Current Medicinal Chemistry - Online First

Ciprofol is a novel sedative-anesthetic that functions similarly to propofol. This study aimed to evaluate the efficacy and safety of ciprofol for the induction and maintenance of general anesthesia in patients undergoing thoracoscopic surgery.

A total of 120 patients undergoing thoracoscopic surgery for pulmonary nodules under general anesthesia were randomly assigned to the ciprofol group or the propofol group. Patients in the ciprofol group received an initial dose of 0.4 mg.kg^-1 of ciprofol for anesthesia induction, followed by an infusion rate ranging from 0.4 mg.kg^-1.h^-1 to 2.4 mg.kg^-1.h^-1 for maintenance. In the propofol group, patients were administered an initial dose of 2.0 mg.kg^-1 of propofol for induction, with a maintenance infusion rate ranging from 4.0 mg.kg^-1.h^-1 to 12 mg.kg^-1h^-1. The primary outcome measured was the success rate of sedation. Secondary outcomes included the time to successful induction of anesthesia, changes in hemodynamics and bispectral index (BIS) within 10 minutes after the initial administration of the study medication, time to respiratory recovery and full alertness, and the incidence of adverse events.

The sedation success rate was 100% in both groups. In this study, statistical analyses revealed no significant differences in the time to eyelash reflex disappearance (p=0.599), induction success time (p=0.431), the moment when the BIS value first fell below 60 (p=0.538), the time to respiratory recovery (p=0.505), or the interval until full wakefulness (p=0.837). Notably, within the first 10 minutes following the initial administration of the study medication, the reduction in blood pressure was significantly more pronounced in the propofol group (p<0.05). Additionally, the mean BIS value was significantly higher in the propofol group (p<0.01). The required dosage of sedative medication was significantly lower in the ciprofol group (p<0.001). Compared to the propofol group, the ciprofol group exhibited a significant reduction in the incidence of adverse events during intubation (p=0.01), a marked decrease in injection pain (p=0.001), and a significant decrease in the incidence of intraoperative hypotension (p<0.05).

Ciprofol exhibits comparable efficacy and safety profiles for both the induction and maintenance of general anesthesia in patients undergoing thoracoscopic surgery. Furthermore, it has been associated with a reduced dosage requirement, significantly lower mean BIS values, and a notable decrease in the incidence of injection pain and intraoperative hypotension.

(ChiCTR2400086976).

The pathogenesis of Delayed Encephalopathy After Acute Carbon Monoxide Poisoning (DEACMP) remains mysterious, and specific predictive markers are lacking. This study aimed to elucidate the molecular underpinnings and identify predictive biomarkers of DEACMP through multi-omics and single-nucleusRNA sequencing (snRNA-seq).

Clinical data and blood samples were collected from 105 participants. Untargeted metabolomics sequencing was employed to profile serum metabolites across these participants. Additionally, individuals from the Healthy Controls (HCs), Acute Carbon Monoxide Poisoning patients (ACOP), Non-Delayed Encephalopathy After ACOP (DEACMP-N), and DEACMP groups (n=3 each) were randomly selected for transcriptome sequencing to identify potential predictive targets and pivotal signaling pathways associated with DEACMP. Furthermore, Severe DEACMP and Control rat models were established. Three rats from the Control, DEACMP, and DEACMP + Dexamethasone + Selenomethionine groups were selected for snRNA-seq. Immunofluorescence multiplexing and qRT-PCR (quantitative Reverse Transcription Polymerase Chain Reaction) were then performed to validate the identified predictive targets.

Analysis of clinical data from 105 participants highlights the pivotal role of inflammation in influencing the prognosis of carbon monoxide poisoning. Metabolomics analysis identified 19 metabolites that significantly differed between the DEACMP-N and DEACMP groups. Transcriptomics analysis of 12 participants indicated that DEACMP is primarily associated with six signaling pathways, including lysosome and tuberculosis. Considering that microglia are central nervous system immune effectors, the snRNA-seq analysis revealed altered gene expression and signaling pathways in microglia during DEACMP, with KEGG (Kyoto Encyclopedia of Genes and Genomes) analysis highlighting neutrophil extracellular trap formation, lysosome, and tuberculosis as the predominant pathways. Differential gene analysis from transcriptome and snRNA-seq identified 28 genes differentially expressed in DEACMP. The STRING (Search Tool for the Retrieval of Interacting Genes/Proteins) database, immune multiplexing, and qRT-PCR confirmed the pivotal role of the Ifngr1/Stat1/Ctss axis in DEACMP.

This research identifies the Ifngr1/Stat1/Ctss axis as a key inflammatory mechanism in the pathogenesis of DEACMP, thereby clarifying previous uncertainties regarding the sequelae of carbon monoxide poisoning. The intersection of lysosomal and tuberculosis pathways, as revealed through metabolomic, transcriptomic, and single-nucleus RNA sequencing analyses—especially within microglia—offers novel mechanistic insights that could inform therapeutic interventions. While the integration of multiple omics methodologies enhances the robustness of these findings, their biological relevance to the pathogenesis of DEACMP requires rigorous validation through independent cohort verification approaches.

This study provides a comprehensive overview of serum metabolite expression, differential gene expression, and signaling pathways in DEACMP, offering a theoretical foundation for understanding the pathogenesis of DEACMP.

Considering infants and young children, it is well established that their physiological and developmental peculiarities should not be confused with those of other patient categories, such as adults or vulnerable patients. Indeed, their anatomic-functional characteristics specifically influence the drug pharmacokinetic/pharmacodynamic profile. Therefore, the availability of specialists devoted to pediatric pharmacology within multidisciplinary teams is highly desirable to improve the care of these patients.

This work aims to describe the role of pediatric clinical pharmacologists in the context of pediatric clinical care in Italy, using a qualitative method based on the type of articles published.

A literature review was conducted according to the PRISMA guidelines, considering articles published on the PubMed database between January 2017 and March 2022 and using specific MeSH terms. The papers were attributed to two blind assessors and then processed for discussion. To support article screening, focusing on the words contained in article titles, the R package evidence synthesis tool revtools was used.

The search identified a total of 1544 articles, of which 93 were selected. The articles analyzed mainly concern therapeutic drug monitoring and pharmacovigilance with adverse drug reactions.

An insight into multidisciplinary work to prevent, diagnose, and treat pediatric diseases and to monitor treatments is provided in this study. However, this concept needs to be strengthened in the long term.

Acute myeloid leukemia (AML) is the most common adult hematologic malignancy, with relapse and drug resistance posing major challenges despite treatment advances. Cryptotanshinone (CTS), a diterpenoid compound derived from Salvia miltiorrhiza, exhibits anticancer activity in various tumors. However, its role and mechanisms in AML remain unclear. This study aims to investigate the inhibitory effects of CTS on AML cells and its potential mechanisms.

Network pharmacology was employed to identify potential AML-related targets of CTS, and a disease-drug-target interaction network was constructed. The effects of CTS on KG-1 cells were assessed using CCK-8 proliferation assays, cell cycle analysis and apoptosis detection. Western blot and quantitative real-time polymerase chain reaction (qRT-PCR) were performed to analyze the regulatory effects of CTS on the endoplasmic reticulum stress (ERS) signaling pathway. The role of the Hippo-YAP signaling pathway in CTS-induced AML inhibition was further explored.

Network pharmacology analysis identified key AML-related targets of CTS, enriched in multiple cancer-related signaling pathways. Experimental results showed that CTS inhibited KG-1 cell proliferation in a dose-dependent manner, induced S-phase arrest, and promoted apoptosis. Furthermore, CTS treatment significantly upregulated ERS-related key proteins. While YAP overexpression attenuated CTS-induced ERS activation and reduced apoptosis levels.

This study indicates that CTS inhibits AML cell proliferation and induces apoptosis while activating the ERS signaling pathway. However, aberrant activation of the Hippo-YAP pathway weakens this effect. These findings provide novel theoretical insights into potential therapeutic strategies for AML.

Staphylococcus aureus infections have become a significant public health issue due to increasing the resistance against known antibiotics, especially by Methicillin-Resistant Staphylococcus aureus (MRSA). Fluoroquinolones are broad-spectrum class of antibiotics mostly utilized in treating various bacterial infections and those caused by S. aureus. Reported data indicated that mutations of Ser84 to Leu, Ser85 to Pro and Glu88 to Lys in DNA gyrase A enzyme are the major cause of fluoroquinolone resistance against S. aureus. Therefore, the development of a novel targeted molecule with potential activity against mutant S. aureus is essential. The antibacterial activity of quinoline-clubbed hydrazone derivatives against S. aureus is noteworthy. However, the mechanism of action of quinoline hydrazone derivatives has not been reported by inhibiting these common mutations of DNA gyrase A.

In this concern, some quinoline hydrazone derivatives as antibacterial agents reported by several research groups have been further studied as mutated S. aureus DNA gyrase A (Pdb id: 8bp2) inhibitors using in-silico techniques viz., molecular docking, MD simulation, DFT analysis, and ADMET predictions.

Among the studied compounds, 42, 43, 48 and 49 were found to be the most active and showed the highest docking score (-7.71 to -9.29 kcalmol^-1) by interaction with mutant (Leu84 and Pro85) S. aureus DNA gyrase A. Further, MD simulation results indicated that these compounds exhibited good stability with the targeted macromolecule under dynamic conditions. The most active compound 49 (ʌE = 0.159 eV) attributed to its lower HOMO-LUMO gap, which was an indicator of a potential inhibitor of fluoroquinolone- resistant S. aureus DNA gyrase A enzyme. ADMET prediction study emphasized that both compounds showed a significant safety profile.

The future perspective emphasized that compounds 42, 43, 48 and 49 could be developed as novel inhibitors against fluoroquinolone-resistant DNA gyrase A enzyme on the completion of drug discovery approaches.

Nasopharyngeal carcinoma (NPC) is an aggressive malignancy with a poor prognosis. Ubiquitination is a complex post translational modification involved in cancer progression. However, ubiquitination related genes (URGs) in immunotherapy of NPC remains largely unexplored.

Differentially expressed URGs were screened based on the single-cell RNA sequencing (scRNA-seq) dataset and a risk model of NPC was constructed and evaluated for prognostic significance. The oncogenic role of RNF149 in NPC was investigated through in vitro and in vivo experiments, including tumor cells, NPC-like organoids, and tumor-bearing mice.

scRNA-seq data showed that URGs scores were higher in cancer cells than in normal epithelial cells. We identified 216 differentially expressed URGs between cancer and normal epithelial cells, but only 33 differentially expressed URGs associated with prognosis. Based on 33 URGs, TCGA-HNSC samples were classified into two distinct subtypes with significant differences in the tumor immune microenvironment, immunotherapy effect, and survival-prognostic genes. Using LASSO algorithm, 13 URGs were selected to construct a risk model, which demonstrated high predictive performance. The expression profiles of these 13 URGs were analyzed in TCGA-HNSC tumor and adjacent non-cancerous samples, and six URGs (BSPRY, OTUB1, PJA1, RNF149, RNF181, USP10) exhibited consistent expression trends. Moreover, quantitative real- time PCR revealed that RNF149 was up-regulated expression in NPC cells compared to the NP69 cells. RNF149 knockdown significantly impeded the proliferative, migratory, and invasive capabilities and exaggerated apoptosis of NPC cells. RNF149 knockdown cells exhibited a reduced capacity to form NPC organoids in a 3D culture system. shRNA-RNF149 diminished subcutaneous tumorigenic capacity of HK-1 cells compared to the control group.

The URGs-based prognostic risk model offers a robust tool for predicting immunotherapy efficacy in NPC and RNF149 promotes NPC progression.

A URGs-related prognostic risk model capable of predicting clinical outcomes in NPC patients and RNF149 promotes NPC progression. Our findings are expected to provide new strategies to improve outcomes for NPC patients.

Diabetes mellitus (DM) is a chronic metabolic disorder that seeks treatment instead of available mitigative therapy.

Six (E)-3-(aryl)-1-phenylprop-2-en-1-one chalcones were synthesized and characterized through various spectroscopic techniques. Their anti-diabetic potential was examined through in-vitro (α-glucosidase and α-amylase inhibition assays), in-vivo (alloxan-induced hyperglycemia), and in-silico studies.

All the chalcones derivatives significantly inhibited α-glucosidase and α-amylase. Compounds 11 (IC50 = 1.10 ± 0.02) and 13 (IC50 = 3.25 ± 0.10 µM) exhibited the most potent activity against α-glucosidase. The effect of compounds 11 and 13 was also significant against α-amylase with IC50 of 13.2 ± 0.50 and 10.2 ± 0.4 µM, respectively. In alloxan-induced hyperglycemic model, a significant (p<0.001) reduction in blood glucose level (BGL) was observed by compounds 10, 11 and 14 with maximum percent inhibition of 47.48, 47.22 and 47.55, respectively. In the oral glucose tolerance test, a continuous reduction in BGL was noted at 60 minutes. No negative effect was seen on lipid profile, and in liver and renal function tests. However, a slight gain in body weight was noted. Moreover, docking result indicates good interaction of these molecules with the target enzymes, α-glucosidase and α-amylase.

These results demonstrate that all these molecules have significant anti-diabetic potential.

Alzheimer's disease (AD) is the most common cause of dementia worldwide, with a steadily increasing prevalence. However, the mechanisms underlying AD remain unclear, and current treatments have only limited efficacy.

This study aimed to identify potential biomarker genes for AD and to explore the underlying mechanisms by integrating microarray analysis, Mendelian randomization (MR), and experimental validation.

AD-related microarray datasets were downloaded from the Gene Expression Omnibus database. Differential expression analysis identified differentially expressed genes (DEGs) between AD and control samples. Summary-level data from genome-wide association studies on AD were integrated with expression quantitative trait loci data to identify genes with potential causal relationships with AD using MR. The intersections between DEGs and causal genes were identified as hub genes. Functional analysis was performed to explore underlying mechanisms. Quantitative real-time PCR was applied to validate the expression of hub genes in clinical samples.

Differential expression analysis identified 312 DEGs, whereas MR identified 202 genes with causal effects on AD. The intersection of these two sets identified four hub genes: FCRLB, MT2A, PFKFB3, and SRGN. Functional analysis indicated significant associations between AD and immune-related pathways. Correlation analysis revealed significant connections between hub genes and immune cells in AD. The expression of MT2A, PFKFB3, and SRGN was significantly upregulated, whereas FCRLB was downregulated in clinical AD samples compared with controls.

The integration of microarray analysis, MR, and experimental validation identified and validated four potential biomarker genes with causal effects on AD, namely FCRLB, MT2A, PFKFB3, and SRGN. Functional analysis indicated a pivotal role of the immune microenvironment in AD. These findings offer insights into the molecular mechanisms of AD and have implications for improving its diagnosis and treatment strategies.

RNA sequencing data and clinical information from GC patients were collected from the TCGA and GEO databases, excluding cases of pure IGC and DGC. Based on ECMR and CA-related genes, supervised clustering via non-negative Matrix Factorization (NMF) was used to identify molecular subtypes in MGC. Differential expression and Cox regression analyses were performed to identify prognostic genes, and an ECMR and CA-based gene signature (ECRS) was developed using machine learning techniques. Gene Set Variation Analysis (GSVA) was conducted to assess functional differences between risk groups, while TIDE and pRRophetic analyses were used to predict responses to immunotherapy and chemotherapy.

A total of 239 MGC patients were classified into two molecular subtypes with significant differences in prognosis. Subtype 2 displayed distinct ECM interactions and connective tissue development pathways. To refine the ECRS model, we tested 117 model combinations across 10 machine learning algorithms, selecting the configuration with the best predictive accuracy. This optimized model distinguished biological and immune characteristics between high- and low-risk groups, with low-risk patients showing greater sensitivity to immunotherapy and standard chemotherapy.

This study identifies novel molecular subtypes of MGC based on ECMR and CA-related genes and establishes an effective ECRS model to predict prognosis, immunotherapy response, and chemotherapy sensitivity. This model supports personalized treatment strategies for MGC.