Australian ethnomedicinal plant extracts promote apoptosis-mediated cell death In human hepatocellular carcinoma in vitro

Introduction: Hepatocellular carcinoma (HCC) Is the leading cause of primary liver cancer with Its prevalence continuing to rise. Although the number of cases continues to rise In both developing and developed countries, prognosis remains poor due to a lack of successful treatments. Inspired by the prospect of developing complementary medicines for this condition, we explore several native Australian plants for anti-carcinogenic activity, especially against HCC. Methods: Cytotoxicity assays against HCC cell lines were conducted using various plant extracts. Biochemical profiling of the plant species was conducted for total phenolics and antioxidant capacity, while reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the active apoptotic pathways. Results: Westringia fruticosa and Prostanthera ovalifolia (small-leaved variety) had high antioxidant (410 and 227 mg/g, respectively) and phenolic contents (72.7 and 42.7 mg/g, respectively). P ovalifolia (small-leaved variety) demonstrated the greatest cytotoxic activity against HepG2 cells (IC50 4.61 ± 0.98 pg/mL) followed by Solanum laciniatum leaves (11.79 ± 0.43 pg/mL) and fruit extracts (ripe, unripe) (14.85 ± 1.80 and 19 ± 1.32 pg/mL, respectively). RT-PCR results confirmed apoptotic events in HepG2 cells, exposed to ripe and unripe S. laciniatum fruit extracts, via caspase-3 pathway. The highest apoptotic induction occurred after 8 hr. Compared to unripe fruits, ripe fruits induced a greater level of apoptosis, as evidenced by a 73 % higher level of caspase-3 mRNA expression and 22 % lower IC50 value. Conclusion: With further investigation, these fruits may provide a valuable source of anticarcinogenic compounds for use as chemotherapeutic or complementary therapies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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