Phytotherapeutics in Cancer: From Potential Drug Candidates to Clinical Translation

Annually, a significant number of individuals succumb to cancer, an anomalous cellular condition characterized by uncontrolled cellular proliferation and the emergence of highly perilous tumors. Identifying underlying molecular mechanism(s) driving disease progression has led to various inventive therapeutic approaches, many of which are presently under pre-clinical and/or clinical trials. Over the recent years, numerous alternative strategies for addressing cancer have also been proposed and put into practice. This article delineates the modern therapeutic drugs employed in cancer treatment and their associated toxicity. Due to inherent drug toxicity associated with most modern treatments, demand rises for alternative therapies and phytochemicals with minimal side effects and proven efficacy against cancer. Analogs of taxol, Vinca alkaloids like vincristine and vinblastine, and podophyllotoxin represent a few illustrative examples in this context. The phytochemicals often work by modifying the activity of molecular pathways that are thought to be involved in the onset and progression of cancer. The principal objective of this study is to provide an overview of our current understanding regarding the pharmacologic effects and molecular targets of the active compounds found in natural products for cancer treatment and collate information about the recent advancements in this realm. The authors' interest in advancing the field of phytochemical research stems from both the potential of these compounds for use as drugs as well as their scientific validity. Accordingly, the significance of herbal formulations is underscored, shedding light on anticancer phytochemicals that are sought after at both preclinical and clinical levels, with discussion on the opportunities and challenges in pre-clinical and clinical cancer studies.

Piperidine nucleus as a promising scaffold for Alzheimer's disease: Current Landscape and Future Perspective

Heterocycles and their derivatives hold an important place in medicinal chemistry due to their vast therapeutic and pharmacological significance and wider implications in drug design and development. Piperidine is a nitrogen-containing heterocyclic moiety that exhibits an array of pharmacological properties. This review discusses the potential of piperidine derivatives against the neurodegenerative disease Alzheimer's. The incidences of Alzheimer's disease are increasing nowadays, and constant efforts are being made to develop a medicinal agent for this disease. We have highlighted the advancement in developing piperidine-based anti-neuronal disease compounds and the profound activities of some major piperidine-bearing drug molecules with their important target site. This review focuses on advancements in the field of natural and synthetic occurring piperidines active against Alzheimer's disease, with emphasis on the past 6 years. The discussion also includes the structure-activity relationship, the structures of the most promising molecules, and their biological activities against Alzheimer's disease. The promising activities revealed by these piperidinebased scaffolds undoubtedly place them at the forefront of discovering prospective drug candidates. Thus, it would be of great interest to researchers working on synthesizing neuroprotective drug candidates.

Exploring the Multitarget Potential of Iridoids: Advances and Applications

Iridoids are secondary plant metabolites that are multitarget compounds active against various diseases. Iridoids are structurally classified into iridoid glycosides and non-glycosidic iridoids according to the presence or absence of intramolecular glycosidic bonds; additionally, iridoid glycosides can be further subdivided into carbocyclic iridoids and secoiridoids. These monoterpenoids belong to the cyclopentan[c]-pyran system, which has a wide range of biological activities, including antiviral, anticancer, antiplasmodial, neuroprotective, anti-thrombolytic, antitrypanosomal, antidiabetic, hepatoprotective, anti-oxidant, antihyperlipidemic and anti-inflammatory properties. The basic chemical structure of iridoids in plants (the iridoid ring scaffold) is biosynthesized in plants by the enzyme iridoid synthase using 8-oxogeranial as a substrate. With advances in phytochemical research, many iridoid compounds with novel structure and outstanding activity have been identified in recent years. Biologically active iridoid derivatives have been found in a variety of plant families, including Plantaginaceae, Rubiaceae, Verbenaceae, and Scrophulariaceae. Iridoids have the potential of modulating many biological events in various diseases. This review highlights the multitarget potential of iridoids and includes a compilation of recent publications on the pharmacology of iridoids. Several in vitro and in vivo models used, along with the results, are also included in the paper. This paper's systematic summary was created by searching for relevant iridoid material on websites such as Google Scholar, PubMed, SciFinder Scholar, Science Direct, and others. The compilation will provide the researchers with a thorough understanding of iridoid and its congeners, which will further help in designing a large number of potential compounds with a strong impact on curing various diseases.

LC-MS/MS studies for identification and characterization of new forced degradation products of dabrafenib and establishment of their degradation pathway

Dabrafenib (Tafinlar) is used for the treatment of patients with BRAF V600 mutation positive unresectable or metastatic melanoma. Forced degradation study of the drug product and drug substance is very much important in drug development and drug discovery to establish the intrinsic stability and understand its behaviors towards different stress conditions. In the current study, compressive stress testing of dabrafenib has been performed as per the recommendation of ICH guidelines to identify and characterize all major degradation products of dabrafenib (DPD) formed. Drug substances were exposed to different stressed conditions as per ICH recommendations. The present study observed that the dabrafenib drug substance is very much sensitive when exposed to oxidative degradation conditions at 80 °C temperature conditions and also sensitive to photolytic degradation conditions. Dabrafenib is stable when treated in acidic, alkaline, neutral and thermal degradation environments as there is no degradation observed in signification percentage under these stressed conditions. The best separation of eight degradation products and dabrafenib drug substance was obtained in Waters BEH (Ethylene Bridge Hybrid) C-18 column (1.7 µm, 100 mm × 2.1 mm) having mobile phase composed of Formic acid (0.1%) and methanol as Eluent A and Eluent B respectively using 225 nm wavelengths. The volume of injection (5 µL) and flow rate (0.3 mL/min) was set throughout the study. Dabrafenib is highly unstable to oxidative stressed conditions as five major degradation products (DPD-II, DPD-III, DPD-IV, DPD-V and DPD-VII) were obtained when exposed to hydrogen peroxide. When dabrafenib is treated under photolytic degradation conditions, three major DPs were formed (DPD-I, DPD-VI and DP-VIII). These DPs were further identified and characterized on sophisticated HRMS/MS/TOF technique for accurate mass measurement. Characterization of all the degradation products was carried out in the ESI positive mode of ionization. The establishment of the degradation pathway of drug substance and fragmentation pathway of DPs were explained in the present study which was never reported in any literature.

Current developments in the Pyran-Based Analogues as Anticancer Agents

Heterocyclic compounds offer an enormous area for new lead molecules for drug discovery. Till today, efforts are being continuously made to find appropriate treatment for the management of the deadly disease of cancer. Amongst the large number of heterocycles that are found in nature, heterocycles having oxygen obtained noteworthy attention due to their distinctive and pharmacological activities.'Pyran' is one of the most significant non-aromatic, six-membered ring composed of one oxygen atom and five carbon atoms. It is considered a privileged structure since pyran and its related derivatives exhibit a wide spectrum of biological activities. Pyran derivatives are found to have excellent anti-cancer properties against various types of cancer. The present review focussed on the current advances in different types of pyran-based derivatives as anti-cancer agents. Various in-vitro (cell based testing), in-vivo (animal based testing) models as well as molecular docking along with results are also covered. A subsection describing briefly natural pyran containing anticancer compounds is also incorporated in the review.

Potential role of nicotinamide analogues against SARS-COV-2 target proteins

Background and objective

Coronavirus 2019 (COVID-19) is caused by ‘severe acute respiratory syndrome coronavirus 2′ (SARS-CoV-2), first reported in Wuhan, China in December 2019, which eventually became a global disaster. Various key mediators have been reported in the pathogenesis of COVID-19. However, no effective pharmacological intervention has been available to combat COVID-19 complications. The present study screens nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) as potential inhibitors of this present generation coronavirus infection using an in-silico approach.

Materials and methods

The SARS-CoV-2 proteins (nucleocapsid, proteases, post-fusion core, phosphatase, endoriboruclease) and ACE-2 protein were selected. The 2D structure of nicotinamide ribonucleoside and nicotinamide ribonucleotide was drawn using ChemDraw 14.0 and saved in .cdx format. The results were analyzed using two parameters: full fitness energy and binding free energy (ΔG).

Results

The full fitness energy and estimated ΔG values from docking of NM, and NMN with selected SARS-CoV-2 target proteins, ADMET prediction and Target prediction indicate the interaction of NR and NMN in the treatment of COVID-19.

Conclusions

Based on full fitness energy and estimated ΔG values from docking studies of NM and NAM with selected SARS-CoV-2 target proteins, ADME prediction, target prediction and toxicity prediction, we expect a possible therapeutic efficacy of NR in the treatment of COVID-19.

LC and LC-MS/MS studies for identification and characterization of new degradation products of ibrutinib and elucidation of their degradation pathway

Forced degradation/stress degradation studies of ibrutinib drug were done in hydrolytic (acidic, alkaline and neutral), thermal, photolytic and oxidative degradation conditions in different temperature conditions as per International Conference on Harmonization (ICH) guideline Q1A(R2) in order to identify and characterize degradation products (DPs) of ibrutinib. The study revealed that ibrutinib is extremely sensitive to oxidative degradation even at room temperature. The drug substance is highly sensitive to alkaline hydrolysis and susceptible to acidic hydrolysis at 80 °C temperature condition, whereas found stable in neutral, photolytic and thermal stress conditions. Successful separation of ibrutinib and its ten degradation products formed during stress degradation condition were observed using Waters Acquity UPLC C-18 stationary phase (100 mm × 2.1 mm, 1.7 μm) with gradient elution using mobile phase consisting of Eluent-A: ammonium acetate (20 mm, pH-6) and Eluent-B: acetonitrile. The detection was carried out at 215 nm wavelength. Flow rate was set at 0.3 mL/min with injection volume of 5 μL. The drug substance degraded to one degradation product (DP-I) in acidic hydrolysis, five DPs (DP-I, DP-II, DP-V, DP-VIII and DP-IX) in basic hydrolysis and five DPs (DP-III, DP-IV, DP-VI, DP-VII and DP-X) in oxidative degradation condition. A novel and highly sensitive HRMS/MS/TOF method was developed to identify and characterize all the ten DPs formed during stress study. All the DPs were characterized using ESI positive mode. Except DP-I, all the degradation products formed were found to be new degradation impurities and their fragmentation pathways have never been reported earlier. The proposed mechanism and pathway of degradation products of ibrutinib were discussed and outlined.

Comprehensive population screening in the Ashkenazi Jewish population for recurrent disease-causing variants

The Ashkenazi Jewish (AJ) population has an increased risk for a variety of recessive diseases due to historical founder effects and genetic drift. For some, the disease-causing founder mutations have been identified and well-characterized, but for others, further study is necessary. The purpose of this study is to assess the carrier frequencies of 85 pathogenic variants causative of 29 recessive conditions in the AJ population. Up to 3000 AJ individuals were genotyped by Luminex MagPlex^® -TAG^™ bead array or Agena Bioscience^™ MassARRAY assays. We identified seven conditions with carrier frequencies higher than 1 in 100, nine between 1 in 100 and 1 in 200, and four between 1 in 200 and 1 in 500. Variants in nine conditions had a detected carrier rate of less than 1 in 500 or were not identified in approximately 2000 AJ individuals. We assessed the combined AJ carrier frequency for 18 relatively prevalent diseases to be 1 in 6, and the risk of AJ individuals to be a carrier couple for one of these 18 diseases as 1 in 441. We note additional recessive genetic conditions should be considered for AJ carrier screening panels.

Carrier screening of RTEL1 mutations in the Ashkenazi Jewish population

Hoyeraal-Hreidarsson syndrome (HH) is a clinically severe variant of dyskeratosis congenita (DC), characterized by cerebellar hypoplasia, microcephaly, intrauterine growth retardation, and severe immunodeficiency in addition to features of DC. Germline mutations in the RTEL1 gene have recently been identified as causative of HH. In this study, the carrier frequency for five RTEL1 mutations that occurred in individuals of Ashkenazi Jewish descent was investigated in order to advise on including them in existing clinical mutation panels for this population. Our screening showed that the carrier frequency for c.3791G>A (p.R1264H) was higher than expected, 1% in the Ashkenazi Orthodox and 0.45% in the general Ashkenazi Jewish population. Haplotype analyses suggested the presence of a common founder. We recommend that the c.3791G>A RTEL1 mutation be considered for inclusion in carrier screening panels in the Ashkenazi population.

A founder mutation in COL4A3 causes autosomal recessive Alport syndrome in the Ashkenazi Jewish population

Alport syndrome is an inherited progressive nephropathy arising from mutations in the type IV collagen genes, COL4A3, COL4A4, and COL4A5. Symptoms also include sensorineural hearing loss and ocular lesions. We determined the molecular basis of Alport syndrome in a non-consanguineous Ashkenazi Jewish family with multiple affected females using linkage analysis and next generation sequencing. We identified a homozygous COL4A3 mutation, c.40_63del, in affected individuals with mutant alleles inherited from each parent on partially conserved haplotypes. Large-scale population screening of 2017 unrelated Ashkenazi Jewish samples revealed a carrier frequency of 1 in 183 indicating that COL4A3 c.40_63del is a founder mutation which may be a common cause of Alport syndrome in this population. Additionally, we determined that heterozygous mutation carriers in this family do not meet criteria for a diagnosis of Thin Basement Membrane Nephropathy and concluded that carriers of c.40_63del are not likely to develop benign familial hematuria.

Scope and limitations of therapies: a neomillennial epistemological evaluation for helping medical practices

Medical practice is in crisis - the sophistications are enormous and expensive, and the outcomes leave much to be desired. An epistemologic evaluation that weighs the scope and limitations of any -pathy or any procedure seems to be the need of the day. As an example, described herein is the logic of such an exercise; and a sample of the exercise itself, taking cancer as an example.

A community genetics approach to population screening in India for mental retardation—a model for developing countries

Some 0.55 million people living in semi-urban and slum populations were screened for mental retardation by trained primary health centre (PHC) doctors, nurses and community health volunteers (CHVs). The staff were provided with prior training on the detection, prevention and diagnosis of mental retardation, prenatal diagnosis, and reproductive responsibilities. Field visits were employed to confirm diagnosed developmental disabilities, and demographic data incorporating social maps of 14 PHCs were prepared. Cases with high-risk genetic factors detected by PHC staff were referred to the Centre for Research in Mental Retardation (CREMERE) for cytogenetic and metabolic investigations, thus linking the study population and the Referral Centre. A genetic team interacted with the patient and family members for genetic counselling. Mental retardation was confirmed in 511 of the 525 cases reported, reflecting the positive impact of training on the CHVs. Potentially preventable environmental factors, such as birth asphyxia, infections, and low birth weight were identified in 251 cases (49%), 137 (27%) of which had additional genetic factors. Genetic causes were found in 186 (36%) individuals, the most common being Down syndrome. The study illustrates the urgent need for the integration of genetic screening into the public health services in India.

Lateral nasal proboscis: antenatal diagnosis and counseling

BACKGROUND

Lateral nasal proboscis is a rare anomaly resulting in incomplete formation of one side of the nose and other variable abnormalities in the adjoining regions of the face, without associated brain malformations. We report a case diagnosed antenatally and confirmed after birth of the infant.

CASE

A 32-year-old white gravida 2 para 1 was referred for a comprehensive fetal ultrasound at 30.5 weeks to evaluate a facial anomaly seen on an ultrasound done to evaluate decreased fetal movements. A fingerlike projection was seen in the left inner eye area with visualization of one nostril and a small nose. After a spontaneous delivery at term, a 3845-g healthy female infant with lateral nasal proboscis and other locally associated anomalies was born and is doing well at 9 months. Reconstructive surgery was done at 3 and 6 months.

CONCLUSION

Accurate antenatal diagnosis of lateral nasal proboscis is possible with ultrasound, which is important because its prognosis and management are different from other types of proboscides.

Renal cell carcinoma with X;1 translocation in a child with Klinefelter syndrome

Klinefelter syndrome (KS) is a sex chromosome abnormality occurring in 1 in 1,000 males. An association with leukemia, germ cell tumor, and male breast cancer has been suggested in KS. Such information is important for professionals caring for KS patients as the condition is frequently not clinically recognizable until after puberty. We report on a renal cell carcinoma (RCC) in a 10-year-old boy with KS. He developed intermittent hematuria at age 10 years and was diagnosed with a right kidney mass, which on pathology was identified as RCC. In addition, he was known to have learning disabilities and language delays. Analysis of peripheral blood chromosomes showed a 47,XXY karyotype while analysis of tumor cells demonstrated clonal abnormalities including a translocation between chromosomes X and 1, designated 47,XXYc,t(X;1)(p11.2;q21)[6]/47,XXYc,t(X;1),r(Xp)[2]/46,X XYc,-X,t(X;1)[7]. Renal cell carcinoma is rare in childhood and is not previously reported in KS. The oncogenetic significance of the chromosomal regions involved in this translocation is discussed in relation to the congenital abnormality of the patient.

Jaccoud's arthritis

A 16 year old girl with multivalvular heart disease and recurrent episodes of polyarthritis with correctable deformities of hands and feet fitting into that of Jaccoud's arthritis is reported. The condition is rare and often difficult to differentiate from rheumatoid arthritis.

Aluminium phosphide poisoning. Two cases with rare presentation

We report two cases of aluminium phosphide poisoning who presented with rare manifestations, one with bleeding diathesis, hepatitis and acute tubular necrosis and the other with acute respiratory failure.

Plasma renin activity in shock due to aluminium phosphide poisoning

Plasma renin activity (PRA) was estimated in 30 patients with aluminium phosphide (AIP) poisoning (study group) admitted in shock. Ten patients in shock other than due to AIP poisoning (Group II A) and 20 normal healthy subjects (Group II B) served as controls. The PRA was significantly higher in the study group and group II A as compared to normal healthy subjects (p less than 0.001). Significantly higher PRA was found in the study group as compared to Group II A (p less than 0.001). The initial higher PRA continued to rise further in the study group but it started decreasing in Group II A as the duration of shock advanced. Continuation of shock in AIP poisoning was probably due to slow release of toxic PH3 gas, which was detected by positive silver nitrate paper test. The rise in PRA was directly proportional to the dose of pesticide consumed. There was direct relationship of mortality with increased PRA. Angiotensin converting enzyme inhibitors may have a role in combating shock in AIp poisoning.

Implantation of fetal thymus and sympathetic ganglion within the anterior eye chamber in mice, to study neuro-immune interaction in thymic development

In this study 13- to 14-day fetal thymic lobes were implanted within the anterior eye chambers in mice either with or without a syngeneic newborn sympathetic ganglion. It was observed after 6 weeks of implantation that the thymic lobes that grew with the ganglia had fewer lymphoid cells than their counterparts which were grown without the ganglia. The cells that developed within the thymic lobes were Thy-1- and peanut agglutinin-positive. The thymic lobes that grew with sympathetic ganglia also showed the presence of adrenergic nerves, perhaps due to reinnervation of the thymic grafts from the ganglia.

Unknown syndrome: congenital heart disease, ptosis, hypodontia, and craniosynostosis

We report a child with total anomalous pulmonary venous drainage, ptosis, hypoplastic teeth, sagittal craniosynostosis, and developmental delay, together with several unusual features.

Recurrence risks for common complications of pregnancy--a review

A review of the literature concerning the more common complications of pregnancy indicates that recurrence risks are available for most and can be summarized as follows: hydatidiform mole--1.3 to 2.9 per cent; recurrent miscarriage--20 to 30 per cent; ectopic pregnancy--20 to 30 per cent; severe preeclampsia--7.5 per cent; mild preeclampsia--29 per cent; preterm labor--15 per cent after one and 30 per cent after two. While recognizing that each individual case merits full investigation and careful assessment, it is proposed that these risk figures provide a useful basis for use in pre- and postpregnancy counseling.

Behaviour disorder in monosomy 10qter

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Changing demography of trisomy 18

The incidence of trisomy 18 in Leicestershire during the years 1980-85 inclusive was one in 3086 births. Eleven of the 21 babies born with trisomy 18 in this period were delivered by caesarean section. Median and mean periods of survival were 2.5 and 22 days, respectively.

Parasympathetic innervation of the thymus: a histochemical and immunocytochemical study

The presence of parasympathetic nerve supply to the thymus has been demonstrated by histochemical and immunocytochemical methods using antibodies against cholineacetyl transferase. Fine nerve fibres have been observed both in the thymic parenchyma and around the blood vessels. The role of the parasympathetic nerve supply to the thymus is briefly discussed.

Trisomy 18 in a 13 year old girl

A 13 year old girl with trisomy 18 is described. She showed profound mental and growth retardation, severe kyphoscoliosis, and unusual ocular features including discontinuous eyebrows, distichiasis, and blue sclerae.