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1.
J Nat Med ; 78(4): 828-837, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39093356

ABSTRACT

The genus Nocardia are gram-positive bacteria, many of which possess pathogenicity and infect human lungs, skin, brain, and other organs. Since research on the genus Nocardia has not progressed as rapidly as that on the genus Streptomyces, the genus Nocardia is considered a useful undeveloped resource for exploring natural products. On the other hand, when the genus Nocardia infects the human body, the strains are attacked by immune cells such as macrophages. Therefore, we suggested a new method for screening natural products by culturing the genus Nocardia in the presence of animal cells. In this review, we describe our recent results in searching for natural products from the genus Nocardia.


Subject(s)
Biological Products , Nocardia , Biological Products/chemistry , Biological Products/pharmacology , Humans , Animals , Actinobacteria
2.
J Nat Med ; 78(3): 732-740, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38592349

ABSTRACT

Three new biflavonoids (1-3) and two known flavonoids (4, 5) were isolated from Xylia kerrii collected in Thailand. Compounds 1-5 showed selective cytotoxicity against the rheumatoid fibroblast-like synovial MH7A cell line, and these compounds showed weak cytotoxicity against the human lung synovial fibroblast WI-38 VA13 sub 2 RA cell line. Notably, compound 1 was highly selective toward MH7A cells with an IC50 value of 6.9 µM, whereas the IC50 value for WI-38 VA13 sub 2 RA cells was > 100 µM. The western blotting analysis of MH7A cells treated with compound 1 showed increased CDKN2A /p16INK4A and caspase-8 levels.


Subject(s)
Arthritis, Rheumatoid , Biflavonoids , Fibroblasts , Plant Extracts , Plant Leaves , Humans , Fibroblasts/drug effects , Arthritis, Rheumatoid/drug therapy , Plant Extracts/pharmacology , Plant Extracts/chemistry , Plant Leaves/chemistry , Cell Line , Biflavonoids/pharmacology , Biflavonoids/chemistry , Biflavonoids/isolation & purification , Thailand , Synovial Membrane/drug effects , Molecular Structure
3.
Front Pharmacol ; 15: 1365815, 2024.
Article in English | MEDLINE | ID: mdl-38659576

ABSTRACT

The virulence of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), depends on the expression of toxins and virulence factors controlled by the quorum-sensing (QS) system, encoded on the virulence accessory gene regulator (agr) locus. The aim of this study was to identify a phytochemical that inhibits Agr-QS function and to elucidate its mechanism. We screened 577 compounds and identified physalin H, physalin B, and isophysalin B--phytochemicals belonging to physalins found in plants of the Solanaceae family--as novel Agr-QS modulators. Biological analyses and in vitro protein-DNA binding assays suggested that these physalins suppress gene expression related to the Agr-QS system by inhibiting binding of the key response regulator AgrA to the agr promoters, reducing the function of hemolytic toxins downstream of these genes in MRSA. Furthermore, although physalin F suppressed gene expression in the Agr-QS system, its anti-hemolytic activity was lower than that of physalins H, B, and isophysalin B. Conversely, five physalins isolated from the same plant with the ability to suppress Agr-QS did not reduce bacterial Agr-QS activity but inhibited AgrA binding to DNA in vitro. A docking simulation revealed that physalin interacts with the DNA-binding site of AgrA in three docking states. The carbonyl oxygens at C-1 and C-18 of physalins, which can suppress Agr-QS, were directed to residues N201 and R198 of AgrA, respectively, whereas these carbonyl oxygens of physalins, without Agr-QS suppression activity, were oriented in different directions. Next, 100-ns molecular dynamics simulations revealed that the hydrogen bond formed between the carbonyl oxygen at C-15 of physalins and L186 of AgrA functions as an anchor, sustaining the interaction between the carbonyl oxygen at C-1 of physalins and N201 of AgrA. Thus, these results suggest that physalin H, physalin B, and isophysalin B inhibit the interaction of AgrA with the agr promoters by binding to the DNA-binding site of AgrA, suppressing the Agr-QS function of S. aureus. Physalins that suppress the Agr-QS function are proposed as potential lead compounds in the anti-virulence strategy for MRSA infections.

4.
Heliyon ; 10(3): e25049, 2024 Feb 15.
Article in English | MEDLINE | ID: mdl-38318065

ABSTRACT

Crinum asiaticum L. (Amaryllidaceae) is a perennial bulbous herb, locally utilized for possessing multifaceted pharmacological properties including anticancer, immune-stimulating, analgesic, antiviral, antimalarial, antibacterial and antifungal, in addition to its popularity as an aesthetic plant. Separation of MeOH extract of C. asiaticum leaves yielded three known compounds as cycloneolitsol (1), hippeastrine (2) and ß-sitosterol (3). Among these, compounds 1 and 2 were subjected to the cytotoxic assay and found that they induced mild effect against HCT116, Huh7 and DU145 cell lines with the IC50 values from 73.76 to 132.53 µM. When tested for TRAIL-resistance abrogating activity, 1 (100 µM) along with TRAIL (100 ng/mL) showed moderate activity in AGS cells producing 25 % more inhibition than the agent alone. Whereas 2 (20 and 30 µM) in combination with TRAIL (100 ng/mL) exhibited strong activity in abrogating TRAIL-resistance and caused 34 % and 36 % more inhibition in AGS cells, respectively. The in-silico studies of compound 2 revealed high docking hits with the TRAIL-associated anti-apoptotic proteins which give a justification for the regulatory interactions to induce such abrogating activity. It is still recommended to conduct further investigations to understand their exact molecular mechanism.

5.
J Nat Med ; 77(2): 370-378, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36495388

ABSTRACT

A new 1,2-diketone physalin, physalin XII (1), and 13 known compounds were isolated from the methanol extract of Physalis minima whole plant collected in Thailand. Among them, five physalins (2-6) had tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-resistance overcoming activity, and physalin F (3) was the most active with an IC50 value of 0.39 µM against human gastric adenocarcinoma cell line AGS in the presence of TRAIL (100 ng/mL). An investigation of the TRAIL-resistance overcoming activity of physalins using western blot analysis showed that 3 promoted TRAIL-induced apoptosis by suppressing anti-apoptotic proteins c-FLIP and Bcl-2.


Subject(s)
Physalis , Humans , Ligands , Cell Line , Tumor Necrosis Factor-alpha , Apoptosis , Cell Line, Tumor
6.
Chem Pharm Bull (Tokyo) ; 70(12): 885-891, 2022.
Article in English | MEDLINE | ID: mdl-36450587

ABSTRACT

A new coumarin derivative (1) and 30 known compounds were isolated from Mammea siamensis and Andrographis paniculata, guided by B cell-specific Moloney murine leukemia virus insertion region 1 (BMI1) promoter inhibitory activity. Among the isolated compounds, 15 compounds showed BMI1 promoter inhibitory activity, and five compounds were found to be cytotoxic. 14-Deoxy-11,12-dehydroandrographolide (18) was highly cytotoxic to DU145 cells with an IC50 value of 25.4 µM. Western blotting analysis of compound 18 in DU145 cells suggested that compound 18 suppresses BMI1 expression.


Subject(s)
Mammea , Animals , Mice , Andrographis paniculata , Cell Line , Polycomb Repressive Complex 1 , Proto-Oncogene Proteins , Triiodobenzoic Acids
8.
Org Lett ; 24(27): 4998-5002, 2022 07 15.
Article in English | MEDLINE | ID: mdl-35792521

ABSTRACT

Two new peptides named uniformides A and B (1 and 2, respectively) were isolated from the cultured extracts of Nocardia uniformis IFM0856T in the presence of mouse macrophage-like cell line J774.1, in modified Czapek-Dox medium. These compounds were not produced in a culture containing only N. uniformis but in one that also included J774.1. Compounds 1 and 2 showed high cytotoxicity against J774.1 and suppressed the production of nitric oxide, IL-6, and IL-1ß by inhibiting the NF-κB pathway.


Subject(s)
Nocardia , Animals , Cell Line , Lipopolysaccharides/pharmacology , Mice , NF-kappa B/metabolism , Nitric Oxide , Nitric Oxide Synthase Type II/metabolism , Nocardia/metabolism
9.
J Nat Med ; 76(2): 482-489, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35040087

ABSTRACT

Two new compounds, thannilignan 9-O-ß-glucoside (1) and 2-(ß-glucopyranosyl)-3-isoxazolin-5-one derivative (2), and seven known compounds were isolated from the methanol extract of Terminalia bellirica leaves, collected in Bangladesh. The structures of the compounds were elucidated using spectroscopic analysis. Among these isolated compounds, corilagin (3) was cytotoxic against human gastric adenocarcinoma cell line AGS at an IC50 of 20.8 µM, and ß-D-glucopyranose 1,3,6-trigallate (4) exhibited the ability to overcome tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resistance.


Subject(s)
Terminalia , Glucosides/pharmacology , Humans , Isoxazoles , Plant Extracts/chemistry
10.
Molecules ; 28(1)2022 Dec 28.
Article in English | MEDLINE | ID: mdl-36615459

ABSTRACT

Eighteen compounds, including fourteen flavonoids (1-14), one steroid (15), two fatty acids (16,17), and one nitrogen-containing compound (18), were isolated from the methanol extract of the whole Blumea lacera plant collected in Thailand. Compounds 1-11 and 15-17 exhibited tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resistance-overcoming activity. Among them, bonanzin (2) and cirsilineol (7) had particularly strong TRAIL resistance-overcoming activity, where the IC50 values against the human gastric adenocarcinoma cell line AGS in the presence of TRAIL (100 ng/mL) were 10.7 µM and 5.9 µM, respectively.


Subject(s)
Asteraceae , Flavonoids , Humans , Flavonoids/pharmacology , Cell Line, Tumor , Ligands , Apoptosis , Asteraceae/metabolism , Tumor Necrosis Factor-alpha , TNF-Related Apoptosis-Inducing Ligand/pharmacology , TNF-Related Apoptosis-Inducing Ligand/metabolism
11.
Chembiochem ; 22(18): 2799-2804, 2021 09 14.
Article in English | MEDLINE | ID: mdl-34216084

ABSTRACT

Pulmonary arterial hypertension (PAH) is a rare and severe progressive disorder characterized by high pulmonary artery pressure. Chronic hypoxia causes a metabolic disorder and the Warburg effect in pulmonary arterial smooth muscle cells (PASMCs). Pyruvate dehydrogenase kinase 1 (PDK1) is a key enzyme in Warburg effect increased by hypoxia-inducible factor (HIF-1). We constructed a cell-based luciferase assay system for HIF-1 inhibitors. Using this system, six HIF-1 inhibitors were identified. Among these inhibitors, the effect of tagitinin C (1) on PASMC was investigated. Tagitinin C (1) clearly decreased the amount of HIF-1ß and the HIF-1 target PDK1. This result indicates that HIF-1 inhibitors effectively decrease PDK1 activity, which is a cause of the metabolic disorder and Warburg effect observed in PASMCs. Identifying naturally occurring HIF-1 inhibitors could provide novel insights into the development of PAH medications.


Subject(s)
Biological Products/chemistry , Hypoxia-Inducible Factor 1, alpha Subunit/antagonists & inhibitors , Biological Products/pharmacology , Biological Products/therapeutic use , Cell Line , Cell Survival/drug effects , Humans , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Myocytes, Smooth Muscle/cytology , Myocytes, Smooth Muscle/metabolism , Pulmonary Arterial Hypertension/drug therapy , Pyruvate Dehydrogenase Acetyl-Transferring Kinase/antagonists & inhibitors , Pyruvate Dehydrogenase Acetyl-Transferring Kinase/metabolism , Sesquiterpenes/chemistry , Sesquiterpenes/pharmacology , Sesquiterpenes/therapeutic use
12.
J Nat Med ; 75(1): 99-104, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33048280

ABSTRACT

A novel C20 natural product, acacienone (1), was isolated from the leaves of Acacia mangium collected in Bangladesh. The structure of compound 1 was elucidated by spectral studies and X-ray crystallographic analysis. Acacienone (1) possesses a terpenoid-related tetracyclic framework containing 20 carbons with biogenetically unusual structural features: (i) vicinal C1-branches at the C-3 and C-4 positions in the A ring, and (ii) a cyclopentenone D ring in an androsterone-like assembly, lacking a methyl group at the C-13 position.


Subject(s)
Acacia/chemistry , Biological Products/therapeutic use , Plant Extracts/chemistry , Plant Leaves/chemistry , Biological Products/pharmacology , Models, Molecular
13.
J Antibiot (Tokyo) ; 74(4): 255-259, 2021 04.
Article in English | MEDLINE | ID: mdl-33318622

ABSTRACT

Notch signaling inhibitors with the potential of immune suppressor production by pathogenic bacteria for easy host infection were searched from extracts of Nocardia sp. Nocobactin NA-a (compound 1) and nocobactin NA-b (compound 2), which have been suggested as pathogenesis factors, were isolated from N. farcinica IFM 11523 isolated from the sputum of a Japanese patient with chronic bronchitis. Compounds 1 and 2 showed Notch inhibitory activities with IC50 values of 12.4 and 17.6 µM, respectively. Compound 1 and 2 decreased of Notch1 protein, Notch intracellular domain, and hairy and enhancer of split 1, which is a Notch signaling target protein. In addition, compounds 1 and 2 showed cytotoxicity against mouse macrophage-like cell line RAW264.7 with IC50 values of 18.9 and 21.1 µM, respectively. These results suggested that the Notch inhibitors production by pathogenic bacteria may increase pathogen infectivity.


Subject(s)
Host-Pathogen Interactions , Nocardia Infections/microbiology , Nocardia/pathogenicity , Oxazoles/metabolism , Receptors, Notch/metabolism , Bronchitis, Chronic/microbiology , Evolution, Molecular , Humans , Hydroxamic Acids/isolation & purification , Hydroxamic Acids/pharmacology , Magnetic Resonance Spectroscopy , Nocardia/growth & development , Nocardia/isolation & purification , Nocardia/metabolism , Oxazoles/isolation & purification , Oxazoles/pharmacology , Receptors, Notch/antagonists & inhibitors , Signal Transduction , Sputum/microbiology , Virulence Factors/metabolism , Virulence Factors/pharmacology
14.
J Nat Med ; 74(2): 476-481, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31863259

ABSTRACT

Upon screening compounds having Wnt signal inhibitory activity through evaluating TCF/ß-catenin transcriptional (TOP) activity, eight cadinane sesquiterpenoids, including three new compounds (1-3), were isolated from wood extracts of Santalum album (Santalaceae). Structures of compounds 1-3 were elucidated by spectral data to have a cadinane skeleton with an aromatic ring. Of the eight compounds isolated, compound 4, identified as mansonone I, was found to be active against TOP, having an IC50 of 1.2 µM.


Subject(s)
Polycyclic Sesquiterpenes/chemistry , Santalum/chemistry , Wnt Signaling Pathway/genetics , Sesquiterpenes/pharmacology
15.
J Nat Med ; 74(1): 76-82, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31321600

ABSTRACT

It is generally accepted that fungi have a number of dormant gene clusters for the synthesis of secondary metabolites, and the activation of these gene clusters can expand the diversity of secondary metabolites in culture. Recent studies have revealed that the mycolic acid-containing bacterium Tsukamurella pulmonis activates dormant gene clusters in the bacterial genus Streptomyces. However, it is not clear whether the mycolic acid-containing bacteria activate dormant gene clusters of fungi. We performed co-culture experiments using marine-derived Aspergillus niger with Mycobacterium smegmatis, a mycolic acid-containing bacteria. The co-cultivation resulted in the production of a pigment by A. niger and increased cytotoxic activity of the extract against human prostate cancer DU145 cells. An analysis of secondary metabolites in the extract of the co-culture broth revealed that the increase in cytotoxic activity was caused by the production of malformin C (1), and that TMC-256A1 (2), desmethylkotanin (3), and aurasperone C (4) were selectively produced under co-culture conditions. In addition, further study suggested that direct interaction between the two microorganisms was necessary for the production of the pigment and the cytotoxic compound malformin C (1) from A. niger. Given the biological activities of malformin C, including cytotoxic activity, our approach for increasing the production of bioactive secondary metabolites has important practical applications and may facilitate structural analyses of novel bioactive compounds.


Subject(s)
Aspergillus niger/pathogenicity , Mycobacterium smegmatis/virology , Animals , Fishes , Humans
16.
Bioorg Med Chem ; 27(13): 2998-3003, 2019 07 01.
Article in English | MEDLINE | ID: mdl-31079965

ABSTRACT

B-cell-specific Moloney murine leukemia virus region 1 (BMI1) is a central component of polycomb repressive complex 1 (PRC1), which maintains epigenetic repression of genes expression via chromatin condensation. BMI1 overexpression downregulates the expression of tumor suppressor genes, such as p16Ink4a and PTEN. BMI1 expression is upregulated in cancer stem cells (CSCs). Therefore, inhibitors of BMI1 expression have potential as therapeutic agents for cancer. This study aimed to identify BMI1 promoter inhibitors from actinomycetes. Using a recently constructed BMI1 promoter assay, we isolated three known compounds, elaiophylin (1), 2-methylelaiophylin (2), and nocardamin (3), from Streptomyces sp. IFM-11958 that inhibited BMI1 promoter activity with IC50 values of 30 nM, 447 nM, 22 µM, respectively. Elaiophylin (1) was the most potent. Western blot and PCR analyses revealed that elaiophylin (1) inhibited BMI1 expression at the mRNA level in human prostate cancer cells (DU145). Elaiophylin (1) also inhibited the sphere-forming activity of human hepatocellular carcinoma cells (Huh7), indicating that elaiophylin (1) suppresses the self-renewal capacity of CSCs. Elaiophylin (1) is the first BMI1 promoter inhibitor isolated from actinomycete metabolites.


Subject(s)
Polycomb Repressive Complex 1/antagonists & inhibitors , Streptomyces/drug effects , Humans
17.
Chem Pharm Bull (Tokyo) ; 66(10): 976-982, 2018.
Article in English | MEDLINE | ID: mdl-30270243

ABSTRACT

A new aminocyclitol derivative, designated nabscessin C (1), was isolated from Nocardia abscessus IFM 10029T. Nabcessin C is an isomer of nabscessins A (2) and B (3) with different positioning of the acyl group. Absolute configuration of nabscessin A was determined by conversion into the 2-deoxy-scyllo-inosamine pentaacetyl derivative (4) by hydrolysis and acetylation of 2. The biosynthetic pathway of nabscessins is proposed based on gene expression analysis.


Subject(s)
Cyclitols/metabolism , Nocardia asteroides/chemistry , Acetylation , Animals , Cell Line , Cell Proliferation , Cyclitols/chemistry , Cyclitols/isolation & purification , Hydrolysis , Mice , Molecular Structure , Nocardia asteroides/metabolism , Seeds/chemistry , Seeds/metabolism
18.
Org Lett ; 20(18): 5831-5834, 2018 09 21.
Article in English | MEDLINE | ID: mdl-30156858

ABSTRACT

A coculture method with a pathogenic actinomycete of the genus Nocardia and an animal cell line was designed to reconstruct and emulate the initial infection state, and a new cyclic nonapeptide, named nocarjamide (1), was obtained by coculture of Nocardia tenerifensis IFM 10554T and the mouse macrophage-like cell line J774.1 in a modified Czapek-Dox medium. Nocarjamide (1) exhibited Wnt signal-activating effects.


Subject(s)
Coculture Techniques , Nocardia/metabolism , Peptides, Cyclic/metabolism , Animals , Cell Line , Cell Survival/drug effects , HEK293 Cells , Humans , Mice , Molecular Conformation , Nocardia/chemistry , Nocardia/growth & development , Peptides, Cyclic/chemistry , Peptides, Cyclic/genetics , Wnt Signaling Pathway/drug effects
19.
J Nat Med ; 72(1): 280-289, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29209902

ABSTRACT

A new amide, named dehydropropylpantothenamide (1), was obtained by a co-culture of Nocardia tenerifensis IFM 10554T in the presence of the mouse macrophage-like cell line J774.1 in modified Czapek-Dox (mCD) medium. Compound 1 was synthesized from D-pantothenic acid calcium salt in 6 steps. The absolute configuration of natural compound 1 was determined by comparisons of the optical rotation and CD spectra of synthetic 1. In the present study, a new method for producing secondary metabolites was demonstrated using a "co-culture" in which the genus Nocardia was cultured in the presence of an animal cell line.


Subject(s)
Nocardia/metabolism , Pantothenic Acid/analogs & derivatives , Pantothenic Acid/isolation & purification , Animals , Bacterial Proteins/genetics , Biosynthetic Pathways , Cell Line , Coculture Techniques , Host-Pathogen Interactions , Macrophages/microbiology , Mice , Nocardia/genetics , Nocardia Infections/metabolism , Nocardia Infections/microbiology , Pantothenic Acid/biosynthesis , Pantothenic Acid/chemistry , Phylogeny
20.
BMC Cancer ; 17(1): 870, 2017 Dec 19.
Article in English | MEDLINE | ID: mdl-29258450

ABSTRACT

BACKGROUND: Sorafenib is a multiple receptor tyrosine kinase inhibitor known to prolong overall survival in patients with advanced hepatocellular carcinoma (HCC). Predicting this drug's survival benefits is challenging because clinical responses are rarely measurable during treatment. In this study, we hypothesized that serum cytokines levels could predict the survival of advanced HCC patients, as sorafenib targets signaling pathways activated in the tumor stromal microenvironment and potentially affects serum cytokine profiles. METHODS: Of 143 patients with advanced-stage HCC, 104 who were recruited between 2003 and 2007 received hepatic arterial infusion chemotherapy (HAIC) that mainly targets tumor epithelial cells at S-phase (cohort 1); additionally, 39 recruited between 2010 and 2012 received sorafenib, which primarily targets the stromal vascular endothelial cells. Serum samples were collected and aliquoted prior to the treatment. Serum EGF, bFGF, HGF, IFN-γ, IL-10, IL-12, IL-2, IL-4, IL-5, IL-6, IL-8, IP-10, MIG, PDGF-BB, SCF, SDF1, TGF-ß, TGF-α, TNF-α, and VEGF-A were measured via enzyme-linked immunosorbent assays. The Modified Response Evaluation Criteria in Solid Tumors were used to assess tumor responses. RESULTS: The median survival time of HCC patients in cohorts 1 (HAIC-treated) and 2 (sorafenib-treated) were 12.0 and 12.4 months, respectively. Kaplan-Meier analysis revealed no significant survival differences between the 2 groups. Patients who survived more than 2 years after sorafenib treatment exhibited higher serum levels of IL-10, IL-12, TNF-a, IL-8, SDF-1, EGF, PDGF-BB, SCF, and TGF-α. Furthermore, cohort 2 patients with higher serum IL-5 (>12 pg/mL), IL-8 (>10 pg/mL), PDGF-BB (>300 pg/mL), and VEGF-A (>50 pg/mL) levels achieved longer survival; cohort 1 patients did not. Hierarchical cluster analysis of 6 cytokines robustly enriched for comparison analysis between cohorts 1 and 2 (IL-5, IL-8, TGF-α, PDGF-BB, CXCL9, and VEGF-A) revealed that elevation of these cytokines correlated with better survival when treated with sorafenib but not with HAIC. CONCLUSIONS: Patients who exhibited survival benefits owing to sorafenib treatment tended to present higher serum cytokines levels, potentially reflecting the activation of stromal signaling in the tumor microenvironment. Our study thus introduces novel biomarkers that may identify advanced HCC patients who may experience survival benefits with sorafenib treatment.


Subject(s)
Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/drug therapy , Cytokines/blood , Liver Neoplasms/blood , Niacinamide/analogs & derivatives , Phenylurea Compounds/administration & dosage , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/pathology , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Liver Neoplasms/drug therapy , Liver Neoplasms/epidemiology , Liver Neoplasms/pathology , Male , Middle Aged , Niacinamide/administration & dosage , Niacinamide/adverse effects , Phenylurea Compounds/adverse effects , Sorafenib , Treatment Outcome
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