Papers by Gregory Anstead
Bioorganic & Medicinal Chemistry Letters, 1993
Squalene epoxidase and oxidosqualene cyclase, two sequential enzymes in the sterol biosynthesis p... more Squalene epoxidase and oxidosqualene cyclase, two sequential enzymes in the sterol biosynthesis pathway, are inhibited effectively by trisnorsqualene methyl hydmxylamine, Squalene epoxidase (SE) and oxidosqualene cycIase (OX) catalyze sequential committed steps of tbe sterol biosynthesis pathway and thus have been the focus of efforts to develop hypocholesterolemic, he&i&M, and ~~~~ agents.3 Recently, trisnorsqualene alcohol 1 (TPJSAP and ~yc~~y~~ 25 have been rqorted as effective inhibitors of SE. A number of trisnorsqualene amim~ and amine oxides
5 Gregory M. Anstead,* Deanna A. Sutton, and John R. 6 Graybill 7 8 1 Department of Medicine, Div... more 5 Gregory M. Anstead,* Deanna A. Sutton, and John R. 6 Graybill 7 8 1 Department of Medicine, Division of Infectious Diseases; and 9 3 Department of Pathology, Fungus Testing Laboratory 10 University of Texas Health Science Center at San Antonio 11 San Antonio, TX 78229 12 13 2 Department of Medicine, Division of Infectious Diseases 14 South Texas Veterans Healthcare System 15 San Antonio, TX 78229 16 17 Submitted to: Journal of Clinical Microbiology 18 19 *Address correspondence to: 20 Gregory M. Anstead, MD, PhD 21 Department of Medicine; Division of Infectious Diseases 22 University of Texas Health Science Center at San Antonio 23 7703 Floyd Curl Drive MC7881 24 San Antonio, TX 78229 25 Phone: 210-567-4666 26 Fax: 210-567-4670 27 Email: [email protected] 28 29 Running title: Adiaspiromycosis causing respiratory failure 30 31
Tropical Medicine and Infectious Disease, 2021
Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typ... more Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrate...
IDCases, 2021
In this paper, we describe a case of fatal disseminated coccidioidomycosis (CM). The patient was ... more In this paper, we describe a case of fatal disseminated coccidioidomycosis (CM). The patient was a 44-year old male with a history of cirrhosis who presented with altered mental status, cough, and an enlarged, ulcerated tongue. On evaluation, the patient was found to have coccidioidal infection of the tongue, lungs, and brain. Despite over two months of antifungal treatment, the patient died from aspiration pneumonia and at autopsy was found to have persistent infection of the tongue and lungs, extensive mycosis of the brain, and involvement of both adrenal glands. The fulminant course of coccidioidomycosis in this patient is ascribed to his baseline cirrhosis and lymphocytopenia. There are few autopsy cases of CM that have been described in the post-antifungal era and few published cases of CM with either tongue or adrenal involvement.
Tropical Medicine and Infectious Disease, 2020
Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis a... more Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch ...
Cureus, 2021
Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection, and a rare cause of... more Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection, and a rare cause of hepatitis. It is often fatal, especially if the diagnosis and treatment are delayed. Herein, we describe the case of a 31year-old female with a history of receiving cytotoxic cancer chemotherapy five months prior who presented with a one-week history of worsening abdominal pain and fever. She was noted to have an outbreak of genital herpes at the time of presentation. Computed tomography (CT) scan of the abdomen showed innumerable hypodensities compatible with hepatic micro-abscesses. A specimen from a subsequent liver biopsy revealed HSV-type cytopathic changes and nuclear staining with an anti-HSV immunohistochemical stain. She was initially started on high-dose oral valacyclovir for genital herpes and was noted to have rapid clinical improvement prior to the histopathologic diagnosis of HSV hepatitis. She achieved full recovery while on oral valacyclovir. This is the first reported case of HSV hepatitis treated with oral valacyclovir and the third reported case of HSV hepatitis mimicking pyogenic abscesses on abdominal imaging. With the high mortality rate associated with HSV hepatitis, one should consider the diagnosis in all patients with multifocal liver lesions of unknown etiology, especially if genital herpes is present at the time of presentation, or in patients who are immunocompromised.
Tropical Medicine and Infectious Disease, 2020
Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache,... more Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, and diverse organ manifestations that can result in critical illness or death. This is the second part of a two-part series describing the rise, decline, and resurgence of flea-borne typhus (FBT) in the United States over the last century. These studies illustrate the influence of historical events, social conditions, technology, and public health interventions on the prevalence of a vector-borne disease. Flea-borne typhus was an emerging disease, primarily in the Southern USA and California, from 1910 to 1945. The primary reservoirs in this period were the rats Rattus norvegicus and Ra. rattus and the main vector was the Oriental rat flea (Xenopsylla cheopis). The period 1930 to 1945 saw a dramatic rise in the number of reported cases. This was due to conditions favorable to the proliferation of rodents and their fleas during the Depression and World War II years, including: dila...
Tropical Medicine and Infectious Disease, 2020
Flea-borne typhus, due to Rickettsia typhi and Rickettsia felis, is an infection causing fever, h... more Flea-borne typhus, due to Rickettsia typhi and Rickettsia felis, is an infection causing fever, headache, rash, hepatitis, thrombocytopenia, and diverse organ manifestations. Although most cases are self-limited, 26%–28% have complications and up to one-third require intensive care. Flea-borne typhus was recognized as an illness similar to epidemic typhus, but having a milder course, in the Southeastern United States and TX from 1913 into the 1920s. Kenneth Maxcy of the US Public Health Service (USPHS) first described the illness in detail and proposed a rodent reservoir and an arthropod vector. Other investigators of the USPHS (Eugene Dyer, Adolph Rumreich, Lucius Badger, Elmer Ceder, William Workman, and George Brigham) determined that the brown and black rats were reservoirs and various species of fleas, especially the Oriental rat flea, were the vectors. The disease was recognized as a health concern in the Southern United States in the 1920s and an increasing number of cases we...
Tropical Medicine and Infectious Disease, 2019
Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions ... more Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aeroco...
The American Journal of Tropical Medicine and Hygiene, 2018
Murine typhus (MT) is an important cause of febrile illness in endemic areas, and there is an epi... more Murine typhus (MT) is an important cause of febrile illness in endemic areas, and there is an epidemiologic resurgence of this infection currently transpiring in Texas and California. Fatal cases and severe neurological complications are rare. A fatal case of MT in a middle-aged man is reported with a course culminating in multi-organ failure and refractory status epilepticus. An autopsy revealed hemorrhagic pneumonia, acute tubular necrosis, and ischemic necrosis in the liver, adrenals, and brain. We have also reviewed the neurologic complications of MT.
Open Forum Infectious Diseases, 2018
Background Hepatotoxicity secondary to therapy for Mycobacterium tuberculosis (MTB) is a common c... more Background Hepatotoxicity secondary to therapy for Mycobacterium tuberculosis (MTB) is a common complication that may lead to treatment interruption. N-Acetylcysteine (NAC) exerts a hepatoprotective effect by repleting glutathione stores and enhancing the cellular antioxidant defense mechanism. NAC has been found to be protective against liver toxicity in animals treated for MTB infection. Randomized controlled trials have shown that its use in humans also decreases the risk of hepatotoxicity associated with anti-MTB treatment but there is minimal data regarding its utility for treatment of liver toxicity. Methods Patients who received NAC from January 2012 to March 2018 for prophylaxis and treatment of increasing liver function tests (LFTs) while on isoniazid (INH) were included. A retrospective review of the medical record system was performed. Results Nineteen patients were included. Eight received NAC for treatment. The average age was 49 years. Seventy percent of patients were ...
Case Reports in Infectious Diseases, 2017
The patient is a 52-year-old African American man with a past medical history of HIV infection (o... more The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small...
Nutrition, 2016
Objective: Prolonged maternal separation (PMS) in the first 2 wk of life has been associated with... more Objective: Prolonged maternal separation (PMS) in the first 2 wk of life has been associated with poor growth with lasting effects in brain structure and function. This study aimed to investigate whether PMS-induced undernutrition could cause systemic inflammation and changes in nutrition-related hormonal levels, affecting hippocampal structure and neurotransmission in C57BL/6J suckling mice. Methods: This study assessed mouse growth parameters coupled with insulin-like growth factor-1 (IGF-1) serum levels. In addition, leptin, adiponectin, and corticosterone serum levels were measured following PMS. Hippocampal stereology and the amino acid levels were also assessed. Furthermore, we measured myelin basic protein and synapthophysin (SYN) expression in the overall brain tissue and hippocampal SYN immunolabeling. For behavioral tests, we analyzed the ontogeny of selected neonatal reflexes. PMS was induced by separating half the pups in each litter from their lactating dams for defined periods each day (4 h on day 1, 8 h on day 2, and 12 h thereafter). A total of 67 suckling pups were used in this study. Results: PMS induced significant slowdown in weight gain and growth impairment. Significant reductions in serum leptin and IGF-1 levels were found following PMS. Total CA3 area and volume were reduced, specifically affecting the pyramidal layer in PMS mice. CA1 pyramidal layer area was also reduced. Overall hippocampal SYN immunolabeling was lower, especially in CA3 field and
Clinics, 2014
OBJECTIVE: To determine the impact of supplemental zinc, vitamin A, and glutamine alone or in com... more OBJECTIVE: To determine the impact of supplemental zinc, vitamin A, and glutamine alone or in combination on growth, intestinal barrier function, stress and satiety-related hormones among Brazilian shantytown children with low median height-forage z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged two months to nine years from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for testing (a total of 120 children) were as follows: (1) glutamine alone, n = 38; (2) glutamine plus vitamin A plus zinc, n = 37; and a placebo (zinc plus vitamin A vehicle) plus glycine (isonitrogenous to glutamine) control treatment, n = 38. Leptin, adiponectin, insulin-like growth factor (IGF-1), and plasma levels of cortisol were measured with immune-enzymatic assays; urinary lactulose/mannitol and serum amino acids were measured with highperformance liquid chromatography. ClinicalTrials.gov: NCT00133406. RESULTS: Glutamine treatment significantly improved weight-for-height z-scores compared to the placeboglycine control treatment. Either glutamine alone or all nutrients combined prevented disruption of the intestinal barrier function, as measured by the percentage of lactulose urinary excretion and the lactulose:mannitol absorption ratio. Plasma leptin was negatively correlated with plasma glutamine (p = 0.002) and arginine (p = 0.001) levels at baseline. After glutamine treatment, leptin was correlated with weight-forage (WAZ) and weight-for-height z-scores (WHZ) (p#0.002) at a 4-month follow-up. In addition, glutamine and all combined nutrients (glutamine, vitamin A, and zinc) improved the intestinal barrier function in these children. CONCLUSION: Taken together, these findings reveal the benefits of glutamine alone or in combination with other gut-trophic nutrients in growing children via interactions with leptin.
Infection and immunity, 2014
Malnutrition is thought to contribute to more than one-third of all childhood deaths via increase... more Malnutrition is thought to contribute to more than one-third of all childhood deaths via increased susceptibility to infection. Malnutrition is a significant risk factor for the development of visceral leishmaniasis, which results from skin inoculation of the intracellular protozoan Leishmania donovani. We previously established a murine model of childhood malnutrition and found that malnutrition decreased the lymph node barrier function and increased the early dissemination of L. donovani. In the present study, we found reduced numbers of resident dendritic cells (conventional and monocyte derived) but not migratory dermal dendritic cells in the skin-draining lymph nodes of L. donovani-infected malnourished mice. Expression of chemokines and their receptors involved in trafficking of dendritic cells and their progenitors to the lymph nodes was dysregulated. C-C chemokine receptor type 2 (CCR2) and its ligands (CCL2 and CCL7) were reduced in the lymph nodes of infected malnourished ...
PLoS Neglected Tropical Diseases, 2013
In a murine model of moderate childhood malnutrition we found that polynutrient deficiency led to... more In a murine model of moderate childhood malnutrition we found that polynutrient deficiency led to a 4-5-fold increase in early visceralization of L. donovani (3 days post-infection) following cutaneous infection and a 16-fold decrease in lymph node barrier function (p,0.04 for all). To begin to understand the mechanistic basis for this malnutrition-related parasite dissemination we analyzed the cellularity, architecture, and function of the skin-draining lymph node. There was no difference in the localization of multiple cell populations in the lymph node of polynutrient deficient (PND) mice, but there was reduced cellularity with fewer CD11c + dendritic cells (DCs), fibroblastic reticular cells (FRCs), MOMA-2 + macrophages, and CD169 + subcapsular sinus macrophage (p,0.05 for all) compared to the well-nourished (WN) mice. The parasites were equally co-localized with DCs associated with the lymph node conduit network in the WN and PND mice, and were found in the high endothelial venule into which the conduits drain. When a fluorescent low molecular weight (10 kD) dextran was delivered in the skin, there was greater efflux of the marker from the lymph node conduit system to the spleens of PND mice (p,0.04), indicating that flow through the conduit system was altered. There was no evidence of disruption of the conduit or subcapsular sinus architecture, indicating that the movement of parasites into the subcortical conduit region was due to an active process and not from passive movement through a leaking barrier. These results indicate that the impaired capacity of the lymph node to act as a barrier to dissemination of L. donovani infection is associated with a reduced number of lymph node phagocytes, which most likely leads to reduced capture of parasites as they transit through the sinuses and conduit system.
Medical Mycology, 2006
A 63-year-old man with a history of cirrhosis of the liver developed Candida glabrata fungemia af... more A 63-year-old man with a history of cirrhosis of the liver developed Candida glabrata fungemia after undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. Treatment with oral fluconazole was initially effective, but when the patient became neutropenic, subsequent blood cultures grew C. glabrata and a thrombus developed, which partially occluded the stent. Despite treatment with fluconazole, blood cultures remained positive for C. glabrata. Treatment with posaconazole resulted in clinical improvement and the patient had only intermittently positive fungal cultures for 6 weeks. A CT scan showed resolution of the inferior vena cava thrombus. Subsequently, the patient developed hepatocellular carcinoma and hepatic encephalopathy and became noncompliant with posaconazole. Blood cultures again became positive for C. glabrata. The patient died a few weeks after the diagnosis of hepatocellular carcinoma, but the cause of death was believed to be worsening liver dysfunction, not C. glabrata infection. Posaconazole had controlled the infection for about 3 months prior to his death. In conclusion, posaconazole may be a useful option in the management of prosthetic endovascular infections caused by C. glabrata.
Journal of Medicinal Chemistry, 1989
We have studied how 2-arylindene systems, unsymmetrical nonsteroidal estrogens, orient themselves... more We have studied how 2-arylindene systems, unsymmetrical nonsteroidal estrogens, orient themselves within the binding site of the estrogen receptor, relative to estradiol, by making a comprehensive comparison of the binding affinity of 16 analogues. These analogues are representatives of two major classes, those substituted a t C-3 with an ethyl or with a phenyl substituent; within each class there are members that have different patterns of hydroxyl group substitution and C-1 oxo or alkyl substitution. Orientational preferences were inferred from the relative binding affinities and were supplemented by computer graphic molecular overlap studies that utilized crystal structures of selected representative compounds and the known tolerance of the estrogen receptor to substituents on the steroidal ligand estradiol. 2-Arylindenes with a 3-aryl substituent appear to orient with the indene system mimicking the A-and Brings of estradiol (indene/AB mode). This orientation is supported by the fact that hydroxyl substitution at C-6 in the indene markedly elevates binding relative to hydroxyl substitution at the para position of the 2-phenyl substituent. A C-1 oxo substituent increases binding further, but a C-1 alkyl group has little effect. By contrast, the 2-arylindenes with a C-3 ethyl substituent appear to bind with the pendant C-2 ring, mimicking the A-ring of estradiol (pendant/A mode), as hydroxyl substitution in this ring elevates binding relative to the C-6 hydroxy analogues. C-1 alkyl substitution elevates binding affinity in this series; such a substituent in a C-1 S configuration would be projected into the receptor region normally occupied by the high-affinity 7a-or ll@-alkyl estradiols. A C-1 oxo substituent produces only a modest binding enhancement in the C-3 ethyl series. A thermodynamic evaluation of receptor fit suggests that the smaller 3-ethyl-2-arylindenes are more efficient than the 2,3-diarylindenes in the use of the molecular bulk to achieve receptor binding. This analysis of the orientational preference of 2-arylindene nonsteroidal estrogens has important implications in the design of donor/acceptor-substituted 2-arylindenes as fluorescent ligands for the estrogen receptor.
Journal of Medicinal Chemistry, 1990
2,3-Diarylindenes are ligands for the estrogen receptor which display intrinsic fluorescence. In ... more 2,3-Diarylindenes are ligands for the estrogen receptor which display intrinsic fluorescence. In order to optimize the receptor binding affinity of these compounds while preserving their desirable fluorescence properties, a series of torsionally modified analogues were prepared. A fluorine or methyl group was introduced on either of the two phenyl substituents ortho to their attachment site to the indene nucleus, in order to increase the out-of-plane twist of the appended rings. The analogues were prepared by the benzylation of appropriate deoxybenzoins, followed by Friedel-Crafts cyclic alkylation-dehydration. Comparison of the X-ray crystal structure of one analogue with unsubstituted analogues confirms the torsional perturbation effected by the ortho substituent. The torsional disposition of the C-2 aryl group in the substituted diphenylindenes is further investigated by UV (absorbance maxima and molar absorptivities), fluorescence (Stokes' shift), and NMR (chemical shifts). These spectroscopic measurements indicate increasing twisting between the C-2 aryl substituent and the indene system according to the following order: 3-ring o-Me-indene 9f less than diphenylindene 15 = 20 degrees less than 3-ring o-F-indene 9c less than 1-Me-indene 16 less than 2-ring o-F-indene 9b less than 2-ring o-Me-indene 9e = 63 degrees. The binding affinity of these analogues to the estrogen receptor was evaluated by a competitive radiometric receptor binding assay. While o-fluoro or o-methyl substitution on the 3-ring increases binding only slightly, binding of the o-fluoro 2-ring analogue is increased ca. 6-fold and the o-methyl analogue 11-fold, giving, in the latter case, a compound with an affinity equivalent to that of estradiol. The increase in binding affinity afforded by ortho substitution correlates with the increase in the torsion angle of the C-2 aryl ring. A thermodynamic evaluation of the receptor fit (Andrews, P. R.; Craik, D. J.; Martin, J. L. J. Med. Chem. 1984, 27, 1648) indicates that, for the o-methyl 2-ring analogue, the effect of the ortho substitution on increasing receptor binding appears to be a combination of increased surface area due to the substituent itself, together with a change in surface area of the ligand that results from the increased torsion of the two aryl rings. An o-fluoro substituent on the 2-ring provides a compromise between the relative planarity required for high fluorescence intensity and the molecular shape needed for increased estrogen receptor binding affinity.(ABSTRACT TRUNCATED AT 400 WORDS)
Journal of Medicinal Chemistry, 1988
In an attempt to elucidate steric and electronic factors that affect the fluorescence and estroge... more In an attempt to elucidate steric and electronic factors that affect the fluorescence and estrogen receptor binding properties of 2,3-diarylindenes, we have prepared and examined the behavior of 11 analogues bearing substituents on the 1-position or on the 2-aryl ring. These compounds were synthesized by alkylation of a 1,2-diarylethanone with 3-methoxybenzyl chloride, followed by cyclodehydration to the indene. The electronic spectra of those compounds without tau-electron accepting groups on the 2-aryl ring display the absorbance and fluorescence of a hindered stilbene system; those with nitro and cyano substituents on the 2-aryl ring show charge-transfer character, having a more bathochromic absorption and fluorescence. One bisphenolic nitroindene, in particular, shows a strong, long-wavelength absorption and an intense emission, with a large Stokes' shift that is highly sensitive to solvent polarity. Estrogen receptor binding affinity measurements on these compounds indicate that substituents that twist the pendant aryl rings (such as a 1-methyl group, or an o-methyl or trifluoromethyl group on the 2-phenyl ring) increase binding affinity. Bulky (4-bromo) or electron-withdrawing groups (3- and 4-nitro, 4-cyano) on the 2-phenyl group, or its replacement with a 3-pyridyl group, greatly reduce binding affinity, suggesting that the complementary region of the receptor is relatively intolerant of bulk and may have specific hydrogen-bonding requirements. This investigation of the concurrent effects of substituents on the fluorescence properties and receptor binding affinity of 2,3-diarylindenes should assist in the development of effective, inherently fluorescent ligands for the estrogen receptor.
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Papers by Gregory Anstead