Overview of natural antiplasmodials from the last decade to inspire medicinal chemistry

BACKGROUND

Despite the major advances in the fight against this parasitic disease, malaria remains a major cause of concerns in 2020. This infection, mainly due to Plasmodium falciparum, causes every year more than 200 million of cases and hundreds of thousands of deaths in developing regions, mostly in Africa. The last statistics show an increase of cases for the third consecutive year, from 211 million in 2015, it has reached 229 million in 2019. This trend could be partially explained by the appearance of resistances to all the used antimalarials, even to artemisinin. Thus, the design of new anti-Plasmodium compounds is an urgent need. For thousands of years, nature has offered to humans the medicines to cure their diseases or the inspiration for development of new active principles. It seems then logical to explore the natural sources to find new molecules to treat this parasitosis.

METHOD

Therefore, this review reports and analyzes the extracts (plants, bacteria, sponges, fungi) and the corresponding isolated compounds showing antiplasmodial properties between 2013 and 2019.

RESULTS & CONCLUSION

Nature remains a major source of active compounds. Indeed, 648 molecules from various origins, mostly plants, have been reported for their inhibitory effect on Plasmodium falciparum. Among them, 188 scaffolds were defined as highly active with IC50 ≤ 5 µM and have been reported here in details. Moreover, the most active compounds showed a large variety of structures: flavonoids, triterpenes, alkaloids... Therefore, these compounds could be an interesting source of inspiration for medicinal chemists. May-be several of these molecules should become the next leads for malaria treatment.

CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

Objective:

Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection.

Methods:

We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed.

Results:

There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait.

Conclusion:

Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study.