1.Two new ursane-type nortriterpenes from Lonicera macranthoides and their iNOS-inhibitory activities.
Yu-Dan MEI ; Nan ZHANG ; Wei-Yang ZHANG ; Jin-Shan TANG ; Hua ZHOU ; Yang YU ; Xin-Sheng YAO
Chinese Journal of Natural Medicines (English Ed.) 2019;17(1):27-32
The flower buds of Lonicera macranthoides (Shan Yin-Hua), represent an important traditional Chinese medicine and food ingredient. A phytochemical investigation of the 70% EtOH extract of the flower buds of L. macranthoides resulted in the isolation of 12 triterpenoids (1-12), including two new ursane-type nortriterpenes, 2α, 24-dihydroxy-23-nor-ursolic acid (1) and 2α, 4α-dihydroxy-23-nor-ursolic acid (2). Their structures were established by multiple spectroscopic methods and comparison with literature data. All isolated compounds were evaluated for their anti-inflammatory effects in LPS-activated RAW264.7 cells. Compounds 1 and 2 exhibited inhibitory effects on iNOS at the concentration of 30 μmol·L.
Animals
;
Anti-Inflammatory Agents
;
chemistry
;
pharmacology
;
Drugs, Chinese Herbal
;
chemistry
;
Enzyme Inhibitors
;
chemistry
;
pharmacology
;
Ethanol
;
chemistry
;
Flowers
;
chemistry
;
Lonicera
;
chemistry
;
Macrophages
;
drug effects
;
metabolism
;
Mice
;
Molecular Structure
;
Nitric Oxide
;
metabolism
;
Nitric Oxide Synthase Type II
;
antagonists & inhibitors
;
Plant Extracts
;
chemistry
;
Plants, Edible
;
chemistry
;
RAW 264.7 Cells
;
Triterpenes
;
chemistry
;
pharmacology
2.Effect of Ambrisentan Therapy on the Expression of Endothelin Receptor, Endothelial Nitric Oxide Synthase and NADPH Oxidase 4 in Monocrotaline-induced Pulmonary Arterial Hypertension Rat Model
Hyeryon LEE ; Arim YEOM ; Kwan Chang KIM ; Young Mi HONG
Korean Circulation Journal 2019;49(9):866-876
BACKGROUND AND OBJECTIVES: Elevated endothelin (ET)-1 level is strongly correlated with the pathogenesis of pulmonary arterial hypertension (PAH). Expression level of nicotinamide adenine dinucleotide phosphate oxidase (NOX) 4 is increased in the PAH patients. Ambrisentan, a selective endothelin receptor A (ERA) antagonist, is widely used in PAH therapy. The current study was undertaken to evaluate the effects of ambrisentan treatment in the monocrotaline (MCT)-induced PAH rat model. METHODS: Rats were categorized into control group (C), monocrotaline group (M) and ambrisentan group (Am). The M and Am were subcutaneously injected 60 mg/kg MCT at day 0, and in Am, ambrisentan was orally administered the day after MCT injection for 4 weeks. The right ventricle (RV) pressure was measured and pathological changes of the lung tissues were observed by Victoria blue staining. Protein expressions of ET-1, ERA, endothelial nitric oxide synthase (eNOS) and NOX4 were confirmed by western blot analysis. RESULTS: Ambrisentan treatment resulted in a recovery of the body weight and RV/left ventricle+septum at week 4. The RV pressure was lowered at weeks 2 and 4 after ambrisentan administration. Medial wall thickening of pulmonary arterioles and the number of intra-acinar arteries were also attenuated by ambrisentan at week 4. Protein expression levels of ET-1 and eNOS were recovered at weeks 2 and 4, and ERA levels recovered at week 4. CONCLUSIONS: Ambrisentan administration resulted in the recovery of ET-1, ERA and eNOS protein expression levels in the PAH model. However, the expression level of NOX4 remained unaffected after ambrisentan treatment.
Animals
;
Arteries
;
Arterioles
;
Blotting, Western
;
Body Weight
;
Endothelin Receptor Antagonists
;
Endothelins
;
Gene Expression
;
Heart Ventricles
;
Humans
;
Hypertension
;
Hypertension, Pulmonary
;
Lung
;
Models, Animal
;
Monocrotaline
;
NADP
;
NADPH Oxidase
;
Nitric Oxide Synthase Type III
;
Oxidoreductases
;
Rats
;
Receptors, Endothelin
;
Victoria
3.The effects of single versus combined therapy using LIM-kinase 2 inhibitor and type 5 phosphodiesterase inhibitor on erectile function in a rat model of cavernous nerve injury-induced erectile dysfunction.
Min Chul CHO ; Junghoon LEE ; Juhyun PARK ; Sohee OH ; Ji Sun CHAI ; Hwancheol SON ; Jae-Seung PAICK ; Soo Woong KIM
Asian Journal of Andrology 2019;21(5):493-500
We aimed to determine whether combination of LIM-kinase 2 inhibitor (LIMK2i) and phosphodiesterase type-5 inhibitor (PDE5i) could restore erectile function through suppressing cavernous fibrosis and improving cavernous apoptosis in a rat model of cavernous nerve crush injury (CNCI). Seventy 12-week-old Sprague-Dawley rats were equally distributed into five groups as follows: (1) sham surgery (Group S), (2) CNCI (Group I), (3) CNCI treated with daily intraperitoneal administration of 10.0 mg kg-1 LIMK2i (Group I + L), (4) daily oral administration of 20.0 mg kg-1 udenafil, PDE5i (Group I + U), and (5) combined administration of 10.0 mg kg-1 LIMK2i and 20.0 mg kg-1 udenafil (Group I + L + U). Rats in Groups I + L, I + U, and I + L + U were treated with respective regimens for 2 weeks after CNCI. At 2 weeks after surgery, erectile response was assessed using electrostimulation. Penile tissues were processed for histological studies and western blot. Group I showed lower intracavernous pressure (ICP)/mean arterial pressure (MAP), lower area under the curve (AUC)/MAP, decreased immunohistochemical staining for alpha-smooth muscle (SM) actin, higher apoptotic index, lower SM/collagen ratio, increased phospho-LIMK2-positive fibroblasts, decreased protein kinase B/endothelial nitric oxide synthase (Akt/eNOS) phosphorylation, increased LIMK2/cofilin phosphorylation, and increased protein expression of fibronectin, compared to Group S. In all three treatment groups, erectile responses, protein expression of fibronectin, and SM/collagen ratio were improved. Group I + L + U showed greater improvement in erectile response than Group I + L. SM content and apoptotic index in Groups I + U and I + L + U were improved compared to those in Group I. However, Group I + L did not show a significant improvement in SM content or apoptotic index. The number of phospho-LIMK2-positive fibroblasts was normalized in Groups I + L and I + L + U, but not in Group I + U. Akt/eNOS phosphorylation was improved in Groups I + U and I + L + U, but not in Group I + L. LIMK2/cofilin phosphorylation was improved in Groups I + L and I + L + U, but not in Group I + U. Our data indicate that combined treatment of LIMK2i and PDE5i immediate after CN injury could improve erectile function by improving cavernous apoptosis or eNOS phosphorylation and suppressing cavernous fibrosis. Rectification of Akt/eNOS and LIMK2/cofilin pathways appears to be involved in their improvement.
Animals
;
Apoptosis/drug effects*
;
Arterial Pressure
;
Electric Stimulation
;
Erectile Dysfunction/pathology*
;
Lim Kinases/antagonists & inhibitors*
;
Male
;
Nerve Crush
;
Nitric Oxide Synthase Type III/metabolism*
;
Penis/pathology*
;
Peripheral Nerve Injuries/pathology*
;
Phosphodiesterase 5 Inhibitors/therapeutic use*
;
Phosphorylation
;
Pyrimidines/therapeutic use*
;
Rats
;
Rats, Sprague-Dawley
;
Sulfonamides/therapeutic use*
4.Inhibitory effect of different Dendrobium species on LPS-induced inflammation in macrophages via suppression of MAPK pathways.
Qiang ZENG ; Chun-Hay KO ; Wing-Sum SIU ; Kai-Kai LI ; Chun-Wai WONG ; Xiao-Qiang HAN ; Liu YANG ; Clara Bik-San LAU ; Jiang-Miao HU ; Ping-Chung LEUNG
Chinese Journal of Natural Medicines (English Ed.) 2018;16(7):481-489
Dendrobii Caulis (DC), named 'Shihu' in Chinese, is a precious herb in traditional Chinese medicine. It is widely used to nourish stomach, enhance body fluid production, tonify "Yin" and reduce heat. More than thirty Dendrobium species are used as folk medicine. Some compounds from DC exhibit inhibitory effects on macrophage inflammation. In the present study, we compared the anti-inflammatory effects among eight Dendrobium species. The results provided evidences to support Dendrobium as folk medicine, which exerted its medicinal function partially by its inhibitory effects on inflammation. To investigate the anti-inflammatory effect of Dendrobium species, mouse macrophage cell line RAW264.7 was activated by lipopolysaccharide. The nitric oxide (NO) level was measured using Griess reagent while the pro-inflammatory cytokines were tested by ELISA. The protein expressions of inducible NO synthase (iNOS), cyclooxygenase-2 (COX-2) and mitogen-activated protein kinases (MAPKs) phosphorylation were evaluated by Western blotting analysis. Among the eight Dendrobium species, both water extracts of D. thyrsiflorum B.S.Williams (DTW) and D. chrysotoxum Lindl (DCHW) showed most significant inhibitory effects on NO production in a concentration-dependent manner. DTW also significantly reduced TNF-α, MCP-1, and IL-6 production. Further investigations showed that DTW suppressed iNOS and COX-2 expression as well as ERK and JNK phosphorylation, suggesting that the inhibitory effects of DTW on LPS-induced macrophage inflammation was through the suppression of MAPK pathways. In conclusion, D. thyrsiflorum B.S.Williams was demonstrated to have potential to be used as alternative or adjuvant therapy for inflammation.
Animals
;
Anti-Inflammatory Agents
;
pharmacology
;
Cyclooxygenase 2
;
genetics
;
Cytokines
;
metabolism
;
Dendrobium
;
chemistry
;
Gene Expression Regulation, Enzymologic
;
drug effects
;
Inflammation
;
chemically induced
;
drug therapy
;
Lipopolysaccharides
;
Macrophages
;
drug effects
;
enzymology
;
Mice
;
Mitogen-Activated Protein Kinases
;
antagonists & inhibitors
;
genetics
;
metabolism
;
Nitric Oxide
;
analysis
;
Nitric Oxide Synthase Type II
;
genetics
;
Phosphorylation
;
drug effects
;
Plant Extracts
;
pharmacology
;
RAW 264.7 Cells
;
Signal Transduction
;
drug effects
5.Calpain inhibition improves erectile function in diabetic mice via upregulating endothelial nitric oxide synthase expression and reducing apoptosis.
Hao LI ; Li-Ping CHEN ; Tao WANG ; Shao-Gang WANG ; Ji-Hong LIU
Asian Journal of Andrology 2018;20(4):342-348
Calpain activation contributes to hyperglycemia-induced endothelial dysfunction and apoptosis. This study was designed to investigate the role of calpain inhibition in improving diabetic erectile dysfunction (ED) in mice. Thirty-eight-week-old male C57BL/6J mice were divided into three groups: (1) nondiabetic control group, (2) diabetic mice + vehicle group, and (3) diabetic mice + MDL28170 (an inhibitor of calpain) group. Type 1 diabetes was induced by intraperitoneal injection of streptozotocin at 60 mg kg-1 body weight for 5 consecutive days. Thirteen weeks later, diabetic mice were treated with MDL28170 or vehicle for 4 weeks. The erectile function was assessed by electrical stimulation of the cavernous nerve. Penile tissues were collected for measurement of calpain activity and the endothelial nitric oxide synthase (eNOS)-nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway. Terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick end labeling (TUNEL) staining was used to evaluate apoptosis. Caspase-3 expression and activity were also measured to determine apoptosis. Our results showed that erectile function was enhanced by MDL28170 treatment in diabetic mice compared with the vehicle diabetic group. No differences in calpain-1 and calpain-2 expressions were observed among the three groups. However, calpain activity was increased in the diabetic group and reduced by MDL28170. The eNOS-NO-cGMP pathway was upregulated by MDL28170 treatment in diabetic mice. Additionally, MDL28170 could attenuate apoptosis and increase the endothelium and smooth muscle levels in corpus cavernosum. Inhibition of calpain could improve erectile function, probably by upregulating the eNOS-NO-cGMP pathway and reducing apoptosis.
Animals
;
Apoptosis/drug effects*
;
Calpain/antagonists & inhibitors*
;
Cyclic GMP/biosynthesis*
;
Diabetes Complications/drug therapy*
;
Diabetes Mellitus, Experimental/complications*
;
Dipeptides/therapeutic use*
;
Endothelium/metabolism*
;
Enzyme Inhibitors/therapeutic use*
;
Erectile Dysfunction/etiology*
;
In Situ Nick-End Labeling
;
Male
;
Mice
;
Mice, Inbred C57BL
;
Muscle, Smooth/metabolism*
;
Nitric Oxide Synthase Type III/biosynthesis*
;
Penis/enzymology*
;
Up-Regulation
6.Afferent Pathway-Mediated Effect of α1 Adrenergic Antagonist, Tamsulosin, on the Neurogenic Bladder After Spinal Cord Injury.
Jin Hee HAN ; Sung Eun KIM ; Il Gyu KO ; Jayoung KIM ; Khae Hawn KIM
International Neurourology Journal 2017;21(3):178-188
PURPOSE: The functions of the lower urinary tract (LUT), such as voiding and storing urine, are dependent on complex central neural networks located in the brain, spinal cord, and peripheral ganglia. Thus, the functions of the LUT are susceptible to various neurologic disorders including spinal cord injury (SCI). SCI at the cervical or thoracic levels disrupts voluntary control of voiding and the normal reflex pathways coordinating bladder and sphincter functions. In this context, it is noteworthy that α1-adrenoceptor blockers have been reported to relieve voiding symptoms and storage symptoms in elderly men with benign prostatic hyperplasia (BPH). Tamsulosin, an α1-adrenoceptor blocker, is also considered the most effective regimen for patients with LUT symptoms such as BPH and overactive bladder (OAB). METHODS: In the present study, the effects of tamsulosin on the expression of c-Fos, nerve growth factor (NGF), and nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) in the afferent micturition areas, including the pontine micturition center (PMC), the ventrolateral periaqueductal gray matter (vlPAG), and the spinal cord (L5), of rats with an SCI were investigated. RESULTS: SCI was found to remarkably upregulate the expression of c-Fos, NGF, and NADPH-d in the afferent pathway of micturition, the dorsal horn of L5, the vlPAG, and the PMC, resulting in the symptoms of OAB. In contrast, tamsulosin treatment significantly suppressed these neural activities and the production of nitric oxide in the afferent pathways of micturition, and consequently, attenuated the symptoms of OAB. CONCLUSIONS: Based on these results, tamsulosin, an α1-adrenoceptor antagonist, could be used to attenuate bladder dysfunction following SCI. However, further studies are needed to elucidate the exact mechanism and effects of tamsulosin on the afferent pathways of micturition.
Adrenergic Antagonists*
;
Afferent Pathways
;
Aged
;
Animals
;
Brain
;
Ganglia
;
Humans
;
Male
;
NAD
;
Nerve Growth Factor
;
Nervous System Diseases
;
Nitric Oxide
;
Nitric Oxide Synthase
;
Periaqueductal Gray
;
Prostatic Hyperplasia
;
Rats
;
Reflex
;
Spinal Cord Dorsal Horn
;
Spinal Cord Injuries*
;
Spinal Cord*
;
Urinary Bladder
;
Urinary Bladder, Neurogenic*
;
Urinary Bladder, Overactive
;
Urinary Tract
;
Urination
7.Polyphenols isolated from Acacia mearnsii bark with anti-inflammatory and carbolytic enzyme inhibitory activities.
Jia XIONG ; Mary H GRACE ; Debora ESPOSITO ; Slavko KOMARNYTSKY ; Fei WANG ; Mary Ann LILA
Chinese Journal of Natural Medicines (English Ed.) 2017;15(11):816-824
The present study was designed to characterize the polyphenols isolated from Acacia mearnsii bark crude extract (B) and fractions (B1-B7) obtained by high-speed counter-current chromatography (HSCCC) and evaluate their anti-inflammatory and carbolytic enzymes (α-glucosidase and α-amylase) inhibitory activities. Fractions B4, B5, B6, B7 (total phenolics 850.3, 983.0, 843.9, and 572.5 mg·g, respectively; proanthocyanidins 75.7, 90.5, 95.0, and 44.8 mg·g, respectively) showed significant activities against reactive oxygen species (ROS), nitric oxide (NO) production, and expression of pro-inflammatory genes interleukin-1β (IL-1β) and inducible nitric oxide synthase (iNOS) in a lipopolysaccharide (LPS)-stimulated mouse macrophage cell line RAW 264.7. All the extracts suppressed α-glucosidase and α-amylase activities, two primary enzymes responsible for carbohydrate digestion. A. mearnsii bark samples possessed significantly stronger inhibitory effects against α-glucosidase enzyme (IC of 0.4-1.4 μg·mL) than the pharmaceutical acarbose (IC 141.8 μg·mL). B6 and B7 (IC 17.6 and 11.7 μg·mL, respectively) exhibited α-amylase inhibitory activity as efficacious as acarbose (IC 15.4 μg·mL). Moreover, B extract, at 25 µg·mL, significantly decreased the non-mitochondrial oxidative burst that is often associated with inflammatory response in human monocytic macrophages.
Acacia
;
chemistry
;
Animals
;
Anti-Inflammatory Agents
;
isolation & purification
;
pharmacology
;
Carbohydrate Metabolism
;
drug effects
;
Glycoside Hydrolase Inhibitors
;
pharmacology
;
Inflammation
;
metabolism
;
Interleukin-1beta
;
metabolism
;
Lipopolysaccharides
;
Macrophages
;
drug effects
;
Mice
;
Nitric Oxide
;
metabolism
;
Nitric Oxide Synthase Type II
;
metabolism
;
Plant Bark
;
chemistry
;
Plant Extracts
;
chemistry
;
pharmacology
;
Polyphenols
;
isolation & purification
;
pharmacology
;
Proanthocyanidins
;
pharmacology
;
RAW 264.7 Cells
;
alpha-Amylases
;
antagonists & inhibitors
;
alpha-Glucosidases
;
metabolism
8.Effect of Pneumoperitoneum on Oxidative Stress and Inflammation via the Arginase Pathway in Rats.
Seokyung SHIN ; Sungwon NA ; Ok Soo KIM ; Yong Seon CHOI ; Shin Hyung KIM ; Young Jun OH
Yonsei Medical Journal 2016;57(1):238-246
PURPOSE: Oxidative stress during CO2 pneumoperitoneum is reported to be associated with decreased bioactivity of nitric oxide (NO). However, the changes in endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and arginase during CO2 pneumoperitoneum have not been elucidated. MATERIALS AND METHODS: Thirty male Sprague-Dawley rats were randomized into three groups. After anesthesia induction, the abdominal cavities of the rats of groups intra-abdominal pressure (IAP)-10 and IAP-20 were insufflated with CO2 at pressures of 10 mm Hg and 20 mm Hg, respectively, for 2 hours. The rats of group IAP-0 were not insufflated. After deflation, plasma NO was measured, while protein expression levels and activity of eNOS, iNOS, arginase (Arg) I, and Arg II were analyzed with aorta and lung tissue samples. RESULTS: Plasma nitrite concentration and eNOS expression were significantly suppressed in groups IAP-10 and IAP-20 compared to IAP-0. While expression of iNOS and Arg I were comparable between the three groups, Arg II expression was significantly greater in group IAP-20 than in group IAP-0. Activity of eNOS was significantly lower in groups IAP-10 and IAP-20 than in group IAP-0, while iNOS activity was significantly greater in group IAP-20 than in groups IAP-0 and IAP-10. Arginase activity was significantly greater in group IAP-20 than in groups IAP-0 and IAP-10. CONCLUSION: The activity of eNOS decreases during CO2 pneumoperitoneum, while iNOS activity is significantly increased, a change that contributes to increased oxidative stress and inflammation. Moreover, arginase expression and activity is increased during CO2 pneumoperitoneum, which seems to act inversely to the NO system.
Animals
;
Aorta/*physiology
;
Arginase/*antagonists & inhibitors
;
Enzyme Inhibitors/administration & dosage/pharmacology
;
Inflammation/etiology/*prevention & control
;
Injections, Subcutaneous
;
Lung Injury/etiology/prevention & control
;
Male
;
Nitric Oxide/metabolism
;
Nitric Oxide Synthase Type II/*metabolism
;
Nitric Oxide Synthase Type III/*metabolism
;
Oxidative Stress/*drug effects
;
Pneumoperitoneum/*complications/drug therapy
;
Rats
;
Rats, Sprague-Dawley
9.Study on material base of Ligusticum wallichii for treating brain ischemia and its molecular mechanism based on molecular docking.
Xiang-gang SONG ; Wei ZHOU ; Chao CHEN ; Shu-mei WANG ; Sheng-wang LIANG
China Journal of Chinese Materia Medica 2015;40(11):2195-2198
To explore the effective ingredients and mechanism of Ligusticum wallichii in treating brain ischemia. Four brain ischemia-related target proteins were selected in the joint screening for the 45 component in L. wallichii reported in literatures based on molecular docking by reference to the corresponding drugs in the market. According to the docking results, multiple components in L. wallichii, such as phthalides, were superior to the corresponding drugs in the market, suggesting that they may be the major effective components in L. wallichii for treating brain ischemia. The method can be used to study the material base and molecular mechanism of traditional Chinese medicines.
Brain Ischemia
;
drug therapy
;
Ligusticum
;
chemistry
;
Medicine, Chinese Traditional
;
Molecular Docking Simulation
;
Nitric Oxide Synthase Type II
;
antagonists & inhibitors
;
Peroxidase
;
antagonists & inhibitors
;
Phytotherapy
;
Tumor Necrosis Factor-alpha
;
antagonists & inhibitors
10.Antiangiogenic Activity of Acer tegmentosum Maxim Water Extract in Vitro and in Vivo.
Eok Cheon KIM ; So Hun KIM ; Shan Ji PIAO ; Tack Joong KIM ; Kiho BAE ; Han Sung KIM ; Soon Sun HONG ; Byoung Ick LEE ; Moonsuk NAM
Journal of Korean Medical Science 2015;30(7):979-987
Angiogenesis, the formation of new blood vessels, is critical for tumor growth and metastasis. Notably, tumors themselves can lead to angiogenesis by inducing vascular endothelial growth factor (VEGF), which is one of the most potent angiogenic factors. Inhibition of angiogenesis is currently perceived as one of the most promising strategies for the blockage of tumor growth. In this study, we investigated the effects of Acer tegmentosum maxim water extract (ATME) on angiogenesis and its underlying signal mechanism. We studied the antiangiogenic activity of ATME by using human umbilical vein endothelial cells (HUVECs). ATME strongly inhibited VEGF-induced endothelial cell proliferation, migration, invasion, and tube formation, as well as vessel sprouting in a rat aortic ring sprouting assay. Moreover, we found that the p44/42 mitogen activated protein (MAP) kinase signaling pathway is involved in the inhibition of angiogenesis by ATME. Moreover, when we performed the in vivo matrigel plug assay, VEGF-induced angiogenesis was potently reduced when compared to that for the control group. Taken together, these results suggest that ATME exhibits potent antiangiogenic activity in vivo and in vitro and that these effects are regulated by the extracellular regulated kinase (ERK) pathway.
Acer/*metabolism
;
Angiogenesis Inhibitors/*pharmacology
;
Animals
;
Cell Line, Tumor
;
Cell Movement/drug effects
;
Cell Proliferation/drug effects
;
Cell Survival
;
Extracellular Signal-Regulated MAP Kinases/*metabolism
;
Hep G2 Cells
;
Human Umbilical Vein Endothelial Cells/*drug effects
;
Humans
;
MAP Kinase Signaling System/drug effects
;
Mice
;
Mice, Inbred C57BL
;
Mitogen-Activated Protein Kinase 1/metabolism
;
Neoplasm Invasiveness/pathology
;
Neovascularization, Pathologic/*drug therapy/prevention & control
;
Nitric Oxide Synthase Type III/metabolism
;
Phosphorylation/drug effects
;
Plant Extracts/pharmacology
;
Rats
;
Rats, Sprague-Dawley
;
Transcription Factors/metabolism
;
Vascular Endothelial Growth Factor A/antagonists & inhibitors/metabolism

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