27 results on '"David DC"'
Search Results
2. The Path to Group A Streptococcus Vaccines: World Health Organization Research and Development Technology Roadmap and Preferred Product Characteristics
- Author
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David Dc Kaslow, Katherine L. O'Brien, Andrew C Steer, Jerome H. Kim, Fernando Gouvea-Reis, Jean-Louis Excler, Jonathan R. Carapetis, Pierre R. Smeesters, Chris A. Van Beneden, and Johan Vekemans
- Subjects
0301 basic medicine ,Microbiology (medical) ,Biomedical Research ,Streptococcus pyogenes ,media_common.quotation_subject ,Global Health ,World Health Organization ,World health ,03 medical and health sciences ,Strategic goal ,0302 clinical medicine ,Cost of Illness ,Streptococcal Infections ,vaccine ,Global health ,Humans ,Medicine ,030212 general & internal medicine ,Antibiotic use ,Policy Making ,media_common ,business.industry ,group A Streptococcus ,Streptococcal Vaccines ,pharyngitis ,Sciences bio-médicales et agricoles ,rheumatic heart disease ,Product characteristics ,Vaccine efficacy ,3. Good health ,Viewpoints ,030104 developmental biology ,Infectious Diseases ,Risk analysis (engineering) ,Technology roadmap ,business ,Diversity (politics) - Abstract
Group A Streptococcus (GAS) infections result in a considerable underappreciated burden of acute and chronic disease globally. A 2018 World Health Assembly resolution calls for better control and prevention. Providing guidance on global health research needs is an important World Health Organization (WHO) activity, influencing prioritization of investments. Here, the role, status, and directions in GAS vaccines research are discussed. WHO preferred product characteristics and a research and development technology roadmap, briefly presented, offer an actionable framework for vaccine development to regulatory and policy decision making, availability, and use. GAS vaccines should be considered for global prevention of the range of clinical manifestations and associated antibiotic use. Impediments related to antigen diversity, safety concerns, and the difficulty to establish vaccine efficacy against rheumatic heart disease are discussed. Demonstration of vaccine efficacy against pharyngitis and skin infections constitutes a key near-term strategic goal. Investments and collaborative partnerships to diversify and advance vaccine candidates are needed., Group A Streptococcus causes a wide spectrum of acute and chronic human disease and considerable antibiotic use. Through a consensus-building consultation process, the World Health Organization developed a vision for vaccine development, highlighting strategic targets, product preferences, and priority research/development activities.
- Published
- 2019
3. Re-examining manufacturing strategy from knowledge advantages
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David Dc Tarn and Juefan Jf Wang
- Subjects
Knowledge management ,Computer science ,business.industry ,Strategy and Management ,Knowledge economy ,05 social sciences ,Knowledge value chain ,General Decision Sciences ,Procedural knowledge ,Competitive advantage ,Empirical research ,Management of Technology and Innovation ,0502 economics and business ,Organizational learning ,Personal knowledge management ,050211 marketing ,business ,Empirical evidence ,050203 business & management - Abstract
Purpose During this current era of the knowledge economy, knowledge activities have greatly impacted manufacturing activities, with knowledge being treated as a critical factor that creates and sustains competitive advantages. Past studies tended to relate knowledge works with organizational tasks and assumed that knowledge workers implement those tasks to achieve organizational goals. Accordingly, the purpose of this paper is to employ the perspective of task domain as the basis to clarify the impact of manufacturing task domains on the manufacturing strategy, as well as the mediating effects of knowledge advantage on such an impact. Design/methodology/approach The authors follow Becerra-Fernandez and Sabherwal’s (2001) task which focus/task breadth dichotomy as the basis to define market-based task domains, employs Leonard-Barton’s (1995) T-shaped skill as the theoretical base to construct knowledge advantages, i.e., knowledge depth (I-shaped skill), diversity (hyphened skill), and convergence (T-shaped skill), and uses the conventional typology to measure the manufacturing strategy (i.e. cost, quality, flexibility, and delivery). The empirical study is conducted via a questionnaire survey and selects Taiwan’s top 600 manufacturers as the population and accordingly collects 131 effective observations. Findings The empirical evidence indicates that firms’ priorities on cost and delivery are positively caused by the focus orientation of the tasks, while their priorities on quality and flexibility are positively caused by both focus and diversity orientations of the tasks. The results also signify that knowledge advantages perform complete mediation on the previous relationships. In more detail, knowledge depth presents mediation on focus orientation, and knowledge convergence exhibits mediating effects both on focus and breadth orientations. The statistics point out that knowledge depth has the highest impact on the manufacturing strategy, but knowledge diversity fails to significantly explain the manufacturing strategy. Originality/value Literature assumed that knowledge activities are task-driven issue; this study hence examines knowledge advantage based on the task domain perspective to clarify the architecture and contents of knowledge advantages.
- Published
- 2017
4. The path to group A Streptococcus vaccines: WHO research and development technology roadmap and preferred product characteristics
- Author
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Vekemans, Johan, Gouvea-Reis, Fernando, Kim, Jerome H, Excler, Jean-Louis, Smeesters, Pierre, O'Brien, Katherine L, Van Beneden, Chris C.A., Steer, Andrew C, Carapetis, Jonathan Rhys, and Kaslow, David DC
- Subjects
group A Streptococcus ,vaccine ,pharyngitis ,Sciences bio-médicales et agricoles ,rheumatic heart disease - Abstract
Group A Streptococcus (GAS) infections result in a considerable under-appreciated burden of acute and chronic disease, globally. A 2018 World Health Assembly resolution calls for better control and prevention. Providing guidance on global health research needs is an important WHO activity, influencing prioritization of investments. Here, the role, status and directions in GAS vaccines research are discussed. WHO preferred product characteristics and a research and development technology roadmap, briefly presented, offer an actionable framework for vaccine development to regulatory and policy decision-making, availability and use. GAS vaccines should be considered for global prevention of the range of clinical manifestations and associated antibiotic use. Impediments related to antigen diversity, safety concerns, and the difficulty to establish vaccine efficacy against rheumatic heart disease are discussed. Demonstration of vaccine efficacy against pharyngitis and skin infections constitute key near-term strategic goals. Investments and collaborative partnerships to diversify and advance vaccine candidates are needed., SCOPUS: re.j, info:eu-repo/semantics/published
- Published
- 2019
5. The Path to Group A Streptococcus Vaccines: World Health Organization Research and Development Technology Roadmap and Preferred Product Characteristics.
- Author
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Vekemans, Johan, Gouvea-Reis, Fernando, Kim, Jerome H, Excler, Jean-Louis, Smeesters, Pierre, O'Brien, Katherine L, Van Beneden, Chris C.A., Steer, Andrew C, Carapetis, Jonathan Rhys, Kaslow, David DC, Vekemans, Johan, Gouvea-Reis, Fernando, Kim, Jerome H, Excler, Jean-Louis, Smeesters, Pierre, O'Brien, Katherine L, Van Beneden, Chris C.A., Steer, Andrew C, Carapetis, Jonathan Rhys, and Kaslow, David DC
- Abstract
Group A Streptococcus (GAS) infections result in a considerable underappreciated burden of acute and chronic disease globally. A 2018 World Health Assembly resolution calls for better control and prevention. Providing guidance on global health research needs is an important World Health Organization (WHO) activity, influencing prioritization of investments. Here, the role, status, and directions in GAS vaccines research are discussed. WHO preferred product characteristics and a research and development technology roadmap, briefly presented, offer an actionable framework for vaccine development to regulatory and policy decision making, availability, and use. GAS vaccines should be considered for global prevention of the range of clinical manifestations and associated antibiotic use. Impediments related to antigen diversity, safety concerns, and the difficulty to establish vaccine efficacy against rheumatic heart disease are discussed. Demonstration of vaccine efficacy against pharyngitis and skin infections constitutes a key near-term strategic goal. Investments and collaborative partnerships to diversify and advance vaccine candidates are needed., info:eu-repo/semantics/published
- Published
- 2019
6. Discovery and functional prioritization of Parkinson's disease candidate genes from large-scale whole exome sequencing
- Author
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Jansen, IE, Ye, H, Heetveld, S, Lechler, MC, Michels, H, Seinstra, RI, Lubbe, SJ, Drouet, V, Lesage, S, Majounie, E, Gibbs, JR, Nalls, MA, Ryten, M, Botia, JA, Vandrovcova, J, Simon-Sanchez, J, Castillo-Lizardo, M, Rizzu, P, Blauwendraat, C, Chouhan, AK, Li, Y, Yogi, P, Amin, N, van Duijn, CM, Morris, HR, Brice, A, Singleton, AB, David, DC, Nollen, EA, Jain, S, Shulman, JM, Heutink, P, Hernandez, DG, Arepalli, S, Brooks, J, Price, R, Nicolas, A, Chong, S, Cookson, MR, Dillman, A, Moore, M, Traynor, BJ, Plagnol, V, Nicholas, WW, Sheerin, UM, Jose, MB, Charlesworth, G, Gardner, M, Guerreiro, R, Trabzuni, D, Hardy, J, Sharma, M, Saad, M, Javier, S-S, Schulte, C, Corvol, JC, Dürr, A, Vidailhet, M, Sveinbjörnsdóttir, S, Barker, R, Caroline, HW-G, Ben-Shlomo, Y, Berendse, HW, van Dijk, KD, Berg, D, Brockmann, K, Wurster, I, Mätzler, W, Gasser, T, Martinez, M, de Bie, RMA, Biffi, A, and Velseboer, D
- Abstract
Background: Whole-exome sequencing (WES) has been successful in identifying genes that cause familial Parkinson's disease (PD). However, until now this approach has not been deployed to study large cohorts of unrelated participants. To discover rare PD susceptibility variants, we performed WES in 1148 unrelated cases and 503 control participants. Candidate genes were subsequently validated for functions relevant to PD based on parallel RNA-interference (RNAi) screens in human cell culture and Drosophila and C. elegans models. Results: Assuming autosomal recessive inheritance, we identify 27 genes that have homozygous or compound heterozygous loss-of-function variants in PD cases. Definitive replication and confirmation of these findings were hindered by potential heterogeneity and by the rarity of the implicated alleles. We therefore looked for potential genetic interactions with established PD mechanisms. Following RNAi-mediated knockdown, 15 of the genes modulated mitochondrial dynamics in human neuronal cultures and four candidates enhanced α-synuclein-induced neurodegeneration in Drosophila. Based on complementary analyses in independent human datasets, five functionally validated genes-GPATCH2L, UHRF1BP1L, PTPRH, ARSB, and VPS13C-also showed evidence consistent with genetic replication. Conclusions: By integrating human genetic and functional evidence, we identify several PD susceptibility gene candidates for further investigation. Our approach highlights a powerful experimental strategy with broad applicability for future studies of disorders with complex genetic etiologies.
- Published
- 2017
7. TECHNIQUE WORKSHOP: DEFENCE AGAINST A ROUNDHOUSE KICK WHILE SEATED.
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CHRISTOPHER, DAVID 'DC', WILLIAMS, MIKE, and BARDOS, DAVID
- Published
- 2018
8. An investigation into the potential use of poly(vinylphosphonic acid-co-acrylic acid) in bone tissue scaffolds
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Dey, Rebecca, GOUGH, JULIE JE, WATTS, DAVID DC, Budd, Peter, Gough, Julie, and Watts, David
- Subjects
poly(vinylphosphonic acid-co-acrylic acid) ,bone tissue engineering ,hydrogels - Abstract
Bone undergoes constant turnover throughout life and has the capacity to regenerate itself. However, the repair of critical size defects, caused by bone diseases such as osteoporosis, can be more problematic. Therefore, there is a clinical need for a bone graft substitute that can be used at sites of surgical intervention to enhance bone regeneration. Poly(vinylphosphonic acid-co-acrylic acid) (PVPA-co-AA) has recently been identified as a potential candidate for use in bone tissue scaffolds. It is hypothesised that PVPA-co-AA can mimic the action of bisphosphonates â a class of drugs used in the treatment of osteoporosis â by binding to calcium ions from bone mineral surfaces. In this way, bisphosphonates can affect bone turnover by increasing the activity of osteoblasts and reducing osteoclast activity. Although PVPA-co-AA has been shown to improve bone formation, the mechanism of action has so far not been fully elucidated. Therefore, this work aims to understand the effect of copolymer composition on the properties of PVPA-co-AA, and thus to determine its effect on osteoblast adhesion and proliferation. PVPA-co-AA copolymers have been synthesised with a range of monomer feed ratios. It was found that a VPA content of 30 mol % led to the greatest calcium binding affinity of the copolymer and is thus expected to lead to enhanced bone formation and mineralisation of the matrix produced by osteoblast cells. The release profile of PVPA-co-AA from electrospun PCL scaffolds was investigated. It was shown that all of the PVPA-co-AA was released into aqueous media within 8 h of immersion. It was also found that the calcium chelation from osteogenic differentiation media significantly increased within the first 8 h. Therefore, it was concluded that PVPA-co-AA is released from the scaffolds, where it can then bind to calcium ions from the bone mineral surface to promote mineralisation, thus acting as a mimic of non-collagenous proteins, which are present in the extracellular matrix (ECM) of bone. Hydrogels of PVPA-co-AA have been produced and the effect of monomer feed ratio (0-50 mol % VPA) on the properties of the gels was explored. It was found that an increase in VPA content led to greater hydrogel swelling and increased porosities. Hydrogels that contained 30 and 50 mol % VPA were shown to have similar morphologies to the native ECM of bone. Rheological testing showed that hydrogels with higher VPA contents were more flexible and could be deformed to a large extent without permanent deformation of their structure. An increase in osteoblast adhesion and proliferation was observed for hydrogels with 30 and 50 mol % VPA content as well as superior cell spreading. Osteoblast cell metabolic activity also increased as a function of VPA content in the hydrogels. This work indicates that hydrogels of PVPA-co-AA, with VPA contents of 30 or 50 mol %, are ideal for use as bone tissue scaffolds. Furthermore, the mechanical and cell adhesion properties of the gels can be tuned by altering the copolymer composition. Finally, composite hydrogels of PVPA-co-AA and hydroxyapatite (HA) have been produced and investigated for their ability to remove fluoride ions from groundwater. It was found that the fluoride uptake ability of PVPA-HA hydrogels was significantly enhanced when compared with HA powder alone. Furthermore, the fluoride uptake was dependent on many factors, including pH, contact time and the presence of competing ions. It was possible to regenerate the hydrogel to remove the fluoride ions, and thus it was shown that the material can be used a number of times with only a slight reduction in its fluoride uptake capacity.
- Published
- 2017
9. 'The State of Society is Awful': Poor Whites, Class, Mobility, and the Mixed-Labour Economy of New Orleans, 1820-1835
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Stallard, Matthew Robert, BROWN, DAVID DC, Zacek, Natalie, and Brown, David
- Abstract
The rapid economic development of the South Western United States transformed the city of New Orleans into a thriving commercial centre and led to unprecedented demographic growth. Highly innovative digital techniques are pioneered in this thesis and combined with a plethora of legal and governmental records and traditional qualitative primary sources to investigate for the first time the development of a white working class in 1820s and 1830s New Orleans.South and North, the antebellum period was defined by the increasing penetration of the global and national capitalistic market system into everyday life and economic activity, which created a large white waged labouring population who were unable to attain the markers of independence and mastery, such as slave ownership, property ownership, heading a household, mastering a trade, directing and controlling dependents, and exercising democratic political rights, which supposedly bound all adult white men together as equal citizens in the age of white supremacist Jacksonian Democracy.By transcribing every entry from the 1820 and 1830s censuses of the city and combining them in a unique linked database with transcriptions from the 1822 and 1832 city directories, this thesis is able to show that poor whites were decreasingly likely to exercise these rights in 1830 than in 1820, were unlikely to remain resident in New Orleans over an extended period of time, and were far more likely to perish in the city’s pestilential disease environment than the more affluent classes of society. The increasing reach of the capitalist market across continents and oceans facilitated the migration of thousands of poor whites from their economically disadvantaged homes to the sites where labour was required. Mobile networks of working class migration which spanned the Atlantic, the Caribbean, the Mississippi Valley, and the eastern United States overlapped at New Orleans, which became a major transport hub for itinerant and indigent arrivals.The alienation of poor whites from basic markers of manhood was compounded by having to acquire the necessities and pleasures of domestic life in the marketplace, denying them the private and familial life which was the cultural norm for republican men. On top of the detrimental impacts of class amongst the white population, the use of a mixed-labour system which combined various slavery arrangements with waged and indentured free black and white labour led to a situation where poor whites were forced to compete with both enslaved and free blacks for jobs, and at times be requested to work in subordination to free black workers. The use of the mixed-labour system was promoted by the property owning and slaveholding elite as it maximised their returns on profit but it simultaneously drove down remuneration for white workers. In a city with a large, affluent, and confident free black population, which included many master craftsmen, slaveholders, and property owners, poor whites found themselves in a position in which the dominant social ideologies of race were undermined. Poor whites reacted to this with violence and protest, whilst elite whites also recognised the anomalous position of the poorest and responded by doubting their commitment to racial solidarity in the summer of 1835 when southern society was tested by insurrectionary panic.
- Published
- 2017
10. Phosphonated Polymers for Nanofibrous Tissue Scaffolds
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Youle, Peter, GOUGH, JULIE JE, WATTS, DAVID DC, Gough, Julie, Watts, David, and Budd, Peter
- Abstract
This thesis, entitled “Phosphonated polymers for nanofibrous tissue scaffolds”, was written by Peter James Youle at the University of Manchester for the degree of Doctor of Philosophy and was submitted in 2016. The work contained within concerns itself with the synthesis and characterisation of phosphonated polymers intended for application as nanofibrous tissue scaffolds for improving the healing of bone; it is based on previous work performed in the University of Manchester that identified poly(ε-caprolactone) (PCL) nanofibres coated with poly(vinylphosphonic acid-co-acrylic acid) (PVPA-co-AA) as a promising material for enhancing bone healing. This thesis initially focuses on the characterisation of a commercially sourced PVPA-co-AA by defining its composition and molar mass using quantitative 31P NMR and aqueous gel permeation chromatography. A method of synthesising the copolymer by free radical polymerization, with controlled rates of monomer addition, was developed to produce PVPA-co-AA copolymers with a range of compositions. Additionally, nanofibres of PVPA-co-AA were then formed by electrospinning and crosslinked with ethylene glycol; the subsequent nanofibres were found to be water stable and retain their structure after hydration and subsequent drying. A block copolymer, polycaprolactone-b-poly(acrylic acid) (PCL-b-PAA), was synthesised by four-step ATRP and two-step NMP based approaches, with the block character of the resulting copolymer being demonstrated by GPC and dynamic light scattering. The PCL-b-PAA was subsequently used as a compatibiliser for PCL and PVPA-co-AA emulsions, which were used to create composite nanofibres by electrospinning. These nanofibre were in turn characterized by scanning electron microscopy and compared to nanofibres formed using a surfactant, Span® 80, and the original dip-coated nanofibres. Finally, a small portion of work was undertaken to develop phosphonated PCL analogues, by attempting to synthesise phosphonated ε-caprolactone monomers.
- Published
- 2017
11. The Vietnam War and the U.S. South:Regional Perspectives on a National War
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Dixon, Lee Russell, BROWN, DAVID DC, Carden-Coyne, Ana, and Brown, David
- Subjects
The Vietnam War ,The U.S. South - Abstract
The American South’s cultural distinctiveness has been a central historiographical issue debated by scholars since the first decades of the country’s inception. Implicitly or explicitly, this debate centres largely on one question – why has the South retained its distinct identity for cultural, social, political and economic exclusivity? This thesis examines southern distinctiveness with specific reference to America’s military involvement in Vietnam during the 1960s and 1970s, providing new insights upon an old question. Although a national effort, which encompassed the service over three million men, America’s 16 year involvement in their war against the communist-backed North Vietnamese Army (NVA) and Viet Minh/Vietcong (VC) forces was shaped by distinct southern influences attributed to the region’s history and culture. This thesis demonstrates that the southern influence over America’s political, economic and military theatres profoundly shaped the direction and administration of the Vietnam War. Southerners occupied crucial leadership roles throughout the Vietnam war era, including the presidency and Secretary of State, while both the Senate and the House of Representatives were led by men from South of the Mason-Dixon Line.
- Published
- 2016
12. Ebony Magazine, Lerone Bennett, Jr., and the Making and Selling of Modern Black History, 1958-1987
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West, James James, BROWN, DAVID DC, Brown, David, and Quinn, Eithne
- Subjects
Lerone Bennett ,Black Popular Culture ,Black Press ,Black History ,Ebony Magazine - Abstract
This thesis is concerned with the ways in which Ebony magazine sought to recover, popularise and utilise black history between the late 1950s and the late 1980s. The dominant scholarly approach to Ebony has focused on the magazine’s bourgeois values and visual aesthetics, and has ignored its importance as a creator and disseminator of black history. By contrast, I highlight the multiple ways in which black history became central to Ebony’s content from the late 1950s onwards. Far from viewing Ebony as peripheral to or simply reflective of popular debates into the black past, I place the magazine at the heart of contestations between the corporate, philosophical and political uses of black history during the second half of the twentieth century. In Ebony, this shift was quarterbacked by Lerone Bennett Jr., the magazine’s senior editor and in-house historian. Bennett’s emergence as a prominent black historian and intellectual, and his increased desire to present history ‘from a black perspective’, was paralleled by Ebony’s broader move from a more politicised to a more market-driven moment. Rooted in my unique position as the first scholar to look at Bennett’s unprocessed papers at Chicago State University, and one of the first researchers to examine Bennett’s collections at Emory University, this thesis sheds new light on the work of Bennett, on Ebony’s significance as a ‘history book’ for millions of readers, and on the magazine’s place at the centre of post-war debates into the form and function of African-American history.
- Published
- 2015
13. An Evaluation of Handling and Physico - Mechanical Properties of Resin-Composite Materials
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Alahdal, Khold Yahya m, WATTS, DAVID DC, CUNLIFFE, JOANNE J, Silikas, Nikolaos, Watts, David, and Cunliffe, Joanne
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Degree of conversion ,Viscosity ,Polymerization kinetics ,Mechanical properties ,Creep ,Depth of cure, mechanical properties ,Handling behaviour ,Speedmixer ,Bulk-fill ,Resin composites ,Visco-elasticity ,Consistency ,Stickiness ,Rheology - Abstract
Resin composites are the most commonly used material in restorative dentistry. They have been used initially for aesthetical reasons, but afterwards were modified to be used widely for their good aesthetic and mechanical properties performance. They are classified as visco-elastic materials which are composed of inorganic fillers and organic matrix.The aim of this study was to investigate some handling properties of uncured resin composites such as stickiness, consistency and rheology. Also, to measure the degree of conversion and creep behaviour under static loading of some resin composites.In the pre-cure stage, their handling properties are very essential to achieve a successful dental restoration. Therefore, dental practitioners are very critical in choosing the resin composite restorative material. A texture analyser was used to measure the stickiness and consistency of some commercial resin composites. Also, the rheology of different commercial and model resin composites were investigated using the Bohlin Rheometer in two different temperatures (room and body temperature).Moreover, Fourier transform infrared spectroscopy (FTIR) was used to determine the degree of conversion of several bulk-fill resin composites (DC) at 4 mm depth at different periods during 24 h post-irradiation.Also, the visco-elastic stability of cured resin composites with different resin matrices was investigated under static load at different maturation times (1 h and 24 h).
- Published
- 2015
14. A safety mechanism enables tissue-specific resistance to protein aggregation during aging in C. elegans.
- Author
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Jung R, Lechler MC, Fernandez-Villegas A, Chung CW, Jones HC, Choi YH, Thompson MA, Rödelsperger C, Röseler W, Kaminski Schierle GS, Sommer RJ, and David DC
- Subjects
- Animals, Aging, Proteasome Endopeptidase Complex, Proteostasis, Caenorhabditis elegans, Protein Aggregates
- Abstract
During aging, proteostasis capacity declines and distinct proteins become unstable and can accumulate as protein aggregates inside and outside of cells. Both in disease and during aging, proteins selectively aggregate in certain tissues and not others. Yet, tissue-specific regulation of cytoplasmic protein aggregation remains poorly understood. Surprisingly, we found that the inhibition of 3 core protein quality control systems, namely chaperones, the proteasome, and macroautophagy, leads to lower levels of age-dependent protein aggregation in Caenorhabditis elegans pharyngeal muscles, but higher levels in body-wall muscles. We describe a novel safety mechanism that selectively targets newly synthesized proteins to suppress their aggregation and associated proteotoxicity. The safety mechanism relies on macroautophagy-independent lysosomal degradation and involves several previously uncharacterized components of the intracellular pathogen response (IPR). We propose that this protective mechanism engages an anti-aggregation machinery targeting aggregating proteins for lysosomal degradation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2023
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15. Targeted protein degradation: from small molecules to complex organelles-a Keystone Symposia report.
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Cable J, Weber-Ban E, Clausen T, Walters KJ, Sharon M, Finley DJ, Gu Y, Hanna J, Feng Y, Martens S, Simonsen A, Hansen M, Zhang H, Goodwin JM, Reggio A, Chang C, Ge L, Schulman BA, Deshaies RJ, Dikic I, Harper JW, Wertz IE, Thomä NH, Słabicki M, Frydman J, Jakob U, David DC, Bennett EJ, Bertozzi CR, Sardana R, Eapen VV, and Carra S
- Subjects
- Autophagy physiology, Humans, Organelles, Proteins metabolism, Proteolysis, Proteasome Endopeptidase Complex metabolism, Ubiquitin metabolism
- Abstract
Targeted protein degradation is critical for proper cellular function and development. Protein degradation pathways, such as the ubiquitin proteasomes system, autophagy, and endosome-lysosome pathway, must be tightly regulated to ensure proper elimination of misfolded and aggregated proteins and regulate changing protein levels during cellular differentiation, while ensuring that normal proteins remain unscathed. Protein degradation pathways have also garnered interest as a means to selectively eliminate target proteins that may be difficult to inhibit via other mechanisms. On June 7 and 8, 2021, several experts in protein degradation pathways met virtually for the Keystone eSymposium "Targeting protein degradation: from small molecules to complex organelles." The event brought together researchers working in different protein degradation pathways in an effort to begin to develop a holistic, integrated vision of protein degradation that incorporates all the major pathways to understand how changes in them can lead to disease pathology and, alternatively, how they can be leveraged for novel therapeutics., (© 2022 New York Academy of Sciences.)
- Published
- 2022
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16. Evaluation of antiangiogenic and antiproliferative potential of ethanolic extracts of Andrographis echioides using in vitro and in ovo assays.
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Muralidharan K, Kumaravelu P, and David DC
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- Angiogenesis Inhibitors isolation & purification, Animals, Antineoplastic Agents, Phytogenic isolation & purification, Cell Proliferation drug effects, Chick Embryo, Chorioallantoic Membrane, Drug Screening Assays, Antitumor, Ethanol chemistry, Humans, MCF-7 Cells, Neoplasms blood supply, Neoplasms drug therapy, Neovascularization, Pathologic drug therapy, Plant Extracts isolation & purification, Andrographis chemistry, Angiogenesis Inhibitors pharmacology, Antineoplastic Agents, Phytogenic pharmacology, Plant Extracts pharmacology
- Abstract
Introduction: Andrographis echioides is a prevalently used medicinal herb in South Asian countries. Scientific researches with the extracts of A. echioides revealed its antipyretic, anti-inflammatory, antimicrobial, ulceroprotective, and hepatoprotective properties. This study was done to elucidate antiproliferative and antiangiogenic potential of ethanolic extracts of A. echioides (EEAE) by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and chorioallantoic membrane (CAM) assay., Materials and Methods: EEAE was prepared using Soxhlet apparatus with ethanol after being sun-dried and powdered. MCF 7 (human invasive breast ductal carcinoma) cell lines retaining attributes of differentiated mammary epithelium with both estrogen and progesterone receptors were treated with EEAE, and antiproliferative effect was seen using Mosmann method of MTT assay using 5-fluorouracil (5-FU) as a comparator. The evaluation of antiangiogenic potential of EEAE was done by comparing mean vessel density (MVD) in chick CAM after treatment with EEAE, thalidomide, and vascular endothelial growth factor (VEGF) using CAM assay, an in ovo assay., Results: EEAE displayed antiproliferative activity from low to high concentrations with MTT assay. The IC
50 of EEAE and 5-FU was 62.5 and 15.6 μg/ml, respectively (P < 0.05). The exhibition of its antiangiogenic activity increased proportionately with increasing concentration. VEGF increased MVD by 45.94%; thalidomide decreased it by 53.76%. There was a decrease of MVD by 5.91%, 20.46%, and 35.95% at concentrations of 25, 50, and 100 μg of EEAE, respectively., Conclusion: EEAE possessed significant antiangiogenic and antiproliferative activity, making them a promising substrate in the development of a novel anticancer drug and can be successfully used in the therapy of various cancers after establishment of the anticancer effects in animal models and subsequently in clinical trials., Competing Interests: None- Published
- 2021
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17. Extracellular proteostasis prevents aggregation during pathogenic attack.
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Gallotta I, Sandhu A, Peters M, Haslbeck M, Jung R, Agilkaya S, Blersch JL, Rödelsperger C, Röseler W, Huang C, Sommer RJ, and David DC
- Subjects
- Aging metabolism, Animals, Caenorhabditis elegans cytology, Caenorhabditis elegans genetics, Caenorhabditis elegans Proteins metabolism, Fatty Acid-Binding Proteins metabolism, MAP Kinase Signaling System, Protein Aggregation, Pathological prevention & control, Proteome genetics, Proteome metabolism, RNA Interference, Caenorhabditis elegans metabolism, Caenorhabditis elegans microbiology, Extracellular Space metabolism, Protein Aggregates, Proteostasis
- Abstract
In metazoans, the secreted proteome participates in intercellular signalling and innate immunity, and builds the extracellular matrix scaffold around cells. Compared with the relatively constant intracellular environment, conditions for proteins in the extracellular space are harsher, and low concentrations of ATP prevent the activity of intracellular components of the protein quality-control machinery. Until now, only a few bona fide extracellular chaperones and proteases have been shown to limit the aggregation of extracellular proteins
1-5 . Here we performed a systematic analysis of the extracellular proteostasis network in Caenorhabditis elegans with an RNA interference screen that targets genes that encode the secreted proteome. We discovered 57 regulators of extracellular protein aggregation, including several proteins related to innate immunity. Because intracellular proteostasis is upregulated in response to pathogens6-9 , we investigated whether pathogens also stimulate extracellular proteostasis. Using a pore-forming toxin to mimic a pathogenic attack, we found that C. elegans responded by increasing the expression of components of extracellular proteostasis and by limiting aggregation of extracellular proteins. The activation of extracellular proteostasis was dependent on stress-activated MAP kinase signalling. Notably, the overexpression of components of extracellular proteostasis delayed ageing and rendered worms resistant to intoxication. We propose that enhanced extracellular proteostasis contributes to systemic host defence by maintaining a functional secreted proteome and avoiding proteotoxicity.- Published
- 2020
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18. Molecular modeling and docking analysis of aspirin with pde7b in the context of neuro-inflammation.
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Balasundaram A and David DC
- Abstract
The PDE7B gene encodes 3'5'-cyclic nucleotide phosphodiesterase (PDE) and a known target in cognitive impairments. Therefore, it is of interest to design and development of potential inhibitors with PDE7B with improved binding features. We document that the amino acid residues such as H186, K190, and G113 of PDE7B protein showed crucial interactions with aspirin for further consideration in this context., (© 2020 Biomedical Informatics.)
- Published
- 2020
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19. Intrinsically aggregation-prone proteins form amyloid-like aggregates and contribute to tissue aging in Caenorhabditis elegans .
- Author
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Huang C, Wagner-Valladolid S, Stephens AD, Jung R, Poudel C, Sinnige T, Lechler MC, Schlörit N, Lu M, Laine RF, Michel CH, Vendruscolo M, Kaminski CF, Kaminski Schierle GS, and David DC
- Subjects
- Animals, Aging, Amyloid metabolism, Caenorhabditis elegans physiology, Caenorhabditis elegans Proteins metabolism, Protein Aggregates
- Abstract
Reduced protein homeostasis leading to increased protein instability is a common molecular feature of aging, but it remains unclear whether this is a cause or consequence of the aging process. In neurodegenerative diseases and other amyloidoses, specific proteins self-assemble into amyloid fibrils and accumulate as pathological aggregates in different tissues. More recently, widespread protein aggregation has been described during normal aging. Until now, an extensive characterization of the nature of age-dependent protein aggregation has been lacking. Here, we show that age-dependent aggregates are rapidly formed by newly synthesized proteins and have an amyloid-like structure resembling that of protein aggregates observed in disease. We then demonstrate that age-dependent protein aggregation accelerates the functional decline of different tissues in C. elegans . Together, these findings imply that amyloid-like aggregates contribute to the aging process and therefore could be important targets for strategies designed to maintain physiological functions in the late stages of life., Competing Interests: CH, SW, AS, RJ, CP, TS, ML, NS, ML, RL, CM, MV, CK, GK, DD No competing interests declared, (© 2019, Huang et al.)
- Published
- 2019
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20. Antimicrobial Resistance of Thermotolerant Campylobacter Species Isolated from Humans, Food-Producing Animals, and Products of Animal Origin: A Worldwide Meta-Analysis.
- Author
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Signorini ML, Rossler E, Díaz David DC, Olivero CR, Romero-Scharpen A, Soto LP, Astesana DM, Berisvil AP, Zimmermann JA, Fusari ML, Frizzo LS, and Zbrun MV
- Subjects
- Animals, Campylobacter drug effects, Campylobacter Infections, Food Microbiology, Humans, Microbial Sensitivity Tests methods, Anti-Bacterial Agents pharmacology, Campylobacter genetics, Campylobacter isolation & purification, Drug Resistance, Multiple, Bacterial drug effects, Drug Resistance, Multiple, Bacterial genetics
- Abstract
The objective of this meta-analysis was to summarize available information on the prevalence of antimicrobial-resistant Campylobacter species in humans, food-producing animals, and products of animal origin. A number of multilevel random-effect meta-analysis models were fitted to estimate mean occurrence rate of antimicrobial-resistant thermotolerant Campylobacter and to compare them throughout the years and among the species, food-producing animals (i.e., bovine, pigs, broilers, hen, goat, and sheep), country of origin, sample type, methodology to determine the antimicrobial susceptibility, and the species of Campylobacter. Among the considered antibiotics, thermotolerant Campylobacter showed the highest resistance to tetracycline (pool estimate [PE] = 0.493; 95% CI 0.466-0.519), nalidixic acid (PE = 0.385; 95% CI 0.348-0.423), and ciprofloxacin (PE = 0.376; 95% CI 0.339-0.415). In general, the prevalence of antimicrobial-resistant Campylobacter spp. was higher in hen, broilers, and swine. Campylobacter coli showed a higher prevalence of antimicrobial resistance than Campylobacter jejuni. Independent of the antimicrobial evaluated, the disk diffusion method showed higher prevalence of antimicrobial-resistant Campylobacter than the methods based on the minimum inhibitory concentration estimation. The meta-analysis showed that the prevalence of antimicrobial-resistant Campylobacter is relevant essentially in foods derived from hens and broilers, and it was observed worldwide. The prevalence of this pathogen is of public health importance and the increase in the prevalence of Campylobacter strains resistant to the antimicrobial of choice worsens the situation, hence, national authorities must monitor the situation in each country with the aim to establish the appropriate risk management measures.
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- 2018
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21. Methods to Study Changes in Inherent Protein Aggregation with Age in Caenorhabditis elegans.
- Author
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Groh N, Gallotta I, Lechler MC, Huang C, Jung R, and David DC
- Subjects
- Age Factors, Animals, Animals, Genetically Modified, Caenorhabditis elegans chemistry, Caenorhabditis elegans genetics, Caenorhabditis elegans Proteins chemistry, Caenorhabditis elegans Proteins genetics, Models, Animal, Protein Aggregates, Recombinant Proteins chemistry, Recombinant Proteins genetics, Recombinant Proteins metabolism, Caenorhabditis elegans metabolism, Caenorhabditis elegans Proteins metabolism
- Abstract
In the last decades, the prevalence of neurodegenerative disorders, such as Alzheimer's disease (AD) and Parkinson's disease (PD), has grown. These age-associated disorders are characterized by the appearance of protein aggregates with fibrillary structure in the brains of these patients. Exactly why normally soluble proteins undergo an aggregation process remains poorly understood. The discovery that protein aggregation is not limited to disease processes and instead part of the normal aging process enables the study of the molecular and cellular mechanisms that regulate protein aggregation, without using ectopically expressed human disease-associated proteins. Here we describe methodologies to examine inherent protein aggregation in Caenorhabditis elegans through complementary approaches. First, we examine how to grow large numbers of age-synchronized C. elegans to obtain aged animals and we present the biochemical procedures to isolate highly-insoluble-large aggregates. In combination with a targeted genetic knockdown, it is possible to dissect the role of a gene of interest in promoting or preventing age-dependent protein aggregation by using either a comprehensive analysis with quantitative mass spectrometry or a candidate-based analysis with antibodies. These findings are then confirmed by in vivo analysis with transgenic animals expressing fluorescent-tagged aggregation-prone proteins. These methods should help clarify why certain proteins are prone to aggregate with age and ultimately how to keep these proteins fully functional.
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- 2017
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22. More stressed out with age? Check your RNA granule aggregation.
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Lechler MC and David DC
- Subjects
- Animals, Caenorhabditis elegans genetics, Forkhead Transcription Factors metabolism, Humans, Longevity, Neurodegenerative Diseases metabolism, Poly(A)-Binding Protein I metabolism, Protein Aggregation, Pathological metabolism, Proteome chemistry, RNA metabolism, Transcription Factors metabolism, Aging metabolism, Caenorhabditis elegans Proteins metabolism, Cytoplasmic Granules metabolism, Prions metabolism, RNA-Binding Proteins metabolism, Stress, Physiological
- Abstract
Low complexity (LC) prion-like domains are over-represented among RNA-binding proteins (RBPs) and contribute to the dynamic nature of RNA granules. Importantly, several neurodegenerative diseases are characterized by cytoplasmic "solid" aggregates formed by mainly nuclear RBPs harboring LC prion-like domains. Although RBP aggregation in disease has been extensively characterized, it remains unknown how the process of aging disturbs RBP dynamics. Our recent study revealed that RNA granule components including 2 key stress granule RBPs with LC prion-like domains, PAB-1 and TIAR-2, aggregate in aged Caenorhabditis elegans in the absence of disease. Here we present new evidence showing that sustained stress granule formation triggers RBP aggregation. In addition, we demonstrate that mild chronic stress during aging promotes mislocalization of nuclear RBPs. We discuss the consequences of aberrant interactions between age-related RBP aggregation and disease-associated RBP aggregation. In particular, we show that FUST-1 and PAB-1 co-localize in aberrant cytoplasmic accumulations. Significantly, long-lived animals with reduced insulin/IGF-1 signaling abrogate stress granule RBP aggregation through activation of the transcription factors HSF-1 and DAF-16. We evaluate the different mechanisms that could maintain dynamic stress granules. Together these findings highlight how changes with age could contribute to pathogenesis in neurodegenerative diseases and disruption of RNA homeostasis.
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- 2017
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23. Age-Dependent Protein Aggregation Initiates Amyloid-β Aggregation.
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Groh N, Bühler A, Huang C, Li KW, van Nierop P, Smit AB, Fändrich M, Baumann F, and David DC
- Abstract
Aging is the most important risk factor for neurodegenerative diseases associated with pathological protein aggregation such as Alzheimer's disease. Although aging is an important player, it remains unknown which molecular changes are relevant for disease initiation. Recently, it has become apparent that widespread protein aggregation is a common feature of aging. Indeed, several studies demonstrate that 100s of proteins become highly insoluble with age, in the absence of obvious disease processes. Yet it remains unclear how these misfolded proteins aggregating with age affect neurodegenerative diseases. Importantly, several of these aggregation-prone proteins are found as minor components in disease-associated hallmark aggregates such as amyloid-β plaques or neurofibrillary tangles. This co-localization raises the possibility that age-dependent protein aggregation directly contributes to pathological aggregation. Here, we show for the first time that highly insoluble proteins from aged Caenorhabditis elegans or aged mouse brains, but not from young individuals, can initiate amyloid-β aggregation in vitro . We tested the seeding potential at four different ages across the adult lifespan of C. elegans . Significantly, protein aggregates formed during the early stages of aging did not act as seeds for amyloid-β aggregation. Instead, we found that changes in protein aggregation occurring during middle-age initiated amyloid-β aggregation. Mass spectrometry analysis revealed several late-aggregating proteins that were previously identified as minor components of amyloid-β plaques and neurofibrillary tangles such as 14-3-3, Ubiquitin-like modifier-activating enzyme 1 and Lamin A/C, highlighting these as strong candidates for cross-seeding. Overall, we demonstrate that widespread protein misfolding and aggregation with age could be critical for the initiation of pathogenesis, and thus should be targeted by therapeutic strategies to alleviate neurodegenerative diseases.
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- 2017
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24. Discovery and functional prioritization of Parkinson's disease candidate genes from large-scale whole exome sequencing.
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Jansen IE, Ye H, Heetveld S, Lechler MC, Michels H, Seinstra RI, Lubbe SJ, Drouet V, Lesage S, Majounie E, Gibbs JR, Nalls MA, Ryten M, Botia JA, Vandrovcova J, Simon-Sanchez J, Castillo-Lizardo M, Rizzu P, Blauwendraat C, Chouhan AK, Li Y, Yogi P, Amin N, van Duijn CM, Morris HR, Brice A, Singleton AB, David DC, Nollen EA, Jain S, Shulman JM, and Heutink P
- Subjects
- Adolescent, Adult, Animals, Animals, Genetically Modified, Caenorhabditis elegans genetics, Case-Control Studies, Cells, Cultured, Child, Disease Models, Animal, Drosophila melanogaster genetics, Exome, Humans, Middle Aged, RNA Interference, Young Adult, Genetic Predisposition to Disease, High-Throughput Nucleotide Sequencing methods, Parkinson Disease genetics, Sequence Analysis, DNA methods, alpha-Synuclein genetics
- Abstract
Background: Whole-exome sequencing (WES) has been successful in identifying genes that cause familial Parkinson's disease (PD). However, until now this approach has not been deployed to study large cohorts of unrelated participants. To discover rare PD susceptibility variants, we performed WES in 1148 unrelated cases and 503 control participants. Candidate genes were subsequently validated for functions relevant to PD based on parallel RNA-interference (RNAi) screens in human cell culture and Drosophila and C. elegans models., Results: Assuming autosomal recessive inheritance, we identify 27 genes that have homozygous or compound heterozygous loss-of-function variants in PD cases. Definitive replication and confirmation of these findings were hindered by potential heterogeneity and by the rarity of the implicated alleles. We therefore looked for potential genetic interactions with established PD mechanisms. Following RNAi-mediated knockdown, 15 of the genes modulated mitochondrial dynamics in human neuronal cultures and four candidates enhanced α-synuclein-induced neurodegeneration in Drosophila. Based on complementary analyses in independent human datasets, five functionally validated genes-GPATCH2L, UHRF1BP1L, PTPRH, ARSB, and VPS13C-also showed evidence consistent with genetic replication., Conclusions: By integrating human genetic and functional evidence, we identify several PD susceptibility gene candidates for further investigation. Our approach highlights a powerful experimental strategy with broad applicability for future studies of disorders with complex genetic etiologies.
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- 2017
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25. Reduced Insulin/IGF-1 Signaling Restores the Dynamic Properties of Key Stress Granule Proteins during Aging.
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Lechler MC, Crawford ED, Groh N, Widmaier K, Jung R, Kirstein J, Trinidad JC, Burlingame AL, and David DC
- Subjects
- Animals, Longevity, Mutation genetics, Protein Aggregates, RNA metabolism, RNA-Binding Proteins metabolism, Receptor, Insulin metabolism, Solubility, Aging metabolism, Caenorhabditis elegans metabolism, Caenorhabditis elegans Proteins metabolism, Cytoplasmic Granules metabolism, Heat-Shock Proteins metabolism, Insulin metabolism, Insulin-Like Growth Factor I metabolism, Signal Transduction
- Abstract
Low-complexity "prion-like" domains in key RNA-binding proteins (RBPs) mediate the reversible assembly of RNA granules. Individual RBPs harboring these domains have been linked to specific neurodegenerative diseases. Although their aggregation in neurodegeneration has been extensively characterized, it remains unknown how the process of aging disturbs RBP dynamics. We show that a wide variety of RNA granule components, including stress granule proteins, become highly insoluble with age in C. elegans and that reduced insulin/insulin-like growth factor 1 (IGF-1) daf-2 receptor signaling efficiently prevents their aggregation. Importantly, stress-granule-related RBP aggregates are associated with reduced fitness. We show that heat shock transcription factor 1 (HSF-1) is a main regulator of stress-granule-related RBP aggregation in both young and aged animals. During aging, increasing DAF-16 activity restores dynamic stress-granule-related RBPs, partly by decreasing the buildup of other misfolded proteins that seed RBP aggregation. Longevity-associated mechanisms found to maintain dynamic RBPs during aging could be relevant for neurodegenerative diseases., (Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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26. Virtual Screening of Phytochemicals to Novel Target (HAT) Rtt109 in Pneumocystis Jirovecii using Bioinformatics Tools.
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Sugumar R, Adithavarman AP, Dakshinamoorthi A, David DC, and Ragunath PK
- Abstract
Introduction: Pneumocystis jirovecii is a fungus that causes Pneumocystis pneumonia in HIV and other immunosuppressed patients. Treatment of Pneumocystis pneumonia with the currently available antifungals is challenging and associated with considerable adverse effects. There is a need to develop drugs against novel targets with minimal human toxicities. Histone Acetyl Transferase (HAT) Rtt109 is a potential therapeutic target in Pneumocystis jirovecii species. HAT is linked to transcription and is required to acetylate conserved lysine residues on histone proteins by transferring an acetyl group from acetyl CoA to form e-N-acetyl lysine. Therefore, inhibitors of HAT can be useful therapeutic options in Pneumocystis pneumonia., Aim: To screen phytochemicals against (HAT) Rtt109 using bioinformatics tool., Materials and Methods: The tertiary structure of Pneumocystis jirovecii (HAT) Rtt109 was modeled by Homology Modeling. The ideal template for modeling was obtained by performing Psi BLAST of the protein sequence. Rtt109-AcCoA/Vps75 protein from Saccharomyces cerevisiae (PDB structure 3Q35) was chosen as the template. The target protein was modeled using Swiss Modeler and validated using Ramachandran plot and Errat 2. Comprehensive text mining was performed to identify phytochemical compounds with antipneumonia and fungicidal properties and these compounds were filtered based on Lipinski's Rule of 5. The chosen compounds were subjected to virtual screening against the target protein (HAT) Rtt109 using Molegro Virtual Docker 4.5. Osiris Property Explorer and Open Tox Server were used to predict ADME-T properties of the chosen phytochemicals., Results: Tertiary structure model of HAT Rtt 109 had a ProSA score of -6.57 and Errat 2 score of 87.34. Structure validation analysis by Ramachandran plot for the model revealed 97% of amino acids were in the favoured region. Of all the phytochemicals subjected to virtual screening against the target protein (HAT) Rtt109, baicalin exhibited highest binding affinity towards the target protein as indicated by the Molegro score of 130.68 and formed 16 H-bonds. The ADME-T property prediction revealed that baicalin was non-mutagenic, non-tumorigenic and had a drug likeness score of 0.87., Conclusion: Baicalin has good binding with Rtt 109 in Pneumocystis jirovecii and can be considered as a novel and valuable treatment option for Pneumocystis pneumonia patients after subjecting it to invivo and invitro studies.
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- 2016
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27. Therapeutic drug monitoring of antiepileptic drugs in a tertiary care hospital in India.
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Harivenkatesh N, Haribalaji N, David DC, and Kumar CM
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- Adolescent, Adult, Anticonvulsants blood, Child, Dose-Response Relationship, Drug, Epilepsy blood, Female, Humans, India, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Tertiary Healthcare statistics & numerical data, Young Adult, Anticonvulsants therapeutic use, Drug Monitoring, Epilepsy drug therapy
- Abstract
Introduction: Therapeutic drug monitoring (TDM) helps to optimize the dose of antiepileptic drugs. Only limited information is available about the clinical utility of TDM of antiepileptic drugs in India. Hence, we aimed to study the clinical utility of antiepileptic TDM in a tertiary care hospital in India and to explore the association between the plasma drug levels and the occurrence of breakthrough seizures and drug toxicity., Methods: All patients taking antiepileptic drugs for whom TDM was done from January 2008 to December 2010 were included in the study. All relevant information was obtained from patient medical records. Trough levels were measured for all drugs using chemiluminescence assay. Drug levels were interpreted as within, below, and above the reference range, as recommended by the International League Against Epilepsy guidelines., Results: Of the 420 samples analyzed during this period, 396 samples were included in this study for analysis. The maximum number of requests was for phenytoin (50%) followed by valproic acid (26%). The most common indication for TDM was dosage adjustment (38%) followed by breakthrough seizures (34%). Among the 135 samples received with breakthrough seizures as indication, more than 50% had drug levels either within or above the reference range. Among the 62 samples referred with clinical symptoms of suspected toxicity, drug levels were above the reference range in only 52% of the samples., Conclusions: Therapeutic drug monitoring was found to be useful in practice, in tailoring drug dosage in accordance with the needs of individual patient, in distinguishing nonresponders from noncompliants, and in aiding in making critical decisions. However, the "reference range" of these antiepileptic drugs was not reliable in predicting the occurrence of breakthrough seizures and clinical symptoms of suspected drug toxicity.
- Published
- 2015
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