Duncan Webster

Anti-mycobacterial natural products from the Canadian medicinal plant Juniperus communis

ETHNOPHARMACOLOGICAL RELEVANCE Common juniper, Juniperus communis, is amongst the plants most frequently used by the indigenous peoples of North America for medicinal purposes. The First Nations of the Canadian Maritimes use infusions of juniper primarily as a tonic and for the treatment of tuberculosis. Previous investigations of extracts derived from the aerial parts of J. communis have shown it to possess anti-mycobacterial activity. The aim of the study is to isolate and identify anti-mycobacterial constituents from the aerial parts of J. communis. MATERIALS AND METHODS Methanolic extracts of J. communis needles and branches were subjected to bioassay guided fractionation using the microplate resazurin assay (MRA) to assess inhibitory activity against Mycobacterium tuberculosis strain H37Ra. The anti-mycobacterial constituents were identified by NMR, MS and polarimetry. RESULTS The diterpenes isocupressic acid and communic acid and the aryltetralin lignan deoxypodophyllotoxin were isolated from the J. communis extract. Isocupressic acid and communic acid (isolated as an inseparable 3:2 mixture of cis and trans isomers) displayed MICs of 78 μM and 31 μM and IC(50)s of 46 μM and 15 μM against M. tuberculosis H37Ra respectively. Deoxypodophyllotoxin was less active, with a MIC of 1004 μM and an IC(50) of 287 μM. CONCLUSIONS Isocupressic acid, communic acid and deoxypodophyllotoxin were identified as the principal constituents responsible for the anti-mycobacterial activity of the aerial parts of J. communis. Although further research will be required to evaluate the relative activities of the two communic acid isomers, this work validates an ethnopharmacological use of this plant by Canadian First Nations and Native American communities.

The Canadian medicinal plant Heracleum maximum contains antimycobacterial diynes and furanocoumarins

ETHNOPHARMACOLOGICAL RELEVANCE Heracleum maximum is amongst the most commonly used plants by the indigenous peoples of North America. The First Nations of the eastern Canada use infusions of Heracleum maximum roots for the treatment of respiratory ailments including tuberculosis. Previous investigations of extracts derived from the roots of Heracleum maximum have shown it to possess antimycobacterial activity. AIM OF THE STUDY To isolate and identify antimycobacterial constituents from the roots of Heracleum maximum. MATERIALS AND METHODS A methanolic extract of Heracleum maximum roots was subjected to bioassay guided fractionation using the microplate resazurin assay (MRA) to assess inhibitory activity against Mycobacterium tuberculosis strain H37Ra. The antimycobacterial constituents were identified by NMR, MS and polarimetry. RESULTS The polyacetylene (3R,8S)-falcarindiol and the furanocoumarins bergapten, isobergapten, angelicin, sphondin, pimpinellin, isopimpinellin and 6-isopentenyloxyisobergapten were isolated from the Heracleum maximum root extract. (3R,8S)-Falcarindiol and 6-isopentenyloxyisobergapten exhibited MICs of 24 μM and 167 μM and IC50s of 6 μM and 27 μM against Mycobacterium tuberculosis H37Ra respectively. The remaining furanocoumarins bergapten, isobergapten, angelicin, sphondin, pimpinellin, and isopimpinellin were less active, with MICs of 925, 1850, 2149, 1859, 812 and 1625 μM and IC50s of 125, 344, 350, 351, 389 and 406 μM. CONCLUSIONS (3R,8S)-Falcarindiol, bergapten, isobergapten, angelicin, sphondin, pimpinellin, isopimpinellin and 6-isopentenyloxyisobergapten were identified as the principal constituents responsible for the antimycobacterial activity of the roots of Heracleum maximum. This work supports the ethnopharmacological use of Heracleum maximum by Canadian First Nations and Native American communities as a treatment for infectious diseases, specifically tuberculosis.

Anti-mycobacterial triterpenes from the Canadian medicinal plant Alnus incana

ETHNOPHARMACOLOGICAL RELEVANCE Alnus incana, commonly known as the gray or speckled alder, is a medicinal plant used by some Canadian First Nations to treat symptoms associated with tuberculosis. The aim of this study was to assess the anti-mycobacterial activity of an Alnus incana bark extract and to identify the active constituents of the extract. MATERIALS AND METHODS Methanolic extracts of the bark of A. incana were subjected to bioassay guided fractionation using Mycobacterium tuberculosis (H37Ra). The active constituents were identified by NMR and MS. RESULTS Four pentacyclic lupane triterpenes were isolated and were identified as betulin, betulinic acid, betulone and lupenone. Betulin displayed a MIC of 12.5 μg/mL and an IC50 of 2.4 μg/mL against M. tuberculosis (H37Ra). Betulinic acid and betulone showed lower anti-mycobacterial activities with IC50 values of 84 and 57 μg/mL respectively. Lupenone was inactive against M. tuberculosis (H37Ra). CONCLUSIONS Betulin, betulinic acid and betulone were identified as the major anti-mycobacterial constituents in the bark of A. incana and the functionality at carbons 3 and 28 of the lupane skeleton would seem to be important in determining the anti-mycobacterial activity of the triterpenes. This work supports the ethnopharmacological use of A. incana by Canadian First Nations communities as a treatment for tuberculosis.

Optimisation of the Microplate Resazurin Assay for Screening and Bioassay-guided Fractionation of Phytochemical Extracts against Mycobacterium tuberculosis

INTRODUCTION Because of increased resistance to current drugs, there is an urgent need to discover new anti-mycobacterial compounds for the development of novel anti-tuberculosis drugs. The microplate resazurin assay (MRA) is commonly used to evaluate natural products and synthetic compounds for anti-mycobacterial activity. However, the assay can be problematic and unreliable when screening methanolic phytochemical extracts. OBJECTIVE To optimise the MRA for the screening and bioassay-guided fractionation of phytochemical extracts using Mycobacterium tuberculosis H37Ra. METHODS The effects of varying assay duration, resazurin solution composition, solvent (dimethyl sulphoxide - DMSO) concentration and type of microtitre plate used on the results and reliability of the MRA were investigated. The optimal bioassay protocol was applied to methanolic extracts of medicinal plants that have been reported to possess anti-mycobacterial activity. RESULTS The variables investigated were found to have significant effects on the results obtained with the MRA. A standardised procedure that can reliably quantify anti-mycobacterial activity of phytochemical extracts in as little as 48 h was identified. The optimised MRA uses 2% aqueous DMSO, with an indicator solution of 62.5 µg/mL resazurin in 5% aqueous Tween 80 over 96 h incubation. CONCLUSION The study has identified an optimal procedure for the MRA when used with M. tuberculosis H37Ra that gives rapid, reliable and consistent results. The assay procedure has been used successfully for the screening and bioassay-guided fractionation of anti-mycobacterial compounds from methanol extracts of Canadian medicinal plants.

The Importance of Frailty in the Assessment of Influenza Vaccine Effectiveness Against Influenza-Related Hospitalization in Elderly People

Background Influenza is an important cause of morbidity and mortality among older adults. Even so, effectiveness of influenza vaccine for older adults has been reported to be lower than for younger adults, and the impact of frailty on vaccine effectiveness (VE) and outcomes is uncertain. We aimed to study VE against influenza hospitalization in older adults, focusing on the impact of frailty. Methods We report VE of trivalent influenza vaccine (TIV) in people ≥65 years of age hospitalized during the 2011-2012 influenza season using a multicenter, prospective, test-negative case-control design. A validated frailty index (FI) was used to measure frailty. Results Three hundred twenty cases and 564 controls (mean age, 80.6 and 78.7 years, respectively) were enrolled. Cases had higher baseline frailty than controls (P = .006). In the fully adjusted model, VE against influenza hospitalization was 58.0% (95% confidence interval [CI], 34.2%-73.2%). The contribution of frailty was important; adjusting for frailty alone yielded a VE estimate of 58.7% (95% CI, 36.2%-73.2%). VE was 77.6% among nonfrail older adults and declined as frailty increased. Conclusions Despite commonly held views that VE is poor in older adults, we found that TIV provided good protection against influenza hospitalization in older adults who were not frail, though VE diminished as frailty increased. Clinical Trials Registration NCT01517191.

Anti-mycobacterial diynes from the Canadian medicinal plant Aralia nudicaulis

ETHNOPHARMACOLOGICAL RELEVANCE Aralia nudicaulis, or wild sarsaparilla, is used as a traditional medicinal plant for the treatment of various illnesses by many of the Canadian First Nations. Iroquois and Algonquin First Nations of Eastern Canada use a tea prepared from dried Aralia nudicaulis rhizome as a cough medicine and for the treatment of tuberculosis. Previous investigations of aqueous extracts of Aralia nudicaulis rhizomes have shown it to possess antimycobacterial activity. AIM OF THE STUDY To isolate and identify antimycobacterial constituents from Aralia nudicaulis rhizomes. MATERIALS AND METHODS Methanolic extracts of Aralia nudicaulis rhizomes were subjected to bioassay guided fractionation using the microplate resazurin assay (MRA) to assess inhibitory activity against Mycobacterium tuberculosis strain H37Ra. The antimycobacterial constituents were identified by NMR, MS and polarimetry. RESULTS Two C17 polyacetylenes with significant antimycobacterial activity were isolated from the Aralia nudicaulis rhizome extract. The polyacetylenes were identified as (3R)-falcarinol and (3R, 9R, 10S)-panaxydol. Falcarinol and panaxydol displayed MICs of 25.6μM and 36.0μM and IC(50)s of 15.3μM and 23.5μM against Mycobacterium tuberculosis H37Ra. CONCLUSIONS Falcarinol and panaxydol were identified as the principal constituents responsible for the antimycobacterial activity of Aralia nudicaulis rhizomes validating an ethnopharmacological use of this plant by the Canadian First Nations.

Burden of vaccine-preventable pneumococcal disease in hospitalized adults: A Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network study

BACKGROUND Pneumococcal community acquired pneumonia (CAPSpn) and invasive pneumococcal disease (IPD) cause significant morbidity and mortality worldwide. Although childhood immunization programs have reduced the overall burden of pneumococcal disease, there is insufficient data in Canada to inform immunization policy in immunocompetent adults. This study aimed to describe clinical outcomes of pneumococcal disease in hospitalized Canadian adults, and determine the proportion of cases caused by vaccine-preventable serotypes. METHODS Active surveillance for CAPSpn and IPD in hospitalized adults was performed in hospitals across five Canadian provinces from December 2010 to 2013. CAPSpn were identified using sputum culture, blood culture, a commercial pan-pneumococcal urine antigen detection (UAD), or a serotype-specific UAD. The serotype distribution was characterized using Quellung reaction, and PCR-based serotyping on cultured isolates, or using a 13-valent pneumococcal conjugate vaccine (PCV13) serotype-specific UAD assay. RESULTS AND CONCLUSIONS In total, 4769 all-cause CAP cases and 81 cases of IPD (non-CAP) were identified. Of the 4769 all-cause CAP cases, a laboratory test for S. pneumoniae was performed in 3851, identifying 14.3% as CAPSpn. Of CAP cases among whom all four diagnostic test were performed, S. pneumoniae was identified in 23.2% (144/621). CAPSpn cases increased with age and the disease burden of illness was evident in terms of requirement for mechanical ventilation, intensive care unit admission, and 30-day mortality. Of serotypeable CAPSpn or IPD results, predominance for serotypes 3, 7F, 19A, and 22F was observed. The proportion of hospitalized CAP cases caused by a PCV13-type S. pneumoniae ranged between 7.0% and 14.8% among cases with at least one test for S. pneumoniae performed or in whom all four diagnostic tests were performed, respectively. Overall, vaccine-preventable pneumococcal CAP and IPD were shown to be significant causes of morbidity and mortality in hospitalized Canadian adults in the three years following infant PCV13 immunization programs in Canada.

California Serogroup Virus Infection Associated with Encephalitis and Cognitive Decline, Canada, 2015

California serogroup (CSG) viruses, such as Jamestown Canyon and snowshoe hare viruses, are mosquitoborne pathogens that cause febrile illness and neurologic disease. Human exposures have been described across Canada, but infections are likely underdiagnosed. We describe a case of neuroinvasive illness in a New Brunswick, Canada, patient infected with a CSG virus.

Transitioning to highly effective therapies for the treatment of chronic hepatitis C virus infection: a policy statement and implementation guideline.

Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments.

Oseltamivir-resistant pandemic H1N1 influenza

In December 2009, a 27-year-old man with severe influenza-like illness was admitted to a tertiary care hospital in Saint John, New Brunswick. The patient had asthma, obesity (body mass index 40.7 kg/m2) and untreated familial hypercholesterolemia. He had not received immunization against pandemic