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      An in vitro study of an Artocarpus heterophyllus substance as a hepatitis C antiviral and its combination with current anti-HCV drugs

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          Abstract

          Background

          Current therapy of chronic hepatitis C virus (HCV) with direct-acting antivirals (DAAs) has dramatically improved the sustained virologic response (SVR) of affected patients; however, treatment with DAAs remains expensive, and drug-resistant HCV variants remain a threat. As a result, there is still a need to continue to develop affordable and effective drugs for the treatment of HCV. Previously, we have demonstrated that a crude extract from Artocarpus heterophyllus leaves is a potential anti-HCV candidate. In this study, we have further purified this crude extract, examined which sub-fraction possesses the highest antiviral activity, and then explored its efficacy at different HCV life cycle stages. We also assessed synergistic antiviral effects between the A. heterophyllus extract and commercially available anti-HCV drugs.

          Methods

          We used vacuum liquid chromatography (VLC) and high-performance liquid chromatography (HPLC) to fractionate a dichloromethane extract of A. heterophyllus leaves. We then examined the anti-HCV activity of the fractions using HCV genotype 2a, JFH1a; the antiviral mode of action was determined by exploring adding the treatments at different times. We examined the antiviral effects on the viral entry stage through a virucidal activity test, viral adsorption examination, and pretreatment of cells with the drug. The effects on the post-viral entry stage were determined by the levels of HCV protein expression and HCV RNA expression in infected cells.

          Results

          Through activity guided purification, we identified the sub-fraction FR3T3 as possessing the most robust anti-HCV activity with an IC 50 value of 4.7 ± 1.0 μg/mL. Mode-of-action analysis revealed that FR3T3 inhibited post-viral entry stages such as HCV NS3 protein expression and HCV RNA replication with marginal effects on the viral entry stage. Thin-layer Chromatography (TLC) indicated that FR3T3 contained terpenoids and chlorophyll-related compounds. We also found a synergistic antiviral activity when the DCM extract of A. heterohyllus was used in combination therapy with commercial anti-HCV drugs; Ribavirin, Simeprevir, Cyclosporin A.

          Conclusions

          The extract of A. heterophyllus and its sub-fraction, FR3T3, presented here have anti-HCV activities and could be candidate drugs for add-on-therapy for treatment of chronic HCV infections.

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          Most cited references41

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          Drug combination studies and their synergy quantification using the Chou-Talalay method.

          This brief perspective article focuses on the most common errors and pitfalls, as well as the do's and don'ts in drug combination studies, in terms of experimental design, data acquisition, data interpretation, and computerized simulation. The Chou-Talalay method for drug combination is based on the median-effect equation, derived from the mass-action law principle, which is the unified theory that provides the common link between single entity and multiple entities, and first order and higher order dynamics. This general equation encompasses the Michaelis-Menten, Hill, Henderson-Hasselbalch, and Scatchard equations in biochemistry and biophysics. The resulting combination index (CI) theorem of Chou-Talalay offers quantitative definition for additive effect (CI = 1), synergism (CI 1) in drug combinations. This theory also provides algorithms for automated computer simulation for synergism and/or antagonism at any effect and dose level, as shown in the CI plot and isobologram, respectively.
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            Natural products derived from plants as a source of drugs

            Nature, the master of craftsman of molecules created almost an inexhaustible array of molecular entities. It stands as an infinite resource for drug development, novel chemotypes and pharmacophores, and scaffolds for amplification into efficacious drugs for a multitude of disease indications and other valuable bioactive agents. Since time immemorial, natural products have been the backbone of traditional system of healing throughout the globe, and have also been an integral part of history and culture. Although the use of bioactive natural products as herbal drug preparations dates back hundreds, even thousands, of years ago, their application as isolated and characterized compounds to modern drug discovery and development started only in the 19th century. It has been well documented that natural products played critical roles in modern drug development, especially for antibacterial and antitumor agents. Even though popularity of the synthetic products increased due to its production cost, time effectiveness, easy quality control, stringent regulation and quick effects, but their safety and efficacy was always remained questionable, resulting in the dependence on the natural products by more than 80% of the total population in the developing world, because of its time tested safety and efficacy. A huge number of natural product-derived compounds in various stages of clinical development highlighted the existing viability and significance of the use of natural products as sources of new drug candidates. Until recently, plants were an important source of novel pharmacologically active compounds with many blockbuster drugs being derived directly or indirectly from plants. Despite the current preoccupation with synthetic chemistry as a vehicle to discover and manufacture drugs, the contribution of plants to disease treatment and prevention is still enormous. Even at the dawn of 21st century, 11% of the 252 drugs considered as basic and essential by the WHO were exclusively of flowering plant origin. Obviously natural products will continue to be extremely important as sources of medicinal agents. In addition to the natural products which have found direct medicinal application as drug entities, many others can serve as chemical models or templates for the design, synthesis, and semi synthesis of novel substances for treating humankind's diseases. Although there are some new approaches to drug discovery, such as combinatorial chemistry and computer-based molecular modeling design, and many drugs are made by synthetic chemistry, none of them can replaced the important role of natural products in drug discovery and development as most of the core structures or scaffolds for synthetic chemicals are based upon natural products. According to Newman and Cragg 2012, the utility of natural products as sources of novel structures is still alive and well. Up to 50% the approved drugs during the last 30 years are from either directly or indirectly from natural products and in the area of cancer, over the time frame from around the 1940s to date, of the 175 small molecules 85 actually being either natural products or directly derived there from. The use of plants as medicines has a long history in the treatment of various diseases. The plant-derived compounds have a long history of clinical use, better patient tolerance and acceptance. To date, 35,000-70,000 plant species have been screened for their medicinal use. Plants especially those with ethnopharmacological uses have been the primary sources of medicine for early drug discovery. Fabricant and Farnsworth, (2001) reported that, 80% of 122 plant derived drugs were related to their original ethnopharmacological purposes. Current drug discovery from plants mainly relied on bioactivity–guided fractionation and led to isolation of many important anticancer drugs such as paclitaxel, camptothecin etc. The first commercial pure natural product introduced for therapeutic use is morphine marketed by Merck in 1826, and the first semi-synthetic pure drug aspirin, based on a natural product salicin isolated from Salix alba, was introduced by Bayer in 1899. This led to the isolation of early drugs such as cocaine, codeine, digitoxin, quinine and pilocarpine, of which some are still in use and several other recent plant derived compounds, which have undergone development and have been marketed as drugs which include Paclitaxel from Taxus brevifolia for lung, ovarian and breast cancer, Artemisinin from traditional Chinese plant Artemisia annua to combat multidrug resistant malaria, Silymarin extracted from the seeds of Silybum marianum for the treatment of liver diseases. There is growing evidence that the old molecules are finding new applications through better understanding of molecular biology and clinical observations. For instance, the alkaloid, forskolin from Coleus forskohlii and phytochemicals from Stephania glabra, are now being rediscovered as adenylate cyclase and nitric oxide activators, which may help in preventing conditions including obesity and atherosclerosis. During the last decade few plant derived drugs have been launched include Arteether, endoperoxide sesquiterpene lactone and semisynthetic natural product derived from Artemisinin used in malarial treatment, Nitisinone derived from natural product Leptospermone (Callistemon citrinus) is used in treatment of antityrosinaemia, galantamine is a natural alkaloid (obtained from Galanthus nivalis) for Alzhemer's, apomorphine is a semisynthetic compound derived from morphine (Papaver somniferum) used in Parkinson's disease, Tiotropium a derivative of atropine from Atropa belladonna in chronic obstructive pulmonary disease, Dronabinol and Cannabidiol obtained from cannabis plant (Cannabis sativa) and Capsaicin active compound from Capsicum annuum are used as pain relievers. Natural products discovered so far have played a vital role in improving the human health and have been the drugs of choice despite facing a tough competition from compounds derived from computational and combinatorial chemistry, due to their safety and efficacy. The most striking feature of natural products in connection to their long lasting importance in drug discovery is their structural diversity that is still largely untapped. Revitalization of the natural products is bringing newer challenges with respect to quality control and standardization along with cost effectiveness. The renewed interest in the development of natural products requires the confluence of the modern techniques and harmonization of regulations related to their research and development between various fields of science.
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              Global Distribution and Prevalence of Hepatitis C Virus Genotypes

              Hepatitis C virus (HCV) exhibits high genetic diversity, characterized by regional variations in genotype prevalence. This poses a challenge to the improved development of vaccines and pan-genotypic treatments, which require the consideration of global trends in HCV genotype prevalence. Here we provide the first comprehensive survey of these trends. To approximate national HCV genotype prevalence, studies published between 1989 and 2013 reporting HCV genotypes are reviewed and combined with overall HCV prevalence estimates from the Global Burden of Disease (GBD) project. We also generate regional and global genotype prevalence estimates, inferring data for countries lacking genotype information. We include 1,217 studies in our analysis, representing 117 countries and 90% of the global population. We calculate that HCV genotype 1 is the most prevalent worldwide, comprising 83.4 million cases (46.2% of all HCV cases), approximately one-third of which are in East Asia. Genotype 3 is the next most prevalent globally (54.3 million, 30.1%); genotypes 2, 4, and 6 are responsible for a total 22.8% of all cases; genotype 5 comprises the remaining <1%. While genotypes 1 and 3 dominate in most countries irrespective of economic status, the largest proportions of genotypes 4 and 5 are in lower-income countries. Conclusion: Although genotype 1 is most common worldwide, nongenotype 1 HCV cases—which are less well served by advances in vaccine and drug development—still comprise over half of all HCV cases. Relative genotype proportions are needed to inform healthcare models, which must be geographically tailored to specific countries or regions in order to improve access to new treatments. Genotype surveillance data are needed from many countries to improve estimates of unmet need. (Hepatology 2015;61:77–87)
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                Author and article information

                Contributors
                achmadfuad@yahoo.com
                Journal
                BMC Complement Med Ther
                BMC Complement Med Ther
                BMC Complementary Medicine and Therapies
                BioMed Central (London )
                2662-7671
                12 October 2021
                12 October 2021
                2021
                : 21
                : 260
                Affiliations
                [1 ]GRID grid.440745.6, ISNI 0000 0001 0152 762X, Institute of Tropical Disease, , Universitas Airlangga, ; Surabaya, 60115 Indonesia
                [2 ]GRID grid.31432.37, ISNI 0000 0001 1092 3077, Department of Public Health, , Kobe University Graduate School of Health Sciences, ; 7-10-2, Tomogaoka, Suma-ku, Kobe, 654-0142 Japan
                [3 ]GRID grid.440745.6, ISNI 0000 0001 0152 762X, Department of Pharmaceutical Sciences, Faculty of Pharmacy, , Universitas Airlangga, ; Surabaya, 60115 Indonesia
                [4 ]GRID grid.440745.6, ISNI 0000 0001 0152 762X, Department of Health, Study Program Traditional Medicine, Vocational Faculty, , Universitas Airlangga, ; Surabaya, Indonesia
                [5 ]GRID grid.444148.9, ISNI 0000 0001 2193 8338, Faculty of Clinical Nutrition and Dietetics, , Konan Women’s University, ; 6-2-23, Morikita-machi, Higashida-ku, Kobe, 658-0001 Japan
                Article
                3408
                10.1186/s12906-021-03408-w
                8507375
                34641875
                926376f7-d0ae-4304-9b5a-a91b5d4fe01d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 March 2021
                : 13 August 2021
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                hepatitis,artocarpus heterophyllus,medicine,infectious disease

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