoclinic centrosymmetric space group, P21/c, with four mol-ecules in the asymmetric unit, thus there is no crystallographically imposed symmetry and it is a racemic mixture. The structure consists of a six-membered unsaturated ring bound to a five-membered pyrrolidine-2,5-dione ring N-bound to a six-membered piperidine-2,6-dione ring and thus has the same basic skeleton as thalidomide, except for the six-membered unsaturated ring substituted for the aromatic ring. In the crystal, the mol-ecules are linked into inversion dimers by R 2 2(8) hydrogen bonding involving the N-H group. In addition, there are bifurcated C-H⋯O inter-actions involving one of the O atoms on the pyrrolidine-2,5-dione with graph-set notation R 1 2(5). These inter-actions along with C-H⋯O inter-actions involving one of the O atoms on the piperidine-2,6-dione ring link the mol-ecules into a complex three-dimensional array. There is pseudomerohedral twinning present which results from a 180° rotation about the [100] reciprocal lattice direction and with a twin law of 1 0 0 0 0 0 0 [BASF 0.044 (1)].
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Affiliation(s)
- Yousef Hijji
- Department of Chemistry and Earth Sciences, Qatar University, Doha, Qatar
| | - Ellis Benjamin
- Department of Chemistry, Richard Stockton College of New Jersey, Galloway, NJ 08205, USA
| | - Jerry P Jasinski
- Department of Chemistry, Keene State College, 229 Main Street, Keene NH 03435, USA
| | - Ray J Butcher
- Department of Chemistry, Howard University, 525 College Street NW, Washington, DC 20059, USA
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Das A, Merrill P, Wilson J, Turner T, Paige M, Capitosti S, Brown M, Freshcorn B, Sok MCP, Song H, Botchwey EA. Evaluating Angiogenic Potential of Small Molecules Using Genetic Network Approaches. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2018; 5:30-41. [PMID: 31008183 PMCID: PMC6474664 DOI: 10.1007/s40883-018-0077-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Control of microvascular network growth is critical to treatment of ischemic tissue diseases and enhancing regenerative capacity of tissue engineering implants. Conventional therapeutic strategies for inducing angiogenesis aim to deliver one or more proangiogenic cytokines or to over-express known pro-angiogenic genes, but seldom address potential compensatory or cooperative effects between signals and the overarching signaling pathways that determine successful outcomes. An emerging grand challenge is harnessing the expanding knowledge base of angiogenic signaling pathways toward development of successful new therapies. We previously performed drug optimization studies by various substitutions of a 2-(2,6-dioxo-3-piperidyl)isoindole-1,3-dione scaffold to discover novel bioactive small molecules capable of inducing growth of microvascular networks, the most potent of which we termed phthalimide neovascularization factor 1 (PNF1, formerly known as SC-3–149). We then showed that PNF-1 regulates the transcription of signaling molecules that are associated with vascular initiation and maturation in a time-dependent manner through a novel pathway compendium analysis in which transcriptional regulatory networks of PNF-1-stimulated microvascular endothelial cells are overlaid with literature-derived angiogenic pathways. In this study, we generated three analogues (SC-3–143, SC-3–263, SC-3–13) through systematic transformations to PNF1 to evaluate the effects of electronic, steric, chiral, and hydrogen bonding changes on angiogenic signaling. We then expanded our compendium analysis toward these new compounds. Variables obtained from the compendium analysis were then used to construct a PLSR model to predict endothelial cell proliferation. Our combined approach suggests mechanisms of action involving suppression of VEGF pathways through TGF-β andNR3C1 network activation. Previously, we discovered a novel small molecule (PNF1) that is capable of inducing growth of microvascular networks, a mechanism that is very important in many regenerative applications. In this study, we alter the structure of PNF1 slightly to get three different analogues and focus on gaining insight into how these drugs induce their pro-angiogenic effects. This is done through a few techniques that result in a map of all the transcripts that are up- or downregulated as a result of administering the drug, a knowledge that is necessary for successful therapeutic strategies. Angiogenesis and neovascularization is important in a number of regenerative medicine therapeutics, including soft tissue regeneration. Having a deep understanding of the transcriptional mechanism of small molecules with this angiogenic potential will aid in designing specific immunomodulatory biomaterials. In the future, we will study these drugs and their angiogenic properties in impactful and clinically translatable applications.
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Affiliation(s)
- Anusuya Das
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Parker Merrill
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jennifer Wilson
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Thomas Turner
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive Suite 1316, Atlanta, GA 30332, USA
| | - Mikell Paige
- Center for Drug Discovery, Georgetown University, Washington, DC, USA
| | - Scott Capitosti
- Center for Drug Discovery, Georgetown University, Washington, DC, USA
| | - Milton Brown
- Center for Drug Discovery, Georgetown University, Washington, DC, USA
| | - Brandon Freshcorn
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mary Caitlin P Sok
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive Suite 1316, Atlanta, GA 30332, USA
| | - Hannah Song
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive Suite 1316, Atlanta, GA 30332, USA
| | - Edward A Botchwey
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive Suite 1316, Atlanta, GA 30332, USA
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4
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Zahran MAH, El-Aarag B, Mehany ABM, Belal A, Younes AS. Design, synthesis, biological evaluations, molecular docking, andin vivostudies of novel phthalimide analogs. Arch Pharm (Weinheim) 2018; 351:e1700363. [DOI: 10.1002/ardp.201700363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Magdy A. H. Zahran
- Faculty of Science, Department of Chemistry; Menoufia University; Shebin El-Koom Egypt
| | - Bishoy El-Aarag
- Biochemistry Division, Faculty of Science, Department of Chemistry; Menoufia University; Shebin El-Koom Egypt
| | - Ahmed B. M. Mehany
- Faculty of Science, Department of Zoology; Al-Azhar University; Cairo Egypt
| | - Amany Belal
- Faculty of Pharmacy, Department of Medicinal Chemistry; Beni-Suef University; Beni-Suef Egypt
| | - Ali S. Younes
- Faculty of Science, Department of Chemistry; Menoufia University; Shebin El-Koom Egypt
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El-Aarag B, Kasai T, Masuda J, Agwa H, Zahran M, Seno M. Anticancer effects of novel thalidomide analogs in A549 cells through inhibition of vascular endothelial growth factor and matrix metalloproteinase-2. Biomed Pharmacother 2016; 85:549-555. [PMID: 27889230 DOI: 10.1016/j.biopha.2016.11.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/04/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022] Open
Abstract
Lung cancer is one of the major causes of cancer-related mortality worldwide, and non-small-cell lung cancer is the most common form of lung cancer. Several studies had shown that thalidomide has potential for prevention and therapy of cancer. Therefore, the current study aimed to investigate the antitumor effects of two novel thalidomide analogs in human lung cancer A549 cells. The antiproliferative, antimigratory, and apoptotic effects in A549 cells induced by thalidomide analogs were examined. In addition, their effects on the expression of mRNAs encoding vascular endothelial growth factor165 (VEGF165) and matrix metalloproteinase-2 (MMP-2) were evaluated. Their influence on the tumor volume in nude mice was also determined. Results revealed that thalidomide analogs exhibited antiproliferative, antimigratory, and apoptotic activities with more pronounced effect than thalidomide drug. Furthermore, analogs 1 and 2 suppressed the expression levels of VEGF165 by 42% and 53.2% and those of MMP-2 by 45% and 52%, respectively. Thalidomide analogs 1 and 2 also reduced the tumor volume by 30.11% and 53.52%, respectively. Therefore, this study provides evidence that thalidomide analogs may serve as a new therapeutic option for treating lung cancer.
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Affiliation(s)
- Bishoy El-Aarag
- Biochemistry Division, Chemistry Department, Faculty of Science, Menoufia University, Shebin El-Koom, Egypt; Division of Chemistry and Biotechnology, Graduate School of Natural Science and Technology, Okayama University, Okayama 7008530, Japan.
| | - Tomonari Kasai
- Division of Chemistry and Biotechnology, Graduate School of Natural Science and Technology, Okayama University, Okayama 7008530, Japan
| | - Junko Masuda
- Division of Chemistry and Biotechnology, Graduate School of Natural Science and Technology, Okayama University, Okayama 7008530, Japan
| | - Hussein Agwa
- Chemistry Department, Faculty of Science, Menoufia University, Shebin El-Koom, Egypt
| | - Magdy Zahran
- Chemistry Department, Faculty of Science, Menoufia University, Shebin El-Koom, Egypt
| | - Masaharu Seno
- Division of Chemistry and Biotechnology, Graduate School of Natural Science and Technology, Okayama University, Okayama 7008530, Japan
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Shibata N. Development of Shelf-Stable Reagents for Fluoro-Functionalization Reactions. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2016. [DOI: 10.1246/bcsj.20160223] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Maeno M, Tokunaga E, Yamamoto T, Suzuki T, Ogino Y, Ito E, Shiro M, Asahi T, Shibata N. Self-disproportionation of enantiomers of thalidomide and its fluorinated analogue via gravity-driven achiral chromatography: mechanistic rationale and implications. Chem Sci 2015; 6:1043-1048. [PMID: 29560192 PMCID: PMC5811091 DOI: 10.1039/c4sc03047h] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/30/2014] [Indexed: 01/13/2023] Open
Abstract
We report on the self-disproportionation of enantiomers (SDE) of non-racemic thalidomide (1) and 3'-fluorothalidomide (2) under the conditions of gravity-driven achiral silica-gel chromatography. The presence of a fluorine atom on the chiral center dramatically alters the structure and polarity of 1 and 2, resulting in the opposite SDE profile on silica-gel.
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Affiliation(s)
- Mayaka Maeno
- Department of Nanopharmaceutical Sciences and Department of Frontier Materials , Nagoya Institute of Technology , Gokiso, Showa-ku , Nagoya 466-8555 , Japan .
| | - Etsuko Tokunaga
- Department of Nanopharmaceutical Sciences and Department of Frontier Materials , Nagoya Institute of Technology , Gokiso, Showa-ku , Nagoya 466-8555 , Japan .
| | - Takeshi Yamamoto
- Department of Nanopharmaceutical Sciences and Department of Frontier Materials , Nagoya Institute of Technology , Gokiso, Showa-ku , Nagoya 466-8555 , Japan .
| | - Toshiya Suzuki
- Department of Life Science and Medical Bioscience , Waseda University (TWIns) , Wakamatsu-cho 2-2, Shinjuku-ku , Tokyo 162-8480 , Japan .
| | - Yoshiyuki Ogino
- Department of Life Science and Medical Bioscience , Waseda University (TWIns) , Wakamatsu-cho 2-2, Shinjuku-ku , Tokyo 162-8480 , Japan .
| | - Emi Ito
- Department of Nanopharmaceutical Sciences and Department of Frontier Materials , Nagoya Institute of Technology , Gokiso, Showa-ku , Nagoya 466-8555 , Japan .
| | - Motoo Shiro
- Consolidated Research Institute for Advanced Science and Medical Care , Waseda University (ASMeW) , Waseda-tsurumaki-cho 513, Shinjuku-ku , Tokyo 162-0041 , Japan
| | - Toru Asahi
- Department of Life Science and Medical Bioscience , Waseda University (TWIns) , Wakamatsu-cho 2-2, Shinjuku-ku , Tokyo 162-8480 , Japan .
| | - Norio Shibata
- Department of Nanopharmaceutical Sciences and Department of Frontier Materials , Nagoya Institute of Technology , Gokiso, Showa-ku , Nagoya 466-8555 , Japan .
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8
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Novel thalidomide analogs: Anti-angiogenic and apoptotic effects on Hep-G2 and MCF-7 cancer cell lines. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.biomag.2014.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Sefcik LS, Petrie Aronin CE, Botchwey EA. Engineering vascularized tissues using natural and synthetic small molecules. Organogenesis 2012; 4:215-27. [PMID: 19337401 DOI: 10.4161/org.4.4.6963] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/10/2008] [Indexed: 12/21/2022] Open
Abstract
Vascular growth and remodeling are complex processes that depend on the proper spatial and temporal regulation of many different signaling molecules to form functional vascular networks. The ability to understand and regulate these signals is an important clinical need with the potential to treat a wide variety of disease pathologies. Current approaches have focused largely on the delivery of proteins to promote neovascularization of ischemic tissues, most notably VEGF and FGF. Although great progress has been made in this area, results from clinical trials are disappointing and safer and more effective approaches are required. To this end, biological agents used for therapeutic neovascularization must be explored beyond the current well-investigated classes. This review focuses on potential pathways for novel drug discovery, utilizing small molecule approaches to induce and enhance neovascularization. Specifically, four classes of new and existing molecules are discussed, including transcriptional activators, receptor selective agonists and antagonists, natural product-derived small molecules, and novel synthetic small molecules.
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Affiliation(s)
- Lauren S Sefcik
- Department of Biomedical Engineering; and Department of Orthopaedic Surgery; University of Virginia; Charlottesville, Virginia USA; Center for Immunity, Inflammation and Regenerative Medicine (CIIR); University of Virginia; Charlottesville, Virginia USA
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10
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Metronomic treatment with low-dose trofosfamide leads to a long-term remission in a patient with docetaxel-refractory advanced metastatic prostate cancer. Case Rep Med 2010; 2010:395720. [PMID: 20396674 PMCID: PMC2853857 DOI: 10.1155/2010/395720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 02/25/2010] [Accepted: 03/15/2010] [Indexed: 11/18/2022] Open
Abstract
The treatment of metastatic prostate cancer patients refractory to androgen withdrawal and docetaxel therapy is currently discouraging and new therapeutic approaches are vastly needed. Here, we report a long-term remission over one year in a 68-year-old patient with metastatic docetaxel-refractory prostate cancer employing low-dose trofosfamide. The patient suffered from distant failure with several bone lesions and lymph node metastases depicted by a (11) C-Choline positron emission tomography/computerized tomography (PET/CT). After initiation of trofosfamide 100 mg taken orally once a day we observed a steadily decreasing PSA value from initial 46.6 down to 2.1 μg/L. The Choline-PET/CT was repeated after 10 months of continuous therapy and demonstrated a partial remission of the bone lesions and a regression of all involved lymph nodes but one. Taken together we found an astonishing and durable activity of the alkylating agent trofosfamide given in a metronomic fashion. We rate the side effects as low and state an excellent therapeutic ratio of this drug in our patient.
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11
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Yamamoto T, Tokunaga E, Nakamura S, Shibata N, Toru T. Synthesis and configurational stability of (S)- and (R)-deuteriothalidomides. Chem Pharm Bull (Tokyo) 2010; 58:110-2. [PMID: 20045977 DOI: 10.1248/cpb.58.110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
3'-Deuteriothalidomide was synthesized and found to be configurationally five times more stable than thalidomide toward racemization at physiological pH.
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Affiliation(s)
- Takeshi Yamamoto
- Department of Frontier Materials, Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan
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12
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Wieghaus KA, Capitosti SM, Anderson CR, Price RJ, Blackman BR, Brown ML, Botchwey EA. Small molecule inducers of angiogenesis for tissue engineering. ACTA ACUST UNITED AC 2006; 12:1903-13. [PMID: 16889520 DOI: 10.1089/ten.2006.12.1903] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Engineering of implantable tissues requires rapid induction of angiogenesis to meet the significant oxygen and nutrient demands of cells during tissue repair. To this end, our laboratories have utilized medicinal chemistry to synthesize non-peptide-based inducers of angiogenesis to aid tissue engineering. In this study, we describe the evaluation of SC-3-149, a small molecule compound with proliferative effects on vascular endothelial cells. Specifically, exogenous exposure of SC-3-149 induced an 18-fold increase in proliferation of human microvascular endothelial cells in vitro at low micromolar potency by day 14 in culture. Moreover, SC-3-149 significantly increased the formation of endothelial cord and tubelike structures in vitro, and improved endothelial scratch wound healing within 24 h. SC-3-149 also significantly inhibited vascular endothelial cell death owing to serum deprivation and high acidity (pH 6). Concurrent incubation of SC-3-149 with vascular endothelial growth factor increased cell survivability under serum-deprived conditions by an additional 7%. In addition, in vivo injection of SC-3-149 into the rat mesentery produced qualitative increases in microvessel length density. Taken together, our studies suggest that SC-3-149 and its analogs may serve as promising new angiogenic agents for targeted drug delivery and therapeutic angiogenesis in tissue engineering.
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Affiliation(s)
- Kristen A Wieghaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia 22908, USA
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Komorowski J, Jerczyńska H, Siejka A, Barańska P, Ławnicka H, Pawłowska Z, Stepień H. Effect of thalidomide affecting VEGF secretion, cell migration, adhesion and capillary tube formation of human endothelial EA.hy 926 cells. Life Sci 2005; 78:2558-63. [PMID: 16310808 DOI: 10.1016/j.lfs.2005.10.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 10/06/2005] [Indexed: 11/23/2022]
Abstract
Angiogenesis, new blood vessel formation, is a multistep process, precisely regulated by pro-angiogenic cytokines, which stimulate endothelial cells to migrate, proliferate and differentiate to form new capillary microvessels. Excessive vascular development and blood vessel remodeling appears in psoriasis, rheumatoid arthritis, diabetic retinopathy and solid tumors formation. Thalidomide [alpha-(N-phthalimido)-glutarimide] is known to be a potent inhibitor of angiogenesis, but the mechanism of its inhibitory action remains unclear. The aim of the study was to investigate the potential influence of thalidomide on the several steps of angiogenesis, using in vitro models. We have evaluated the effect of thalidomide on VEGF secretion, cell migration, adhesion as well as in capillary formation of human endothelial cell line EA.hy 926. Thalidomide at the concentrations of 0.01 microM and 10 microM inhibited VEGF secretion into supernatants, decreased the number of formed capillary tubes and increased cell adhesion to collagen. Administration of thalidomide at the concentration of 0.01 microM increased cell migration, while at 10 microM, it decreased cell migration. Thalidomide in concentrations from 0.1 microM to 10 microM did not change cell proliferation of 72-h cell cultures. We conclude that anti-angiogenic action of thalidomide is due to direct inhibitory action on VEGF secretion and capillary microvessel formation as well as immunomodulatory influence on EA.hy 926 cells migration and adhesion.
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Affiliation(s)
- Jan Komorowski
- Department of Clinical Endocrinology, Chair of Endocrinology, Medical University of Lodz Dr Sterling 3 Street, 91-425 Lodz, Poland
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