Podophyllotoxin: Recent Advances in the Development of Hybridization Strategies to Enhance Its Antitumoral Profile.

Podophyllotoxin is a naturally occurring cyclolignan isolated from rhizomes of Podophyllum sp. In the clinic, it is used mainly as an antiviral; however, its antitumor activity is even more interesting. While podophyllotoxin possesses severe side effects that limit its development as an anticancer agent, nevertheless, it has become a good lead compound for the synthesis of derivatives with fewer side effects and better selectivity. Several examples, such as etoposide, highlight the potential of this natural product for chemomodulation in the search for new antitumor agents. This review focuses on the recent chemical modifications (2017-mid-2023) of the podophyllotoxin skeleton performed mainly at the C-ring (but also at the lactone D-ring and at the trimethoxyphenyl E-ring) together with their biological properties. Special emphasis is placed on hybrids or conjugates with other natural products (either primary or secondary metabolites) and other molecules (heterocycles, benzoheterocycles, synthetic drugs, and other moieties) that contribute to improved podophyllotoxin bioactivity. In fact, hybridization has been a good strategy to design podophyllotoxin derivatives with enhanced bioactivity. The way in which the two components are joined (directly or through spacers) was also considered for the organization of this review. This comprehensive perspective is presented with the aim of guiding the medicinal chemistry community in the design of new podophyllotoxin-based drugs with improved anticancer properties.

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort.

BACKGROUND: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. METHODS: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. RESULTS: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). CONCLUSIONS: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.

Sensitivity to change and minimal clinically important difference of the angioedema control test.

BACKGROUND: The Angioedema Control Test (AECT) is a patient-reported outcome measure developed and validated for the assessment of disease control in patients with recurrent angioedema. Its sensitivity to change and minimal clinically important difference (MCID) have hitherto not been established. METHODS: Patients with recurrent angioedema due to chronic spontaneous urticaria, hereditary angioedema, or acquired C1-inhibitor deficiency were repeatedly asked to complete the AECT along with the Angioedema Quality of Life Questionnaire (AE-QoL), Dermatology Life Quality Index (DLQI), and anchors for disease control and whether treatment was sufficient during routine care visits. The sensitivity to the change of the AECT was determined by correlating changes in its scores over time with changes in the applied anchors. The MCID was determined using anchor-based and distributional criterion-based approaches. RESULTS: Eighty-six cases were used for this analysis. Changes in AECT scores correlated well with AE-QoL changes (but less with changes in the DLQI) as well as other applied anchors, demonstrating its sensitivity to change. The MCID was found to be three points for improvement of angioedema control. The available number of cases with meaningful deterioration in our dataset was too low to reach a definite conclusion on the MCID for deterioration of angioedema control. CONCLUSION: The AECT is a valuable tool to assess changes in disease control in patients with recurrent angioedema over time. The lowest AECT score change that reflects a meaningful improvement of disease control to patients (MCID) is three points.

Patients With Chronic Spontaneous Urticaria Who Have Wheals, Angioedema, or Both, Differ Demographically, Clinically, and in Response to Treatment-Results From CURE.

BACKGROUND: Patients with chronic spontaneous urticaria (CSU) have spontaneous wheals (W), angioedema (AE), or both, for longer than 6 weeks. Clinical differences between patients with standalone W, standalone AE, and W and AE (W+AE) remain incompletely understood. OBJECTIVE: To compare W, AE, and W+AE CSU patients regarding demographics, disease characteristics, comorbidities, disease burden, and treatment response. METHODS: Baseline data from 3,698 CSU patients in the ongoing, prospective, international, multicenter, observational Chronic Urticaria REgistry (CURE) were analyzed (data cut: September 2022). RESULTS: Across all CSU patients, 59%, 36%, and 5% had W+AE, W, and AE, respectively. The W+AE patients, compared with W and AE patients, showed the lowest male-to-female ratio (0.33), higher rates of concomitant psychiatric disease (17% vs 11% vs 6%, respectively), autoimmune disease (13% vs 7% vs 9%, respectively), and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (9% vs 5% vs 2%, respectively) and the highest disease impact. The W patients, compared with W+AE and AE patients, showed the lowest rates of concomitant hypertension (15% vs 21% vs 40%, respectively) and obesity (11% vs 16% vs 17%, respectively), the highest rate of concomitant inducible urticaria (24% vs 22% vs 6%, respectively), and shorter W duration. The AE patients, compared with W+AE and W patients, were older at disease onset, showed longer AE duration, and the best response to increased doses of H1-antihistamines (58% vs 24% vs 31%, respectively) and omalizumab (92% vs 67% vs 60%, respectively). CONCLUSIONS: Our findings provide a better understanding of CSU phenotypes and may guide patient care and research efforts that aim to link them to pathogenic drivers.

Inferring the ecology of north-Pacific albacore tuna from catch-and-effort data.

Catch-and-effort data are among the primary sources of information for assessing the status of terrestrial wildlife and fish. In fishery science, elaborate stock-assessment models are fitted to such data in order to estimate fish-population sizes and guide management decisions. Given the importance of catch-and-effort data, we scoured a comprehensive dataset pertaining to albacore tuna (Thunnus alalunga) in the north Pacific Ocean for novel ecological information content about this commercially valuable species. Specifically, we used unsupervised learning based on finite mixture modelling to reveal that the north Pacific albacore-tuna stock can be divided into four pseudo-cohorts. We discovered that smaller body mass pseudo-cohorts inhabit relatively high-subtropical to temperate-latitudes, with hotspots off the coast of Japan. Larger body mass pseudo-cohorts inhabit lower-tropical to subtropical-latitudes, with hotspots in the western and central north Pacific. These results offer evidence that albacore tuna prefer different habitats depending on their body mass, and point to long-term migratory routes for the species that the current tagging technology is unlikely to capture in full. We discuss the implications of the results for data-driven modelling of albacore tuna in the north Pacific, as well as the management of the north Pacific albacore-tuna fishery.

An Alpha-Glucan from Lomentospora prolificans Mediates Fungal-Host Interaction Signaling through Dectin-1 and Mincle.

Scedosporium and Lomentospora are a group of filamentous fungi with some clinically relevant species causing either localized, invasive, or disseminated infections. Understanding how the host immune response is activated and how fungi interact with the host is crucial for a better management of the infection. In this context, an α-glucan has already been described in S. boydii, which plays a role in the inflammatory response. In the present study, an α-glucan has been characterized in L. prolificans and was shown to be exposed on the fungal surface. The α-glucan is recognized by peritoneal macrophages and induces oxidative burst in activated phagocytes. Its recognition by macrophages is mediated by receptors that include Dectin-1 and Mincle, but not TLR2 and TLR4. These results contribute to the understanding of how Scedosporium's and Lomentospora's physiopathologies are developed in patients suffering with scedosporiosis and lomentosporiosis.

Most Patients With Autoimmune Chronic Spontaneous Urticaria Also Have Autoallergic Urticaria, but Not ViceVersa.

BACKGROUND: Two endotypes of chronic spontaneous urticaria (CSU) associated with mast cell-activating autoantibodies are described, namely autoallergic chronic spontaneous urticaria (aaCSU; with immunoglobulin E [IgE]-anti-autoallergens) and autoimmune chronic spontaneous urticaria (aiCSU; with IgG-anti-high-affinity receptor for the Fc region of immunoglobulin E [FcεRI]/IgE). OBJECTIVE: To investigate the rates of CSU patients with aaCSU and aiCSU. METHODS: We analyzed 111 CSU patients for aaCSU (ie, IgE to thyroid peroxidase, interleukin 24) and for aiCSU (ie, a positive autologous serum skin and Basophil Activation Test plus immunoglobulin G [IgG]-anti-FcεRI/IgE). Clinical and laboratory parameters were compared in patients with aaCSU, aiCSU, and both. RESULTS: Across 111 patients with CSU, 64 (58%) had aaCSU and 9 (8%) had aiCSU. Eight of the 9 aiCSU patients had aaCSU, but only 8 of 64 patients with aaCSU had aiCSU. In total, 7% (8 of 111) of patients had both aiCSU and aaCSU, 41% (46 of 111) had neither, and 16% (18 of 111) tested negative for all markers of aaCSU and aiCSU assessed. Patients with aaCSU or aiCSU are different from those without: patients with stand-alone aaCSU tend to be younger than non-aaCSU patients, aiCSU, and aaCSU/aiCSU overlapping subpopulations. In contrast, patients with aiCSU, with or without aaCSU coexistence, are more often female, have higher levels of thyroid peroxidase autoantibodies (both IgG and IgE), and show more severe quality of life impairment. CONCLUSIONS: Our novel finding that aiCSU coexisting with aaCSU needs to be confirmed in bigger cohorts and multicenter studies. Autoimmunity driven by autoreactive IgE and/or IgG in CSU needs further investigation for better understanding of the pathophysiology.

Case report: Recurrent angioedema: Diagnosing the rare and the frequent.

Hereditary angiodema with normal C1 inhibitor and unknown mutation (HAE-nC1INH-UNK), an exceedingly rare subtype of HAE, appears to be often diagnosed in patients who do not have this condition, but have mast cell-mediated angioedema. Here, we report two patients diagnosed with HAE-nC1INH-UNK by their physicians, who referred them to our center for treatment continuation with costly kallikrein-kinin-system targeted therapies. We describe how we established the correct diagnosis of recurrent mast cell-mediated angioedema after thorough investigation of both patients and initiated effective treatment with omalizumab. Also, we present and discuss the consensus criteria for diagnosing the very rare condition HAE-nC1INH in light of recent research and based on our own clinical experience. In conclusion, HAE-nC1INH-UNK should only be considered after more common differential diagnoses, i.e., mast cell-mediated angioedema, have thoroughly been investigated and ruled out. This approach reduces both the patients' disease burden and healthcare costs and contributes to meaningful research.

Impaired sweating in patients with cholinergic urticaria is linked to low expression of acetylcholine receptor CHRM3 and acetylcholine esterase in sweat glands.

Background: Cholinergic urticaria (CholU), a frequent form of chronic inducible urticaria, is characterized by itchy wheals and angioedema in response to sweating. As of now, the rate and pathophysiological relevance of impaired sweating in patients with CholU are ill-defined. Aim: To assess in CholU patients the rate and extent of impaired sweating and its links to clinical and pathophysiological features of CholU. Patients and methods: We assessed sweating in patients with CholU (n = 13) subjected to pulse-controlled ergometry (PCE) provocation testing. Pre- and post-PCE biopsies of lesional (L) and non-lesional (NL) skin were analyzed for the expression of acetylcholine receptor M3 (CHRM3) and acetylcholine esterase (ACh-E) by quantitative histomorphometry and compared to those of healthy control subjects (HCs). CholU patients were assessed for disease duration and severity as well as other clinical features. Results: Of the 13 patients with CholU, 10 showed reduced sweating in response to PCE provocation, and 3 had severely reduced sweating. Reduced sweating was linked to long disease duration and high disease severity. CholU patients with impaired sweating responses showed reduced sweat gland epithelial expression of CHRM3 and ACh-E. Conclusion: Reduced sweating is common in CholU patients, especially in those with long-standing and severe disease, and it can be severe. Reduced expression of CHRM3 and ACh-E may be the cause or consequence of CholU in patients with impaired sweating, and this should be explored by further studies.

Topical inflammasome inhibition with disulfiram prevents irritant contact dermatitis.

BACKGROUND: The pathogenesis of contact dermatitis, a common inflammatory skin disease with limited treatment options, is held to be driven by inflammasome activation induced by allergens and irritants. We here aim to identify inflammasome-targeting treatment strategies for irritant contact dermatitis. METHODS: A high content screen with 41,184 small molecules was performed using fluorescent Apoptosis associated speck-like protein containing a CARD (ASC) speck formation as a readout for inflammasome activation. Hit compounds were validated for inhibition of interleukin (IL)-1ß secretion. Of these, the approved thiuramdisulfide derivative disulfiram was selected and tested in a patch test model of irritant contact dermatitis in 25 healthy volunteers. Topical application of disulfiram, mometasone or vehicle was followed by application of sodiumdodecylsulfate (SDS) for 24 h each. Eczema induction was quantified by mexameter and laser speckle imaging. Corneocyte sampling of lesional skin was performed to assess inflammasome-mediated cytokines IL-1ß and IL-18. RESULTS: Disulfiram induced a dose-dependent inhibition of ASC speck formation and IL-1ß release in cellular assays in vitro. In vivo, treatment with disulfiram, but not with vehicle and less mometasone, inhibited SDS-induced eczema. This was demonstrated by significantly lower erythema and total perfusion values assessed by mexameter and laser speckle imaging for disulfiram compared to vehicle (p < 0.001) and/or mometasone (p < 0.001). Also, corneocyte IL-18 levels were significantly reduced after application of disulfiram compared to vehicle (p < 0.001). CONCLUSION: We show that disulfiram is a dose-dependent inhibitor of inflammasome pathway activation in vitro and inhibitor of SDS-induced eczema in vivo. Topical application of disulfiram represents a potential treatment option for irritant contact dermatitis.

Lanadelumab Efficacy, Safety, and Injection Interval Extension in HAE: A Real-Life Study.

BACKGROUND: Lanadelumab has been available in Germany for the prophylactic treatment of hereditary angioedema since February 2019. OBJECTIVE: To investigate real-life treatment outcome of lanadelumab and gain practical experience in adapting the therapy to individual patients. METHODS: The study included 34 patients. In 24 patients with hereditary angioedema and 4 patients with angioedema due to acquired C1-inhibitor deficiency, the previous treatment was switched to lanadelumab. In 6 patients with hereditary angioedema, lanadelumab from the open-label Hereditary Angioedema Long-term Prophylaxis study was continued in regular care. During the transition, patients were monitored using the angioedema control test and the angioedema quality of life questionnaire. At the time at which patients became symptom-free, the dosage interval was increased gradually (+3 days). RESULTS: On average, the angioedema control test values improved from 7.5 (poorly controlled disease) to 14.9 (well-controlled disease), and all patients showed adequate disease control. All treated patients, except 1 outlier, scored angioedema quality of life questionnaire values representing only a slight reduction in quality of life (mean, 14 points). At the time point of data collection, 9 patients used an average fixed injection interval of 30 days. Twenty-two patients were symptom-free from the beginning of the treatment phase and intended to extend their injection interval from 30 to 32.5 days (median). We recommended reducing the initial dosing interval from 24 to 21 days (median) to 3 patients because of intermediately occurring symptoms. CONCLUSIONS: Gradual extension of injection intervals of lanadelumab presented in this study can minimize the burden of therapy without losing efficacy.

Use of weather and climate information essential for SDG implementation.

Owing to a lack of understanding, and data being unavailable, unusable or unsuitable, weather and climate information is currently underutilized in Sustainable Development Goal implementation. Improvements are essential in knowledge brokering, clarifying responsibilities, multi-institutional and multi-stakeholder governance arrangements and research on systemic risks and decisions.

Storyline description of Southern Hemisphere midlatitude circulation and precipitation response to greenhouse gas forcing.

As evidence of climate change strengthens, knowledge of its regional implications becomes an urgent need for decision making. Current understanding of regional precipitation changes is substantially limited by our understanding of the atmospheric circulation response to climate change, which to a high degree remains uncertain. This uncertainty is reflected in the wide spread in atmospheric circulation changes projected in multimodel ensembles, which cannot be directly interpreted in a probabilistic sense. The uncertainty can instead be represented by studying a discrete set of physically plausible storylines of atmospheric circulation changes. By mining CMIP5 model output, here we take this broader perspective and develop storylines for Southern Hemisphere (SH) midlatitude circulation changes, conditioned on the degree of global-mean warming, based on the climate responses of two remote drivers: the enhanced warming of the tropical upper troposphere and the strengthening of the stratospheric polar vortex. For the three continental domains in the SH, we analyse the precipitation changes under each storyline. To allow comparison with previous studies, we also link both circulation and precipitation changes with those of the Southern Annular Mode. Our results show that the response to tropical warming leads to a strengthening of the midlatitude westerly winds, whilst the response to a delayed breakdown (for DJF) or strengthening (for JJA) of the stratospheric vortex leads to a poleward shift of the westerly winds and the storm tracks. However, the circulation response is not zonally symmetric and the regional precipitation storylines for South America, South Africa, South of Australia and New Zealand exhibit quite specific dependencies on the two remote drivers, which are not well represented by changes in the Southern Annular Mode.

Age, growth, reproduction and management of Southwestern Atlantic's largest and endangered herbivorous reef fish, Scarus trispinosus Valenciennes, 1840.

The Brazilian-endemic greenbeack parrotfish, Scarus trispinosus Valenciennes, 1840, is the largest herbivorous reef fish in the South Atlantic. Following the sharp decline of large carnivorous reef fishes, parrotfishes (Labridae: Scarinae) were progressively targeted by commercial fisheries in Brazil, resulting in a global population decline of 50% for S. trispinosus. Most of its remnant population is concentrated in the Abrolhos Bank, where the present study was conducted. We present novel information on age, growth and the reproductive cycle of S. trispinosus, based on 814 individuals obtained from commercial fisheries' landings and scientific collections, between 2010 and 2013. Sex ratio was biased toward females (1:8), and spawning occurred year-round with discrete peaks in February-March and June-December. Increment analysis indicated annual deposition of growth rings in otoliths, which presented 1-22 rings. The asymptotic length at which growth is zero (L ∞) was estimated from a Bayesian logistic regression at 85.28 cm, growth rate (K) at 0.14 year-1, and the theoretical age at zero size (t 0) at 0.16. Subregional demographic structuring was detected, with predominance of slower-growing individuals in shallower inshore reefs and predominance of faster-growing and older individuals in deeper offshore sites. We demonstrate that S. trispinosus is highly vulnerable to over-exploitation due to its large size, long live and slow-growth, and review the management measures proposed since its Red List assessment in 2012.

Presencias y ausencias de la ética en la formación en psicología comunitaria en el Perú / Presences and absences of ethics in training in community psychology in Perú / Presenças e ausências de ética na formação em psicologia comunitária no Peru

Enmarcado en el proyecto de investigación latinoamericana "Ética y Formación en Psicología Comunitaria", el presente artículo analiza sílabos de cursos de Psicología Comunitaria y cursos afines en el Perú. El objetivo es identificar las presencias y ausencias de componentes éticos en la enseñanza de esta área como parte de la formación profesional de bachilleres en Psicología a nivel nacional. Se realizó un análisis documental cuantitativo y cualitativo de 48 sílabos, pertenecientes a 22 universidades peruanas. Los resultados muestran que los cursos de Psicología Comunitaria y cursos afines son incluidos desde etapas tempranas de los programas de Psicología, con frecuencia con referencia a aspectos éticos y trabajo de campo, pero con ausencias claves que afectan el desarrollo de la disciplina en su carácter transformador, como son metodologías inconsistentes con los postulados de la Psicología Comunitaria latinoamericana, limitados o nulos espacios de reflexión sobre la propia práctica, y dificultades para incluir problemáticas locales.

Framed in the Latin-American research project "Ethics and Training in Community Psychology", the present article reports an analysis of Community Psychology and similar courses in Peru. The aim is to identify presences and absences of ethical components when teaching this area, as part of the professional Psychology bachelor's degree nationwide. Based on 48 syllabi from 22 Peruvian universities, the results in both quantitative and qualitative analysis of the major research show that Community Psychology and similar courses are often included in the first years of Psychology studies and that ethic is mentioned as part of the courses. However, the syllabi lack of key elements that affect the development of the discipline in its transformative nature, such as methodologies that are not consistent with the principles of Latin-American Community Psychology, limited or none-existing monitoring spaces for the fieldwork, and the difficulty to include local issues.

Enquadrado no projeto de pesquisa latino-americano "Ética e Formação em Psicologia Comunitária", este artigo analisa ligações de cursos de Psicologia Comunitária e cursos relacionados no Peru. O objetivo é identificar a presença e ausência de componentes éticos no ensino dessa área como parte da formação profissional de graduados do ensino médio em Psicologia em nível nacional. Foi realizada uma análise documental quantitativa e qualitativa de 48 ligações pertencentes a 22 universidades peruanas. Os resultados mostram que a Psicologia Comunitária e cursos relacionados estão incluídos desde os estágios iniciais dos programas de Psicologia, muitas vezes com referência a aspectos éticos e trabalho de campo, mas com ausências-chave que afetam o desenvolvimento da disciplina em seu caráter transformador, tais como metodologias inconsistentes com os postulados da Psicologia Comunitária latino-americana, espaço limitado ou nenhum para reflexão sobre sua própria prática e dificuldades em incluir problemas locais.