However, while SR1001 inhibited Th17 cells in the human beings and mouse, it induced in vitro also, the enlargement of human Tregs and Th1, recommending that its results on EAE may possibly not be applicable to individual disease straight

However, while SR1001 inhibited Th17 cells in the human beings and mouse, it induced in vitro also, the enlargement of human Tregs and Th1, recommending that its results on EAE may possibly not be applicable to individual disease straight. 41 along with B crystalline are implicated in the remission and relapse of multiple sclerosis.6 Pertinent towards the development of effective treatment for relapsing-remitting CNS autoimmune illnesses may be the age-old issue of where autoreactive storage lymphocytes have a home in between shows of recurrent inflammation. In a recently available study, an extremely delicate assay was utilized to monitor autoreactive lymphocytes that mediate blinding uveitis. The autoreactive uveitogenic storage T cells that mediate persistent uveitis were discovered to preferentially have a home in the bone tissue marrow through STAT3-reliant mechanisms.12 Used together, these observations claim that STAT3 pathways and Th17 cells are attractive TGR-1202 hydrochloride goals for inhibiting CNS autoimmune disease. STAT3 inhibitors The necessity of STAT3 for the era of Th17 and advancement of EAE or EAU, shows that the STAT3 pathway is certainly a potential healing target you can use to avoid or mitigate uveitis or MS. Many materials have already been discovered and made to inhibit STAT3 pathway and Th17 cells in vitro. Although many of the substances are commercially obtainable their in vivo features never have been evaluated in animal types of CNS autoimmune illnesses. ORLL-NIH001 is certainly a artificial 406-kDa small chemical substance compound produced by Orchid Analysis Laboratories in India. ORLL-NIH001 continues to be useful to inhibit STAT3 pathways in preclinical types of oncology and has been used to take care of uveitis.40 ORLL-NIH001 reduced degrees of Th17 cells substantially, aswell as, the IFN–expressing Th17 subset that correlates with development of EAU.11,13 The inhibitory ramifications of ORLL-NIH001 derived partly through the downregulation of 41, 47, CXCR3 and CCR6. ORLL-NIH001-mediated inhibition of protein necessary for lymphocyte trafficking in to the retina was validated using two commercially obtainable selective inhibitors of STAT3: a cell-permeable phosphopeptide that inhibits STAT3 by binding to STAT3-SH2 domain (STAT3 peptide; Calbiochem) and an amidosalicylic acid compound that selectively inhibits STAT3 activation and STAT3-dependent transcription (S31-201; Calbiochem).40 It is notable that ORLL-NIH001 suppressed EAU in mice treated with the drug before disease induction, as well as, mice that received the drug after establishment of EAU, suggesting that ORLL-NIH001 may be used in treating pre-existing uveitis.40 However, a drawback to therapeutic use of ORLL-NIH001 is its bioavailablility as frequent administration of the drug is required. Although delivery of the drug by intravenous injection is effective, oral administration and subcutaneous injection are attractive alternatives. SOCS1 and SOCS3 mimetic peptides Some SOCS proteins possess a kinase inhibitory region (KIR) that binds to tyrosine-phosphorylated JAKs and suppress JAK activities.41 SOCS1 and SOCS3 KIR mimetics have been shown to inhibit STAT pathways41 and the small peptide mimetics of SOCS1 effectively inhibits IL-6 and IFN- signaling in vitro and in vivo by targeting JAK-STAT pathway.42-44 Several SOCS1 mimetic peptides that are attached to lipophilic palmitoyl-lysine and arginine groups (see Table 1) are effective in penetrating cells and inhibiting JAK2 kinase activity.42 SOCS1 mimetics have also been used to inhibit Th17 expansion in EAE. 42-44 Orally administered SOCS1 mimetics are also effective in inhibiting the production of IL-17, IFN-, TNF- or IL-23 and antagonizing STAT3 activation by inflammatory cells. 41 Because they readily cross the blood brain barrier, SOCS1-KIR are considered to be more clinical efficacious than therapeutic antibodies that have difficulty in crossing the BBB. Table?1. SOCS mimetics thead th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Peptide /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Sequence /th /thead SOCS1-KIR hr / 53DTHFRTFRSHSDYRRI hr / SOCS1-KIR2A hr / 53DTHARTARSHSDYRRI hr / Tyrosine kinase inhibitory peptide (TKIP)WLVFFVIFYFFR Open in a separate window SOCS1-KIR (consisting of the kinase inhibitory region of SOCS1) and TKIP (complementary to the auto-phosphorylation site of JAK2) peptides inhibit STAT 1 activation/phosphorylation, and have been shown to be efficacious in the prevention and treatment of EAE. SOCS1-KIR and TKIP possess cell-penetrating capacity through the addition of a lipophilic palmitoyl-lysine group to the N-terminal region of the peptide. SOCS1-KIR2A, possessing two alanine substitutions, has been used as a specificity control to SOCS1-KIR. Synthetic chemical inhibitors of Th17 developmental pathway In addition to STATs, other transcription factors that contribute to Th17 development and expansion are potential therapeutic targets in Th17-mediated disease. For example, the nuclear receptors, retinoic-acid-receptor-related orphan receptors (ROR) and ROR-t, play essential roles in the development of the Th17 phenotype and are therefore attractive targets for treating EAE or EAU. Two drugs that block the activities of ROR and ROR-t have been shown to prevent Th17 differentiation.SOCS1-KIR2A, possessing two alanine substitutions, has been used as a specificity control to SOCS1-KIR. Synthetic chemical inhibitors of Th17 developmental pathway In addition to STATs, other transcription factors that contribute to Th17 development and expansion are potential therapeutic targets in Th17-mediated disease. Consistent with the critical role of STAT3 in Th17 differentiation, mice with targeted deletion of STAT3 in CD4+ T-cells (STAT3KO) cannot generate Th17 and do not develop EAU or EAE.11 A major reason why STAT3KO mice are resistant to developing EAU or EAE is that the pathogenic T cells are defective in the expression and activation of 41 or 47 integrins and cannot traffic into the CNS.11,12 They are also defective in the expression of osteopontin that promotes chemotactic properties of leukocytes.6 In fact, osteopontin and 41 along with B crystalline are implicated in the relapse and remission of multiple sclerosis.6 Pertinent to the development of effective treatment for relapsing-remitting CNS autoimmune illnesses may be the age-old issue of where autoreactive storage lymphocytes have a home in between shows of recurrent inflammation. In a recently available study, an extremely delicate assay was utilized to monitor autoreactive lymphocytes that mediate blinding uveitis. The autoreactive uveitogenic storage T cells that mediate persistent uveitis were discovered to preferentially have a home in the bone tissue marrow through STAT3-reliant mechanisms.12 Used together, these observations claim that STAT3 pathways and Th17 cells are attractive goals for inhibiting CNS autoimmune disease. STAT3 inhibitors The necessity of STAT3 for the era of Th17 and advancement of EAE or EAU, shows that the STAT3 pathway is normally a potential healing target you can use to avoid or mitigate uveitis or MS. Many compounds have already been created and discovered to inhibit STAT3 pathway and Th17 cells in vitro. Although some of these substances are commercially obtainable their in vivo features never have been evaluated in animal types of CNS autoimmune illnesses. ORLL-NIH001 is normally a artificial 406-kDa small chemical substance compound produced by Orchid Analysis Laboratories in India. ORLL-NIH001 continues to be useful to inhibit STAT3 pathways in preclinical types of oncology and has been used to take care of uveitis.40 ORLL-NIH001 substantially reduced degrees of Th17 cells, aswell as, the IFN–expressing Th17 subset that correlates with development of EAU.11,13 The inhibitory ramifications of ORLL-NIH001 derived partly in the downregulation of 41, 47, CCR6 and CXCR3. ORLL-NIH001-mediated inhibition of protein necessary for lymphocyte trafficking in to the retina was validated using two commercially obtainable selective inhibitors of STAT3: a cell-permeable phosphopeptide that inhibits STAT3 by binding to STAT3-SH2 domains (STAT3 peptide; Calbiochem) and an amidosalicylic acidity substance that selectively inhibits STAT3 activation and STAT3-reliant transcription (S31-201; Calbiochem).40 It really is notable that ORLL-NIH001 suppressed EAU in mice treated using the medication before disease induction, aswell as, mice that received the medication after establishment of EAU, recommending that ORLL-NIH001 can be utilized in dealing with pre-existing uveitis.40 However, a drawback to therapeutic usage of ORLL-NIH001 is its bioavailablility as frequent administration from the medication is necessary. Although delivery from the medication by intravenous shot is effective, dental administration and subcutaneous shot are appealing alternatives. SOCS1 and SOCS3 mimetic peptides Some SOCS protein have a very kinase inhibitory area (KIR) that binds to tyrosine-phosphorylated JAKs and suppress JAK actions.41 SOCS1 and SOCS3 TGR-1202 hydrochloride KIR mimetics have already been proven to inhibit STAT pathways41 and the tiny peptide mimetics of SOCS1 effectively inhibits IL-6 and IFN- signaling in vitro and in vivo by targeting JAK-STAT pathway.42-44 Several SOCS1 mimetic peptides that are mounted on lipophilic palmitoyl-lysine and arginine groupings (see Desk 1) work in penetrating cells and inhibiting JAK2 kinase activity.42 SOCS1 mimetics are also utilized to inhibit Th17 expansion in EAE.42-44 Orally administered SOCS1 mimetics may also be effective in inhibiting the creation of IL-17, IFN-, TNF- or IL-23 and antagonizing STAT3 activation by inflammatory cells.41 Because they readily cross the bloodstream brain hurdle, SOCS1-KIR are believed to become more clinical efficacious than therapeutic antibodies which have difficulty in crossing the BBB. Desk?1. SOCS mimetics thead th align=”middle” valign=”best” rowspan=”1″ colspan=”1″ Peptide /th th align=”middle” valign=”best” rowspan=”1″ colspan=”1″ Series /th /thead SOCS1-KIR hr / 53DTHFRTFRSHSDYRRI hr / SOCS1-KIR2A hr / 53DTHARTARSHSDYRRI hr / Tyrosine kinase inhibitory peptide (TKIP)WLVFFVIFYFFR Open up in another screen SOCS1-KIR (comprising the kinase inhibitory area of SOCS1) and TKIP (complementary towards the auto-phosphorylation site of JAK2) peptides inhibit STAT 1 activation/phosphorylation, and also have been shown to become efficacious in the avoidance and treatment of EAE. SOCS1-KIR and TKIP possess cell-penetrating capability through the addition of a lipophilic palmitoyl-lysine group towards the N-terminal area of.Another concern associated with the therapeutic usage of ROR and ROR-t inhibitors is normally that their influence on various other cell types that express these orphan receptors are unidentified. a putative MS defensive haplotype.39 In keeping with the critical role of STAT3 in Th17 differentiation, mice with targeted deletion of STAT3 in Compact disc4+ T-cells (STAT3KO) cannot create Th17 , nor develop EAU or EAE.11 A significant reason STAT3KO mice are resistant to developing EAU or EAE would be that the pathogenic T cells are defective in the expression and activation of 41 or 47 integrins and cannot visitors in to the CNS.11,12 Also, they are defective in the appearance of osteopontin that promotes chemotactic properties of leukocytes.6 Actually, osteopontin and 41 along with B crystalline are implicated in the relapse and remission of multiple sclerosis.6 Pertinent towards the development of effective treatment for relapsing-remitting CNS autoimmune illnesses may be the age-old issue of where autoreactive storage lymphocytes have a home in between shows of recurrent inflammation. In a recently available study, an extremely delicate assay was utilized to monitor autoreactive lymphocytes that mediate blinding uveitis. The autoreactive uveitogenic storage T cells that mediate persistent uveitis were discovered to preferentially have a home in the bone tissue marrow through STAT3-reliant mechanisms.12 Used together, these observations claim that STAT3 pathways and Th17 cells are attractive goals for inhibiting CNS autoimmune disease. STAT3 inhibitors The necessity of STAT3 for the generation of Th17 and development of EAU or EAE, suggests that the STAT3 pathway is usually a potential therapeutic target that can be used to prevent or mitigate uveitis or MS. Several compounds have been developed and found to inhibit STAT3 pathway and Th17 cells in vitro. Although many of these compounds are commercially available their in vivo functions have not been assessed in animal models of CNS autoimmune diseases. ORLL-NIH001 is usually a synthetic 406-kDa small chemical compound developed by Orchid Research Laboratories in India. ORLL-NIH001 has been utilized to inhibit STAT3 pathways in preclinical models of oncology and has recently been used to treat uveitis.40 ORLL-NIH001 substantially reduced levels of Th17 cells, as well as, the IFN–expressing Th17 subset that correlates with development of EAU.11,13 The inhibitory effects of ORLL-NIH001 derived in part from your downregulation of 41, 47, CCR6 and CXCR3. ORLL-NIH001-mediated inhibition of proteins required for lymphocyte trafficking into the retina was validated using two commercially available selective inhibitors of STAT3: a cell-permeable phosphopeptide that inhibits STAT3 by binding to STAT3-SH2 domain TGR-1202 hydrochloride name (STAT3 peptide; Calbiochem) and an amidosalicylic acid compound that selectively inhibits STAT3 activation and STAT3-dependent transcription (S31-201; Calbiochem).40 It is notable that ORLL-NIH001 suppressed EAU in mice treated with the drug before disease induction, as well as, mice that received the drug after establishment of EAU, suggesting that ORLL-NIH001 may be used in treating pre-existing uveitis.40 However, a drawback to therapeutic use of ORLL-NIH001 is its bioavailablility as frequent administration of the drug is required. Although delivery of the drug by intravenous injection is effective, oral administration and subcutaneous injection are attractive alternatives. SOCS1 and SOCS3 mimetic peptides Some SOCS proteins possess a kinase inhibitory region (KIR) that binds to tyrosine-phosphorylated JAKs and suppress JAK activities.41 SOCS1 and SOCS3 KIR mimetics have been shown to inhibit STAT pathways41 and the small peptide mimetics of SOCS1 effectively inhibits IL-6 and IFN- signaling in vitro and in vivo by targeting JAK-STAT pathway.42-44 Several SOCS1 mimetic peptides that are attached to lipophilic palmitoyl-lysine and arginine groups (see Table 1) are effective in penetrating cells and inhibiting JAK2 kinase activity.42 SOCS1 mimetics have also been used to inhibit Th17 expansion in EAE.42-44 Orally administered SOCS1 mimetics are also effective in inhibiting the production of IL-17, IFN-, TNF- or IL-23 and antagonizing STAT3 activation by inflammatory cells.41 Because they readily cross the blood brain barrier, SOCS1-KIR are considered to be more clinical efficacious than therapeutic antibodies that have difficulty in crossing the BBB. Table?1. SOCS mimetics thead th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Peptide /th th align=”center”.The JAK-STAT pathway is one of the most important pathways utilized by cells of the innate and adaptive immune systems to initiate and regulate immune responses. Consistent with the crucial role of STAT3 in Th17 differentiation, mice with targeted deletion of STAT3 in CD4+ T-cells (STAT3KO) cannot generate Th17 and do not develop EAU or EAE.11 A major reason why STAT3KO mice are resistant to developing EAU or EAE is that the pathogenic T cells are defective in the expression and activation of 41 or 47 integrins and cannot traffic into the CNS.11,12 They are also defective in the expression of osteopontin that promotes chemotactic properties of leukocytes.6 In fact, osteopontin and 41 along with B crystalline are implicated in the relapse TGR-1202 hydrochloride and remission of multiple sclerosis.6 Pertinent to the development of effective treatment for relapsing-remitting CNS autoimmune diseases is the age-old question of where autoreactive memory lymphocytes reside in between episodes of recurrent inflammation. In a recent study, a very sensitive assay was used to track autoreactive lymphocytes that mediate blinding uveitis. The autoreactive uveitogenic memory T cells that mediate chronic uveitis were found to preferentially reside in the bone marrow through STAT3-dependent mechanisms.12 Taken together, these observations suggest that STAT3 pathways and Th17 cells are attractive targets for inhibiting CNS autoimmune disease. STAT3 inhibitors The requirement of STAT3 for the generation of Th17 and development of EAU or EAE, suggests that the STAT3 pathway is usually a potential therapeutic target that can be used to prevent or mitigate uveitis or MS. Several compounds have been developed and found to inhibit STAT3 pathway and Th17 cells in vitro. Although many of these compounds are commercially available their in vivo functions have not been assessed in animal models of CNS autoimmune diseases. ORLL-NIH001 is usually a synthetic 406-kDa small chemical compound developed by Orchid Research Laboratories in India. ORLL-NIH001 has been utilized to inhibit STAT3 pathways in preclinical models of oncology and has recently been used to treat uveitis.40 ORLL-NIH001 substantially reduced levels of Th17 cells, as well as, the IFN–expressing Th17 subset that correlates with development of EAU.11,13 The inhibitory effects of ORLL-NIH001 derived in part from the downregulation of 41, 47, CCR6 and CXCR3. ORLL-NIH001-mediated inhibition of proteins required for lymphocyte trafficking into the retina was validated using two commercially available selective inhibitors of STAT3: a cell-permeable phosphopeptide that inhibits STAT3 by binding to STAT3-SH2 domain (STAT3 peptide; Calbiochem) and an amidosalicylic acid compound that selectively inhibits STAT3 activation and STAT3-dependent transcription (S31-201; Calbiochem).40 It is notable that ORLL-NIH001 suppressed EAU in mice treated with the drug before disease induction, as well as, mice that HSPC150 received the drug after establishment of EAU, suggesting that ORLL-NIH001 may be used in treating pre-existing uveitis.40 However, a drawback to therapeutic use of ORLL-NIH001 is its bioavailablility as frequent administration of the drug is required. Although delivery of the drug by intravenous injection is effective, oral administration and subcutaneous injection are attractive alternatives. SOCS1 and SOCS3 mimetic peptides Some SOCS proteins possess a kinase inhibitory region (KIR) that binds to tyrosine-phosphorylated JAKs and suppress JAK activities.41 SOCS1 and SOCS3 KIR mimetics have been shown to inhibit STAT pathways41 and the small peptide mimetics of SOCS1 effectively inhibits IL-6 and IFN- signaling in vitro and in vivo by targeting JAK-STAT pathway.42-44 Several SOCS1 mimetic peptides that are attached to lipophilic palmitoyl-lysine and arginine groups (see Table 1) are effective in penetrating cells and inhibiting JAK2 kinase activity.42 SOCS1 mimetics have also been used to inhibit Th17 expansion in EAE.42-44 Orally administered SOCS1 mimetics are also effective in inhibiting the production of IL-17, IFN-, TNF- or IL-23 and antagonizing STAT3 activation by inflammatory cells.41 Because they readily cross the blood brain barrier, SOCS1-KIR are considered to be more clinical efficacious than therapeutic antibodies that have difficulty in crossing the BBB. Table?1. SOCS mimetics thead th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Peptide /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Sequence /th /thead SOCS1-KIR hr / 53DTHFRTFRSHSDYRRI hr / SOCS1-KIR2A hr / 53DTHARTARSHSDYRRI hr / Tyrosine kinase inhibitory peptide (TKIP)WLVFFVIFYFFR Open in a separate window SOCS1-KIR (consisting of the kinase inhibitory region of SOCS1) and TKIP (complementary to the auto-phosphorylation site of JAK2) peptides inhibit STAT 1 activation/phosphorylation, and have been shown to be efficacious in the prevention and treatment of EAE. SOCS1-KIR and TKIP possess cell-penetrating capacity through the addition of a lipophilic palmitoyl-lysine group to the N-terminal region of the peptide..The autoreactive uveitogenic memory T cells that mediate chronic uveitis were found to preferentially reside in the bone marrow through STAT3-dependent mechanisms.12 Taken together, these observations suggest that STAT3 pathways and Th17 cells are attractive targets for inhibiting CNS autoimmune disease. STAT3 inhibitors The requirement of STAT3 for the generation of Th17 and development of EAU or EAE, suggests that the STAT3 pathway is a potential therapeutic target that can be used to prevent or mitigate uveitis or MS. Th17 differentiation, mice with targeted deletion of STAT3 in CD4+ T-cells (STAT3KO) cannot generate Th17 and do not develop EAU or EAE.11 A major reason why STAT3KO mice are resistant to developing EAU or EAE is that the pathogenic T cells are defective in the expression and activation of 41 or 47 integrins and cannot traffic into the CNS.11,12 They are also defective in the expression of osteopontin that promotes chemotactic properties of leukocytes.6 In fact, osteopontin and 41 along with B crystalline are implicated in the relapse and remission of multiple sclerosis.6 Pertinent to the development of effective treatment for relapsing-remitting CNS autoimmune diseases is the age-old question of where autoreactive memory lymphocytes reside in between episodes of recurrent inflammation. In a recent study, a very sensitive assay was used to track autoreactive lymphocytes that mediate blinding uveitis. The autoreactive uveitogenic memory T cells that mediate chronic uveitis were found to preferentially reside in the bone marrow through STAT3-dependent mechanisms.12 Taken together, these observations suggest that STAT3 pathways and Th17 cells are attractive targets for inhibiting CNS autoimmune disease. STAT3 inhibitors The requirement of STAT3 for the generation of Th17 and development of EAU or EAE, suggests that the STAT3 pathway is a potential therapeutic target that can be used to prevent or mitigate uveitis or MS. Several compounds have been developed and found to inhibit STAT3 pathway and Th17 cells in vitro. Although many of these compounds are commercially available their in vivo functions have not been assessed in animal models of CNS autoimmune diseases. ORLL-NIH001 is a synthetic 406-kDa small chemical compound developed by Orchid Research Laboratories in India. ORLL-NIH001 has been utilized to inhibit STAT3 pathways in preclinical models of oncology and has recently been used to treat uveitis.40 ORLL-NIH001 substantially reduced levels of Th17 cells, as well as, the IFN–expressing Th17 subset that correlates with development of EAU.11,13 The inhibitory effects of ORLL-NIH001 derived in part from the downregulation of 41, 47, CCR6 and CXCR3. ORLL-NIH001-mediated inhibition of proteins required for lymphocyte trafficking into the retina was validated using two commercially available selective inhibitors of STAT3: a cell-permeable phosphopeptide that inhibits STAT3 by binding to STAT3-SH2 domain (STAT3 peptide; Calbiochem) and an amidosalicylic acid compound that selectively inhibits STAT3 activation and STAT3-dependent transcription (S31-201; Calbiochem).40 It is notable that ORLL-NIH001 suppressed EAU in mice treated with the drug before disease induction, as well as, mice that received the drug after establishment of EAU, suggesting that ORLL-NIH001 may be used in treating pre-existing uveitis.40 However, a drawback to therapeutic use of ORLL-NIH001 is its bioavailablility as frequent administration of the drug is required. Although delivery of the drug by intravenous injection is effective, oral administration and subcutaneous injection are attractive alternatives. SOCS1 and SOCS3 mimetic peptides Some SOCS proteins possess a kinase inhibitory region (KIR) that binds to tyrosine-phosphorylated JAKs and suppress JAK activities.41 SOCS1 and SOCS3 KIR mimetics have been shown to inhibit STAT pathways41 and the small peptide mimetics of SOCS1 effectively inhibits IL-6 and IFN- signaling in vitro and in vivo by targeting JAK-STAT pathway.42-44 Several SOCS1 mimetic peptides that are attached to lipophilic palmitoyl-lysine and arginine organizations (see Table 1) are effective in penetrating cells and inhibiting JAK2 kinase activity.42 SOCS1 mimetics have also been used to inhibit Th17 expansion in EAE.42-44 Orally administered SOCS1 mimetics will also be effective in inhibiting the production of IL-17, IFN-, TNF- or IL-23 and antagonizing STAT3 activation by inflammatory cells.41 Because they readily cross the blood brain barrier, SOCS1-KIR are considered to be more clinical efficacious than therapeutic antibodies that have difficulty in crossing the BBB. Table?1. SOCS mimetics thead th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Peptide /th th align=”center” valign=”top” rowspan=”1″ colspan=”1″ Sequence /th /thead SOCS1-KIR hr / 53DTHFRTFRSHSDYRRI hr / SOCS1-KIR2A hr / 53DTHARTARSHSDYRRI hr / Tyrosine kinase inhibitory peptide (TKIP)WLVFFVIFYFFR Open in a separate windowpane SOCS1-KIR (consisting of the kinase inhibitory region of SOCS1) and TKIP (complementary to the auto-phosphorylation site of JAK2) peptides inhibit STAT 1 activation/phosphorylation, and have been demonstrated to be efficacious in the prevention and treatment of.