Current Pharmaceutical Biotechnology - Volume 18, Issue 8, 2017

Background: Women of reproductive age diagnosed with cancer are often interested in preserving gametes or reproductive tissue that would allow for future genetic parenthood. Preservation of fertility is often accomplished in young cancer patients via ovarian stimulation followed by oocyte or embryo cryopreservation. Conventional stimulation protocols, however, require 2-4 weeks to complete ovarian stimulation, oocyte retrieval and possible fertilization. Such a strategy may not be feasible in patients requiring urgent cancer treatment. Recent studies have highlighted that random start ovarian stimulation can be initiated irrespective of the phase of the menstrual cycle and is an attractive alternative to conventional ovarian stimulation. The primary aim of the current review is to discuss the feasibility and success of random start ovarian stimulation for oocyte or embryo cryopreservation in women desiring fertility preservation prior to gonadotoxic cancer therapy. Method: We performed a systematic review of medical literature published between January 2000 to June 2017 reporting the utility of random start ovarian stimulation for fertility preservation. Search terms included “fertility preservation,” “cancer,” “ovarian stimulation,” “random-start ovarian stimulation,” “embryo cryopreservation, and” “oocyte cryopreservation.” Publications were included in this review only if patients underwent random start ovarian stimulation prior to cancer therapy. Results: Nineteen publications were identified and perused by the authors. Most publications described the utility of random start ovarian stimulation in the setting of breast cancer. Radom-start stimulation was associated with a reduced time interval between ovarian stimulation initiation and oocyte or embryo cryopreservation. The yield of mature oocytes and their developmental potential into embryos was comparable between conventional and random-start protocols, albeit with higher gonadotropin doses in the latter. Conclusion: The current review suggests that random start ovarian stimulation can shorten the interval between ovarian stimulation and oocyte retrieval, with the yield of oocytes and embryos being comparable to conventional stimulation protocols. Thus, random start ovarian stimulation may serve as a better option for fertility preservation in patients requiring urgent cancer treatment.

Background: Poor ovarian responders (POR) pose a challenge to a physicians' ability to choose a stimulation protocol that maximizes the number of oocytes harvested and their chances of conception with multiple protocols aimed at improving pregnancy rates in this poor prognosis population. The Bologna criteria standardized the diagnosis of POR and allows for a more homogenous patient population in clinical trials. Methods: A structured review of the literature, which encompasses research on Bologna-defined POR, identified several proposed protocols to optimize pregnancy rates in poor responders. In addition, we reviewed the utility of utilizing oocyte quality enhancers such as luteal pre-treatment, coenzyme Q10 (CoQ10), dihydroepiandrosterone (DHEA), and growth hormone (GH). Conclusion: Controlled ovarian stimulation strategies with adjuvant aromatase inhibitors and clomiphene citrate have shown similar pregnancy outcomes to higher dose gonadotropin in GnRH antagonist protocols. While the standardization of Bologna defined POR has allowed for more comparable patient populations to study the effectiveness of different protocols for ovarian stimulation, there is currently no convincing data that has determined the ideal protocol for controlled ovarian stimulation in this patient population. Further research is needed to identify optimal treatment strategies.

Background: The role of elevated baseline progesterone (P) levels in outcomes of frozen embryo transfers (FET) performed in an artificial cycle has not been investigated yet. Objective: To evaluate the role of elevated P in artificial FET. Method: Case series study of 12 patients with high P levels undergoing artificial FET recruited during a 6-month period in a tertiary referral center. Results: The clinical pregnancy rate per transfer was 4/12 (33.3%). The biochemical pregnancy rate was 6/12 (50.0%). Conclusion: Elevated levels of P do not seem to have a negative impact on reproductive outcome, and may even be associated with high clinical and biochemical pregnancy rates. Further prospective or large retrospective studies are required to examine the clinical importance of our findings in a larger population.

Background: The use of GnRH analogue medication is essential in reproductive medicine to avoid premature ovulation by pituitary suppression for the duration of ovarian stimulation by gonadotrophins. The type of pituitary suppression by either GnRH agonist analogues versus GnRH antagonist analogues may result in different embryological hence clinical results. Preimplantation genetic diagnosis is a subtype of IVF in which embryos are created for genetic diagnosis of hereditary disorders in order to avoid genetically affected children. Embryological quality hence ovarian stimulation in preimplantation genetic diagnosis is crucial as genetic selection will reduce the number of available embryos to a fraction of the total. Objective: The aim of this study was to assess the efficiency of GnRH antagonist versus GnRH agonist treatment for pituitary suppression in ovarian stimulation for PGD, by proxy of number and quality of embryos at cleavage stage available for biopsy. Method: We conducted a prospective randomised controlled trial comparing pituitary suppression by GnRH antagonist versus GnRH agonist in ovarian stimulation for PGD. The primary outcome measure was the number of embryos of sufficient quality for biopsy at cleavage stage. Secondary outcome parameters were the number of blastocysts available of top quality, and clinical pregnancy rate. Results: There was no difference in number of oocytes retrieved, embryos at cleavage stage available for biopsy or embryo quality. The clinical pregnancy rate was higher in the GnRH agonist group; however the sample size was insufficient to allow conclusions. Conclusion: The use of GnRH agonist versus antagonist treatment does not result in differences in a number of oocytes, embryos or embryo quality in ovarian stimulation for preimplantation genetic diagnosis.

Background: While there are guidelines for the use of intravenous immunoglobulins in children with Guillain-Barre syndrome and myasthenia gravis based on high-level evidence studies, data are scarce for the majority of neurologic disorders in this age group. Neuronal antibodies are detected in children with seizures of autoimmune etiology. Intravenous immunoglobulins with their broad immunomodulatory mechanism of action could be ideally effective in different forms of immunedysregulated intractable epilepsies such as autoimmune epilepsy and autoimmune Rasmussen encephalitis. We conducted a systematic review of the literature for evidence of the use of intravenous immunoglobulins in a variety of neurologic diseases in childhood. Method: A comprehensive literature search was conducted using Pubmed as the medical database source without date range. Prospective studies in pediatric groups including objective measures of clinical outcomes were systematically selected. Results: A total of 11 prospective studies were identified in the literature demonstrating a favorable effect of this therapeutic option in children with drug-resistant epilepsy and in cases of encephalitis. No serious adverse effects were reported. No prospective studies about the use of intravenous immunoglobulins in children with demyelinating disorders or neurologic paraneoplasmatic syndromes were found. Conclusion: In this review, we summarize the recent advances in the field of intravenous immunoglobulins used in pediatric neurological diseases. Literature data supports a beneficial effect in this age group. Whilst awaiting the results of large scale studies, administration of intravenous immunoglobulins could be justified in refractory child epilepsy. Otherwise, its use should be guided by the individual needs of each child, depending on the underlying neurological disease.

Background: Vaccine formulations may contain visible and/or subvisible particles, which can vary in both size and morphology. Extrinsic particles, which are particles not part of the product such as foreign contaminants, are generally considered undesirable and should be eliminated or controlled in injectable products. However, biological products, in particular vaccines, may also contain particles that are inherent to the product. Here we focus on the characterization of visible and subvisible particles in a live, replication-deficient viral vaccine candidate against HSV genital herpes in an early developmental stage. Method: HSV-2 viral vaccine was characterized using a panel of analytical methods, including Fourier transform infrared spectroscopy (FTIR), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), Western blot, liquid chromatography-mass spectrometry (LC-MS), light microscopy, transmission electron microscopy (TEM), micro-flow imaging (MFI), dynamic light scattering (DLS), right angle light scattering (RALS), and intrinsic fluorescence. Results: Particles in HSV-2 vaccine typically ranged from hundreds of nanometers to hundreds of micrometers in size and were determined to be inherent to the product. The infectious titer did not correlate with any trend in subvisible particle concentration and size distribution as shown by DLS, MFI, and TEM under stressed conditions. This suggested that particle changes in the submicron range were related to HSV-2 virion structure and had direct impact on biological activity. It was also observed that subvisible and visible particles could induce aggregation in the viral product. The temperature induced aggregation was observed by RALS, intrinsic fluorescence, and DLS. The increase of subvisible particle size with temperature could be fitted to a two-step thermokinetic model. Conclusion: Visible and subvisible particles were found to be inherent to the HSV-2 viral vaccine product. The mechanism of protein aggregation was discussed and a two-step thermokinetic aggregation profile was proposed. The approaches reported in this study may be applied to a variety of vaccines and other biological products, as a way to assess the consistency of the manufacturing process and identify key product quality attributes.

Background: For design of a subunit vaccine for tuberculosis, identification of antigenic Tcell epitope is of utmost importance. Several MHC prediction server are available that can accurately predict antigenic peptide of variable lengths. However, peptides predicted from one server not necessarily are predicted form another server, thus creating a confusing situation for scientists to choose a best epitope. Method: Keeping the above problem in mind, we developed a comprehensive database of peptides of Mycobacterial proteins. Each protein was taken from PubMed and was run through different MHC prediction servers, with the results being compiled into one database. Results: For each protein, PeMtb generates a set of three different mers of variable lengths (12 mer or 13-mer) based on their ranking; with each mer being predicted for a plethora of MHC alleles. Researcher can choose the peptide (mers) that gives best binding affinity from most of the servers. Conclusion: The database relieves the investigators of the painstaking task of searching various MHC prediction servers for the right epitope (T-cell epitope) for a particular Mycobacterial antigen. We trust and anticipate that PeMtb will be a practical platform for trial and computational analyses of antigenic peptides for Mycobacterium tuberculosis. All the resources and information can be accessed by PeMtb home page www.pemtb-amu.org.

Background: Enterococcus faecalis 2001 is a probiotic lactic acid bacterium and has been used as a biological response modifier (BRM). From physiological limitation of bacterial preservation in storage and safety, the live E. faecalis 2001 has been heat-treated and the BRM components containing high level of β-glucan, named EF-2001, were prepared. Method: The heat-treated EF-2001 has been examined for the antioxidative potential for radical scavenging and anti-tumor activities as well as immune-enhancing response in mice. Lymphocyte versus polymorphonuclear leukocyte ratio was increased in mice upon treatment with EF-2001. The number of lymphocytes was increased in the EF-2001-treated group. In the mice bearing two different Ehrlich solid and Sarcoma-180 carcinomas, the treatment with EF-2001 resulted in anti-tumor action. Tumor-suppressive capacity upon treatment with EF-2001 was significantly increased compared to normal controls. Results: During the time interval administration of 5 weeks between the priming and secondary administration of EF-2001, the expression and production levels of TNF-α were also observed in the EF- 2001-administered mice. Additionally, anti-tumor activity examined with the intravenous administration of EF 2001 with a 34 times interval was also observed, as the growth of Sarcoma180 cells was clearly inhibited by the EF-2001. Conclusion: From the results, it was suggested that the immune response is enhanced due to antioxidative activity caused by the EF-2001 and anti-tumor activity by NK cells and TNF-α.

Background: Connexin (Cx) proteins are the building blocks of gap junctions. Among these, Cx37 and Cx40 are expressed on vascular system and reported to have cardioprotective role. Linking polymorphisms in genes coding for Cx and coronary artery disease (CAD) risk showed conflicting results in different populations. None has been studied before in Egyptians. Therefore, the aims of this study were to investigate the influence of Cx37 C1019T and Cx40 A71G polymorphisms on the predisposition of acute myocardial infarction (AMI) in Egyptians, to study linkage disequilibrium (LD) and combined effects of single nucleotide polymorphisms (SNPs) and to correlate the genotypes with sVCAM-1 serum levels. Methods: Total of 201 Egyptian subjects were recruited for the study. They were divided into 104 AMI patients and 97 healthy controls. Genotypes for each participant were determined using a polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Serum sVCAM-1was measured by ELISA. Results: Allele frequencies for both Cx37 and Cx40 were not significantly different between AMI and Controls (p=0.93 and p=0.26 respectively). Moreover, studying the dominant and recessive models concluded that none of the genotypes was a risk factor. Both SNPs were not in LD (R2=0.0027). Serum analysis showed higher levels of sVCAM-1 in AMI patients (p<0.0001). sVCAM-1 levels were not significantly different among SNPs (Cx37; p=0.244 and Cx40; p=0.266). Conclusion: This study shows that Cx37 C1019T and Cx40 A71G polymorphisms are not associated with cardioprotective role in Egyptians. Moreover, both SNPs are inherited separately and none of the genotypes were associated with higher sVCAM-1 levels.

Background: Among the many researches on cellular uptake and intracellular trafficking pathways of αvβ3-targeted nanomedicines, a large number of studies utilize serum-free medium to evaluate drug effects and cellular mechanisms in vitro whether the medium is serum free or not has not been paid much attention. Methods: The aim of this study was to assess the impact of serum on αvβ3-mediated endocytosis and intracellular trafficking pathways. cRGDfK conjugated with Alexa Fluor® 555 was used to recognize αvβ3 integrins specifically. Transferrin-Alexa Fluor® 488 conjugates were selected as the intracellular trafficking pathway markers by real-time confocal analysis method using confocal laser-scanning microscope. Results: The results showed that after internalization, cRGDfK showed perfect colocalization with transferrin (Tfn) when the cells were cultured in serum-free medium, but manifested obvious separation from Tfn to recycle back to the plasma membrane when the cells were cultured in complete medium. cRGDfK travels two quite different pathways under different culture conditions. Conclusion: We strongly recommended that when the intracellular mechanisms or pharmacodynamics of αvβ3-targeted nanomedicines was investigated, serum free medium or medium with serum should be taken into consideration. We hope this paper will provide helpful suggestions for studies on αvβ3- targeted drug delivery system.

Background: Citrullus colocynthis (L.) Schrad is an important medicinal plant belonging to the family Cucurbitaceae. Cucurbitacin E glucoside (1) was isolated from Citrullus colocynthis fruits. A novel mono-ester of cucurbitacin-E and cinnamyl and caffeoyl-β-D-glucoside (2 and 3) was synthesized by reaction of cucurbitacin E glucoside with cinnamic and/or caffeic acid in the presence of CHCl2 and K2CO3 with constant stirring with an ice-cooling state for 24h. Mass analyses of the isolated and purified compounds were determined. Methods: The elemental analysis (C, H, N) suggesting the molecular formulae of the compounds (1-3) to be C38H54O13, C47H60O14, and C47H60O16; respectively. I.R., 1H-NMR, and 13C-NMR analyses were recorded. The median lethal doses (LD50s) of compounds (1-3) in rats were 1262.5, 2500 and 2350 mg/kg b.w., respectively. The anti-inflammatory, total antioxidant, reducing power, anti-reactive oxygen species (ROS) and anti-reactive nitrogen species (RNS) were more pronounced in compound 3 compared to compounds (1-2). This study provides the scientific basis for the anti-inflammatory effects of the isolated cucurbitacin E glucoside (1) and its derivatives (2 and 3) in a t-BHP (tert-butyl hydrogen peroxide)-induced liver damage model. Results: Injection of rats with t-BHP (1.8 mmol/kg) showed a significant increase in plasma alanine transaminases (ALT), aspartate transaminases (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and malondialdehyde (MDA) as well as hepatic tumor Necrosis Factor-α (TNF-α), interleukin- 6 (IL-6) and interleukin-23 (IL-23) when compared with control group. Also, injection of rats with t-BHP showed a significant increase in a liver level of reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST) as compared with control group. Oral administration of cucurbitacin E glucoside (1) and its derivatives (2 and 3) at a concentration of 25 and 50 mg/kg b.wt daily for 5 days showed a significant protection against-induced alteration in liver GSH, SOD, CAT and GST as well as plasma ALT, AST, ALP, LDH and MDA levels. Furthermore, Cucurbitacin E glucoside (1) and its derivatives (2 and 3) inhibited the elevation of proinflammatory cytokines (TNF-α, IL-6, and IL-23) in the livers of t-BHP-treated rat models. Conclusion: These results suggested that mechanistic-based evidence substantiating the traditional claims of cucurbitacin E glucoside (1) and its derivatives (2 and 3) to be applied for the treatment of inflammation-related disorders, such as oxidative liver damage and inflammation diseases.