Comparative efficacy and safety of pharmacological interventions for managing sickle cell disease complications in children and adolescents: a systematic review with network meta-analyses

Objectives: Sickle cell disease (SCD), an inherited hemoglobinopathy that causes anemia, severe pain, and vaso-occlusive crisis (VOC), is currently recognized as a global public health concern, being the leading cause of pediatric stroke. Our aim was to synthesize the evidence on the efficacy and safety of interventions for managing SCD in this population. Methods: A systematic review with searches in PubMed, Scopus, and Web of Science was performed (April-2022). Randomized controlled trials comparing disease-modifying agents in SCD patients under 18 years old were included. For each outcome of interest, data were pooled by means of Bayesian network meta-analyses with the surface under the cumulative ranking curve analyses (SUCRA). Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Results: Seventeen trials (1982-2022) mostly from African countries (65%) and North America (53%), assessing the effect of different interventions’ regimens (hydroxyurea [n=6 trials], L-arginine [n=3], antiplatelets [n=2], immunotherapy/monoclonal antibodies [n=2], sulfates [n=2], docosahexaenoic acid [n=1], niprisan [n=1]) and placebo were included. No statistical differences among treatments were found for the main outcomes. SUCRA revealed that immunotherapy/monoclonal antibodies and hydroxyurea 20 mg/kg are potentially more effective against acute chest syndrome (83% and 76% probabilities, respectively), VOC (71% and 80%, respectively) and needing of transfusions (72% and 75%, respectively), while L-arginine (100-200 mg/kg) and placebo were more prone to these events. Although therapies were overall considered safe, antiplatelet and sulfates may lead to more discontinuations and severe adverse events (uncertainty evidence). Results were similar between age subgroups (<10 years vs. 10-19 years). Conclusions: The available evidence on the effect of drugs on managing SCD in children and adolescents is insufficient and weak. No clear definition for some outcomes exists. Hydroxyurea may remain the standard of care for this population, however, long-term well-designed, and well-reported trials comparing new immunotherapy/monoclonal antibodies should be performed.info:eu-repo/semantics/publishedVersio

Taxonomic characterization of Xanthomonas species

Orientador: Suzete Aparecida Lanza DestéfanoTese (doutorado) - Universidade Estadual de Campinas, Instituto de BiologiaResumo: Espécies pertencentes ao gênero Xanthomonas são responsáveis por doenças que podem causar grandes perdas econômicas em diversas culturas. Esses fitopatógenos têm sido objeto de diversos estudos taxonômicos resultando em significativas alterações na classificação em nível inter e infraespecífico. O presente estudo teve por objetivo caracterizar taxonomicamente bactérias do gênero envolvendo: (1) diferenciação e análises filogenéticas de espécies do gênero Xanthomonas; (2) esclarecimento da posição taxonômica de linhagens classificadas como Xanthomonas sp.; (3) diferenciação de patovares da espécie X. campestris; (4) desenvolvimento de primers específicos para X. campestris, X. translucens, X. cucurbitae e X. melonis. O par de primers rpoB2F/rpoB3R, desenhado a partir de sequências do gene rpoB, foi empregado em experimentos de amplificas;ao utilizando-se DNAs de 26 espécies do gênero Xanthomonas e os produtos de amplificas;ao (800 pb) foram digeridos com diversas endonucleases. Os perfis de restrição obtidos com a utilização da enzima Hae III permitiram a diferenciação da maioria das espécies, incluindo os patógenos de mesmo hospedeiro como X. albilineans e X. sacchari (patogênicas à cana-de-açúcar); X. cucurbitae . e X. melonis (patogênicas ao melão); X. vesicatoria, X. gardneri e X. euvesicatoria/X. perforans (patogênicas ao tomateiro). Ainda, os produtos de amplificação do gene rpoB foram seqüenciados e a árvore filogenética construída a partir destas sequências também possibilitou a diferenciação das espécies do gênero, indicando que o gene rpoB pode ser considerado um marcador molecular eficiente para o estudo das relações filogenéticas de espécies do gênero Xanthomonas. Os DNAs de linhagens classificadas como Xanthomonas sp. também foram analisados por meio de experimentos de amplificação com primers específicos para a espécie X. axonopodis, de hibridizas;ao DNA-DNA, e analise de multilocus utilizando-se sequências dos genes rpoB, rpoA, atpA, recA e região espaçadora 16S-23S DNAr. Os resultados mostraram que as linhagens de X. sp. pv. viticola, X. sp. pv. betae e X. sp. pv. paulliniae pertencem a espécie X. axonopodis, entretanto, não foi possível definir a posição taxonômica das linhagens de X. sp. pv. arracaciae, X. sp. pv. esculenti e X. sp. pv. eucalypti, embora várias ferramentas tenham sido utilizadas. Assim, somente estudos complementares deverão ser conduzidos visando esclarecer a classificação dessas linhagens. Nesse estudo também foram analisadas as espécies X. campestris, X. translucens, X. cucurbitae e X. melonis. Visando a diferenciação dos patovares da espécie X. campestris, os DNAs destas linhagens foram submetidos a experimentos de PCR-RFLP do gene rpoB e as digestões duplas utilizando-se Cfo I/Mbo I. Os resultados permitiram a diferenciação dos patovares X.c. pv. raphani, X.c. pv. barbariae, X.c. pv. incanae, X.c. pv. armoraciae e X.c. pv. campestris/ X.c. pv. aberrans. Ainda, os dados obtidos nas amilises do gene rpoB permitiram o desenvolvimento de primers específicos para as espécies X. campestris, patogênicas as crucíferas (rpoB2F/xcamR) e X. translucens, patogênicas a gramíneas e cereais (trans1F/trans2R). Alem disso, amilises de sequências da região espaçadora 16S-23S DNAr possibilitaram o desenho do par de primers mecF/mecR, especifico para X. cucurbitae e X. melonis, espécies patogênicas ao melão. A especificidade destes primers foi confirmada em experimentos de amplificação utilizando-se DNAs de algumas bactérias de diferentes gêneros isoladas de mesma espécie de plantas hospedeiras. O nível de sensibilidade da técnica de PCR utilizando-se os primers desenvolvidos foi de 0,1 pg para rpoB/xcam, de 0,01 ng para trans1F/trans2R e de 1 pg para mecF/mecRAbstract: Xanthomonas species are responsible for diseases causing economic losses in many crops. These phytopathogens have been subject of several taxonomic studies resulting in significant changes at interespecific or infraspecific level. This study aimed the taxonomic characterization of Xanthomonas species including: (1) differentiation and phylogenetic analysis of Xanthomonas species; (2) clarification of taxonomic position of strains classified as Xanthomonas sp.; (3) differentiation of the pathovars of X. campestris; ( 4) development of specific primers for X. campestris, X. translucens, X. cucurbitae and X. melonis. The rpoB2F/rpoB3R primers, designed from rpoB gene sequences, were employed in amplification experiments using DNAs from 26 species of Xanthomonas genus and the products (800 bp) were digested with different restriction enzymes. Profiles using Hae III allowed to differentiate the most species of the genus, including pathogens the affect the same plant host as X. albilineans e X. sacchari (pathogenic to sugarcane); X. cucurbitae e X. melonis (pathogenic to melon); X. vesicatoria, X. gardneri and X. euvesicatoria/X. perforans (pathogenic to tomato). Amplification products of the rpoB gene were sequenced and the phylpgenetic tree constructed from these sequences also allowed the differentiation of the Xanthomonas species, indicating that the rpoB gene can be used as an efficient molecular marker for phylogenetic relationships studies within the Xanthomonas genus. DNA of the strains classified as Xanthomonas sp. were also analysed by the amplification experiments using specific primers for X. axonopodis species, DNA-DNA hybridization and multilocus sequence analysis of the genes rpoB, rpoA, atpA, recA and intergenic spacer region 16S-23S rDNA. Results showed that the strains of X. sp. pv. viticola, X. sp. pv. betae and X. sp. pv. paulliniae belong to X. axonopodis species, however, it was not possible to define the taxonomic position of X. sp. pv. arracaciae, X. sp. pv. esculenti and X. sp. pv. eucalypti, although different approaches have been used. Thus, further studies should be conducted in order to clarify their classification. In this study X. campestris, X. translucens, X. cucurbitae and X. melonis were also analyzed. In order to differentiate the pathovars of the X. campestris specie, the DNAs of these strains were submitted to PCR-RFLP analysis of the rpoB gene and the double digestions using Cfo I/Mbo I allowed the differentiation of the pathovars X. c. pv. raphani, X.c. pv. barbariae, X.c. pv. incanae, X.c. pv. armoraciae and X.c. pv. campestris/ X.c. pv. aberrans. Also, the data obtained in the rpoB gene analysis allowed the development of specific primers for the species X. campestris, pathogenic to crucifers (rpoB2F/xcamR) and X. translucens, pathogenic to grasses and cereals (trans1F/trans2R). Furthermore, intergenic spacer 16S-23S rDNA sequences analysis enabled the development of the mecF/mecR primers, specific for X cucurbitae and X melonis, both pathogenic to melon. The specificity of these primers was confirmed by amplification experiments using DNAs from bacteria belonging to different genera pathogenic to the same plant hosts. Sensitivity level of the PCR technique using the primers developed was 0,1 pg for rpoB/xcam, 0,01 ng for trans1F/trans2R and 1 pg for mecF/mecRDoutoradoGenetica de MicroorganismosDoutor em Genetica e Biologia Molecula

Heterogeneity in protocols and outcomes to study the effect of renin‐angiotensin system blockers in inflammatory bowel disease: a systematic review

Background: The renin-angiotensin system (RAS) has been associated with inflammatory bowel disease (IBD), supporting the translational relevance of RAS blockers. Comparability of study design/outcomes is fundamental for data analysis/discussion. Objectives: We aimed at evaluating the heterogeneity among protocols and outcomes to study the effect of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in IBD. Methods: This study was performed and reported in accordance with the Cochrane recommendations and PRISMA (PROSPERO-CRD42022323853). Systematic searches were performed in PubMed, Scopus, and Web of Science. Studies that met the inclusion criteria were selected. Quality assessment of the studies was done with the SYRCLES's risk of bias tools for animal studies. Results: Thirty-five pre-clinical studies and six clinical studies were included. Chemical induction of colitis was the most used model, but variable doses of the induction agent were reported. All studies reported at least a disease activity index, a macroscopic score, or a histologic assessment, but these scores were methodologically heterogeneous and reported for different characteristics. Great heterogeneity was also found in drug interventions. Inflammatory markers assessed as outcomes were different across studies. Conclusion: Lack of standardization of protocols and outcomes among studies threatens the evidence on how RAS blockers influence IBD outcomes.info:eu-repo/semantics/publishedVersio

Efficacy and safety of pharmacological interventions for managing sickle cell disease complications in children and adolescents: systematic review with network meta‐analysis

This work was partially supported by FCT_UIDB/05608/2020 and FCT_UIDP/05608/2020.This study aimed to synthesize the evidence on the effects of disease-modifying agents for managing sickle cell disease (SCD) in children and adolescents by means of a systematic review with network meta-analyses, the surface under the cumulative ranking curve (SUCRA) and stochastic multicriteria acceptability analyses (SMAA) (CRD42022328471). Eighteen randomized controlled trials (hydroxyurea [n = 7], l-arginine [n = 3], antiplatelets [n = 2], immunotherapy/monoclonal antibodies [n = 2], sulfates [n = 2], docosahexaenoic acid [n = 1], niprisan [n = 1]) were analyzed. SUCRA and SMAA demonstrated that hydroxyurea at higher doses (30 mg/kg/day) or at fixed doses (20 mg/kg/day) and immunotherapy/monoclonal antibodies are more effective for preventing vaso-occlusive crisis (i.e., lower probabilities of incidence of this event; 14, 25, and 30%, respectively), acute chest syndrome (probabilities ranging from 8 to 30%), and needing of transfusions (11-31%), while l-arginine (100-200 mg/kg) and placebo were more prone to these events. Therapies were overall considered safe; however, antiplatelets and sulfates may lead to more severe adverse events. Although the evidence was graded as insufficient and weak, hydroxyurea remains the standard of care for this population, especially if a maximum tolerated dose schedule is considered.info:eu-repo/semantics/publishedVersio

Naringenin-4'-glucuronide as a new drug candidate against the COVID-19 Omicron variant: a study based on molecular docking, molecular dynamics, MM/PBSA and MM/GBSA

This study aimed to identify natural bioactive compounds (NBCs) as potential inhibitors of the spike (S1) receptor binding domain (RBD) of the COVID-19 Omicron variant using computer simulations (in silico). NBCs with previously proven biological in vitro activity were obtained from the ZINC database and analyzed through virtual screening, molecular docking, molecular dynamics (MD), molecular mechanics/Poisson-Boltzmann surface area (MM/PBSA), and molecular mechanics/generalized Born surface area (MM/GBSA). Remdesivir was used as a reference drug in docking and MD calculations. A total of 170,906 compounds were analyzed. Molecular docking screening revealed the top four NBCs with a high affinity with the spike (affinity energy <-7 kcal/mol) to be ZINC000045789238, ZINC000004098448, ZINC000008662732, and ZINC000003995616. In the MD analysis, the four ligands formed a complex with the highest dynamic equilibrium S1 (mean RMSD <0.3 nm), lowest fluctuation of the complex amino acid residues (RMSF <1.3), and solvent accessibility stability. However, the ZINC000045789238-spike complex (naringenin-4'-O glucuronide) was the only one that simultaneously had minus signal (-) MM/PBSA and MM/GBSA binding free energy values (-3.74 kcal/mol and -15.65 kcal/mol, respectively), indicating favorable binding. This ligand (naringenin-4'-O glucuronide) was also the one that produced the highest number of hydrogen bonds in the entire dynamic period (average = 4601 bonds per nanosecond). Six mutant amino acid residues formed these hydrogen bonds from the RBD region of S1 in the Omicron variant: Asn417, Ser494, Ser496, Arg403, Arg408, and His505. Naringenin-4'-O-glucuronide showed promising results as a potential drug candidate against COVID-19. In vitro, and preclinical studies are needed to confirm these findings.info:eu-repo/semantics/publishedVersio

Chromobacterium amazonense Sp Nov isolated from water samples from The Rio Negro, Amazon, Brazil

The taxonomic position of a bacterium isolated from water samples from the Rio Negro, in Amazon, Brazil, was determined by using a polyphasic approach. The organism formed a distinct phyletic line in the Chromobacterium 16S rRNA gene tree and had chemotaxonomic and morphological properties consistent with its classification in this genus. It was found to be closely related to Chromobacterium vaccinii DSM 25150(T) (98.6 % 16S rRNA gene similarity) and shared 98.5 % 16S rRNA gene similarity with Chromobacterium piscinae LGM 3947(T). DNA-DNA relatedness studies showed that isolate CBMAI 310(T) belongs to distinct genomic species. The isolate was readily distinguished from the type strain of these species using a combination of phenotypic and chemotaxonomic properties. Thus, based on genotypic and phenotypic data, it is proposed that isolate CBMAI 310(T) (=DSM 26508(T)) be classified in the genus Chromobacterium as the type strain of a novel species, namely, Chromobacterium amazonense sp. nov107410571063CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação2005/60852-

Chromobacterium Amazonense Sp. Nov. Isolated From Water Samples From The Rio Negro, Amazon, Brazil.

The taxonomic position of a bacterium isolated from water samples from the Rio Negro, in Amazon, Brazil, was determined by using a polyphasic approach. The organism formed a distinct phyletic line in the Chromobacterium 16S rRNA gene tree and had chemotaxonomic and morphological properties consistent with its classification in this genus. It was found to be closely related to Chromobacterium vaccinii DSM 25150(T) (98.6 % 16S rRNA gene similarity) and shared 98.5 % 16S rRNA gene similarity with Chromobacterium piscinae LGM 3947(T). DNA-DNA relatedness studies showed that isolate CBMAI 310(T) belongs to distinct genomic species. The isolate was readily distinguished from the type strain of these species using a combination of phenotypic and chemotaxonomic properties. Thus, based on genotypic and phenotypic data, it is proposed that isolate CBMAI 310(T) (=DSM 26508(T)) be classified in the genus Chromobacterium as the type strain of a novel species, namely, Chromobacterium amazonense sp. nov.1071057-6