Computational investigation of the Plasmodium falciparum fatty acid biosynthetic pathway toward the discovery of novel antimalarials

The structural peculiarities of a protein are related to its biological function. In the fatty acid elongation cycle, one small carrier protein shuttles and delivers the acyl intermediates from one enzyme to the other. The carrier has to recognize several enzymatic counterparts, specifically interact with each of them, and finally transiently deliver the carried substrate to the active site. Carry out such a complex game requires the players to be flexible and efficiently adapt their structure to the interacting protein or substrate. In a drug discovery effort, the structure-function relationships of a target system should be taken into account to optimistically interfere with its biological function. In this doctoral work, the essential role of structural plasticity in key steps of fatty acid biosynthesis in Plasmodium falciparum is investigated by means of molecular simulations. The key steps considered include the delivery of acyl substrates and the structural rearrangements of catalytic pockets upon ligand binding. The ground-level bases for carrier/enzyme recognition and interaction are also put forward. The structural features of the target have driven the selection of proper drug discovery tools, which captured the dynamics of biological processes and could allow the rational design of novel inhibitors. The model may be perspectively used for the identification of novel pathway-based antimalarial compounds.

Outcome of HIV-infected patients with hepatocellular carcinoma: a comparison with HIV negative controls

Background and rationale for the study. This study investigated whether human immunodeficiency virus (HIV) infection adversely affects the prognosis of patients diagnosed with hepatocellular carcinoma (HCC).Thirty-four HIV-positive patients with chronic liver disease, consecutively diagnosed with HCC from 1998 to 2007 were one-to-one matched with 34 HIV negative controls for: sex, liver function (Child-Turcotte-Pugh class [CTP]), cancer stage (BCLC model) and, whenever possible, age, etiology of liver disease and modality of cancer diagnosis. Survival in the two groups and independent prognostic predictors were assessed. Results. Among HIV patients 88% were receiving HAART. HIV-RNA was undetectable in 65% of cases; median lymphocyte CD4+ count was 368.5/mmc. Etiology of liver disease was mostly related to HCV infection. CTP class was: A in 38%, B in 41%, C in 21% of cases. BCLC cancer stage was: early in 50%, intermediate in 23.5%, advanced in 5.9%, end-stage in 20.6% of cases. HCC treatments and death causes did not differ between the two groups. Median survival did not differ, being 16 months (95% CI: 6-26) in HIV positive and 23 months (95% CI: 5-41) in HIV negative patients (P=0.391). BCLC cancer stage and HCC treatment proved to be independent predictors of survival both in the whole population and in HIV patients. Conclusions. Survival of HIV infected patients receiving antiretroviral therapy and diagnosed with HCC is similar to that of HIV negative patients bearing this tumor. Prognosis is determined by the cancer bulk and its treatment.