肺结核合并呼吸衰竭患者的护理体会

目的:分析探讨肺结核合并呼吸衰竭患者的临床护理措施,为总结临床有效护理效应提供依据。方法:回顾性分析我院2010年1月至2013年4月间收治的78例肺结核合并呼吸衰竭患者的临床护理措施的临床资料。结果:经过相应的治疗和护理,病情好转46例,死亡25例,另外7例患者病情缓解出院。其中多脏器功能衰竭死亡患者22例。结论:积极有效的治疗和护理措施,能改善患者的病情,提高治疗效果,延长患者生存期。     

Association of laryngeal and nasopharyngeal tuberculosis: a case report

Introduction

To the best of our knowledge, the association of nasopharyngeal and laryngeal tuberculosis has never been described before in the literature. We report here a first observation.

Case presentation

We report the case of a 38-year-old Arab man who presented with an isolated hoarseness. Radiological and endoscopic examinations showed a thickening of the left lateral wall of his nasopharynx and the left vocal cord. Pathology revealed the diagnosis of tuberculosis of both localizations. He received a 6-month antituberculous chemotherapy with a satisfying uneventful evolution.

Conclusions

Tuberculosis should be considered in the differential diagnosis of soft tissue masses of the head and neck, particularly when the imaging findings and clinical presentation are atypical. The diagnosis of tuberculosis is mainly based on histopathological and/or bacteriological examination.     

Stereoselective synthesis of β-arabino glycosyl sulfones as potential inhibitors of mycobacterial cell wall biosynthesis

A series of β-arabino glycosyl sulfones with varying alkyl chain lengths were synthesised in a stereoselective fashion as putative mimics of decaprenolphosphoarabinose (DPA), and as potential inhibitors of mycobacterial cell wall biosynthesis. Biological testing against Mycobacterium bovis BCG revealed low to moderate anti-mycobacterial activity with marked dependence on alkyl chain length, which was maximal for a C-12 chain.     

Design and synthesis of purine connected piperazine derivatives as novel inhibitors of Mycobacterium tuberculosis

A series of novel purine linked piperazine derivatives were synthesized to identify new, potent inhibitors of Mycobacterium tuberculosis. The compounds were designed to target MurB disrupting the biosynthesis of the peptidoglycan and exert antiproliferative effects. The first series of purine-2,6-dione linked piperazine derivatives were synthesized using an advanced intermediate 1-(3,4-difluorobenzyl)-7-(but-2-ynyl)-3-methyl-8-(piperazin-1-yl)-1H-purine-2,6(3H,7H)-dione hydrochloride (6) which was coupled with varied carboxylic acid chloride derivatives. Following this piperazine linked derivatives were also synthesized from 6 using diverse isocyanate partners. The anti-mycobacterial activity of the analogues was tested against Mycobacterium tuberculosis H37Rv which revealed a cluster of six analogues (11, 24, 27, 32, 33 and 34), possessed promising activity. In comparison, a set of these new compounds possessed greater potencies relative to current drugs used in the clinic such as Ethambutol. These results were also correlated with computational molecular docking analysis, providing models for strong interactions of the inhibitors with MurB providing a template for the future development of preclinical agents against Mycobacterium tuberculosis.     

Synthetic approaches towards bedaquiline and its derivatives

Bedaquiline is a diarylquinoline drug that demonstrates potent and selective inhibition of mycobacterial ATP synthase, and is clinically administered for the treatment of multi-drug resistant tuberculosis. Due to its excellent activity and novel mechanism of action, bedaquiline has been the focus of a number of synthetic studies. This review will discuss these synthetic approaches, as well as the synthesis and bioactivity of the numerous derivatives and molecular probes inspired by bedaquiline.     

Design,synthesis and biological activity of novel substituted 3-benzoic acid derivatives as MtDHFR inhibitors

The enzyme dihydrofolate reductase from M. tuberculosis (MtDHFR) has a high unexploited potential to be a target for new drugs against tuberculosis (TB), due to its importance for pathogen survival. Preliminary studies have obtained fragment-like molecules with low affinity to MtDHFR which can potentially become lead compounds. Taking this into account, the fragment MB872 was used as a prototype for analogue development by bioisosterism/retro-bioisosterism, which resulted in 20 new substituted 3-benzoic acid derivatives. Compounds were active against MtDHFR, with IC₅₀ values ranging from 7 to 40 μM, where compound 4e not only had the best inhibitory activity (IC₅₀ = 7 μM), but also was 71-fold more active than the original fragment MB872. The 4e inhibition kinetics indicated an uncompetitive mechanism, which was supported by molecular modeling which suggested that the compounds can access an independent backpocket from the substrate and competitive inhibitors. Thus, based on these results, substituted 3-benzoic acid derivatives have strong potential to be developed as novel MtDHFR inhibitors and also anti-TB agents.     

Fluorescent probes for investigating peptidoglycan biosynthesis in mycobacteria

Tuberculosis killed 1.5 million people in 2018. Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis, is the most deadly infectious bacteria in the world. A strength of mycobacterial pathogens — their formidable cell wall — could also be one of their greatest molecular vulnerabilities. As in other bacteria, peptidoglycan (PG) maintenance and integrity is essential to mycobacterial survival. But Mtb PG is unique, and a better understanding of its biosynthetic machinery could lead to new drugs or more effective treatment regimens. Such investigations are being accelerated by the application of fluorescent probes, including those based on vancomycin, β-lactams, PG stem mimics, d-amino acids, and reactive glycans. This review will describe how fluorescent probes are being used to uncover new information on the regulation and drug susceptibility of two classes of enzymes that fortify the Mtb PG: the penicillin-binding proteins and the L,D-transpeptidases.     

结核分枝杆菌CFP10和ESAT6对巨噬细胞RAW264.7凋亡及AIM2/ASC/Caspase-8通路的影响

【背景】10 kD培养滤液蛋白(culture filtrate protein 10,CFP10)和6 kD早期分泌性抗原靶蛋白(early secretary antigenic target-6 kD,ESAT6)是结核分枝杆菌(Mycobacterium tuberculosis,Mtb)重要的毒力因子,能引起巨噬细胞的凋亡。【目的】探讨CFP10和ESAT6对巨噬细胞RAW264.7凋亡及AIM2/ASC/Caspase-8信号通路的影响。【方法】利用大肠杆菌表达并纯化获得了CFP10和ESAT6蛋白,重组蛋白处理巨噬细胞RAW264.7后,利用CCK8试剂盒检测细胞存活率,确定重组蛋白处理细胞浓度,利用Western blotting技术检测细胞凋亡相关蛋白及AIM2和ASC炎性小体的变化,利用流式细胞术检测细胞凋亡率。【结果】SDS-PAGE和Western blotting结果表明重组蛋白CFP10和ESAT6表达正确,不同浓度的CFP10和ESAT6处理RAW264.7后,对细胞的增殖能力具有明显的抑制作用,当CFP10和ESAT6单独处理且浓度为5 μg/mL时,细胞存活率较对照组有显著下降(P<0.001),且随着蛋白浓度的增加细胞存活率显著下降(P<0.001)。Western blotting结果表明,CFP10和ESAT6蛋白单独处理巨噬细胞24 h后均能引起巨噬细胞发生凋亡。当终浓度为5 μg/mL的CFP10和ESAT6共处理巨噬细胞时,共处理组凋亡相关蛋白BAD、CHOP、Caspase-8和Caspase-3较ESAT6单独处理组有极显著差异(P<0.001),说明CFP10和ESAT6共处理显著降低了ESAT6单独处理引起的巨噬细胞的凋亡,进一步研究发现ESAT6能激活AIM2、ASC炎性小体。【结论】结核分枝杆菌CFP10和ESAT6处理RAW264.7后均能引起巨噬细胞发生凋亡,当二者共处理时,CFP10会显著降低ESAT6单独处理引起的细胞的凋亡,进一步的研究表明,ESAT6可能通过激活AIM2/ASC/Caspase-8信号通路从而引起巨噬细胞发生凋亡。研究结果为进一步探究Mtb感染过程中CFP10和ESAT6蛋白对巨噬细胞凋亡的调控作用及其分子机制奠定了基础。     

Repurposing of FDA-approved drugs to target MurB and MurE enzymes in Mycobacterium tuberculosis

Abstract

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb) is one amongst the top 10 causes of death worldwide. The growing rise in antibiotic resistance compounded with slow and expensive drug discovery has further aggravated the situation. ‘Drug repurposing’ is a promising approach where known drugs are examined for a new indication. In the present study, we have attempted to identify drugs that could target MurB and MurE enzymes involved in the muramic acid synthesis pathway (Mur Pathway) in Mtb. FDA-approved drugs from two repositories i.e. Drug Bank (1932 drugs) and e-LEA3D (1852 drugs) were screened against these proteins. Several criteria were applied to study the protein-drug interactions and the consensus drugs were further studied by molecular dynamics (MD) simulation. Our study found Sulfadoxine (–7.3?kcal/mol) and Pyrimethamine (–7.8?kcal/mol) to show stable interaction with MurB while Lifitegrast (–10.5?kcal/mol) and Sildenafil (–9.1?kcal/mol) showed most reliable interaction with MurE. Furthermore, binding free energy (ΔG_bind), RMSD and RMSF data and the number of hydrogen bonds corroborated the stability of interactions and hence these drugs for repurposing should be explored further.

Communicated by Ramaswamy H. Sarma     

结核分枝杆菌感染动物模型的研究进展

人类结核病位居单一病原引起死亡的严重传染病之首,结核分枝杆菌是其主要病原.尽管结核分枝杆菌可引起许多种动物感染并患病,但人类是其主要宿主.动物模型作为研究人类疾病的标准化工具,虽然不能完全模拟人类结核病的整个过程,但可成为研究结核病的有用工具,有助于研究其发病机制、治疗过程及宿主对病原的免疫病理学反应.由于不同种类动物...