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Orthopaedic surgery has a crucial role in the management of diabetic foot ulceration and Charcot foot. There is a need to raise awareness of the orthopaedic surgeon as an important member of the multidisciplinary team in the surgical treatment of these diabetic foot complications. This article describes three vital roles of the orthopaedic surgeon: surgical management of deformity; treatment of neuropathic diabetic foot infection; and management of Charcot foot deformity. With high-quality surgical care provided by dedicated orthopaedic surgery, the outcomes of diabetic foot ulceration and Charcot foot can be very favourable. [ABSTRACT FROM AUTHOR]

New copaene-type and nerolidol-type sesquiterpenoids, 7-hydroxymustakone (1) and 15-hydroxynerolidol (2), and a 15-norlabdane diterpenoid, kaempcandiol (3), together with four known compounds (4-7) were isolated from the chloroform extract of Kaempferia candida roots and rhizomes. The structures of the new compounds 1-3 were elucidated based on 1D and 2D NMR and HRESIMS spectroscopic analyses. The extract of the K. candida roots and rhizomes and all isolated compounds 1-7 possessed HIV-1 viral protein R (Vpr) inhibitory activities on the TREx-HeLa-Vpr cell line at a 5 μM concentration, without detectable cytotoxicity.

Six new isopimarane diterpenoids, shanpanootols A-F (1-6), along with two known analogues, were isolated from the ethyl acetate-soluble extract of Kaempferia pulchra rhizomes collected in Myanmar. The structures of these compounds were elucidated by extensive spectroscopic techniques such as 1D and 2D NMR and HRESIMS. The absolute configuration of 1 was determined by the modified Mosher method. The new isolates (1-6) were tested for their Vpr inhibitory activities against TREx-HeLa-Vpr cells. Shanpanootols C (3) and E (5) inhibited Vpr at doses of 2.5 and 5 μM, respectively., (Copyright © 2021 Elsevier B.V. All rights reserved.)

SmltD is an ATP-dependent ligase that catalyzes the condensation of UDP-MurNAc-l-Ala and l-Glu to form UDP-MurNAc-l-Ala-l-Glu, in the newly discovered peptidoglycan biosynthesis pathway of a Gram-negative multiple-drug-resistant pathogen, Stenotrophomonas maltophilia. Phytochemical investigation of the 70% ethanol extract from Woodfordia fruticosa flowers collected in Myanmar led to the identification of anti-SmltD active flavonoids, kaempferol 3-O-(6''-galloyl)-β-d-glucopyranoside (1), astragalin (2), and juglalin (3). Among them, 1 showed the most potent SmltD inhibitory activity. An enzyme steady-state kinetic study revealed that 1 exerted competitive inhibition with respect to ATP. The results of this study provided an attractive foundation for the further development of novel inhibitors of SmltD., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Two new trihydroxy derivative of Δ 8(14),15 -isopimarane diterpenoids, shanpanootols G (1) and H (2), along with three known analogues were isolated from the ethyl acetate-soluble extract of Kaempferia pulchra rhizomes collected in Shan State of Myanmar. The structures of these compounds including their absolute configurations were elucidated by the combination of one dimensional (1D) and 2D-NMR spectroscopic methods, high resolution mass spectrometric technique, and the experimental and the calculated electronic circular dichroism (ECD) data. The isopimarane diterpenoids (1-5) were tested for their Viral protein R (Vpr) inhibitory activities against TREx-HeLa-Vpr cells. Shanpanootol H (2) and (1R,2S,5S,9R,10S,13R)-1,2-dihydroxypimara-8(14),15-dien-7-one (4) exhibited anti-Vpr activities at the 5 µM treated dose.

A new brominated pyrrolactam stylissaol A (1) together with four known analogues, 2-bromoaldisine, aldisine, spongiacidin D, and Z-hymenialdisine, were isolated from the EtOAc extract of marine sponge Stylissa massa collected in Myanmar. The absolute configuration at C-10 of 1 was determined as R by the electronic circular dichroism (ECD) data. Among the isolated compounds, 2-bromoaldisine showed anti-Viral Protein R (Vpr) activity against TREx-HeLa-Vpr cells with an effective dose of 10 µM and its potency was comparable to that of positive control damnacanthal.

Two new homodrimane sesquiterpenoids, globbatones A and B (1 and 2), and one 16-norlabdane diterpenoid, globbatone C (3), together with two new naturally occurring, (E)-labda-8(17),12-diene-15,16-olide (4) and γ-bicyclohomofarnesen-12-ol (5), and one known homodrimane sesquiterpenoid (6), nine known labdane diterpenoids (7-15), and one isospongian diterpenoid (16), were isolated from the chloroform extract of Globba sherwoodiana rhizomes. The structures of the new compounds 1-3 were elucidated based on 1D and 2D NMR and HRESIMS spectroscopic analyses. The chloroform extract of G. sherwoodiana rhizomes and 10 μM concentrations of some of its constituents 1, 3, 4, 8, 9, 12, and 14 showed the moderate anti-Vpr activities, without cytotoxic effects on the TREx-HeLa-Vpr cell line., Competing Interests: Declaration of Competing Interest The authors declare no competing final interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Three new quassinoids, javanicinols A and B (1 and 2) and 4-keto-(16S)-methoxyjavanicin B (3), together with three known quassinoids (4-6) were isolated from the chloroform-soluble fraction of the methanol extract of the Picrasma javanica wood. The structures of 1-3 were determined by spectroscopic analyses, including 1D and 2D NMR, HRESIMS, and CD. The anti-HIV-1 viral protein R (Vpr) assay revealed that 1 and 2 exhibited potent anti-Vpr activities at 1.25 μM. Furthermore, the assay also revealed the potent anti-Vpr activities of (16R)-methoxyjavanicin B (7) and (16S)-methoxyjavanicin B (8), which were previously isolated from the Picrasma javanica wood.

Kaempulchraols B-D (2-4), isopimara-8(9),15-diene diterpenoids isolated from Kaempferia pulchra rhizomes collected in Myanmar, were identified as potent NF-κB inhibitors. These compounds were also effective as NO inhibitory agents, with IC 50 values of 47.69, 44.97, and 38.17 μM, respectively, without showing any cytotoxicity against LPS-induced RAW264.7 cells. Investigations of the mechanisms of action of 2-4 revealed that they inhibit the NF-κB-mediated transactivation of a luciferase reporter gene, IL-6 production, and COX-2 expression, with an effective dose of 25 μM. Thus, isopimarane diterpenoids are suggested to be potent inhibitors of NF-κB pathways and could be further explored as potential anti-inflammatory lead compounds.

Inflammation is an extensively recognized link to many pathological diseases. It is a host response for protection from infections and tissue damage. Infections trigger acute inflammation; however, persistent infection will contribute to chronic inflammation and higher disease susceptibility. Deregulated inflammatory responses can cause excessive or long-lasting tissue damage, manifested as cancer, immune disorders, diabetes, etc. NF-κB is a central mediator of pro-inflammatory gene induction and functions in both innate and adaptive immune cells; therefore, the anti-inflammatory regulation of NF-κB is needed. Natural products reportedly play an important role in controlling the inflammatory response pathways. However, the anti-inflammatory activities of isopimara-8-(14),15-diene diterpenoids have not yet been fully elucidated. To elucidate the anti-inflammatory activities of the isopimara-8(14),15-diene diterpenoids, we investigated 21 isopimara-8(14),15-diene diterpenoids previously isolated from Kaempferia pulchra rhizomes. Eleven compounds exhibited NO inhibitory activity against lipopolysaccharide (LPS)-induced RAW264.7 cells, with IC 50 values ranging from 30 to 100 μM. Furthermore, the most potent kaempulchraols P and Q, with IC 50 values of 39.88 and 36.05 μM, respectively, inhibited the NF-κB-mediated transactivation of a luciferase reporter gene, IL-6 production, and COX-2 expression, with an effective dose of 25 μM. These findings provide new insights into the anti-inflammatory activities of the isopimara-8(14),15-diene diterpenoids., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Viral protein R (Vpr) is a small, basic accessory protein (14 kDa) that is well conserved in Human immunodeficiency virus-1 (HIV-1), HIV-2, and simian immunodeficiency virus (SIV). Numerous investigations over the past 2 decades have suggested that Vpr would be an attractive target for HIV disease treatment. Small molecules, including fumagillin, damnacanthal, quercetin, vipirinin, isopimarane diterpenoids, picrasane quassinoids, iridoids, and bis-iridoid glycosides, have been reported as potent Vpr inhibitors. These compounds may not only represent HIV drug seeds, but also could be new target compounds for biochemical synthesis such as current synthetic biology and enzyme bioengineering approaches, due to their anti-Vpr activities. In our investigations of different types of compounds with Vpr inhibitory activity, we found that the CHCl 3 soluble, crude extract of the whole Swertia chirata plant inhibited the expression of Vpr in Hela cells harboring the TREx plasmid encoding full-length Vpr (TREx-HeLa-Vpr cells). The purification and isolation of the active CHCl 3 soluble portion afforded six secondary metabolites, including four xanthone derivatives, decussatine (1), methylswertianin (2), 1-hydroxy-3,5-dimethoxyxanthone (3), and bellidifolin (4), and two triterpenoids, oleanolic acid (5) and 12-hydroxyoleanolic lactone (6). The evaluation of the anti-Vpr activities of 1, 2, and 4-6 against TREx-HeLa-Vpr cells revealed that 4 and 5 are potent Vpr inhibitors with an effective dose of 10 μM, and are chemically and structurally distinct from previously reported inhibitors., (Copyright © 2019 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

Jatropha multifida is a medicinal plant that belongs to the Euphorbiaceae family. Our investigation revealed that the chloroform extract of J. multifida stems showed anti-melanin deposition activity against α-melanocyte stimulating hormone (α-MSH)- and 3-isobutyl-1-methylxanthine (IBMX)-induced melanogenesis in the mouse melanoma cell line (B16-F10). Further fractionation and purification of the major constituents led to the isolation of two coumarins (1 and 2) and seven known lignoids (3-9). All isolated compounds exhibited anti-melanin deposition activities against the mouse melanoma cell line (B16-F10) with IC 50 values ranging from 37.5 to 560.1 µM, without any cytotoxicity even at high concentrations, except for 8. Further mechanistic studies suggested that 9 downregulated tyrosinase mRNA expression, while the anti-melanin deposition activities of 4 and 8 appeared to be unrelated to tyrosinase inhibition and the downregulated expression of the key melanogenesis-associated mRNAs. These results suggested that J. multifida could possess potent skin whitening ingredients.

Picrasma javanica Blume (Simaroubaceae) is a medium-sized tree that is distributed widely in tropical Asia. In our previous study, we isolated quassinoids from P. javanica bark collected in Myanmar, and reported their antiproliferative activities. In our ongoing research for the discovery of bioactive compounds from Myanmar medicinal plants, two new quassinoids, (16R)-methoxyjavanicin B (1) and (16S)-methoxyjavanicin B (2), along with seven known compounds (3-9), were isolated during the phytochemical investigation of the CHCl 3 soluble portion of the MeOH extract of P. javanica wood. The structures of the new compounds were elucidated by analyses of their spectroscopic data (1D- and 2D-NMR, HRESIMS, and CD). A cytotoxicity assay revealed that compound 8 showed moderate activities against all tested cancer cell lines, the human lung (A549), breast (MCF7), and cervical (HeLa), and the normal fibroblast cell line, with IC 50 values ranging from 48.6 to 65.9 μM. Furthermore, the antibacterial assay demonstrated that 1 and 2 had the highest activities (MIC value of 1.6 μM each), followed by 5 and 3 (MIC values of 3.1 and 6.3 μM, respectively) against the Gram-positive bacterium B. subtilis.

A new dinorcassane diterpenoid, seikphoochinal A (1), and four known compounds, pinostrobin (2), 4',7-dimethylkaempferol (3), and galanals A (4) and B (5), were isolated from the chloroform-soluble crude extract of wild type Boesenbergia rotunda rhizomes collected in Lower Myanmar. The chemical structures of these compounds were identified, using a combination of spectroscopic methods. The presence of the diterpenoids 1, 4, and 5 demonstrated the structural diversity of wild type B. rotunda. Among the isolates, compounds 4 and 5 exhibited significant antiproliferative activities against a small panel of human cancer cell lines, including lung (LK-2, A549), stomach (ECC4), breast (MCF7), cervix (HeLa), and prostate (DU145)., (© 2019 Wiley-VHCA AG, Zurich, Switzerland.)

Four new bis-iridoid glycosides, saungmaygaosides A-D (1-4), and six known iridoid glycosides (5-10) were isolated from the n-butanol extract of the stems of Picrorhiza kurroa collected in Myanmar. Their structures were elucidated by extensive spectroscopic techniques. All of the isolates were assayed for anti-Vpr activity, using TREx-HeLa-Vpr cells. Among the isolates, saungmaygaoside D (4), sylvestroside IV dimethyl acetal (7), and sweroside (8) were the most potent inhibitors with effective doses of 5 and 10 μM, respectively, without showing any notable cytotoxicities., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Three new lignoids, premnan A (1), premnan B (2), and tauntangyiol C (3), were isolated from Premna serratifolia wood, a traditional cosmetic plant in Myanmar, together with a new lignoid, premnan C (4) assumed to be an artifact, one natural new lignoid (5), and three known lignoids (6-8). The structures of the new compounds 1-4 were elucidated based on 1D and 2D NMR, IR spectroscopy, and HRESIMS. The absolute configurations of 1-4 were also determined by optical rotation, circular dichroism (CD) data analyses, and comparisons with the reported literature. All isolated compounds were tested for their melanogenesis activities against the B16-F10 mouse melanoma cell line. Compounds 1 and 4 showed melanogenesis enhancing activities of 31% and 50%, respectively, at a 50 μM concentration. Compounds 2, 3, and 6 increased melanin production by 67%, 30%, and 45%, respectively, at a 100 μM concentration, without any cytotoxicity., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Two new tetrahydrofuran lignans, taungtangyiols A (1) and B (2), and eight known furofuran lignans (3-10), were isolated from the chloroform extract of Premna integrifolia wood collected in Myanmar. Their structures were elucidated by extensive spectroscopic techniques. The X-ray crystal structure of 1 clearly indicated its relative configuration. Taungtangyiols A (1) and B (2) inhibited the deposition of melanin in B16F10 mouse melanoma cells, with IC 50 values of 50.7 and 40.9 μM, respectively, without notable cytotoxicity. An SAR study demonstrated that the furofuran and dioxymethylene moieties of the lignans play a vital role in inhibiting melanogenesis., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Marine organisms such as marine sponges and soft corals are valuable sources of pharmacologically active secondary metabolites. In our ongoing research on the discovery of new secondary metabolites from marine organisms, two new pyrrolo-2-aminoimidazoles, clathriroles A (1) and B (2), were isolated from the water-soluble portion prepared from the methanol and acetone (2:1) extract of the marine sponge, Clathria prolifera, collected in Myanmar. The chemical structures of the isolated compounds were determined using extensive spectroscopic techniques, including NMR, HRESIMS, IR, and optical rotation, and comparisons with the reported literature. The spectroscopic analyses of 1 and 2 suggested that 1 is an enantiomer of antifungal N-methylmanzacidin C isolated from the marine sponge Axinella brevistyla, whereas 2 is a diastereomer of manzacidin D at C-11 isolated from the marine sponge Astrosclera willeyana. To the best of our knowledge, this is the first report of the isolation of the pyrrolo-2-aminoimidazole compounds from C. prolifera. Furthermore, in contrast to the potency of N-methylmanzacidin C against Saccharomyces cerevisiae, the antifungal assay revealed that 1 and 2 lack any activity against this strain. Thus, these observations may suggest that the absolute configurations at both C-9 and C-11 play an important role in controlling the antifungal activity of this type of compound.

Human immunodeficiency virus type-1 (HIV-1) is a lentiviral family member that encodes the retroviral Gag, Pol, and Env proteins, along with six additional accessory proteins, Tat, Rev, Vpu, Vif, Nef, and Vpr. The currently approved anti-HIV drugs target the Pol and Env encoded proteins. However, these drugs are only effective in reducing viral replication. Furthermore, the drugs' toxicities and the emergence of drug-resistant strains have become serious worldwide problems. Resistance eventually arises to all of the approved anti-HIV drugs, including the newly approved drugs that target HIV integrase (IN). Drug resistance likely emerges because of spontaneous mutations that occur during viral replication. Therefore, new drugs that effectively block other viral components must be developed to reduce the rate of resistance and suppress viral replication with little or no long-term toxicity. The accessory proteins may expand treatment options. Viral protein R (Vpr) is one of the promising drug targets among the HIV accessory proteins. However, the search for inhibitors continues in anti-HIV drug discovery. In this review, we summarize the naturally occurring compounds discovered from two Myanmar medicinal plants as well as their structure-activity relationships. A total of 49 secondary metabolites were isolated from Kaempferia pulchra rhizomes and Picrasama javanica bark, and the types of compounds were identified as isopimarane diterpenoids and picrasane quassinoids, respectively. Among the isolates, 7 diterpenoids and 15 quassinoids were found to be Vpr inhibitors lacking detectable toxicity, and their potencies varied according to their respective functionalities.

Four new labdane diterpenoids, 12β-hydroxy-15-norlabda-8(17),13(14)-dien-16-oic acid (1), (E)-15-ethoxy-15-methoxylabda-8(17),12-dien-16-al (2), (E)-15α-ethoxy-14α-hydroxylabda-8(17),12-dien-16-olide (3), and 15-ethoxy-12β-hydroxylabda-8(17),13(14)-dien-16,15-olide (4) were isolated from the methanol extract of Curcuma amada rhizomes collected in Myanmar, together with 13 known analogs. Their structures were elucidated by extensive spectroscopic techniques. All of the isolates were evaluated for their antiproliferative activities against a small panel of five different human cancer cell lines (A549, human lung cancer; HeLa, human cervical cancer; MCF7, human breast cancer; PANC-1 and PSN-1, human pancreatic cancer). Among the isolates, compounds 2-4, 7, 8, 12, and 17 showed mild antiproliferative activities with IC 50 values ranging from 19.7 to 96.1μM. (E)-14-Hydroxy-15-norlabda-8(17),12-dien-16-al (11) exhibited strong antiproliferative activities selectively against HeLa, PANC-1, and PSN-1 cells, with IC 50 values of 5.88, 1.00, and 3.98μM, respectively. These potencies were comparable to those of the positive control, 5-fluorouracil., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: To contribute to the development of novel anti-influenza drugs, we investigated the anti-influenza activity of crude extracts from 118 medicinal plants collected in Myanmar. We discovered that extract from the stems of Jatropha multifida Linn. showed anti-influenza activity. J. multifida has been used in traditional medicine for the treatment of various diseases, and the stem has been reported to possess antimicrobial, antimalarial, and antitumor activities. However, the anti-influenza activity of this extract has not yet been investigated., Methods: We prepared water (H 2 O), ethyl acetate (EtOAc), n-hexane (Hex), and chloroform (CHCl 3 ) extracts from the stems of J. multifida collected in Myanmar, and examined the survival of Madin-Darby canine kidney (MDCK) cells infected with the influenza A (H1N1) virus, and the inhibitory effects of these crude extracts on influenza A viral infection and growth in MDCK cells., Results: The H 2 O extracts from the stems of J. multifida promoted the survival of MDCK cells infected with the influenza A H1N1 virus. The EtOAc and CHCl 3 extracts resulted in similar, but weaker, effects. The H 2 O, EtOAc, and CHCl 3 extracts from the stems of J. multifida inhibited influenza A virus H1N1 infection; the H 2 O extract possessed the strongest inhibitory effect on influenza infection in MDCK cells. The EtOAc, Hex, and CHCl 3 extracts all inhibited the growth of influenza A H1N1 virus, and the CHCl 3 extract demonstrated the strongest activity in MDCK cells., Conclusion: The H 2 O or CHCl 3 extracts from the stems of J. multifida collected in Myanmar demonstrated the strongest inhibition of influenza A H1N1 viral infection or growth in MDCK cells, respectively. These results indicated that the stems of J. multifida could be regarded as an anti-influenza herbal medicine as well as a potential crude drug source for the development of anti-influenza compounds.

Viral protein R (Vpr) is an accessory protein that plays important roles in the viral pathogenesis of Human Immunodeficiency Virus-1 (HIV-1). An assay for anti-Vpr activity, using TREx-HeLa-Vpr cells, is a promising strategy to discover Vpr inhibitors. The anti-Vpr assay revealed that the CHCl3-soluble extract of Picrasma javanica bark possesses potent anti-Vpr activity. Furthermore, studies of quassinoids (1-15) previously isolated from the extract demonstrated that all of the tested quassinoids exhibit anti-Vpr activity. Among the tested compounds, javanicin I (15) exhibited the most potent anti-Vpr activity ((***)p <0.001) in comparing with that of the positive control, damnacanthal. The structure-activity relationships of the active quassinoids suggested that the presence of a methyl group at C-13 in the 2,12,14-triene-1,11,16-trione-2,12-dimethoxy-18-norpicrasane quassinoids is the important factor for the potent inhibitory effect in TREx-HeLa-Vpr cells., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Viral protein R (Vpr), an accessory gene of HIV-1, plays important roles in viral pathogenesis. Screening of Myanmar medicinal plants that are popular as primary treatments for HIV/AIDS and for HIV-related problems revealed the potent anti-Vpr activity of the CHCl3-soluble extract of Kaempferia pulchra rhizomes, in comparison with that of the positive control, damnacanthal. Fractionation of the active CHCl3-soluble extract led to the identification of 30 isopimarane diterpenoids, including kaempulchraols A-W (1-23). All isolates were assayed for anti-Vpr activity against TREx-HeLa-Vpr cells, in which Vpr expression is tightly regulated by tetracycline. Kaempulchraols B (2), D (4), G (7), Q (17), T (20), U (21), and W (23) exhibited potent anti-Vpr activity, at concentrations ranging from 1.56 to 6.25μM. The structure-activity relationships of the active kaempulchraols suggested that the presence of a hydroxy group at C-14 in an isopimara-8(9),15-diene skeleton and the presence of an acetoxy group at C-1 or C-7 in an isopimara-8(14),15-diene skeleton are the critical factors for the inhibitory effects against TREx-HeLa-Vpr cells., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Seven new tetracyclic quassinoids, picrajavanicins A-G (1-7), along with three known analogues, were isolated from a CHCl3-soluble extract of the bark of Picrasma javanica collected in Myanmar. The structures of these compounds were elucidated using spectroscopic techniques, including 1D and 2D NMR. The absolute configuration at C-2 of 2 was determined to be S by the modified Mosher method. All the isolates were tested for their antiproliferative activities against a small panel of five human cancer cell lines. However, none of the isolated compounds exhibited inhibitory activity against any of the cancer cells used (IC50 values >10 μM).

The isolation of the oily fraction obtained from the CHCl3-soluble extract of the rhizomes of Kaempferia pulchra afforded five new isopimarane diterpenoids, kaempulchraols P-T (1-5), along with two known analogues. The structures were elucidated using spectroscopic techniques, including 2D NMR spectroscopy.

Eight new diterpenoids, kaempulchraols A-H (1-8), along with five known analogues were isolated from the CHCl3-soluble extract of rhizomes of Kaempferia pulchra of Myanmar. The structures of these compounds were elucidated using extensive spectroscopic techniques including X-ray diffraction analysis. All the isolates were tested for their antiproliferative activity against a panel of five human cancer cell lines (A549, human lung cancer; HeLa, human cervix cancer; PANC-1 and PSN-1, human pancreatic cancer; MDA-MB-231, human breast cancer) and TIG-3, normal human primary fibroblast cells. Kaempulchraol F (6) exhibited weak activity against the human pancreatic PSN-1 cell line with an IC50 value of 12.3 μM.