Iranian Journal of Pharmaceutical Research
Volume:20 Issue: 4, Autumn 2021

Coronavirus disease -19 (COVID-19) pandemic, caused by SARS-CoV-2, has gradually spread worldwide, becoming a major public health event. This situation requires designing a novel antiviral agent against the SARS-CoV-2; however, this is time-consuming and the use of repurposed medicines may be promising. One such medicine is favipiravir, primarily introduced as an anti-influenza agent in east world. The aim of this study was to evaluate the efficacy and safety of favipiravir in comparison with lopinavir-ritonavir in SARS-CoV-2 infection. In this randomized clinical trial, 62 patients were recruited. These patients had bilateral pulmonary infiltration with peripheral oxygen saturation lower than 93%. The median time from symptoms onset to intervention initiation was seven days. Favipiravir was not available in the Iranian pharmaceutical market, and it was decided to formulate it at the research laboratory of School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients received favipiravir tablet at a dose of 1600 mg orally twice a day for day one and then 600 mg orally twice a day for days 2 to 6. In the second group, the patients received lopinavir-ritonavir combination tablet at a dose of 200/50 mg twice a day for seven days. Fever, cough, and dyspnea were improved significantly in favipiravir group in comparison with lopinavir-ritonavir group on days four and five. Mortality rate and ICU stay in both groups were similar, and there was no significant difference in this regard (P = 0.463 and P = 0.286, respectively). Chest X-ray improvement also was not significantly different between the two groups. Adverse drug reactions occurred in both groups, and impaired liver enzymes were the most frequent adverse effect. In conclusion, early administration of oral favipiravir may reduce the duration of clinical signs and symptoms in patients with COVID-19 and hospitalization period. The mortality rate also should be investigated in future clinical trials.

Severe acute respiratory syndrome (SARS) is an infectious and highly transmissible disease that is affected by SARS coronavirus (SARS-CoV) and for which there are presently no approved treatments. COVID-19 is a new strain of coronavirus that has not been previously identified in humans. It is also a member of the coronaviruse family and known to cause similar illnesses in humans. The last outbreak has been identified as a Pandemic because of COVID-19 infections in humans. This review has been prepared to give some information to readers or scientists about some new generation of boron-doped or boron attached composite quantum dots during the design phase of the drug or drug delivery systems to be developed to combat COVID-19 and to help in the design of new drugs and systems by opening some new horizons. All scientists and researchers must quickly share their ideas and experiences in the fight against COVID-19 to find a better therapy or strategy for humans, and thus we can be successful. In this sense, this review offers readers some new ideas and rational perspectives. In conclusion, boron-containing composite carbon quantum dots appear to be the most suitable delivery system for treating COVID-19 infections especially when they are delivered through the lung.

Aspirin exacerbated respiratory disease (AERD) is known by the triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), aspirin hypersensitivity, and asthma, but its etiology and physiopathogenesis are still unclear. This cross-sectional study was designed to investigate allergy and inflammatory cells (neutrophils vs. eosinophils) dominancy in nasal polyp tissue of patients with AERD compared to non-AERD patients. CRSwNP patients scheduled for endoscopic sinus surgery were recruited in this study. Nasal polyp tissue was analyzed for infiltrating cells, and Eosinophil dominant and neutrophil dominant polyps were determined. AERD was confirmed by oral aspirin challenge (OAC). Demographics data; history of asthma, exacerbation by using NSAIDs, routine use of aspirin, type of surgery (primary or revision), and results of skin prick test and spirometry were recorded. Pathology results and contributing factors compared between AERD and non-AERD patients. Sixty-five patients (39 women, 26 men) were enrolled in the study (mean age 38.83 ± 12.43 years). Thirty (46%) patients had positive OAC tests. Totally 41 patients (63.1%) had eosinophilic polyps. 80% of patients with eosinophilic polyp had positive OAC and were AERD (P < 0.05). There was no significant difference in demographics, revision surgery, and concomitant asthma between AERD and non-AERD groups (P > 0.05). The positive skin prick test was higher in AERD and also in eosinophilic polyp patients, but it was not statistically significant (P = 0.086 and P = 0.177). Eosinophilic polyps are more common in AERD. A positive skin prick test is associated with AERD and eosinophilic polyp.

Relapsed/refractory acute myeloid leukemia (RR-AML) are important types of hematological malignancy for which no effective salvage chemotherapy has been approved. The main purpose of this study was to determine the effectiveness of adding Bortezomib to salvage chemotherapy protocol in RR-AML patients. In this prospective non-interventional study, 40 consecutive patients with RR-AML attending Taleghani Hospital who underwent salvage therapy, were enrolled and subdivided into salvage chemotherapy plus Bortezomib and salvage chemotherapy without Bortezomib and the therapeutic response, adverse effects, and survival among them were determined. The results in this study demonstrated that complete response was present in 30% and 25% in Bortezomib group and the other group, respectively and the partial response was seen in 35% and 50% and no response was present in 35% and 25%, respectively (P = 0.621). Furthermore, in each group, 15% had a side effect (P = 1.000). Mean survival was 8.2 and 7.1 in Bortezomib and the other group, respectively (P = 0.275). Based on the obtained results, it may be concluded that adding Bortezomib to salvage chemotherapy is feasible in RR-AML patients. For evaluation of efficacy further study is recommended.

In the present study, imatinib-loaded transfersomal gel (imatinib-TFS-Gel) was developed to minimize the oral dosing frequency and side effects during rheumatoid arthritis (RA) therapy. Imatinib-loaded transfersomes (imatinib-TFS) were prepared by the film-hydration method. The effects of lecithin content, lecithin/ EA ratio, and the type of EA on the characteristics of the imatinib-TFS were studied using a D-optimal design. Morphology of imatinib-TFS was investigated using scanning electron microscopy. The optimized imatinib-TFS formulation was used to prepare imatinib-TFS-Gel with the aid of Carbopol 940 as the gelling agent. The Optimized imatinib-TFS had a spherical shape with the particle size of 140.53 ± 0.87 nm, polydispersity index of 0.44 ± 0.01, the zeta potential of -17.63 ± 0.65 mV, encapsulation efficiency of 98.70 ± 0.38%, and release efficiency of 81.26 ± 0.70 %. Ex-vivo skin permeation studies through the rat skin showed that the cumulative amount of imatinib permeated from imatinib-TFS-Gel was significantly higher than that from imatinib-Gel. The RA rat model indicated a substantial reduction in paw edema during the 14 days study following the application of imatinib-TFS-Gel as compared with imatinib-Gel. Therefore, imatinib-TFS-Gel can be considered as a promising drug delivery system for the treatment of RA.

Benzodiazepines (BZD) are among the main classes of tranquilizing drugs, bearing much less toxicity compared to other drugs acting on the CNS. Considering the pharmacophore model of BZD binding to GABA-A receptor, novel diphenyl 1,3,4-oxadiazole compounds as BZD ligands were designed. The compounds were synthesized and structurally confirmed using LCMS, IR and NMR techniques. We investigated the affinity of the compounds to BZD receptors using radioligand [3H]-flumazenil by in-vitro studies. In addition, sedative-hypnotic, anxiety, anticonvulsant, muscle relaxant, memory impairment, and motor coordination activities of the synthesized compounds were evaluated using in-vivo studies. Based on in-vitro studies, compounds 7i and 7j were the most potent with IC50 values of 1.54 and 1.66 nM respectively. In-vivo studies showed that compound 7i has the highest impact on increased sedation, muscle relaxation, and decreased anxiety and these observations were antagonized by flumazenil. Compounds 7e and 7i were the most potent anticonvulsant agents among synthesized compounds in both MES and PTZ induced seizure tests. All synthesized compounds significantly decreased latency to fall in the Rotarod test but none of them had a significant impact on the memory impairment test.

Cutaneous leishmaniasis is caused by protozoa of the genus Leishmania and spread by sandflies. The standard therapy for this ailment is the first-line medication of pentavalent antimonial and the second drug line of pentamidine amphotericin B. All are practiced over the years and exhibit adverse toxicity effects. Herbal product-derived medicine is a promising potential source for treating parasitic diseases. Xanthatin, a xanthanolide sesquiterpene lactone, is isolated from Xanthium strumarium L. treats several ailments in many countries. In the present study, we investigated the leishmanicidal activity of the xanthatin by using a metabolomics-based analysis in J774 macrophages and amastigotes phases in Leishmania major. Xanthatin was isolated and identified by NMR spectroscopy. Macrophage toxicity of xanthatin performed by MTT assay. Macrophages infected by the L. major's promastigote stationary phase, the infection rate (IR), and multiplication index (MI) were calculated. Axenic amastigotes were treated with xanthatin. Cell quenching and metabolite extraction were performed, and the metabolome profile was analyzed with NMR spectroscopy. Outliers were classified by using multivariate statistical analysis software, and relevant metabolites and pathways were worked out. The xanthatin IC50 rate defined 0.75 µg/mL base on macrophages viability and also in-vitro activity of xanthatin on amastigotes showed the best leishmanicidal activity in IR and MI values of 53% and 62.5%, respectively. Xanthatin altered amino sugars and nucleotide sugars metabolism, starch and sucrose metabolism, cyanoamino acid, and galactose metabolism. Our finding revealed that the main target of xanthatin is carbon metabolism, which is an essential step for amastigotes virulence.

Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery and can be linked to the increased morbidity and mortality. Therefore, in the present study, the effect of preoperative administration of acetazolamide was evaluated to investigate whether it could prevent occurrence of post-operative AKI after CABG surgery. In this randomized controlled clinical trial, 130 patients who were candidates to undergo elective CABG surgery from January 21, 2020 to February 8, 2021 were randomly allocated to intervention group (receiving 500 mg of acetazolamide orally 2 h preoperatively) and control group. The patients were evaluated for AKI based on the kidney disease- improving global outcomes (KDIGO) criteria based on their serum creatinine (SCr) level and urine output until 7 days postoperatively. There was no significant difference in baseline demographics between the two groups. The total incidence of AKI was measured as 43%. Analysis of post-operative AKI incidence showed no statistically significant difference between the two groups (P = 0.860). Mean post-operative SCr level on day 1 was significantly higher in the acetazolamide group (P = 0.036). A significant difference was found in length of hospitalization stay between the groups, which was higher in the control group (P = 0.006). Our results did not demonstrate a significant protective effect of acetazolamide on incidence of post-operative AKI in the patients undergone elective on-pump CABG surgery.

The selection of the appropriate fragment of the cell surface receptors as an antigen is significant for the production of antibodies. CD133, as a suitable biomarker candidate in the cancer stem cells (CSCs), is a glycosylated protein. The antibodies used for analyzing it recognize glycosylated epitopes of CD133. Since the glycosylated motifs have a dynamic nature over the lifetime of a protein, they limit the detection of CD133. In this study, to access a specific antibody against the antigenic, accessible, and non-glycosylated fragment of the native CD133, we performed an in-silico analysis. Then, we expressed the third domain (D-EC3) (serine641-leucine710) in E. coli BL21 (DE3), then the purified recombinant antigen immunized BALB/c mice. Finally, the dignity of an epitope of pure recombinant antigen has been approved by the interactions of antibody and antigen with the use of mice immunized sera via ELISA and flow cytometry experimentation. The results showed that the selected non-glycosylated fragment can compete well with the commercial antibody against the glycosylated epitopes to identify the native cell surface markers. The results can be considered for diagnosis and target therapy development of CD133+ cancer cells.

Having multiple dimensions, uncertainties and several stakeholders, the costly pharmacogenomics (PGx) is associated with dynamic implementation complexities. Identification of these challenges is critical to harness its full potential, especially in developing countries with fragile healthcare systems and scarce resources. This is the first study aimed to identify most salient challenges related to PGx implementation, with respect to the experiences of early-adopters and local experts’ prospects, in the context of a developing country in the Middle East. To perform a comprehensive reconnaissance on PGx adoption challenges a scoping literature review was conducted based on national drug policy components: efficacy/safety, access, affordability and rational use of medicine (RUM). Strategic option development and analysis workshop method with cognitive mapping as the technique was used to evaluate challenges in the context of Iran. The cognitive maps were face-validated and analyzed via Decision Explorer XML. The findings indicated a complex network of issues relative to PGx adoption, categorized in national drug policy indicators. In the rational use of medicine category, ethics, education, bench -to- bedside strategies, guidelines, compliance, and health system issues were found. Clinical trial issues, test's utility, and biomarker validation were identified in the efficacy group. Affordability included  pricing, reimbursement, and value assessment issues. Finally, access category included regulation, availability, and stakeholder management challenges. The current study identified the most significant challenges ahead of clinical implementation of PGx in a developing country. This could be the basis of a policy-note development in future work, which may consolidate vital communication among stakeholders and accelerate the efficient implementation in developing new-comer countries.

Prostate cancer is one of the common cancers with a high mortality rate in men. Therefore, there is always a necessity to discover new medications for treatment or alleviating its symptoms. In recent years, anticancer properties of a number of delphinium species were reported, but there is no study on the anticancer effects of Delphinium semibarbatum (D. semibarbatum) alkaloid contents. Therefore, this survey aimed to check the cytotoxicity and apoptotic properties of D. semibarbatum alkaloid fractions (DSAFs) against prostate cancer cells. Cytotoxicity was measured by MTT assay. We examined the apoptosis by detecting annexin V-FITC/PI staining, the mitochondrial membrane potential (ΔΨm) disruption, reactive oxygen species (ROS) generation, the activity of caspase-3, and expression of the Bax and Bcl-2 in cancer cells. DSAFs treatment inhibited the growth of LNCaP and DU‐145 cells by the increase of apoptotic (Q2+Q3) cells detected by annexin V/PI assay. We found over-generation of intracellular ROS and ΔΨm loss in mitochondrial membrane potential treated cell lines. Attenuation of anti-apoptotic Bcl-2 followed by the increase in pro-apoptotic Bax bands, as well as activation of the caspase-3 enzyme was shown in Western blot analysis. Phytochemical analysis suggested that hetisine type diterpene alkaloids were probably responsible for apoptotic activities. Conclusively, the present study demonstrated that D. semibarbatum alkaloid content exerted antiproliferative effects against prostate cancer cells by inducing the intrinsic pathway of apoptosis.

Mobilization and engraftment of Hematopoietic Stem Cells (HSCs) are challenging issues in Autologous HSC transplantation (AHSCT) so several attempts such as colony-stimulating factors (CSF) and plerixafor have been used for enhancement of HSCs mobilization and engraftment. In this randomized, double-blind and placebo-controlled study, we evaluated the melatonin’s efficacy and safety, as endogenous CSF inducer, co-administered with Filgrastim in mobilizing and engraftment of HSC. AHSCT patients were randomized to receive either Melatonin or placebo plus filgrastim. Of Fifty-one patients, 26 patients received the melatonin (In mobilization phase 3 mg sublingual twice daily, then 9 mg single dose 30 min before apheresis session and then 3 mg twice daily from +1 until engraftment) and 25 patients received the placebo. The mean number of CD34 cells/kg × 106 in the melatonin group was 6.54 versus 4.22 in the placebo group (p = 0.025). The mean day to neutrophil engraftment in the melatonin group was 11.69 ± 2.093, whereas 12.68 ± 2.42 days in the placebo group (p = 0.021). In this study, the second apheresis session requirement, the use of plerixafor and hospital stay duration, were comparable between the two groups. Considering the result of the study, it could be suggested that melatonin plus Filgrastim can be effectively used in AHSCT patients to enhance the number of peripheral CD34 cells/kg × 106 and decrease the day number of neutrophil engraftment.

The coronavirus disease-2019 (COVID-19) was first recognized in Wuhan, China, and quickly spread worldwide. Between all proposed research guidelines, inhibition of the main protease (Mpro) protein of the virus will be one of the main strategies for COVID-19 treatment. The present work was aimed to perform a computational study on FDA-approved drugs, similar to piperine scaffold, to find possible Mpro inhibitors. Firstly, virtual screening studies were performed on a library of FDA-approved drugs (43 medicinal compounds, similar to piperine scaffold). Among imported 43 drugs to virtual screening, 34 compounds were extracted. Four top-ranked drugs in terms of the highest interactions and the lowest binding energy were selected for the IFD study. Among these selections, lasofoxifene showed the lowest IFD score (-691.743 kcal mol-1). The stability of lasofoxifene in the COVID-19 Mpro protein active site was confirmed with 100 ns MD simulation. Lasofoxifene binding free energy was obtained -107.09 and -173.97 kcal mol-1, using Prime MM-GBSA and g_mmpbsa methods, respectively. The identified lasofoxifene by the presented computational approaches could be a suitable lead for inhibiting Mpro protein and COVID-19 treatment.

Brain-derived neurotrophic factor (BDNF) is a protein that performs a neurotrophic function. BDNF and its receptors are widely expressed in the nervous system and can promote the growth of neurons and the formation of neuronal synapses in the brain. Studies have shown that a lack of BDNF can lead to impairment of memory and cognitive functions, indicating that BDNF plays an important role in mental illness and neurodegenerative diseases. The combination of stem cells and BDNF-releasing nanomaterials holds great promise in regenerative medicine, especially in the treatment of neurological diseases. For example, Alzheimer's disease, depression, Parkinson's disease, spinal cord injury, etc. The combination of stem cell/pharmacologically active carrier and BDNF-nano/hydrogel provided a useful new type of local delivery tool for the treatment of the nervous system and other diseases. It can not only provide BDNF but also stem cells. These studies will provide a scientific basis for the development and application of BDNF in the future.

As a strong and addictive psychostimulant, methamphetamine (METH) is often misused worldwide. Although relapse is the greatest challenge to the effective treatment of drug dependency, now, for METH addiction, there is not available accepted pharmacotherapy. To characterize a probable new target in this indication, a biological system comprised of endocannabinoids, known as the endocannabinoid system (ECS), has been advised. As a non-psychotomimetic Phytocannabinoid in Cannabis sativa, cannabidiol (CBD) has been used in preclinical and clinical studies for treating neuropsychiatric disorders. In this review article, we focus on the effects of CBD in the treatment of addiction in a preclinical investigation concerning the pharmaceutic effectiveness and the underlying mechanisms of action on drug abuse specially METH. Growing evidence shows that CBD is a potential therapeutic agent in reducing drug reward, as evaluated in conditioned place preference (CPP), brain-stimulation reward paradigms, and self- administration. Furthermore, CBD plays an effective role in decreasing relapse in animal research. Through multiple-mechanisms, there is a belief that CBD modulates brain dopamine responding to METH, resulting in a reduction of METH-seeking behaviors. As our studies indicate, CBD can decrease METH addiction-associated problems, for example, symptoms of withdrawal and craving. It is needed for conducting more preclinical investigations and upcoming clinical trials to entirely assess the CBD capability as interference for METH addiction.

Exposure to certain environmental toxins has been shown to be associated with cellular senescence mainly through induction of oxidative stress and impact on cellular systems. Acrylamide (ACR) has raised worldwide concerns regarding the high risk of human dietary exposure to its hazardous effect. Although there is ample evidence about the carcinogenicity of ACR, limited studies have focused on its impact on cellular aging. The levels of β-galactosidase (SA-β-gal) activity, cell cycle distribution, and the expression of the senescence-associated gene and inflammatory markers were evaluated following exposure of embryonic fibroblast cells to ACR. A significant elevation in SA-β-gal activity after exposure to different concentrations of ACR was accompanied by a considerably increased level of reactive oxygen species and lipid peroxidation. ACR-treated cells showed a noticeable decline in the total antioxidant capacity and thiol molecules. Moreover, the expression of cellular senescence-related genes including p38, p53, and p21 significantly upregulated at the high concentration of 5 mM ACR. ACR also induced G0/G1 phase arrest in embryonic fibroblast cells. The current study results revealed that exposure to ACR could enhance senescence response, contributing to increased oxidative stress and cellular damage.

Illegal and excessive use of veterinary antibiotics as a food additive for growth promotion in livestock can lead to allergic reactions and antibiotic resistance, which is a worldwide concern. A biochip-based semi-quantitative screening method of antimicrobial residues in milk was validated based on Commission Decision 2002/657/EC and the European guideline to validate screening methods for veterinary medicines. This multi-analytical screening method enables to determine of 3 beta-lactams (cefalexin, ampicillin, and cefuroxime) simultaneously. Analysis of 20 blank and 20 spiked milk samples showed that for all 3 antibiotic residues, the positivity threshold T was above cut-off value Fm, and no false-positive results were obtained for all 3 antibiotics. All detection capabilities (CCβ) were below Maximum Residue Level (MRL) authorized by European Commission. 47 UHT cow’s milk samples collected from Tehran province, IR Iran, were screened, and compliance was found in 100% of samples. This study found that the biochip method is valid to determine antibiotic residues in milk samples at the measured validation levels. The method was fast, simple, and able to simultaneous screen three families of beta-lactams from a single milk sample with almost no sample preparation.

Thiazolidinedione (TZD), being a privileged scaffold, has been known as a significant structural moiety of antidiabetic drugs. TZD has been known to improve glycaemic control in type 2 diabetes mellitus (T2DM) by increasing insulin sensitivity in the body. A novel series of 5-benzylidene 2,4-thiazolidinedione derivatives were designed, synthesized (V1-V28), and structurally confirmed by different spectroscopic techniques such as FTIR, 1H NMR, 13C NMR, and Mass spectrometry. Upon the safety assessment of the synthesized molecules in non-transformed hepatocytes by MTT reduction assay, these were found non-toxic. These derivatives were then further evaluated for their antihyperglycemic and antihyperlipidemic properties in a high-fat diet and low dose of streptozotocin-induced diabetic rats. Altogether, seven biochemical parameters were analyzed, namely blood glucose, triglycerides, cholesterol, creatinine, blood urea nitrogen, HDL-cholesterol, and glycosylated hemoglobin in serum by standard methods. Four synthetic molecules (V2, V4, V5, and V20) possessed significant hypoglycaemic and hypolipidemic activity as compared to the positive control pioglitazone. Moreover, the histopathological studies of the heart and liver revealed no significant toxicity. Two representative compounds V2 and V4, were evaluated for their PPARγ activation potential, demonstrating that they were partial PPARγ agonists, thus confirming our designing hypothesis. Based on the results obtained, we assume that these compounds have the potential to be developed as future antidiabetic agents.

Glioblastoma is the most lethal malignancy of the brain and is resistant to conventional cancer treatments. Gene-therapy approaches like using tumor suppressor miRNAs are promising in the treatment of glioblastoma. They control the expression of oncogenes and influence tumor features and behaviors. Therefore, in the present study, it was predicted that miR-142 regulates oncogenic epidermal growth factor receptor (EGFR) signaling pathway via TargetScan and miRWalk online tools. Its differential expression level was reduced in glioblastoma according to the previous microarray results, and its predicted target genes were upregulated, as shown by the Expression Atlas. The miR-142 was overexpressed in U-87 glioblastoma cells via lentiviral transduction, and the way it influences proliferation and migration of cells was investigated through MTT assay and wound healing assay. Apoptosis rate was also measured via the Annexin V assay, and cell-cycle analysis was done. Then, real-time polymerase chain reaction (real-time PCR) and western blotting were performed to assess fold changes in mRNA and protein levels of the miR-142 predicted targets. Direct target genes of miR-142 were confirmed through a dual-luciferase reporter assay. The miR-142 significantly suppressed cell proliferation and migration and induced apoptosis and cell-cycle arrest in U-87 glioblastoma cells. This was accompanied by a decrease in expression of SHC adaptor protein 4 (SHC4), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), v-akt murine thymoma viral oncogene homolog 1 (AKT1), Kirsten rat sarcoma viral oncogene homolog (KRAS), and mitogen-activated protein kinase 8 (MAPK8) oncogenes at mRNA and protein levels in glioblastoma cells. Also, AKT1 was demonstrated as a direct target of miR-142. Overall, miR-424 acts as tumor suppressor miRNA in glioblastoma cells.

The development of controlled-release drug delivery systems has a great potential to improve the efficacy of anticancer drugs. This study aimed to develop and optimize the production of hybrid lipid-polymer nanoparticles (HLPNPs) for the targeted delivery of melphalan anticancer drugs. Response surface methodology (RSM) and central composite design (CCD) were used to evaluate and optimize the effects of three independent variables including lipid, polymer, and polyvinyl alcohol (PVA) ratios on the nanoparticles (NPs) size and drug entrapment efficiency (EE%). Hybrid NPs were prepared using the nanoprecipitation method. The results demonstrated that spherical NPs were synthesized, and the rate of EE% went up by increasing the polymer as well as decreasing the PVA concentrations. The nanoformulation released melphalan in a sustained and controlled manner (17.39% in a period time of 48 h). Also, cytotoxicity evaluations showed that HLPNPs caused an increase in the efficacy of melphalan against human ovarian A2780CP and SKOV3 cancer cells. Overall, the results of this study demonstrated that HLPNPs can be considered as a promising carrier for the delivery of hydrophobic anticancer drugs such as melphalan and the evaluation in-vivo.

Cancers in terms of morbidity and mortality are one of the major universal issues. New compounds of anticancer agents based on β-aryl-β-mercapto ketones scaffold possessing piperidinyl ethoxy or morpholinyl ethoxy groups were synthesized and evaluated as cytotoxic agents. Cytotoxic effects of synthesized compounds were measured against MCF-7, human ER-positive breast cancer cell lines, using MTT assay. The results indicated that all compounds had high cytotoxic activity on MCF-7 cancerous cells, even more than the reference drug Tamoxifen. Among them, compounds 3-(4-(2-morpholinoethoxy)phenyl)-1-phenyl-3-(phenylthio)propan-1-one (4a) and 1-(4-methoxyphenyl)-3-(3-(2-morpholinoethoxy)phenyl)-3-(phenylthio)propan-1-one (4h) had no significant cytotoxic effects on normal cells compared to Tamoxifen. Our results also indicated that adding tertiary amine basic side chain, found in Tamoxifen drug, to 1,3-diphenyl-3-(phenylthio)propan-1-ones improves the cytotoxic effects of these compounds on breast cancer cells.

Excessive exposure to the sources of fluoride in drinking water, oral care products, and food is a widespread problem. Fluoride is associated with impairment in child intelligence development. It causes DNA damage, oxidative stress, and mitochondrial dysfunction, mainly due to the production of reactive oxygen species (ROS). It has been postulated that the use of antioxidants such as astaxanthin, may alleviate fluoride’s adverse effects. This study assessed the effects of fluoride on cellular ROS content and rat’s learning and memory ability and investigated the protective potency of astaxanthin with emphasis on the role of glutamate using the Morris Water Maze test, glutamate concentration determination, and western blot techniques. The fluoride treatment of cells results in an increment of cellular ROS, whereas astaxanthin inhibits lipid peroxidation. Fluoride significantly decreases the cellular glutamate uptake and glutamate transporter, protein level, possibly due to the disruption of mitochondrial energy metabolism and defect of the transporter recycle, respectively. The in-vivo study indicated that the treatment of rats with fluoride led to a loss of learning, while astaxanthin improved memory dysfunction. Measurement of ROS and glutamate levels of rat brain hippocampus showed that fluoride increased the ROS but decreased the glutamate. On the other hand, the utilization of astaxanthin decreased the brain ROS content and increased the glutamate level. It seems that fluoride disrupts the normal function of neurons via increment of ROS production and decrement of glutamate level, whereas astaxanthin has neuroprotective potency due to the ROS scavenging ability.

A practical high-performance liquid chromatography-mass spectrometry method was developed for the analysis of N-nitrosodimethylamine (NDMA) characterized as an impurity, in combination with reports of the carcinogen found in ranitidine samples. After simple extraction of ranitidine samples, all compounds were analyzed with a high-performance liquid chromatography-mass spectrometry. Sensitivity was enhanced by employing the ten-way valve switching technology, which was examined to allow NDMA to enter the mass spectrometry and cut out the ranitidine samples extremely. A good linear relationship was observed within 3-100 ng·mL−1 (r = 0.9992). The validated approach was effectively used to evaluate the NDMA contents in ranitidine samples in circulation, which revealed a difference among 21 batches. Quantitative determination of NDMA was within the scope of 3.38-57.05 ng·mL-1. Moreover, the contamination levels of NDMA in seven batches of products from six manufacturers were listed to exceed the acceptable daily intake. The sensitive method was verified to be appropriate to determine NDMA, even with low contents of NDMA in ranitidine products; the analysis of the selected samples reveals that some samples exceeded the national limit requirements. Therefore, it is worthwhile to conduct comprehensive quality control of the other drugs containing NDMA.

In order to improve the transfection efficiency of gene vectors and monitor the effect of gene therapy, this study prepared a drug delivery vector with dual functions. The thiourea reaction was used to synthesize polyethyleneimine (PEI, MW: 1.8 kDa) with superparamagnetic iron oxide nanoparticles (SPION) (PEI1800-SPION), and the lipid polycationic gene vector PEI1800-SPION loaded cationic liposome (LP-PEI1800-SPION) was further prepared by ethanol injection method. Agarose gel electrophoresis experiment, cytotoxicity experiment, and In-vitro gene silencing experiment were used to evaluate the vector and screen the optimal prescription of LP-PEI1800-SPION/siRNA. When the weight ratio of LP-PEI1800-SPION to siRNA is 20, the transfection efficiency of the nanoparticles was the highest, and the silencing efficiency of the target protein was the largest. The cytotoxicity of LP-PEI1800-SPION was low; when the concentration was in the range of 1-50 μg/mL, the survival rate of the four types of cells was above 80%. Prussian blue staining experiments and In-vitro MRI imaging experiments showed that cells had significant uptake and imaging capabilities for LP-PEI1800-SPION. In conclusion, the visualized polycationic lipid siRNA delivery vehicle (LP-PEI1800-SPION) was successfully prepared in this experiment, which provides a research basis for further theranostics of liver cancer.

This was a randomized, double-blind clinical trial to compare the efficacy and safety of Atazanavir/Ritonavir (ATZ/RTV) with Lopinavir/Ritonavir (LPV/RTV) in moderate Coronavirus disease 2019 (COVID-19). Participants were randomly assigned to receive a single dose of hydroxychloroquine (HCQ) plus ATZ/RTV or LPV/RTV for a minimum of 5 to a maximum of 10 days. The primary outcomes were the reduced length of hospital stay and clinical recovery within 10 days from starting the intervention. The rate of intensive care unit (ICU) admission, intubation, and mortality, the lengths of ICU stay and being intubated, recovery within 14 days, and the frequency of adverse reactions was considered as secondary outcomes. Among 132 enrolled patients, 62 cases in each arm were analyzed at the end of the intervention. Fifty-one (82.3%) cases in the ATZ/RTV arm versus 41 (66.1%) in the LPV/RTV arm were discharged within 10 days (P = 0.06). The median number of the intervention days was 6 (IQR: 5-8) in ATZ/RTV arm versus 7 (IQR: 6-9) in LPV/RTV arm (P = 0.01). The rate and length of ICU admission and intubation (P ≥ 0.99), rate of mortality (P = 0.49), and recovery within 14 days (P = 0.09) were not statistically different between groups. The most reported adverse reactions were nausea and vomiting that all cases were in the LPV/RTV arm (P = 0.006). ATZ/RTV is better tolerated in comparison with LPV/RTV; however, it did not show more efficacies than LPV/RTV in clinical outcomes of COVID-19 in this study.

Amphotericin B (AMB) is a macrolide polyene antibiotic presenting potent anti-cutaneous leishmania activity. Nonetheless, its low water solubility, side effects, and toxicity have limited its therapeutic efficiency. The present study aimed to improve the solubility of AmB in oil-in-water using chitosan and determine its cytotoxicity on macrophages, as well as Leishmania major promastigote and amastigote. Olive oil, span 80, tween 80, AmB, and DMSO were employed as excipients, and nanoemulsions (NEs) were prepared by sonicator bath at 37 °C for 1 h at the highest power and stirred overnight with pH 5.5. Thereafter, chitosan was added to the NE and stirred overnight to obtain chitosan nanoemulsion (CNE). The CNE was optimized and investigated for different in-vitro parameters, such as droplet size, zeta potential, morphology, drug content, in-vitro drug release, and in-vitro cytotoxicity. Droplet size and zeta potential for CNE with AmB were obtained at 13.33 ± 1.3 nm, 30.90 ± 1.9 mV, respectively. Encapsulation efficiency and drug loading of the final CNE were reported as 100% and 0.64%, respectively. The results of in-vitro cytotoxicity revealed that CNE did not cause any cytotoxicity in macrophages. The CNE not only reduced drug toxicity for the macrophage but also had a suitable inhibition effect on the parasite. The CNE with AmB exerted an inhibitory effect on L. major promastigote/ amastigote phase. Furthermore, CNE with AmB represented a promising approach for leishmaniasis treatment. Therefore, the obtained outcomes of the IC50 proposed that the application of CNE can cause no toxicity and guarantees better quality drug release.

Currently, there are no effective treatments for liver diseases. Treatment usually involves controlling complications and supportive care. As liver injuries also affect other organs such as the spleen, kidney, and brain due to their anatomical and physiological relationships, finding an effective treatment is urgently needed. This research aimed to evaluate the therapeutic effect of Schisandrin B (Sch B) in the liver and other organs in thioacetamide (TAA)-intoxicated mice. In this study, mice were exposed to a single intraperitoneal injection of 200 mg/kg TAA to induce hepatitis. Following Sch B (20 mg/kg/day, 28 consecutive days) treatment, biochemistry analysis and histopathological examination of different organs were performed, in addition to western blotting and flow cytometry to evaluate the involvement of inflammasomes and apoptotic proteins. Our results showed that administration of Sch B protected against TAA-induced damages, and it disparately affected inflammasome activation and apoptosis in different organs. Furthermore, Sch B treatment improved organ function, as indicated by the improvement of serum biochemical parameters. Collectively, our findings reveal a beneficial effect of Sch B on different organ damages in mice intoxicated with TAA.

Myocardial infarction causes heart tissue damages; therefore, using non-invasive methods to regenerate the heart tissue could be very helpful. Recent studies claimed that the inhibition of the Wnt signaling could promote cardiac remodeling and induce cardiac regeneration. Therefore, a tankyrase inhibitor to stabilize the AXIN and inhibit the Wnt/β-catenin signaling pathway will induce cardiac regeneration after injury. In this regard, virtual screening procedure, using molecular docking of 9127 FDA and world approved drugs, including herbal medicine, was done over the crystal structures of tankyrase 1 (TNKS1) and tankyrase 2 (TNKS2) catalytic poly (ADP-ribose) polymerase (PARP) domains with PDB ID: 2RF5 and 3KR7, respectively, to find potential small molecule inhibitors to regenerate injured heart tissue. Subsequently, molecular dynamics simulations were done to assess the stability of selected ligands phenothrin and ethyl rosinate in the binding pocket of TNKS1 and TNKS2 for 100 ns, respectively. Both compounds show suitable interaction in their binding pocket. The molecular dynamics simulation results confirm their stability. The binding free energy of complexes was carried out by the MM-PBSA method. ADME properties also indicate the potential of drug-likeness of both compounds. Taking together both drugs may be promising for inducing cardiac regeneration after injury. Nevertheless, clinical approval remains.

Senegalia nigrescens (knob thorn) is a deciduous tree distributed in savannah regions from Tanzania to South Africa used for timber but also medicinally for the treatment of convulsions, wounds, and skin problems. In this study, the biological activities of six phytocompounds, namely: 3β-hydroxy-20(29)-en-lupan-30-al (1), 30-hydroxylup-20(29)-en-3β-ol (2), ent-kaur-15-en-18,20-diol (3), melanoxetin (4), quercetin (5) and quercetin-3-O-methyl ether (6), isolated from S. nigrescens were investigated. The compounds were screened against two bacterial (Escherichia coli and Staphylococcus aureus) and one fungal (Candida albicans) strain and were also tested for their cytotoxicity on breast cancer (MDA-MB-231) and normal murine macrophage (RAW 264.7) cell line. Effects of the compounds on attenuating the lipopolysaccharide (LPS)-induced intracellular reactive oxygen species (ROS) production in RAW 264.7 cells were quantified with the H2DCF-DA assay. This study revealed that flavonols (5 and 6) had the strongest antibacterial and antifungal effects, both having MIC values of 62.5, 31.25 and 31.25 µg/mL on E. coli, S. aureus and C. albicans, respectively. Compounds 2, 3 and 6 were the most cytotoxic against the breast cancer cells with IC50 values of 11.86, 12.62 and 14.03 µg/mL, respectively, while the least toxicity towards normal cells were observed in compounds 2, 5 and 6. All compounds (1-6) significantly lowered ROS production in RAW264.7 cells. In conclusion, tested compounds represent potential promising candidates as antimicrobial, anticancer and antidotes for LPS-induced oxidative stress. This is the first report on the antifungal, cytotoxicity and antioxidative activities of the ent-kaurene diterpenoid, ent-kaur-15-en-18,20-diol (3).

Pharmaceutical companies in developing countries are heavily influenced by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and economic liberalization rules. To adjust to the new patent regime, pharmaceutical companies had to adopt some strategies. A systematic review was conducted on the experiences of the pharmaceutical industry in developing countries and strategies adopted by local pharmaceutical companies to survive after the TRIPS agreement. Scopus, PubMed, and ProQuest databases were searched, and twenty-five papers were reviewed. The pharmaceutical industry experiences have been classified into successful and unsuccessful experiences based on criteria developed by the authors. Firm strategies were also divided into four categories based on external and internal factors: aggressive, conservative, competitive, and defensive strategies. Companies were able to survive and even grow after the TRIPS agreement by rebuilding their structures, improving their competencies, and adopting appropriate strategies in line with the new conditions.

The Ferulago genus appertains to the Umbelliferae family comprises 49 species which are mainly distributed in Asia, Europe, and Africa. This paper aims to review the morphological properties of Ferulago species, herbal components, and their pharmacological properties.The information of this review paper has been collected from journals available in databases including Science Direct, Web of Science, Scopus, PubMed, EBSCO, Google Scholar, and Hindawi up to March 2020. In traditional medicine, the genus of Ferulago has been used to treat intestinal worms, snake bites, wound skin infections, diseases of the spleen and gastrointestinal tract, and headaches. It not only has been used traditionally as a preservative agent to dairy, oil ghee, and meat but also has given them a pleasant taste. The main components of Ferulago spp. are monoterpenes, sesquiterpenes, coumarin, furanocoumarin, flavonoids, and terpenoids have been the reason for the antimicrobial, antioxidant, anticoagulant, antidiabetic, Alzheimer, and larvicidal properties of this plant. This review confirms that many traditional uses of some Ferulago species have now been validated by modern pharmacology research. Rigorous investigations of all the species of Ferulago concerning phytochemical and pharmacological properties, mainly their mechanism of action, efficacy, and safety might offer a context for researchers to prosper plant-derived medications like anti-diabetes, antibiotics, and sedatives treating drugs, and the key to directing clinical trials.

Ectopic pregnancy (EP) is considered a main reproductive health challenge. According to the side effects of using methotrexate (MTX), it is rational to find safer drugs in the management of EP. This randomized controlled trial aimed to evaluate the efficacy and safety of adding letrozole to the single-dose MTX in the management of EPs. This study was conducted in an academic hospital affiliated to Tehran University of Medical Sciences. Women with EP and stable vital signs with β-hCG levels ≤3500 were assigned randomly to receive MTX + placebo or MTX + letrozole. The regression pattern of β-hCG, need for further surgery, and potential side effects were compared between groups. A total of 90 women were assigned equally to the study groups and were matched in age, body mass index (BMI), serum biochemistry, and primary levels of β-hCG. No drug-related side effects were observed in groups. The rates of further surgery (p = 0.614) and second dose of MTX (p = 0.809) were not significant between groups. In the MTX + placebo group, we observed a minor increase in β-hCG levels on day 4 followed by a decreasing pattern on days 7 and 14. But, in MTX + letrozole group, a decreasing pattern in β-hCG levels from day 1 through day 14 was perceived. The results support using MTX + letrozole to treat stable women diagnosed with tubal EP as a safe and efficient method. Further studies are required to evaluate letrozole alone as an alternative therapy in EPs.

Nowadays, mesenchymal stem cells (MSCs) are the most widely used cell sources for bone regenerative medicine. Electrospun polyacrylonitrile (PAN)-based scaffolds play an important role in bone tissue engineering due to their good mechanical properties, which could be enhanced by the presence of nanoparticles such as nanoclay. This study evaluated the in-vitro effect of different concentrations of nanoclay in surface characteristic properties of PAN-based electrospun nanofiber scaffolds and the osteogenic differentiation ability of adipose-derived mesenchymal stem cells (AD-MSCs). After electrospinning nanofibers, their structure were assessed through some characterization tests. Then AD-MSCs isolation and characterization were done, and the cell attachment and the biocompatibility were determined. Finally, osteogenic differentiation-related markers, genes, and proteins were studied. Clay-PAN25% electrospun nanofiber scaffold could support attachment, proliferation, and osteogenic differentiation of AD-MSCs better than other groups. Also, nanoclay could enhance the properties of PAN-based scaffolds, such as fiber diameter, topography, surface charge, hydrophilicity, roughness, and degradation, as well as osteogenic differentiation of cells. As a result, Clay-PAN25% with the highest concentration of nanoclay was found as a promising biodegradable and cost-effective scaffold for osteogenic differentiation of AD-MSCs.

Mycosporin-like amino acids (MAAs) are a group of UV-absorbing compounds, which can be produced by various organisms such as algae and cyanobacteria, particularly if they survive in highly irradiated environments. In this study, the production of MAAs by two species of Fischerlla sp. (F5 and F14), isolated from the North of Iran, was investigated. Both species, which had previously been morphologically detected as Fisherella sp., were confirmed molecularly by sequencing the PCR amplicon of the 16S rRNA gene. The species were cultured in sterilized BG.11 medium for 21 days, then biomasses were separated, and their MAAs content was extracted by methanol and partially purified using chloroform liquid-liquid extraction. The extract was analyzed using high-performance liquid chromatography (HPLC) and liquid chromatography-mass spectroscopy (LC-MS). In both species, the compounds with MAAs characteristics were observed. They had maximum absorbance (λmax) in the range of 300–400 nm, which was confirmed by the LC-MS analysis. In F5 species, the peaks with m/z 340 and 391 and in another one (F14), a peak with m/z 333.2 were recorded, that the latter might be Shinorine. In general, further analysis should be performed to elucidate the exact structural aspects of these compounds. In conclusion, both Fischerella sp. studied here were capable of producing MAAs and can be evaluated for use in sunscreen pharmaceutical and cosmetic products.

ropofol is a short-acting intravenous anesthetic that is commonly used for induction and maintenance of anesthesia. Subanesthetic low doses of propofol has also been used to treat intractable migraine attacks in emergency wards with dramatic results. However, there is little information on the long-term efficacy of this drug in migraine headaches. The aim of this nonrandomized prospective observational study was to assess the effect of propofol anesthesia on the pain severity and frequency of migraine attacks in a 6-month follow-up period after anesthesia in patients with migraine headaches. The study was conducted on 51 known cases of migraine ranging in age from 21 to 66 years. Before anesthesia, patients completed a questionnaire including their characteristics, pain intensity of the headache using a visual analog scale, and a number of headache repetitions per month. All patients received propofol as the main anesthetic agent. At the end of anesthesia, the total amount of propofol usage was recorded. Patients were then followed up by telephone in the first, third, and sixth months after anesthesia, and the severity and frequency of the headache were recorded. Pain intensity or pain frequency significantly improved in 22 patients (43.1%), remained unchanged in 24 (47%), and worsened in 5 cases (9.8%) 6 months after anesthesia compared to before the anesthesia. In conclusion, since about half of the patients had significant improvement in the headache, propofol anesthesia may be considered as an acceptable anesthetic method in patients with migraine.

In the present study, the phenolic content by using LC MS/MS method, anticholinergic, antioxidant (metal reduction, radical and removal of lipid peroxidation), and antibacterial activities of Erica manipuliflora Salisb. (EMS) extract were determined. The amount of vanillic acid, fumaric acid, catechin hydrate, quercetin, and phloridzin dihydrate were found higher than other compounds. The ethanol extract of the EMS showed an inhibition effect on the Acetylcholinesterase (AChE) enzyme with IC50 value of 0.124 ± 0.008 mg mL-1. Also, this extract of the EMS indicated radical (DPPH and ABTS) scavenging activity (about 20%) and the reducing capacity for Cu(II) and Fe(III) close to trolox, and inhibited the oxidation of linoleic acid with 40.5% at 20 μg mL-1. Antibacterial activity of the extracts was investigated against Staphylococcus aureus, Escherichia coli, and Salmonella Typhimurium using agar disc diffusion and minimum inhibitory concentration (MIC) methods. The EMS extract was found to be effective when used at least 312 mg mL-1 concentration on the pathogenic microorganisms. Consequently, it has an important non-synthetic natural content that can be used in the treatment of many diseases due to its many bioactivities such as anticholinergic, antioxidant (radical removal, lipid peroxidation prevention, etc.) and antibacterial.

Chronic cerebral hypoperfusion (CCH) leads to vascular dementia with progressive hippocampal damage and cognitive impairments. In the present study, we compared early and late Minocycline (MINO) treatment on cognitive function, long and short-term synaptic-plasticity following CCH. We used bilateral common carotid arteries occlusion model (2VO) for induction of hypoperfusion. Male Sprague-Dawley rats were divided into 5 following groups (each having 2 subgroups): 2VO + V (vehicle), 2VO+MINO-E (early treatment of MINO on days 0 to 3 after 2VO), 2VO+MINO-L (late-treatment on days 21 to 32 after 2VO), control, and sham. Passive-avoidance (PA) and radial arm maze (RAM) tests were used to investigate learning and memory. Long term and short term synaptic plasticity were assessed by field potential recording, the brains were removed after recording and preserved for histological study to count pyramidal cells in CA1 region. Cerebral hypoperfusion could impair memory performance, synaptic plasticity, and basal synaptic transmission (BST) along with hippocampal cell loss. Thus, we found a significant reduction in step-through latency (STL) of PA test with a higher number of working and reference errors in RAM in CCH rats. However, only late treatment with MINO improved memory performance, synaptic plasticity, hippocampal cell loss, and increased neurotransmitter pool (NP) in CCH rats, but early treatment could not produce long-lasting beneficial effects 32 days after 2VO. MINO may improve synaptic plasticity and memory performance in hypo-perfused rats directly and indirectly by increasing NP and/or suppressing inflammatory factors, respectively.

In the 21st century, while some people seek to use artificial intelligence for health services delivery, others have to surrender their health rights to meet basic needs. The gradient in health has become more pronounced in the COVID-19 crisis considering discrepancies in disease prevalence, geographical accessibility, availability, affordability, quality/safety of health services, and human resources. Through PubMed, GoogleScholar, Scopus, WHO, OECD, and UN databases, the English documents and global statistics were collected. Determining the role of health equity-related factors and introducing mechanisms to maintain regional and international justice in health, specifically during the COVID-19 pandemic, were among the core concepts of this paper. Social determinants of health (SDH), interregional and intraregional bodies are the main drivers of discrimination in health services. Governments should relish chief health strategists' role in possessing legitimacy, accountability, direction, transparent performance, fairness, and good governance in one word. Improving health literacy and telemedicine, providing income support, and reforming insurance where needed, are other national mechanisms to amend inequity. Among interregional issues, what is concerning is the matter of sanctions on access to health services, which is against the Universal Declaration of Human Rights. Shortage of vital medications, ventilators, test kits, COVID-19 vaccines, pharmaceutical raw materials, foreign currency, decreased national currency value, purchasing power parity, and quality/safety of health services resulted from such oppression. The article also provides practical suggestions, paving the way for re-establishing global solidarity and developing health justice in deprived regions.

Heart failure (HF) is one of the most important cardiovascular diseases (CVD), causing many die every year. Cardiac tissue engineering is a multidisciplinary field for creating functional tissues to improve the cardiac function of the damaged heart and get hope for end-stage patients. Recent works have focused on creating engineered cardiac tissue ex-vivo. Simultaneously, new approaches are used to study ways of induction of regeneration in the damaged heart after injury. The heart as a complex physiological pump consists of many cells such as cardiomyocytes (80–90% of the heart volume). These cardiomyocytes are elongated, aligned, and have beating properties. To create the heart muscle, which should be functional, soft and elastic scaffolds are required to resemble the native heart tissue. These mechanical characteristics are not compatible with all materials and should be well selected. Some scaffolds promote the viability and differentiation of stem cells. Each material has advantages and disadvantages with relevant influence behavior for cells. In this review, we present an overview of the general approaches developed to generate functional cardiac tissues, discussing the different cell sources, biomaterials, pharmacological agents, and engineering strategies in this manner. Moreover, we discuss the main challenges in cardiac tissue engineering that cause difficulties to construct heart muscle. We trust that researchers interested in developing cardiac tissue engineering will find the information reviewed here useful. Furthermore, we think that providing a unified framework will further the development of human engineered cardiac tissue constructs.

The pharmaceutical industry's performance in the global economy has been affected by the growing competition associated with globalization, economic liberalization, and the trade-related aspect of the intellectual property rights (TRIPS) agreement. To maintain performance, organizations need to consider strategic foresight (SF) and organizational resilience (OR) to anticipate future trends and survive crises. By proposing a conceptual framework, this study examines the relationship between organizational resilience, strategic foresight, competitive advantage (CA), and firm performance (FP). A conceptual framework was developed to assess the hypotheses in the pharmaceutical industry. Then, partial least squares structural equation modeling (PLS-SEM) was applied to investigate the relationships quantitatively. The results of structural equation modeling (SEM) based on the data generated from 202 completed questionnaires by the pharmaceutical companies in Iran demonstrate that OR, SF, and CA have significant positive impacts on FP. Moreover, CA partially mediates the relationship between OR and FP and also between SF and FP. The findings of this study enrich the existing literature by demonstrating that early detection of environmental change and resilient manner assist Iranian pharmaceutical firms to survive if joining the WTO. This is the first study that examines the direct and indirect effect of OR and SF on the FP, considering the mediating impact of CA. This investigation attempts to address the mechanisms through which OR and SF affect organizational performance, especially in the pharmaceutical industry.