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    <IdentifierDoi>10.3205/id000036</IdentifierDoi>
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    <ArticleType>Research Article</ArticleType>
    <TitleGroup>
      <Title language="en">Anti-tubercular activity of a natural stilbene and its synthetic derivatives</Title>
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          <Lastname>Reinheimer</Lastname>
          <LastnameHeading>Reinheimer</LastnameHeading>
          <Firstname>Claudia</Firstname>
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          <AcademicTitle>Priv.-Doz. Dr. Dr. med.</AcademicTitle>
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        <Address>Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Paul-Ehrlich-Stra&#223;e 40, 60596 Frankfurt am Main, Germany, Phone: &#43;49-69-6301-6282<Affiliation>Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt, Germany</Affiliation></Address>
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          <Affiliation>Institute of Pharmaceutical Chemistry, Goethe-University, Frankfurt, Germany</Affiliation>
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          <Affiliation>Institute of Pharmaceutical Chemistry, Goethe-University, Frankfurt, Germany</Affiliation>
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          <Affiliation>Merck endowed chair for Molecular Biotechnology, Department of Biosciences and Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Frankfurt, Germany</Affiliation>
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          <Firstname>Volkhard A. J.</Firstname>
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        <Address>
          <Affiliation>Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt, Germany</Affiliation>
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          <Affiliation>Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt, Germany</Affiliation>
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          <Corporatename>German Medical Science GMS Publishing House</Corporatename>
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        <Address>D&#252;sseldorf</Address>
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    <SubjectGroup>
      <SubjectheadingDDB>610</SubjectheadingDDB>
      <Keyword language="en">tuberculosis</Keyword>
      <Keyword language="en">drug resistance</Keyword>
      <Keyword language="en">new substances</Keyword>
      <Keyword language="en">epoxide hydrolases</Keyword>
      <Keyword language="en">stilbene</Keyword>
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    <DatePublished>20180201</DatePublished></DatePublishedList>
    <Language>engl</Language>
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      <AltText language="de">Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).</AltText>
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      <Journal>
        <ISSN>2195-8831</ISSN>
        <Volume>6</Volume>
        <JournalTitle>GMS Infectious Diseases</JournalTitle>
        <JournalTitleAbbr>GMS Infect Dis</JournalTitleAbbr>
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    <Abstract language="en" linked="yes"><Pgraph><Mark1>Objectives:</Mark1> Tuberculosis (TB) and multidrug- and extensively drug-resistant TB in particular are remaining a major global health challenge and efficient new drugs against TB are needed. This study evaluated the anti-tubercular activity of a natural stilbene and its synthetic derivatives against <Mark2>M. tuberculosis</Mark2>.</Pgraph><Pgraph><Mark1>Methods:</Mark1> Isopropylstilbene and its synthetic derivatives were analyzed for their anti-tubercular activity against <Mark2>M. tuberculosis</Mark2> ATCC 27294 as well as multidrug- and extensively drug-resistant <Mark2>M. tuberculosis</Mark2> clinical isolates by using MGIT 960 instrumentation and EpiCenter software equipped with TB eXiST module. Cytotoxic effects of drug candidates were determined by a MTT dye reduction assay using A549 adenocarcinomic human alveolar basal epithelial cells.</Pgraph><Pgraph><Mark1>Results:</Mark1> Growth of <Mark2>M. tuberculosis</Mark2> ATCC 27294 was suppressed by the natural isopropylstilbene HB64 as well as synthetic derivatives DB56 and DB55 at 25 &#181;g&#47;ml. Growth of clinical isolates MDR and XDR <TextGroup><Mark2>M. tuberculosis</Mark2></TextGroup> was suppressed by HB64 at 100 &#181;g&#47;ml as well as by synthetic derivatives DB56 and DB55 at 50 &#181;g&#47;ml and 25 &#181;g&#47;ml, respectively. No anti-tubercular activity was demonstrated for synthetic derivatives DB53, EB251, and RB57 at 100 &#181;g&#47;ml. Toxicity in terms of IC<Subscript>50</Subscript> values of HB64, DB55 and DB56 were 7.92 &#181;g&#47;ml, 12.15 &#181;g&#47;ml and 16.01 &#181;g&#47;ml, respectively.</Pgraph><Pgraph><Mark1>Conclusions:</Mark1> Synthetical derivatives of stilbene might be effective candidates as anti-tubercular drugs. However, toxicity of these substances as determined by IC<Subscript>50</Subscript> values might limit therapeutic success <Mark2>in vivo</Mark2>. Further investigations should address lowering the toxicity for parenteral administration by remodeling stilbene derivatives.</Pgraph></Abstract>
    <TextBlock linked="yes" name="Introduction">
      <MainHeadline>Introduction</MainHeadline><Pgraph>Tuberculosis (TB) incidence is declining globally, however, multidrug-resistant TB (MDR-TB), defined as TB with resistance to isoniazid (INH) and rifampicin (R), and extensively drug-resistant (XDR-TB), defined as MDR with additional resistance to a fluoroquinolone and to one or more of the injectable drugs, remain major global health challenges <TextLink reference="1"></TextLink>. MDR-TB strains are representing a major threat to TB control since the 1990s, and the emergence of the first XDR-TB cases in 2006 <TextLink reference="2"></TextLink> has impressively demonstrated that treatment options for XDR-TB have become alarmingly narrow and the need for new drugs is pressing. While evidence supports the repurposing of antibiotics approved for other indications, such as linezolid <TextLink reference="3"></TextLink>, the new drugs bedaquiline and delamanid have recently been approved for the treatment of drug-resistant tuberculosis <TextLink reference="4"></TextLink>. Despite this silver lining, the increasing burden of XDR-TB underlines the demand on efficient new substances. </Pgraph><Pgraph>Since the sequence of the <Mark2>M. tuberculosis</Mark2> genome has been published, a number of characteristics have been described, <Mark2>e.g.</Mark2> the genome encodes for at least 20 epoxide hydrolases (EHs), which has formerly been reported by Cole et al. to be an unusually large number for a single bacterium <TextLink reference="5"></TextLink>. EHs are key enzymes in the arachidonic acid cascade <TextLink reference="6"></TextLink> and essential to many organisms because of their ability to transform chemically reactive and detrimental epoxides into less reactive substances <TextLink reference="7"></TextLink>, <TextLink reference="8"></TextLink>. </Pgraph><Pgraph>Substances to inhibit EHs may therefore promising substances in future anti-tubercular therapy. </Pgraph><Pgraph>Stilbenes have formerly been observed to have an inhibitory effect on EHs <TextLink reference="9"></TextLink>. Natural stilbenes are a group of nonflavonoid phytochemicals of polyphenolic structure characterized by the presence of a 1,2-diphenylethylene core <TextLink reference="10"></TextLink>, <TextLink reference="11"></TextLink>. Considering (a) the stilbenes&#8217; inhibitory effect on EHs, (b) the potential toxicity of EH substrates to <Mark2>M. tuberculosis</Mark2> in general and (c) the unusual large number of EHs in <Mark2>M. tuberculosis</Mark2>, EHs therefore are proposed to be a promising target for innovative anti-tubercular drugs (ATD). The role of stilbenes and stilbene-derived substances as potentially innovative ATD has scientifically not been addressed yet, to our knowledge. This study therefore aims at evaluation the anti-tubercular activity of a natural stilbene and its synthetic derivatives against <Mark2>M. tuberculosis</Mark2>.</Pgraph></TextBlock>
    <TextBlock linked="yes" name="Material and methods">
      <MainHeadline>Material and methods</MainHeadline><SubHeadline>Natural stilbenes and its synthetic derivatives</SubHeadline><Pgraph>The natural stilbene isopropylstilbene (HB64, Figure 1a <ImgLink imgNo="1" imgType="figure"/>) isolated from <Mark2>Photorhabdus luminescens</Mark2> <TextLink reference="12"></TextLink>, <TextLink reference="13"></TextLink> as well as its synthetic derivatives were analyzed for their anti-tubercular activity.</Pgraph><SubHeadline2>(E)-styryl-1H-benzo&#91;d&#93;imidazoles (DB53, DB55, DB56)</SubHeadline2><Pgraph>In a round-bottom flask 250 mg of 3,4-diaminotoluene derivatives (1.0 eq), o-trifluoromethyl cinnamic acid (<TextGroup><PlainText>1.0 eq</PlainText></TextGroup>) and EDC&#42;HCl (1.5 eq) was dissolved in 10 ml DMF. Catalytic amounts of DMAP (0.05 eq) and imidazole (0.05 eq) were added, and the reaction was stirred for <TextGroup><PlainText>4 h</PlainText></TextGroup> at room temperature. After addition of 150 ml of distilled water, the precipitated solid was obtained by vacuum filtration and washed twice with 10 ml of water.</Pgraph><Pgraph>100 mg of cinnamic acid amides were suspended in <TextGroup><PlainText>2 ml</PlainText></TextGroup> of 6 M aqueous hydrochloric acid. 2.5 ml of EtOH were added, and the mixture was heated under microwave irradiation for 10 minutes at 120&#176;C. The reaction was cooled to room temperature, and subsequently cooled at 4&#176;C. The resulting sediment was filtered off and washed with water. Substances are named DB53 (R&#61;F), DB55 (R&#61;CH<Subscript>3</Subscript>), DB56 (R&#61;Cl) (Figure 1b <ImgLink imgNo="1" imgType="figure"/>).</Pgraph><SubHeadline2>N-((3s, 5s, 7s)-adamantam-1-yl)-6-chloro-2-(4-morpholinophenyl)imidazo&#91;1, 2-a&#93;pyridine-3-amine (EB251) and ethyl 1-(3-((3-cyclohexylureido)methyl)benzyl)-1H-pyrrole-2-carboxylate (RB57)</SubHeadline2><Pgraph>Synthesis has formerly been described by Buscat&#243; et al. <TextLink reference="14"></TextLink>, <TextLink reference="15"></TextLink> (Figure 1c,d <ImgLink imgNo="1" imgType="figure"/>).</Pgraph><Pgraph> </Pgraph><SubHeadline>Bacterial strains</SubHeadline><Pgraph>Reference strain <Mark2>M. tuberculosis</Mark2> ATCC 27294 as well as MDR and XDR <Mark2>M. tuberculosis</Mark2> clinical isolates were used to determine the anti-tubercular activity of a natural stilbene and its synthetical derivatives.  </Pgraph><SubHeadline>Susceptibility testing of M. tuberculosis </SubHeadline><Pgraph>The MGIT 960 system was used for anti-tubercular susceptibility testing as previously described <TextLink reference="16"></TextLink>. MGIT tubes supplemented with 0.8 ml of supplement (MGIT 960 SIRE supplement; Becton Dickinson) were inoculated with <TextGroup><PlainText>0.1 ml</PlainText></TextGroup> of the drug solution at various concentrations and 0.5 ml of the test strain suspension, i.e. <Mark2>M. tuberculosis</Mark2> ATCC 27294 as well as MDR and XDR <Mark2>M. tuberculosis</Mark2> clinical isolates. For preparation of the drug-free growth control tube, the organism suspension was diluted 1:100 with sterile saline, and then 0.5 ml was inoculated into the tube (proportion testing). Quantitative drug susceptibility testing (DST) was performed using the MGIT 960 instrumentation and EpiCenter software version 5.53 equipped with the TB eXiST module (Becton Dickinson), providing features as previously described <TextLink reference="16"></TextLink>, including automated recording of the readings, additional incubation time beyond the time to positivity of the drug-free control, and graphical representation of the growth unit (GU) value increase. The susceptibility testing sets were placed in the MGIT 960 instrument and continuously monitored using EpiCenter TB eXiST software.</Pgraph><Pgraph>The susceptibility testing was performed in triplicate. Results were interpreted as follows: at the time when the growth unit (GU) of the drug-free control tube was &#62;400, if the GU of the drug-containing tube to be compared was &#8805;100, the strain was resistant (R). If the GU of the drug-containing tube was &#60;100, it was interpreted as susceptible (S). Rifampicin and isoniazid were used as positive control drugs.</Pgraph><SubHeadline>Assessment of cytotoxic effects</SubHeadline><Pgraph>Cytotoxic effects of drug candidates were determined <TextGroup><PlainText>by a</PlainText></TextGroup> 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye reduction assay. Cells were plated in 96-well microtiter plates at a density 20,000&#8211;50,000 cells&#47; well <TextLink reference="17"></TextLink>. The cells were incubated in a culture medium at concentrations between 0.19 and 100 &#181;g&#47;ml of the anti-tubercular drug. After 5 days of incubation at 37.0&#176;C in 5&#37; CO<Subscript>2</Subscript> atmosphere, 25 &#181;l MTT substrate (2 mg&#47;ml) was added and plates were incubated at 37.0&#176;C for <TextGroup><PlainText>4 hours</PlainText></TextGroup>. After incubation, cells were lysed in 100 ml buffer containing 2&#37; (w&#47;v) SDS and 5<TextGroup><PlainText>0&#37; (v</PlainText></TextGroup>&#47;v) <Mark2>N,N</Mark2>-dimethylformamide with the pH adjusted to 4.7. Absorbance at 560&#47;620 nm was determined for each well using a 96-well multiscanner. After correcting for the background, the results were expressed as percentage viability relative to a control culture which received no drug.</Pgraph></TextBlock>
    <TextBlock linked="yes" name="Results and discussion">
      <MainHeadline>Results and discussion</MainHeadline><Pgraph>The global spread of TB and its multi- or extensively drug resistant strains is remaining a matter of public health concern worldwide <TextLink reference="1"></TextLink>, <TextLink reference="2"></TextLink>. Therefore, new compounds against <Mark2>M. tuberculosis</Mark2> are urgently needed <TextLink reference="18"></TextLink>. In order to address this issue, we tested the anti-tubercular activity of a natural stilbene and its synthetic derivatives.</Pgraph><Pgraph>Numerous assay systems have been established for the evaluation of compounds against <Mark2>M. tuberculosis</Mark2> and we followed a method based on monitoring growth&#47;inhibition via fluorometric detection of oxygen consumption <TextLink reference="16"></TextLink>.</Pgraph><Pgraph>A total of six substances were used for quantitative DST on the basis of the MGIT 960 instrumentation and <TextGroup><PlainText>EpiCenter</PlainText></TextGroup>. Growth of <Mark2>M. tuberculosis</Mark2> ATCC 27294 was suppressed by HB64 at 25 &#181;g&#47;ml as well as synthetic derivatives DB56 and DB55 at 25 &#181;g&#47;ml each (Table 1 <ImgLink imgNo="1" imgType="table"/>). Growth of clinical isolate MDR <Mark2>M. tuberculosis</Mark2> was suppressed by HB64 at 100 &#181;g&#47;ml as well as by synthetic derivatives DB56 and DB55 at 50 &#181;g&#47;ml and 25 &#181;g&#47;ml, respectively (Table 1 <ImgLink imgNo="1" imgType="table"/>). Furthermore, HB64, DB55 and DB56 were tested against clinical isolate XDR <TextGroup><Mark2>M. tuberculosis</Mark2></TextGroup> with growth suppression at 100 &#181;g&#47;ml, 25 &#181;g&#47;ml and 50 &#181;g&#47;ml, respectively (Table 1 <ImgLink imgNo="1" imgType="table"/>). Interestingly, compared with the natural stilbene, synthetic derivatives (DB55 and DB56) showed enhanced <Mark2>in vitro</Mark2> activity against MDR and XDR <Mark2>M. tuberculosis</Mark2>.</Pgraph><Pgraph>The natural stilbene (HB64) also known as benvitimod has been accepted for clinical trial for the treatment of psoriasis. Benvitimod demonstrated to be an effective topical anti-inflammatory molecule that showed a negligible absorption and was well tolerated <TextLink reference="19"></TextLink>. In the present study we determined the toxicity in terms of IC<Subscript>50</Subscript> values for those substances that show anti-tubercular activity (Table 2 <ImgLink imgNo="2" imgType="table"/>). The IC<Subscript>50</Subscript> values turned out to be lower than the MIC of those substances exhibiting anti-tubercular activity, an issue that would limit systemic application <Mark2>in vivo</Mark2>. Furthermore, rapid metabolization of stilbenes after administration has been described <TextLink reference="20"></TextLink>, which might further influence pharmacokinetics and -activities.</Pgraph><Pgraph>Finally, synthetical derivatives of stilbene might be effective candidates as anti-tubercular drugs. However, toxicity of these substances as determined by IC<Subscript>50</Subscript> values limit therapeutic success <Mark2>in vivo</Mark2>. Further investigations need to address lowering the toxicity by remodeling stilbene derivatives.</Pgraph></TextBlock>
    <TextBlock linked="yes" name="Notes">
      <MainHeadline>Notes</MainHeadline><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing <TextGroup><PlainText>interests</PlainText></TextGroup>.</Pgraph><SubHeadline>Acknowledgments</SubHeadline><Pgraph>We thank Denia Frank and Kuflom Gebreamlack for excellent technical support.</Pgraph><SubHeadline>Authors&#8217; contributions</SubHeadline><Pgraph><UnorderedList><ListItem level="1">Conceptualization: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Formal analysis: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Funding acquisition: CR, TW</ListItem><ListItem level="1">Investigation: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Methodology: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Project administration: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Resources: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Software: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Supervision: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Validation: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Visualization: CR, DB, EP, HB, VK, TW</ListItem><ListItem level="1">Writing &#8211; original draft: CR, TW</ListItem><ListItem level="1">Writing &#8211; review &#38; editing: CR, DB, EP, HB, VK, TW</ListItem></UnorderedList></Pgraph><SubHeadline>Funding</SubHeadline><Pgraph>This work was supported by the Foundation <Mark2>Nachl&#228;sse Marie Christine Held und Erika Hecker,</Mark2> Hospital of Goethe-University, Frankfurt am Main, Germany.</Pgraph></TextBlock>
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          <Caption><Pgraph><Mark1>Table 1: Anti-tubercular activity of stilbenes </Mark1><LineBreak></LineBreak>MIC of substances against <Mark2>M. tuberculosis</Mark2> ATCC 27294 as well as MDR and XDR <Mark2>M. tuberculosis</Mark2> clinical isolates </Pgraph></Caption>
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          <Caption><Pgraph><Mark1>Table 2: Toxicity of stilbenes</Mark1><LineBreak></LineBreak>IC<Subscript>50</Subscript> of selected substances</Pgraph></Caption>
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          <Caption><Pgraph><Mark1>Figure 1: Natural stilbene and its synthetic derivatives evaluated in this study</Mark1><LineBreak></LineBreak>a) Natural stilbene, isopropylstilbene (HB64); b) (E)-styryl-1H-benzo&#91;d&#93;imidazoles with DB53 (R&#61;F), DB55 (R&#61;CH3), DB56 (R&#61;Cl); c) N-((3s, 5s, 7s)-adamantam-1-yl)-6-chloro-2-(4-morpholinophenyl)imidazo&#91;1, 2-a&#93;pyridine-3-amine (EB251); d) 1-(3-((3-cyclohexylureido)methyl)benzyl)-1H-pyrrole-2-carboxylate (RB57)</Pgraph></Caption>
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