BACKGROUND AND OBJECTIVES: N-acetyl-l-leucine (NALL) has been established to improve the neurologic manifestations of Niemann-Pick disease type C (NPC) after 12 weeks in a placebo-controlled trial. In the open-label extension phase (EP) follow-up, data were obtained after 12 and 18 months to evaluate the long-term effects of NALL for NPC. METHODS: This is an ongoing, multinational, multicenter EP. Patients with a genetic diagnosis of NPC aged 4 years or older who completed the placebo-controlled trial were eligible to continue in the EP and receive orally administered NALL 2-3 times per day in 3 tiers of weight-based dosing. The primary end point is the modified 5-domain NPC Clinical Severity Scale (NPC-CSS) (range 0-25 points; lower score representing better neurologic status); data from the EP cohort are compared with the expected annual trajectory of decline (i.e., disease progression) established in natural history studies. Analyses are also performed on exploratory end points, including the 15-domain and 4-domain NPC-CSSs and the Scale for Assessment and Rating of Ataxia (SARA). RESULTS: Fifty-three patients aged 5-67 years (45.3% female, 54.7% male) were enrolled in the EP. After 12 months, the mean (±SD) change from baseline on the 5-domain NPC-CSS was -0.27 (±2.42) with NALL vs +1.5 (±3.16) in the historical cohort (95% CI -3.05 to -0.48; p = 0.009), corresponding to a 118% reduction in annual disease progression. After 18 months, the mean (±SD) change was +0.05 (±2.95) with NALL vs +2.25 (±4.74) in the historical cohort (95% CI -4.06 to -0.35; p = 0.023). The 15-domain and 4-domain NPC-CSSs were consistent with the 5-domain NPC-CSS. The improvements in neurologic manifestations demonstrated in the placebo-controlled trial on the primary SARA end point were sustained over the long-term follow-up. NALL was well tolerated, and no treatment-related adverse events or serious reactions occurred. DISCUSSION: Treatment with NALL was associated with a significant reduction in NPC disease progression after 12 and 18 months, demonstrating a disease-modifying, neuroprotective effect. TRIAL REGISTRATION INFORMATION: The trial is registered with ClinicalTrials.gov (NCT05163288; registered December 6, 2021), EudraCT (2021-005356-10). The first patient was enrolled into the EP on March 8, 2023. The trial was funded by IntraBio Inc. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that NALL reduces disease progression in NPC.

• MeSH
• Child MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Leucine * analogs & derivatives   therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Neuroprotective Agents * therapeutic use   MeSH
• Niemann-Pick Disease, Type C * drug therapy   MeSH
• Child, Preschool MeSH
• Disease Progression MeSH
• Severity of Illness Index MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH

This article presents a method for producing hydrogel dressings using high methylated pectin from apples or citrus, doped with the antiseptic agent, octenidine dihydrochloride. Octenidine was incorporated in-situ during the polymer crosslinking. The pectins were characterized by their varying molecular weight characteristics, monosaccharide composition, and degree of esterification (DE). The study assessed the feasibility of producing biologically active hydrogels with pectin and delved into how the polymer's characteristics affect the properties of the resulting dressings. The structure evaluation of hydrogel materials showed interactions between individual components of the system and their dependence on the type of used pectin. Both the antimicrobial properties and cytotoxicity of the dressings were evaluated. The results suggest that the primary determinants of the functional attributes of the hydrogels are the molecular weight characteristics and the DE of the pectin. As these values rise, there is an increase in polymer-polymer interactions, overshadowing polymer-additive interactions. This intensification strengthens the mechanical and thermal stability of the hydrogels and enhances the release of active components into the surrounding environment. Biological evaluations demonstrated the ability of octenidine to be released from the dressings and effectively inhibit the growth of microbial pathogens.

• MeSH
• Anti-Infective Agents, Local * chemistry   pharmacology   MeSH
• Citrus chemistry   MeSH
• Hydrogels * chemistry   pharmacology   MeSH
• Imines * chemistry   MeSH
• Humans MeSH
• Malus chemistry   MeSH
• Microbial Sensitivity Tests MeSH
• Molecular Weight MeSH
• Bandages * MeSH
• Pectins * chemistry   pharmacology   MeSH
• Pyridines * chemistry   pharmacology   MeSH
• Staphylococcus aureus drug effects   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Niemann-Pick typ C predstavuje veľmi vzácne a závažné lyzozómové ochorenie. Diagnostika tohto ochorenia je komplementárna a žiadny z testov sám o sebe nemusí stačiť pre jednoznačné stanovenie diagnózy. Tento príspevok opisuje, ako sa od pozorovania prvých príznakov krok za krokom prišlo k stanoveniu konečnej diagnózy, a ktoré vyšetrenia boli pre diagnostiku potrebné. Pozornosť bude venovaná aj dôrazu na potrebu genetického vyšetrenia v prípade potvrdenia tejto diagnózy u rodičov ako prevencia prepuknutia ochorenia u ďalších súrodencov.

The Niemann-Pick type C is a very rare and serious lysosomal storage disease. The diagnosis of this disease is complex, and none of the tests alone is sufficient to confirm the diagnosis. This thesis describes the diagnosis from initial observation of first symptoms to confirmation of the final diagnosis. We also list all the test required to establish the diagnosis. We also focus on importance of genetic testing of parents as a preventative approach to disease onset of other children.

• MeSH
• Child MeSH
• Lysosomal Storage Diseases, Nervous System MeSH
• Niemann-Pick Disease, Type C diagnostic imaging   diagnosis   genetics   physiopathology   therapy   MeSH
• Splenomegaly MeSH
• Check Tag
• Child MeSH
• Publication type
• Case Reports MeSH

Hyaluronan, a linear glycosaminoglycan comprising D-N-acetylglucosamine and D-glucuronic acid, is the main component of the extracellular matrix. Its influence on cell proliferation, migration, inflammation, signalling, and other functions, depends heavily on its molecular weight and chemical modification. Unsaturated HA oligosaccharides are available in defined length and purity. Their potential therapeutic utility can be further improved by chemical modification, e. g., reduction. No synthesis of such modified oligosaccharides, either stepwise or by hyaluronan cleavage, has been reported yet. Here we show a three-step synthesis (esterification, depolymerization and reduction) of unsaturated even numbered hyaluronan oligosaccharides with carboxylates and the reducing terminus reduced to an alcohol. Particular oligosaccharides were synthesised. The modified oligosaccharides are not cleaved by mammalian or bacterial hyaluronidase and do not affect the growth of mouse and human fibroblasts. Further, MTT and NRU viability tests showed that they inhibit the growth of human colon carcinoma cells HT-29 by 20-50 % in concentrations 500-1000 μg/mL. Interestingly, this effect takes place regardless of CD44 receptor expression and was not observed with unmodified HA oligosaccharides. These compounds could serve as enzymatically stable building blocks for biologically active substances.

• MeSH
• Hyaluronan Receptors metabolism   MeSH
• HT29 Cells MeSH
• Cytostatic Agents * pharmacology   chemistry   chemical synthesis   MeSH
• Fibroblasts drug effects   MeSH
• Hyaluronoglucosaminidase * metabolism   antagonists & inhibitors   MeSH
• Hyaluronic Acid * chemistry   pharmacology   MeSH
• Humans MeSH
• Mice MeSH
• Oligosaccharides * chemistry   pharmacology   MeSH
• Cell Proliferation * drug effects   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Niemann-Pick disease type C is a rare lysosomal storage disorder. We evaluated the safety and efficacy of N-acetyl-l-leucine (NALL), an agent that potentially ameliorates lysosomal and metabolic dysfunction, for the treatment of Niemann-Pick disease type C. METHODS: In this double-blind, placebo-controlled, crossover trial, we randomly assigned patients 4 years of age or older with genetically confirmed Niemann-Pick disease type C in a 1:1 ratio to receive NALL for 12 weeks, followed by placebo for 12 weeks, or to receive placebo for 12 weeks, followed by NALL for 12 weeks. NALL or matching placebo was administered orally two to three times per day, with patients 4 to 12 years of age receiving weight-based doses (2 to 4 g per day) and those 13 years of age or older receiving a dose of 4 g per day. The primary end point was the total score on the Scale for the Assessment and Rating of Ataxia (SARA; range, 0 to 40, with lower scores indicating better neurologic status). Secondary end points included scores on the Clinical Global Impression of Improvement, the Spinocerebellar Ataxia Functional Index, and the Modified Disability Rating Scale. Crossover data from the two 12-week periods in each group were included in the comparisons of NALL with placebo. RESULTS: A total of 60 patients 5 to 67 years of age were enrolled. The mean baseline SARA total scores used in the primary analysis were 15.88 before receipt of the first dose of NALL (60 patients) and 15.68 before receipt of the first dose of placebo (59 patients; 1 patient never received placebo). The mean (±SD) change from baseline in the SARA total score was -1.97±2.43 points after 12 weeks of receiving NALL and -0.60±2.39 points after 12 weeks of receiving placebo (least-squares mean difference, -1.28 points; 95% confidence interval, -1.91 to -0.65; P<0.001). The results for the secondary end points were generally supportive of the findings in the primary analysis, but these were not adjusted for multiple comparisons. The incidence of adverse events was similar with NALL and placebo, and no treatment-related serious adverse events occurred. CONCLUSIONS: Among patients with Niemann-Pick disease type C, treatment with NALL for 12 weeks led to better neurologic status than placebo. A longer period is needed to determine the long-term effects of this agent in patients with Niemann-Pick disease type C. (Funded by IntraBio; ClinicalTrials.gov number, NCT05163288; EudraCT number, 2021-005356-10.).

• MeSH
• Child MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Cross-Over Studies MeSH
• Central Nervous System Agents * administration & dosage   therapeutic use   MeSH
• Leucine analogs & derivatives   therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Niemann-Pick Disease, Type C * complications   diagnosis   drug therapy   genetics   MeSH
• Child, Preschool MeSH
• Data Collection MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Child, Preschool MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Carotenoids are the most abundant lipid-soluble phytochemicals and are used as dietary supplements to protect against diseases caused by oxidative stress. Astaxanthin, a xanthophyll carotenoid, is a very potent antioxidant with numerous beneficial effects on cellular functions and signaling pathways. In this study, using spleen cells from healthy Balb/c mice, we report the bio-functional effects of an astaxanthin-rich extract (EXT) prepared from the microalga Haematococcus pluvialis and its astaxanthin monoesters-rich fraction (ME) and astaxanthin diesters-rich fraction (DE) obtained by fractionation of EXT using countercurrent chromatography (CCC). After incubation under standard culture conditions (humidity, 37 °C, 5% CO2, atmospheric oxygen), the viability of untreated splenocytes, as determined by the trypan blue exclusion assay, the MTT assay, and the neutral red assay, decreases to approximately 75% after 24 h compared with naïve splenocytes. This effect correlated with the decrease in mitochondrial membrane potential and the transition of ~59% of cells to the early stage of apoptosis, as well as with the decreased ROS production, indicating that hyperoxia in cell-culture deteriorates cell functions. They are restored or stimulated by co-cultivation with EXT, ME, and DE up to 10 μg/mL in the order EXT > DE > ME, suggesting that esterification increases bioavailability to cells in vitro. ROS and H2O2 concentrations reflect mRNA transcriptional activity of Nrf2, superoxide dismutase 1 (SOD1), catalase, and glutathione peroxidase 1, as well as SOD-mediated ROS conversion, whereas they inversely correlate with iNOS-mediated NO production. The highest-tested concentration of EXT, ME, and DE (40 μg/mL) is detrimental to cells, probably because of the overwhelming scavenging activity of astaxanthin and its esters for the reactive oxygen/nitrogen species required for cellular functions and signal transduction at low physiological concentrations. In this study, we demonstrate that differential activities of ME and DE contribute to the final antioxidant and cytoprotective effects of astaxanthin extract, which is beneficial in preventing a wide range of ROS-induced adverse effects, with DE being more effective. In addition, the selection of physioxia-like conditions for pharmacological research is highlighted.

• Publication type
• Journal Article MeSH

Congenital disorders of glycosylation (CDG) and Niemann-Pick type C (NPC) disease are inborn errors of metabolism that can both present with infantile-onset severe liver disease and other multisystemic manifestations. Plasma bile acid and N-palmitoyl-O-phosphocholineserine (PPCS) are screening biomarkers with proposed improved sensitivity and specificity for NPC. We report an infant with ATP6AP1-CDG who presented with cholestatic liver failure and elevated plasma oxysterols and bile acid, mimicking NPC clinically and biochemically. On further investigation, PPCS, but not the bile acid derivative N-(3β,5α,6β-trihydroxy-cholan-24-oyl) glycine (TCG), were elevated in plasma samples from individuals with ATP6AP1-, ALG1-, ALG8-, and PMM2-CDG. These findings highlight the importance of keeping CDG within the diagnostic differential when evaluating children with early onset severe liver disease and elevated bile acid or PPCS to prevent delayed diagnosis and treatment.

• MeSH
• Child MeSH
• Glycosylation MeSH
• Hydrolases MeSH
• Infant MeSH
• Humans MeSH
• Niemann-Pick Disease, Type C * MeSH
• Oxysterols * MeSH
• Vacuolar Proton-Translocating ATPases * MeSH
• Congenital Disorders of Glycosylation * MeSH
• Bile Acids and Salts MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

The efforts have been made to review phyllosilicate derived (clay-based) heterogeneous catalysts for biodiesel production via lignocellulose derived feedstocks. These catalysts have many practical and potential applications in green catalysis. Phyllosilicate derived heterogeneous catalysts (modified via any of these approaches like acid activated clays, ion exchanged clays and layered double hydroxides) exhibits excellent catalytic activity for producing cost effective and high yield biodiesel. The combination of different protocols (intercalated catalysts, ion exchanged catalysts, acidic activated clay catalysts, clay-supported catalysts, composites and hybrids, pillared interlayer clay catalysts, and hierarchically structured catalysts) was implemented so as to achieve the synergetic effects (acidic-basic) in resultant material (catalyst) for efficient conversion of lignocellulose derived feedstock (non-edible oils) to biodiesel. Utilisation of these Phyllosilicate derived catalysts will pave path for future researchers to investigate the cost-effective, accessible and improved approaches in synthesising novel catalysts that could be used for converting lignocellulosic biomass to eco-friendly biodiesel.

• MeSH
• Biomass MeSH
• Biofuels * MeSH
• Esterification MeSH
• Catalysis MeSH
• Lignin MeSH
• Plant Oils * MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

OBJECTIVE: Classical ATP-independent non-shivering thermogenesis enabled by uncoupling protein 1 (UCP1) in brown adipose tissue (BAT) is activated, but not essential for survival, in the cold. It has long been suspected that futile ATP-consuming substrate cycles also contribute to thermogenesis and can partially compensate for the genetic ablation of UCP1 in mouse models. Futile ATP-dependent thermogenesis could thereby enable survival in the cold even when brown fat is less abundant or missing. METHODS: In this study, we explore different potential sources of UCP1-independent thermogenesis and identify a futile ATP-consuming triglyceride/fatty acid cycle as the main contributor to cellular heat production in brown adipocytes lacking UCP1. We uncover the mechanism on a molecular level and pinpoint the key enzymes involved using pharmacological and genetic interference. RESULTS: ATGL is the most important lipase in terms of releasing fatty acids from lipid droplets, while DGAT1 accounts for the majority of fatty acid re-esterification in UCP1-ablated brown adipocytes. Furthermore, we demonstrate that chronic cold exposure causes a pronounced remodeling of adipose tissues and leads to the recruitment of lipid cycling capacity specifically in BAT of UCP1-knockout mice, possibly fueled by fatty acids from white fat. Quantification of triglyceride/fatty acid cycling clearly shows that UCP1-ablated animals significantly increase turnover rates at room temperature and below. CONCLUSION: Our results suggest an important role for futile lipid cycling in adaptive thermogenesis and total energy expenditure.

• MeSH
• Adenosine Triphosphate metabolism   MeSH
• Adipose Tissue, Brown * metabolism   MeSH
• Fatty Acids metabolism   MeSH
• Mice, Knockout MeSH
• Mice MeSH
• Thermogenesis * MeSH
• Triglycerides metabolism   MeSH
• Uncoupling Protein 1 genetics   metabolism   MeSH
• Animals MeSH
• Check Tag
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Niemann-Pick Disease Type C (NPC) is an autosomal recessive rare disease characterised by progressive neurovisceral manifestations. The collection of on-going large-scale NPC clinical data may generate better understandings of the natural history of the disease. Here we report NPC patient data from the International Niemann-Pick Disease Registry (INPDR). METHOD: The INPDR is a web-based, patient-led independent registry for the collection of prospective and retrospective clinical data from Niemann-Pick Disease patients. Baseline data from NPC patients enrolled into the INPDR from September 2014 to December 2019 was extracted to analyse the demographic, genetic and clinical features of the disease. RESULTS: A total of 203 NPC patients from six European countries were included in this study. The mean age (SD) at diagnosis was 11.2 years (14.2). Among enrolled patients, 168 had known neurological manifestations: 43 (24.2%) had early-infantile onset, 47 (26.4%) had late-infantile onset, 41 (23.0%) had juvenile onset, and 37 (20.8%) had adult onset. 10 (5.6%) patients had the neonatal rapidly fatal systemic form. Among the 97 patients with identified NPC1 variants, the most common variant was the c. 3182T > C variant responsible for the p.lle1061Thr protein change, reported in 35.1% (N = 34) of patients. The frequencies of hepatomegaly and neonatal jaundice were greatest in patients with early-infantile and late-infantile neurological onset. Splenomegaly was the most commonly reported observation, including 80% of adult-onset patients. The most commonly reported neurological manifestations were cognitive impairment (78.5%), dysarthria (75.9%), ataxia (75.9%), vertical supranuclear gaze palsy (70.9%) and dysphagia (69.6%). A 6-domain composite disability scale was used to calculate the overall disability score for each neurological form. Across all with neurological onset, the majority of patients showed moderate to severe impairments in all domains, except for 'swallowing' and 'seizure'. The age at diagnosis and death increased with increased age of neurological symptom onset. Miglustat use was recorded in 62.4% of patients and the most common symptomatic therapies used by patients were antiepileptics (32.9%), antidepressants (11.8%) and antacids (9.4%). CONCLUSION: The proportion of participants at each age of neurological onset was relatively equal across the cohort. Neurological manifestations, such as ataxia, dysphagia, and dysarthria, were frequently observed across all age categories.

• MeSH
• Child MeSH
• Adult MeSH
• Enzyme Inhibitors therapeutic use   MeSH
• Humans MeSH
• Niemann-Pick Disease, Type C * drug therapy   MeSH
• Infant, Newborn MeSH
• Prospective Studies MeSH
• Registries MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH