Synthesis, in vitro cytotoxic activity and molecular docking study of Androstene and Estrone Derivatives

The development and discovery of steroidal drugs to cure cervical cancer is of the most important. The Claisen condensation of androstene and estrone with aromatic aldehydes was catalyzed by potassium tert. butoxide in tert. butanol to give the corresponding 2-arylidene and 16-arylidene estrone. Subsequently, the 16-arylidene estrone reacted with acid chloride in presence of quaternary amine in halogenated solvent resulting in the steroidal arylidene derivatives. Synthesis, Characterization and in vitro cytotoxic activity of arylidenes are rationalized. Fifteen compounds are synthesized and six of them were evaluated for cytotoxic activity against cervical cancer cell line. HT-3 cell line examination revealed a considerable growth inhibition. Compounds 4a, 4b, 6b, 8c, and 8d, which are estrone-based arylidenes, are the most potent of the series, with IC₅₀ value of 7.15, 10.76, 6.37, 3.56, and 1.55 µM/ml against HT-3 cell line. In addition, molecular docking studies were performed for the steroidal arylidenes to elucidate the binding interactions. Compound 4a, 4b, 6b, 8c and 8d showed excellent binding energy. Docking studies agreed well with in vitro studies. The end result offers an alternative approach to develop steroidal arylidenes that are more effective and are based on estrone, leading to the development of novel anticancer agents.

Anterior Interosseous Nerve to Ulnar Nerve Transfer: A systematic review

Background

Objectives

Methods

Results

Conclusion

0731 Obstructive Sleep Apnea with Predominant Respiratory Effort Related Arousals: Theta Power in C3- M2 And C4-M1 Derivation Comparison in Male And Female

Introduction

Theta power in electroencephalography has been studied as a correlate to REM sleep. An increase in theta power during REM sleep has been observed in patients during recovery sleep after sleep deprivation. Emotional memories appear to be processed and consolidated during REM sleep.The role of hippocampal theta wave activity during REM sleep on emotional memory processing is limited. The importance of theta power has not been well characterized in patients with obstructive sleep apnea (OSA) with predominant respiratory Effort Related Arousals (RERAs). This report aims to study the theta power in patients with OSA with predominant Respiratory Effort Related Arousals (RERAs) with an apnea-hypopnea index (AHI) of < 5.

Methods

We have identified 38 patients with baseline polysomnograms performed from December 2019 to July 2019 with AHI < 5 and a Respiratory Disturbance Index (RDI) of at least 5 or greater. Patients with chronic hypoxemic respiratory failure, hypoventilation and predominant central sleep apnea were excluded from the study. Total power of frequency in bands was obtained for theta waves (4-8 Hz) and total waves (1-30 Hz). Relative theta power was calculated on the last REM sleep using C3-M2 and C4-M1 derivations. Paired two-tailed t-Test was performed on the theta power in C3-M2 and C4-M1 in both the sexes.

Results

Initial analysis was performed in 38 patients out of which 20 were male and 18 female. Among males, (Mean ± SEM) age was 52.3 (±2.9); Epworth Sleepiness Scale (ESS) of 6.6 (±1.1), AHI of 2.1 (±0.3), and RDI of 7.3 (±0.3).Whereas in female (Mean ± SEM) age was 46.8 (± 2.8), ESS of 7.7 (±1.4), AHI of 2.3 (±0.35), and RDI of 6.9 (±0.4). Statistically significant difference was noted in the theta power between the C3-M2 and C4-M1 derivations with P value of 0.03 and 0.04 in male and female respectively. However, no significant difference was found when C3-M2 and C4 -M1 was compared between male and female. Further, statistical analysis will be performed after gathering data from a larger sample size.

Conclusion

There was significant difference between C3-M2 and C4-M1;overall no difference was found between sexes.

Support

none

0802 To Examine the Effect of Gabapentin Enacarbil in Primary Restless Legs Syndrome Patients Who are on Dopaminergic Agents and Exhibiting Augmentation

Introduction

Augmentation is defined as worsening of the symptoms of Restless Legs Syndrome after a brief period of initial improvement with dopaminergic agents resulting in either an earlier onset, increase in severity, quicker onset, spread to other body parts. The exact prevalence of this phenomenon is not known and in patients experiencing augmentation, it can pose a difficult diagnostic and therapeutic challenge to the clinician. In our study, we found extended-release gabapentin to be an effective intervention in patients experiencing dopaminergic augmentation

Methods

This is an open-label single-arm study done in patients exhibiting augmentation while on dopaminergic agents. Patients who were enrolled in the study were initiated on oral extended-release gabapentin(Horizont) 600 mg at 5 pm at the beginning of the study. At day 90, attempts were made to reduce or discontinue dopaminergic agents. International Restless Legs Syndrome-Rating Scale (IRLS) and Augmentation Severity Rating Scale(ASRS) were recorded at each visit.

Results

A total of 10 patients were enrolled in the study while only 8 patients completed it. Compared to the baseline (visit 2), there is a significant improvement in both the augmentation severity(p= 0.0131) and the IRLS (p=0.0497). Wilcoxon matched-pairs signed rank test was used for statistical analysis.

Conclusion

Extended-release Gabapentin is an effective treatment option in primary RLS patients experiencing augmentation secondary to dopaminergic medication usage.

Support

The study is funded and medication is provided by Arbor Pharmaceuticals.

0619 To Rely or No to Rely: Understanding the Demographics and Polysomnographic Features of False Negative Home Sleep Apnea Testing

Introduction

The current gold standard for a definitive diagnosis of OSA is an in-center Polysomnography (PSG). Home Sleep Apnea Testing(HSAT) has become an important tool in identifying high-risk populations. One of the limitations of the study is the lack of Electroencephalographic (EEG) data. This prevents the inclusion of Respiratory Effort Related Arousals (RERAs). We attempted to identify the patients whose HSAT showed an REI of less than 5 but are at risk for having sleep apnea based on the presence of airflow and thoraco-abdominal fluctuations.

Methods

Patients in this study were those that underwent HSAT from September 2016 till June of 2019. The studies reviewed and interpreted by board certified Sleep Specialists. Studies were done using nox-T3 sleep monitor and Nomad portable Home Sleep Testing type III devices-Both are type 3 Portable Monitors. Only those patients whose REI in their HSAT less than 5 were included in this study. All these patients had multiple airflow fluctuations in their HSAT that raised the suspicion for the presence of RERAs. None of these patients had significant hypoxemia in the HSAT.Airflow fluctuations were defined by the presence of fluctuations in the signal in the airflow channel along with increasing thoracoabdominal channels. Those patients with REI of less than 5 and without airflow fluctuations were excluded from the study.

Results

A total of 178 patients were recommended to undergo an in-center polysomnogram. Of those, 92 patients completed their polysomnogram with 59 patients ending up with a diagnosis of sleep apnea while 33 did not suggesting a false negative rate of 64.13%. Of those who were positive, 39 were females while 20 were males. Both groups did not differ significantly. Females had a median BMI of 32.9(28.19 for males), a median ESS of 11(8 in males) and a median RDI of 14.8(13.25).

Conclusion

Our study shows that both Home Sleep apnea testing can have a high proportion of false-negative results in patients exhibiting thoraco-abdominal and airflow fluctuations. The interpreting physicians should understand the limitations of the HSAT and should have a low threshold to recommend an in-center polysomnogram.

Support

None.

Compensatory sleep response to 12 h wakefulness in young and old rats

There is a pronounced decline in sleep with age. Diminished output from the circadian oscillator, the suprachiasmatic nucleus, might play a role, because there is a decrease in the amplitude of the day-night sleep rhythm in the elderly. However, sleep is also regulated by homeostatic mechanisms that build sleep drive during wakefulness, and a decline in these mechanisms could also decrease sleep. Because this question has never been addressed in old animals, the present study examined the effects of 12 h wakefulness on compensatory sleep response in young (3.5 mo) and old (21.5 mo) Sprague-Dawley and F344 rats. Old rats in both strains had a diminished compensatory increase in slow-wave sleep (SWS) after 12 h of wakefulness (0700-1900, light-on period) compared with the young rats. In contrast, compensatory REM sleep rebound was unaffected by age. To assess whether the reduced SWS rebound in old rats might result from loss of neurons implicated in sleep generation, we counted the number of c-Fos immunoreactive (c-Fos-ir) cells in the ventral lateral preoptic (VLPO) area and found no differences between young and old rats. These findings indicate that old rats, similar to elderly humans, demonstrate less sleep after prolonged wakefulness. The findings also indicate that although old rats have a decline in sleep, this cannot be attributed to loss of VLPO neurons implicated in sleep.

Role of adenosine in behavioral state modulation: a microdialysis study in the freely moving cat

There is considerable evidence to suggest that the activity of forebrain and mesopontine cholinergic neurons is intimately involved in electroencephalographic arousal. Furthermore, our previous in vitro investigation suggested that both cholinergic systems are under a powerful tonic inhibitory control by endogenous adenosine. We thus examined the in vivo effect, on electrographically defined behavioral states, of microdialysis perfusion of adenosine into the cholinergic zones of the substantia innominata of the basal forebrain and the laterodorsal tegmental nucleus of freely moving cats. Localized perfusion of adenosine into either the basal forebrain or the laterodorsal tegmental nucleus caused a marked alteration in sleep-wake architecture. Adenosine (300 microM) perfused into either the basal forebrain or laterodorsal tegmental nucleus produced a dramatic decrease in waking, to about 50% of the basal level. Perfusion into the basal forebrain resulted in a significant increase in rapid eye movement sleep, while slow wave sleep was unchanged. In contrast, adenosine perfusion into the laterodorsal tegmental nucleus produced an increase of both slow wave sleep and rapid eye movement sleep, the magnitude of which were proportional to the decrease in waking. Electroencephalographic power spectral analysis showed that adenosine perfusion into the basal forebrain increased the relative power in the delta frequency band, whereas higher frequency bands (theta, alpha, beta and gamma) showed a decrease. These data strongly support the hypothesis that adenosine might play a key role as an endogenous modulator of wakefulness and sleep. The decrease in wakefulness may be directly related to the inhibition of cholinergic neurons of the basal forebrain and the laterodorsal tegmentum. The increase in rapid eye movement sleep is a novel but robust effect whose origin, at present, is uncertain. The observation that local perfusion of adenosine into either the basal forebrain or the laterodorsal tegmental nucleus dramatically decreases wakefulness suggests that these areas might represent a major site of action of the xanthine stimulants (adenosine antagonists) found in coffee and tea.

Chronic low-amplitude electrical stimulation of the laterodorsal tegmental nucleus of freely moving cats increases REM sleep

While cholinergic stimulation of the PRF evokes a REM-like state, electrical stimulation of LDT/PPT neurons has not been used to test the hypothesis of mesopontine cholinergic control of REM sleep. Adult cats were implanted for electrographic recording and with bipolar unilateral stimulating electrodes, either in the LDT or within the PRF (stimulation control). Baseline recordings of the normal sleep-wake cycle were carried out for 5 h. On the next day, continuous stimulation of the LDT or mPRF was carried out during the same time period (0.5 ms pulses, 1 microA, 8 Hz) and with post-stimulation recording for 3 h. A second baseline recording day followed with same protocol as the first baseline day. This 3-day sequence, separated by 3 days, was repeated three times in each of the three LDT and the three medial PRF cats. Five hours of chronic low-amplitude stimulation of the LDT induced a highly significant increase in total REM and in the duration of REM sleep bouts. Stimulation of the mPRF did not affect any of the behavioral states. This study, the first to our knowledge to use low-amplitude stimulation of LDT in freely moving cats, indicates the importance of mesopontine cholinergic neurons in REM sleep.

Microdialysis perfusion of 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) in the dorsal raphe nucleus decreases serotonin release and increases rapid eye movement sleep in the freely moving cat

In vivo microdialysis was used to analyze the role of dorsal raphe nucleus (DRN) neurons in regulating the sleep-waking cycle. Measurements of extracellular serotonin (5-HT) were made in the DRN of freely moving adult cats before and during microdialysis perfusion of 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a selective 5-HT1A receptor agonist, in artificial CSF. Behavioral state alterations were measured by simultaneous polygraphic recordings. During waking and artificial CSF perfusion of probes histologically localized to the DRN, extracellular 5-HT was 4 fmol/7.5 micro L dialysate sample. With the addition of 8-OH-DPAT (10 microM in artificial CSF) to the perfusate, 5-HT levels in the same state decreased 50%, to 2 fmol/sample (p < 0.01), presumably through 5-HT1A autoreceptor-mediated inhibition of serotonergic neural activity. Concomitantly, this 8-OH-DPAT perfusion produced a short latency, threefold increase in rapid eye movement (REM) sleep, from 10 to 30% of the total recorded time (p < 0.05), whereas waking was not significantly affected. In contrast, and suggesting DRN specificity, 8-OH-DPAT delivery through a probe in the aqueduct did not increase REM sleep but rather tended to increase waking and decrease slow wave sleep. The data on REM sleep provide the first biochemically validated and direct evidence that suppression of DRN serotonergic activity increases REM sleep, and furnish a key complement to our laboratory's in vitro data indicating that mesopontine cholinergic neurons, a target of DRN projections, are inhibited by 5-HT. The 8-OH-DPAT-induced reduction of DRN 5-HT is consistent with the hypothesis that the concomitant REM sleep disinhibition is mediated by DRN serotonergic projections to mesopontine cholinergic neurons, which other data implicate in REM sleep production.

Effect of rapid eye movement sleep deprivation on 5'-nucleotidase activity in the rat brain

Adenosine has been implicated in the regulation of rapid eye movement sleep (REMS). In an attempt to understand the mechanism of production of adenosine in relation to REMS it was hypothesized that should it be involved in REMS, the latter's deprivation is likely to affect its synthetic machinery. Hence, male albino rats were deprived of REMS by the flower pot technique and the activity of 5'-nucleotidase, an enzyme responsible for adenosine synthesis, was estimated in the cerebrum, cerebellum and brain stem. Suitable control experiments were conducted to rule out the non-specific effects. The results showed that 5'-nucleotidase activity decreased only after 4 days deprivation and in the cerebrum only; while short-term (2 days) deprivation did not affect the enzyme activity in any of the brain areas. The altered enzyme activity returned to baseline level after recovery from REMS deprivation. The results from other control experiments suggested that the effects were primarily due to REMS deprivation and not due to non-specific factors. It is proposed that if adenosine is involved in REMS, its production is unlikely to depend on 5'-nucleotidase or it may account primarily for EEG desynchronization.

Rapid eye movement sleep deprivation decreases membrane fluidity in the rat brain

In this study we examined the effects of rapid eye movement sleep (REMS) deprivation on synaptosomal and microsomal membrane fluidity by studying 1,6-diphenyl-1,3,5-hexatriene (DPH) fluorescence polarization in control as well as REMS-deprived rats. The flower pot technique was used to perform 24, 48 and 96 h REMS deprivation. Suitable control experiments were carried out to rule out the nonspecific effects. The results showed that DPH fluorescence polarization increased both in the microsome as well as in the synaptosome in REMS-deprived animals, except in the cerebellum, indicating that there was a generalized decrease in membrane fluidity in the rat brain. The alterations in membrane fluidity returned to baseline upon recovery from REMS deprivation. Control experiments suggested that the alterations were primarily caused by REMS deprivation and not due to nonspecific effects. This finding supports REMS deprivation induced other changes reported earlier. This increase in membrane rigidity could be at least one of the possibilities for REMS loss induced alterations in physiological phenomena including membrane bound enzyme activities and receptor densities.

Rapid eye movement sleep-deprivation-induced changes in glucose metabolic enzymes in rat brain

Glucose metabolism and energy expenditure are altered during rapid eye movement (REM) sleep. To understand this mechanism, it was hypothesized that the enzymes involved in the metabolism of glucose, viz. hexokinase and glucose-6-phosphatase, are affected by REM sleep deprivation. The flower pot technique was used for 1-, 2- and 4-day periods of REM sleep deprivation. Suitable control experiments were carried out to rule out the nonspecific effects. The results showed that glucose-6-phosphatase was first to be affected, and it showed decreased activity. In longer periods of deprivation, there was an increase in hexokinase activity. Both the altered enzyme activities returned to baseline level on recovery from REM sleep deprivation. Control experiments suggest that alterations were primarily caused by REM sleep deprivation, not nonspecific effects.

Vasoactive intestinal peptide enhances lung preservation

The outcome of lung transplantation is often dependent on the quality of the donor lungs. To explore a way to improve lung preservation, vasoactive intestinal peptide (VIP) was added to pneumoplegic solutions. The 4 solutions tested were Krebs solution, Krebs solution with VIP, University of Wisconsin solution, and the University of Wisconsin solution with VIP. The lungs of 8 male Sprague-Dawley rats were flushed and stored in these solutions for 24 hr. At regular intervals, tissue was sampled and examined by light, scanning, and transmission electron microscopy. Casts of the vasculature were made after 4 hr and viewed by a scanning electron microscope. Lungs appeared well preserved by light microscopy at all intervals. Although inflammatory cells around arteries, arterial constriction, bronchiolar epithelial detachment, peribronchiolar edema, and alveolar size inhomogeneity were greater with time, there was no significant difference among the 4 groups by light microscopy. Scanning microscopy of tissue at 24 hr confirmed the information found on light microscopy but did not allow separation of the groups. The vascular casts showed that edema around large vessels was less in the lungs treated with VIP (P < 0.01). Transmission electron microscopy showed that lungs stored in the solutions with VIP had significantly more normal-shaped mitochondria, less mitochondrial edema, less distortion of mitochondrial cristae, thinner basal lamina, and less aggregation of nuclear chromatin at most intervals sampled after 4 hr. We conclude that VIP added to certain pneumoplegic solutions improves the ultrastructure of rat lung stored in the cold for up to 24 hr. VIP may be an important additive to pneumoplegic solutions to improve preservation of lung before transplantation.

Effect of rapid eye movement sleep deprivation on rat brain monoamine oxidases

Monoamine oxidase, monoamine oxidase-A, and monoamine oxidase-B activities were compared in free moving, rapid eye movement sleep-deprived, recovered, and control rat brains. The activities were estimated in the whole brain, cerebrum, cerebellum, whole brainstem, medulla, pons, and midbrain. The flowerpot method was used for continuing deprivation for one, two, or four days. Monoamine oxidase activity decreased significantly in the cerebrum and the cerebellum of the sleep-deprived rats, whereas monoamine oxidase-A and monoamine oxidase-B were differentially affected. Medullary MAO-A was the first to be affected, showing an increase after just one day of rapid eye movement sleep deprivation, while longer deprivation decreased its activity. The activity of monoamine oxidase-B was not significantly affected in any brain areas of the deprived rats until after two days of rapid eye movement sleep deprivation. All the altered enzyme activities returned to control levels after recovery. Control experiments suggest that the decrease was primarily caused by the rapid eye movement sleep deprivation and was not due to nonspecific effects. These findings are consistent with past studies and may help to explain earlier observations. The results support the involvement of aminergic mechanisms in rapid eye movement sleep. The plausible reasons for the changes in the activities of monoamine oxidases, after rapid eye movement sleep deprivation, are discussed.

Effect of REM sleep deprivation on molecular forms of acetylcholinesterase in rats

Since REM sleep deprivation was reported to increase the activity of acetylcholinesterase, an attempt was made to investigate whether the different forms of enzyme could be affected selectively. The flower pot method was used for deprivation and suitable control experiments were conducted. The bound and the soluble forms, if affected would show an increase or a decrease, respectively, on REM deprivation. The former is affected first in the pons while the latter in the medulla. The findings support the pontomedullary cholinergic mechanism for the generation of REM sleep. Though there may be a possibility of conversion of the free to the bound form, the increase in the latter was more than the decrease in the former.

Short-term REM sleep deprivation increases acetylcholinesterase activity in the medulla of rats

Involvement of cholinergic ponto-medullary brainstem mechanism regulating rapid eye movement (REM) sleep is known. Recently it was found that though short term REM deprivation influenced brainstem neuronal excitability, the activity of the brainstem acetylcholinesterase was not affected until after 96 h deprivation. Therefore, it was hypothesized that short-term REM deprivation might influence acetylcholinesterase in a restricted brainstem region. Results of this study show that the enzyme activity increased only in the medulla after 24 and 48 h REM deprivation. The flower pot technique was used for depriving the experimental rats of REM sleep. Suitable control experiments were conducted to rule out the possibility of non-specific effects. Thus, the medullary cholinergic mechanism probably is more important for REM.

Effect of REM sleep deprivation on rat brain acetylcholinesterase

Acetylcholinesterase activity was compared in control, rapid eye movement sleep-deprived and recovered rat brain. The activity was estimated in the whole brain, cerebrum, brain stem and cerebellum. Flower pot technique was used for continuing deprivation for two, four and eight days. The results showed that the enzyme activity increased significantly in the deprived rat brain and it returned to control/normal level on recovery. The enzyme activity increased first in the brain stem, while the activity in the cerebellum showed no significant change. Control experiments suggest that the increase was primarily caused by the deprivation. The finding fits well with existing knowledge and would possibly help in explaining earlier observations.