Circadian pharmacology of L-alanosine (SDX-102) in mice

L-alanosine (SDX-102) exerts its cytotoxicity through inhibition of de novo purine biosynthesis, an effect potentiated by methylthioadenosine phosphorylase (MTAP) deficiency. The relevance of circadian dosing time was investigated for chronotherapeutic optimization of SDX-102. Toxicity was assessed in healthy mice following single (1,150, 1,650, or 1,850 mg/kg/d) or multiple doses (250 or 270 mg/kg/d). Efficacy was tested in mice with P388 leukemia receiving multiple doses (225 or 250 mg/kg/d). SDX-102 was administered at six circadian times 4 hours apart in mice synchronized with 12 hours of light alternating with 12 hours of darkness. MTAP expression was determined in liver, bone marrow, small intestinal mucosa, and P388 cells. Dosing at 19 hours after light onset reduced lethality 5-fold after single administration and 3-fold after multiple doses as compared with worst time [P < 0.001 and P < 0.01, respectively (chi2 test)]. Neutropenia, lymphopenia, and bone marrow hemorrhagic lesions were significantly less in mice dosed at 19 hours after light onset as compared with 7 hours after light onset. SDX-102 at 7 hours after light onset transiently ablated the 24-hour patterns in body temperature and activity. A circadian rhythm characterized small intestinal MTAP expression with a maximum at 6:30 hours after light onset (P = 0.04). A minor survival improvement was found in MTAP-deficient P388 mice receiving SDX-102 at 7 or 23 hours after light onset as compared with other times (P = 0.03, log-rank test). In conclusion, the therapeutic index of SDX-102 was improved by the delivery of SDX-102 in the mid to late activity span. These results support the concept of chronomodulated infusion of SDX-102 in cancer patients.     

Mechanism of staphylococcal multiresistance plasmid replication origin assembly by the RepA protein

The staphylococcal multiresistance plasmids are key contributors to the alarming rise in bacterial multidrug resistance. A conserved replication initiator, RepA, encoded on these plasmids is essential for their propagation. RepA proteins consist of flexibly linked N-terminal (NTD) and C-terminal (CTD) domains. Despite their essential role in replication, the molecular basis for RepA function is unknown. Here we describe a complete structural and functional dissection of RepA proteins. Unexpectedly, both the RepA NTD and CTD show similarity to the corresponding domains of the bacterial primosome protein, DnaD. Although the RepA and DnaD NTD both contain winged helix-turn-helices, the DnaD NTD self-assembles into large scaffolds whereas the tetrameric RepA NTD binds DNA iterons using a newly described DNA binding mode. Strikingly, structural and atomic force microscopy data reveal that the NTD tetramer mediates DNA bridging, suggesting a molecular mechanism for origin handcuffing. Finally, data show that the RepA CTD interacts with the host DnaG primase, which binds the replicative helicase. Thus, these combined data reveal the molecular mechanism by which RepA mediates the specific replicon assembly of staphylococcal multiresistant plasmids.The emergence of multidrug-resistant bacteria is a mounting global health crisis. In particular, multidrug-resistant Staphylococcus aureus is a major cause of nosocomial and community-acquired infections and is resistant to most antibiotics commonly used for patient treatment (1). Hospital intensive care units in many countries, including the United States, now report methicillin-resistant S. aureus infection rates exceeding 50% (2, 3). Antibiotic resistance in contemporary infectious S. aureus strains, such as in hospitals, is often encoded by plasmids that can be transmitted between strains via horizontal DNA transfer mechanisms. These plasmids are typically classified as small (<5 kb) multicopy plasmids, which usually encode only a single resistance gene; medium-sized (8–40 kb) multirestance plasmids that confer resistance to multiple antibiotics, disinfectants, and/or heavy metals; and large (>40 kb) conjugative multiresistance plasmids that additionally encode a conjugative DNA transfer mechanism (4–6). Importantly, sequence analyses have shown that most staphylococcal conjugative and nonconjugative multiresistance plasmids encode a highly conserved replication initiation protein, denoted RepA_N (5–15). RepA_N proteins are also encoded by plasmids from other Gram-positive bacteria as well as by some phage, underscoring their ubiquitous nature (10). These RepA proteins are essential for replication of multiresistance plasmids, and hence plasmid carriage and dissemination, yet the mechanisms by which these proteins function in replication are currently unknown.The DNA replication cycle can be divided into three stages: initiation, elongation, and termination. Replication initiation proteins (RepA) mediate the crucial first step of initiation. Bacterial chromosome replication is initiated by the chromosomal replication initiator protein, DnaA, which binds the origin and recruits the replication components known as the primosome (16). In Gram-negative bacteria the primosome includes DnaG primase, the replicative helicase (DnaB), and DnaC (17). Replication initiation in Gram-positive bacteria involves DnaG primase and helicase (DnaC) and the proteins DnaD, DnaI, and DnaB (18–22). DnaD binds first to DnaA at the origin. This is followed by binding of DnaI/DnaB and DnaG, which together recruit the replicative helicase (23, 24). Instead of DnaA, plasmids encode and use their own specific replication initiator binding protein. Structures are only available for RepA proteins (F, R6K, and pPS10 Rep) harbored in Gram-negative bacteria. These proteins contain winged helix-turn-helix (winged HTH) domains and bind iteron DNA as monomers to, in some still unclear manner, drive replicon assembly (25–27).Replication mechanisms used by plasmids harbored in Gram-positive bacteria are less well understood and are distinct from their Gram-negative counterparts. Indeed, most plasmid RepA proteins in Gram-negative and Gram-positive bacteria show no sequence homology and seem to be unrelated. The multiresistance RepA proteins are arguably among the most abundant of plasmid Rep proteins, yet how they function is not known. Data suggest that these proteins are composed of three main regions: an N-terminal domain (NTD) consisting of ∼120 aa, a long and variable linker region (∼30–50 residues), and a C-terminal domain (CTD) of ∼120 residues (28–31). The NTD and CTD are both essential for replication. The NTD exhibits the highest level of sequence conservation, which has resulted in the designation of plasmids that encode these proteins as the RepA_N replicon family (10). Although not as well conserved as the NTD, RepA CTD regions show homology between plasmids found in genus-specific clusters, suggesting that this domain may perform a host-specific role (28–32). Although the function of the RepA CTD remains enigmatic, recent studies have indicated that the NTD mediates DNA binding and interacts with iterons that reside within the plasmid origin (30). The essential roles played by RepA proteins in multiresistance plasmid retention marks them as attractive targets for the development of specific chemotherapeutics. However, the successful design of such compounds necessitates structural and mechanistic insight. Here, we describe a detailed dissection of the RepA proteins from the multiresistance plasmids pSK41 and pTZ2126. The combined data reveal the molecular underpinnings of a minimalist replication assembly mediated by multiresistance RepA proteins.     

Continuous normothermic blood cardioplegia: Initial experience

The concept of continuous normothermic blood cardioplegia has been developed on the principles of electromechanical arrest and normothermic aerobic perfusion. This method appears to be a safer alternative to current methods of hypothermic myocardial protection. We report our experience with the use of continuous normothermic blood cardioplegia in twenty patients who underwent cardiac surgery. The analysis of results included cardiopulmonary bypass events, potassium kinetics, recovery rhythm, need for cardioversion and inotropes, and reperfusion time. From the initial results, it appears that the technique of normothermic cardioplegia is reproducible and safe. Its advantage lies in the shorter reperfusion periods and it has a potential to become the first choice method of myocardial protection in procedures involving long cross-clamp periods.     

Selective Inhibition of PTP1B by Vitalboside A from Syzygium cumini Enhances Insulin Sensitivity and Attenuates Lipid Accumulation Via Partial Agonism to PPARγ: In Vitro and In Silico Investigation

Although antidiabetic drugs show good insulin‐sensitizing property for T2DM, they also exhibit undesirable side‐effects. Partial peroxisome proliferator‐activated receptor γ agonism with protein tyrosine phosphatase 1B inhibition is considered as an alternative therapeutic approach toward the development of a safe insulin sensitizer. Bioactivity‐based fractionation and purification of Syzygium cumini seeds led to the isolation and identification of bifunctional Vitalboside A, which showed antidiabetic and anti‐adipogenic activities, as measured by glucose uptake in L6 and 3T3‐L1 adipocytes and Nile red assay. A non‐competitive allosteric inhibition of protein tyrosine phosphatase 1B by Vitalboside A was observed, which was confirmed by docking studies. Inhibitor studies with wortmannin and genistein showed an IRTK‐ and PI3K‐dependent glucose uptake. A PI3K/AKT‐dependent activation of GLUT4 translocation and an inactivation of GSK3β were observed, confirming its insulin‐sensitizing potential. Vitalboside A exhibited partial transactivation of peroxisome proliferator‐activated receptor γ with an increase in adiponectin secretion, which was confirmed using docking analysis. Vitalboside A is a bifunctional molecule derived from edible plant showing inhibition of PTP1B and partial agonism to peroxisome proliferator‐activated receptor γ which could be a promising therapeutic agent in the management of obesity and diabetes.     

Bayesian modelling of lung function data from multiple‐breath washout tests

Paediatric respiratory researchers have widely adopted the multiple‐breath washout (MBW) test because it allows assessment of lung function in unsedated infants and is well suited to longitudinal studies of lung development and disease. However, a substantial proportion of MBW tests in infants fail current acceptability criteria. We hypothesised that a model‐based approach to analysing the data, in place of traditional simple empirical summaries, would enable more efficient use of these tests. We therefore developed a novel statistical model for infant MBW data and applied it to 1197 tests from 432 individuals from a large birth cohort study. We focus on Bayesian estimation of the lung clearance index, the most commonly used summary of lung function from MBW tests. Our results show that the model provides an excellent fit to the data and shed further light on statistical properties of the standard empirical approach. Furthermore, the modelling approach enables the lung clearance index to be estimated by using tests with different degrees of completeness, something not possible with the standard approach. Our model therefore allows previously unused data to be used rather than discarded, as well as routine use of shorter tests without significant loss of precision. Beyond our specific application, our work illustrates a number of important aspects of Bayesian modelling in practice, such as the importance of hierarchical specifications to account for repeated measurements and the value of model checking via posterior predictive distributions.     

Laser: The torch of freedom for ankyloglossia

The tongue is an important oral structure that affects speech, position of teeth, periodontal tissues, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia or tongue-tie, is a congenital anomaly characterized by an abnormally short lingual frenulum, which restricts mobility of the tongue. Though the ankyloglossia is not a serious condition, it may lead to a host of problems including infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. Hence, management of ankyloglossia should be considered at any age considering the risk-benefit evaluation. Tongue being highly vascular and mobile structure, laser-assisted lingual frenectomy is the simplest, safest and less traumatic of all the treatment modalities available, with most promising results in minimally invasive dentistry. Here, a case of ankyloglossia is reported with its management by diode laser.KEY WORDS: Ankyloglossia, diode laser, lingual frenectomy, tongue-tie