Patent Abstract:
an extract of carica papaya leaves obtained from a plant of age six months and younger from the date of germination of the seed is used as an inhibitor of hif to effectively block hypoxia - inducible factor function and methods of use thereof . more specifically it relates to the use of the carica papaya plant extract to eliminate unwanted cells by inhibiting hif in the prevention and treatment of hypoxia - related conditions and diseases such as inflammatory diseases , vascular diseases , cancer and infectious diseases . in a particular embodiment , a solid hypoxic tumor in a patient is treated by administering to the patient a therapeutically acceptable amount of an extract of carica papaya leaves obtained from a plant of age six months and younger from the date of germination of the seed , preferably an alcohol extract such as a methanol extract , whereby to inhibit hypoxia - inducible factors in the tumor .

Detailed Description:
the discovery of the unique properties of the extract of young carica papaya leaves arose from an investigation of the effects of the extracts of various plants on hif activity , and the effect of the age of the carica papaya leaves on hif inhibitory activities . descriptions of those experiments will be given followed by specific investigations of extracts from carica papaya leaves . a human osteosarcoma cell line , saos - 2 stably expressing four copies of the erythropoietin hypoxia response elements ( hre - luc saos2 ; shafee et al ., malaysian patent application #: pi 2012003492 ), was cultured in dmem medium ( paa , usa ) supplemented with 10 % ( v / v ) fetal bovine serum ( fbs ; paa , usa ) and 1 % ( v / v ) antibiotic - antimycotic ( paa , usa ) in a humidified incubator supplied with ambient oxygen and 5 % co 2 at 37 ° c . an hypoxic gaseous environment was created by incubating cells in a proox in vitro chamber ( biospherix ), controlled by proox model 110 ( biospherix ). the cells were supplied 0 . 5 % o 2 , 94 . 5 % n 2 and 5 % co 2 at 37 ° c . nine types of plants with known medicinal properties were tested in this study , and are described in table 1 : the voucher specimens were deposited in the herbarium of institute of biosciences , universiti putra malaysia . leaves of these plants were subjected to methanolic extraction as described in hsu et al ., 2010 . the leaves were washed with distilled water and left to air - dry at room temperature or in an oven at 40 ° c . until a constant weight was obtained . dried leaves were then blended into a powder form , soaked and extracted in methanol at a 1 : 3 ratio ( w / v ) for three days at room temperature . extracts were filtered by whatman no . 1 filter paper with the aid of a vacuum pump . the residues were re - extracted twice using the same methanolic method . filtrates were then concentrated by rotary evaporator at a maximum of 40 ° c . concentrated extracts were collected in glass vials with push - in caps and dried in an oven at 40 ° c . until a constant weight was obtained . all of the crude extracts were stored − 80 ° c . prior to use , the extracts were prepared at the required concentrations by dissolving them in serum - free dmem media with a final dmso concentration of less than 0 . 5 % ( v / v ), centrifuged at 1000 × g and filtered through 0 . 22 μm filters . overnight cultures of cells , initially seeded at 1 . 5 × 10 4 cells per well in a 96 - well plate , were treated with selected concentrations of plant extracts and incubated in normoxic or hypoxic conditions . after 24 h of incubation , an mtt assay ( jamal et al ., 2012 ) was employed to determine cell viability following treatment of cultured cells with selected concentrations of the crude plant extract . these concentrations were determined empirically and selected to cover a range of effects , ranging from no effect to significant cytotoxicity . initially , cells were seeded at 1 . 5 × 10 4 cells per well in a 96 - well plate for 24 h . the cells were treated with selected concentrations of the extract and incubated in normoxic or hypoxic conditions . after 24 h of treatment , spent culture medium was replaced with fresh serum - free dmem containing 0 . 5 mg / ml mtt . after a further 4 h of incubation in 5 % co 2 at 37 ° c ., formazan precipitates that formed were dissolved with 100 μl of dmso and the reaction was read in a microplate reader ( model 550 , biorad , hercules , calif .) at 570 nm absorbance and 630 nm as the reference wavelength . cells were co - transfected with a hypoxia - driven firefly luciferase reporter plasmid construct containing four copies of the erythropoietin ( epo ) hypoxia response elements ( hre ) and a prl - cmv expressing renilla luciferase as described previously ( kaluz et al ., 2008 , shafee et al ., 2009 , shafe et al . malaysian patent application no . pi 2012003492 ). transfected cells were treated with appropriate concentrations of plant extracts and incubated in either normoxic or hypoxic conditions . after 24 h , firefly and renilla luciferase signal intensities were measured ( kaluz et al ., 2008 , shafee et al , 2009 ). percent hif inhibition was calculated as a ratio of the difference between untreated and plant extract - treated sample to the untreated sample . a positive value indicates hif inhibition , while a negative value denotes hif activation . the student t - test was used to analyze the experimental data in this study . results were expressed as mean ± standard error of the mean ( sem ). a ρ value of & lt ; 0 . 05 was considered significant . to investigate whether hypoxia affects cellular responses to plant extract treatment , cells were treated with selected concentrations of each extract , and their viability was determined . as positive controls for inhibition of hif activity , we included cisplatin ( duyndam et al ., 2007 ), and chetomin ( tan et al ., 2005 ). different patterns of cytotoxicity were observed when the cells were treated in normoxic versus hypoxic conditions . as expected ( song et al ., 2006 ), the ic 50 value for cisplatin in hypoxia is significantly higher than in normoxia ( fig1 a ). for the first time , we show that the ic 50 of chetomin also increased in hypoxia . melastoma malabathricum , strobilanthes crispus and pereskia grandifolia , showed no drastic differences in cytotoxicity when lower concentrations (& lt ; 50 μg / ml ) of extracts were used ( fig1 a ). however , at concentrations higher than 150 μg / ml , cytotoxicity to melastoma malabathricum became more evident in the hypoxic compared to the normoxic cultures . cytotoxic and antiproliferative activities of methanolic extracts of melastoma malabathricum have been previously reported ( devehat et al ., 2002 ). their studies , which were done under normoxia , showed that the ic 50 values of the extract ranges from 19 to & gt ; 400 μg / ml depending on the cell line tested . results in the present study showed that hypoxic cancer cells are more susceptible to melastoma malabathricum cytotoxicity when the concentrations used are above 150 μg / ml . therefore , it is likely that the ic 50 of the extracts will be lower in hypoxic cancer cells . for strobilanthes crispus the difference in cytotoxicity began to be seen as early as 100 μg / ml . beginning at this concentration , cells in the hypoxic environment showed a higher rate of cell death compared to the cells in the normoxic environment . the opposite situation was observed in the cells treated with pereskia grandifolia . cytotoxicity of the cells was observed to be higher in the normoxic condition instead , even though cytotoxicity was seen earlier , at 25 μg / ml . gynura procumbens , hydrocotyle sibthorpioides and carica papaya extracts showed different cytotoxicities in normoxia and hypoxia at all concentrations used . gynura procumbent and hydocotyle sibthorpioides were found to induce cell proliferation at concentrations lower than 150 μg / ml . no induction was seen for carica papaya extract . interestingly , in hypoxia , all these extracts induced higher cell proliferation than in normoxia . to the best of our knowledge , this is the first report to show induction of cell proliferation in cancer cells by these three plant extracts . gynura procumbens has been shown to contribute towards the wound healing process ( zahra et al ., 2011 ). our findings of increased cell proliferation , albeit in cancer cells , may help contribute towards further understanding of mechanisms involve in the process of wound healing . similar to our findings in the normoxic condition , the inefficiency of hydrocotyle sibthorpioides extracts in cell killing was also reported previously ( huang et al ., 2008 ). they showed that the ic 50 of hydrocotyle sibthorpioides ethanolic extracts in cancer cells was & gt ; 2000 μg / ml . for carica papaya , we observed a minimal stimulatory effect in hypoxia at concentrations lower than 250 μg / ml . however , above this concentration , its cytotoxicity increased tremendously . in normoxia , on the other hand , the extract showed a gradual increase in cytotoxicity with increasing concentrations of extracts . this result is supported by otsuki et al . ( 2010 ) which reported anti - proliferative responses of various tumor cell lines in normoxic conditions towards carica papaya extracts . orthosiphon aristatus , pereskia bleo and clinacanthus nutans extracts showed minimal cytotoxicity in both normoxic and hypoxic conditions . orthosiphon aristatus extract , which was previously shown to have antioxidant and anti - inflammatory effects ( hsu et al ., 2010 ), showed a gradual reduction of cell viability with increasing amounts of extract used in the normoxic condition . but in the hypoxic condition , no statistically significant difference in cytotoxicity was observed until 500 μg / ml were used , when a sharp drop in cell viability was observed in both normoxic and hypoxic conditions , indicating a general cytotoxity . for pereskia bleo and clinacanthus nutans extracts , no significant cytotoxicity was seen until at the highest concentrations tested under normoxic conditions . this finding is in agreement with a study by er et al . ( 2007 ) which also failed to observe any notable anti - proliferative effect of pereskia bleo methanolic extract in 4t1 and nih / 3t3 cell lines . in contrast , malek et al . ( 2009 ) reported cytotoxicity effects of pereskia bleo methanolic extract in several cancer cell lines . besides the different types of cancer cells used , another possible explanation for these inconsistencies is the gaseous conditions used in their studies . in our study , we found that hypoxic environment led to growth stimulatory response by pereskia bleo but not for clinacanthus nutans . this result strongly suggests that microenvironmental conditions contribute towards cellular responses to plant extract treatments . the following describes the specific investigation of whether hif is affected by carica papaya plant extract treatment , hre - luc saos2 cells were treated with selected concentrations of the extract , and their hif - responsive luciferase signal was determined . the untreated samples showed the expected response pattern , where the signal was only increased in hypoxia but not normoxia ( fig3 ). the high hypoxic signal was dramatically reduced in cells treated with various concentrations of carica papaya extracts . at the lowest concentration tested ( 0 . 1 mg / ml ) the signal was reduced by almost 40 %. as the concentration of the extract increased , the signal also decreased . however , due to the possibility of general cytotoxicity of the extracts on the cells , the reduced signals need to be further studied . prior to performing further investigation , we compared the inhibitory properties of the carica papaya against cisplatin , a known inhibitor of hif ( duyndam et al ., 2007 ). at 0 . 1 mg / ml concentration , carica papaya extract reproducibly inhibits hip signals by approximately 40 % ( fig4 ). this inhibition was comparable to cisplatin , where the inhibition was around 60 %. to confirm that the signal inhibition was not due to a general effect of extract treatment on the hre - luc saos2 cells , another plant extract was used as a control . treatment of this extract at a similar concentration to carica papaya extract , did not result in any hif inhibitory signal . instead , a slight increase was observed . this increase was expected since hif is also a stress - response signal ( semenza , 2011 ; miyata et al ., 2011 ). therefore , cells which undergo stress , in this case perhaps by the presence of the extract , will display a slight increase in hif activity . these data clearly demonstrate the specificity of carica papaya extract on hif inhibition . to verify that the reduced hif signals were not due to cytotoxicity effects of the carica papaya extract on the cells , we performed an mtt assay on the treated cells . at 0 . 1 mg / ml concentration , where hif signal was suppressed by as much as 40 %, the cells appeared to be viable ( fig1 a ). in fact , the cell number was slightly increased in the hypoxic condition , suggesting a minimal effect of the carica papaya extract on the general properties of the cells . at higher concentrations , the extract began to affect cell viability , particularly in the hypoxic condition . this interesting observation suggests that hypoxic cells are more susceptible to carica papaya - induced cytotoxicity compared to normoxic cells . therefore , carica papaya is an ideal candidate to eliminate unwanted hypoxic cells . to observe the pattern of hre - luc saos2 cell killing by hif - inhibitors in normoxic and hypoxic conditions , cisplatin was used . additionally , another specific inhibitor of hif , chetomin ( tan et al ., 2005 ), was also used . this was a proof - of - concept study to confirm the results observed in the carica papaya extract - treated samples . referring to the respective plots for carica papaya , cisplatin , and chetomin in fig1 a , a different pattern of cytotoxicity was observed when the cells were treated with these drugs in normoxic versus hypoxic conditions . as expected , the ic 50 value for cisplatin in hypoxia is significantly higher than in normoxia . hypoxia - induced resistance to cisplatin treatment was previously reported ( song et al ., 2006 ). for the first time , we have shown in this study that the ic 50 of chetomin also increased in hypoxia . our data demonstrate that methanolic carica papaya plant extracts showed different ic 50 values in hypoxic versus normoxic conditions ( fig4 ). this is not entirely unexpected , since cellular responses and adaptations to the hypoxic environment are complex and play important roles in normal cellular physiology . hypoxic tumor cells are known to be more resistant to certain drugs ( reviewed in brown , 2000 ). we found that the ic 50 of carica papaya extract in hypoxia was reduced by almost 3 - fold when compared to normoxia . this finding demonstrates carica papaya as a candidate for the elimination of unwanted hypoxic cells . to investigate the effects of a combination treatment , using carica papaya with either cisplatin or chetomin , we performed experiments using ic 50 concentrations of each material . results obtained showed that the combination treatment led to an increase in cytotoxicity compared to individual treatments . in this combination treatment , the killing effect improved by 4 - fold in both conditions tested . this observation suggests that carica papaya is a good candidate , as individual or combination treatment for drug resistant cells , particularly with respect to targeting hypoxic cells . since hif is known to be a master regulator of cellular responses to low oxygen conditions ( semenza , 2011 ), it is likely that the variation in cellular responses to plant extracts in hypoxic versus normoxic conditions was due to differences in their hip activities . to investigate this possibility , a hypoxia - driven reporter assay ( kaluz et al ., 2008 ) was performed in samples treated with the lowest concentrations of each plant extract . signal intensity of this assay is directly proportional to hif activity . these lowest concentrations were chosen since they provide the least effects on the general properties of the cells . treatment of cells with plant extracts did not show any significant variation in the normoxic basal level of hif activities ( data not shown ). varying responses , however , were observed in the hypoxic samples ( fig2 ). treatment with all of the plant extracts , except for carica papaya , resulted in further activation of hip activity , as evidenced from the negative values of the hif inhibition . the level of activation however , varied among the different plant extracts . these variations did not show any obvious correlation to their viability at the low concentrations tested ( fig1 a ). interestingly , the only candidate hip inhibitor found in this study , which was the carica papaya extract , led to an almost 40 % inhibition of hip activity . this inhibition was almost comparable to cisplatin treatment , a known hif inhibitor ( duyndam et al ., 2007 ). this novel finding indicates the potential of carica papaya extract as an agent to kill hypoxic cancer cells through inhibition of hif activity . data presented in the foregoing study show specific cytotoxic effects of carica papaya extract under hypoxic conditions as evidenced from a 3 - fold reduction in ic 50 of hypoxic versus normoxic cells . this reduced ic 50 was achieved through specific inhibition of hif activities . having established the effectiveness of carica papaya extract to inhibit hip activity , experiments were performed to determine the effect the age of the carica papaya leaves on hif inhibition . leaves of the c . papaya were subjected to the methanolic extraction method to obtain crude leave extracts . several batches of leave samples were originally obtained from different ages of plants from a farm that cultivates specific c . papaya varieties . the extracts were used in a hif inhibition assay using the cell - based hif assay system described above . hhif inhibitory activities were found to be dependent on the age of the plant from where the leaves were originally harvested . referring to fig5 , statistically significant , replicable inhibition was seen in crude extract of leaves from plants ages 6 months and younger . an opposite effect , statistically significant activation of hif , was noted when samples were obtained from plants that were older than 6 months of age . to compare the invention to the disclosure in prior art morimoto et al . us patent application no . 20080069907 , hif assays were performed using extraction procedures detailed in their patent application with plants that were older than 10 month . referring to fig6 , results showed that a replicable inhibition of hif was not seen . the hif activity was instead increased , as evident from the negative values of hif inhibition ( the y - axis ). the alcohol used to extract the carica papaya leaves was methanol . in general , one can use any of the monohydric , polyhydric , unsaturated aliphatic , or alicyclic alcohols , exemplified by methanol , ethanol , propanol , isopropanol , n - butanol , sec - butanol , isobutanol , tert - butanol , pentan - 1 - ol , 3 - methylbutan - 1 - ol , 2 - methylbutan - 1 - ol , 2 , 2 - dimethylpropan - 2 - ol , pentan - 3 - ol , pentan - 2 - ol , 3 - methylbutan - 2 - ol , 2 - methylbutan - 2 - ol , ethane - 1 , 2 - diol , propane - 1 , 2 - diol , propane - 1 , 2 , 3 - triol , butane - 1 , 2 , 3 , 4 - tetraol , or pentane - 1 , 2 , 3 , 4 , 5 - pentol . the alcohol is preferably an acyclic alcohol having from 1 to five carbon atoms , most preferably methanol . as described above , performed experiments using combinations of carica papaya and cisplatin or chetomin led to an increase in cytotoxicity by 4 - fold . other chemotherapeutic agents can be used . more particularly , one can use in combination with the carica papaya extract a chemotherapeutic agent selected from the group consisting of cisplatin , chetomin , methotrexate , trimetrexate , adriamycin , taxotere , 5 - fluorouracil , vincristine , vinblastine , pamidronate disodium , anastrozole , exemestane , cyclophosphamide , epirubicin , toremifene , letrozole , trastuzumab , megestrol , tamoxifen , paclitaxel , docetaxel , capecitabine , goserelin acetate , 0 - epi - 1 , 25 dihydroxyvitamin d3 , 4 - ipomeanol , 5 - ethynyluracil , 9 - dihydrotaxol , abiraterone , acivicin , aclarubicin , acodazole hydrochloride , acronine , acylfulvene , adecypenol , adozelesin , aldesleukin , all - tk antagonists , altretamine , ambamustine , ambomycin , ametantrone acetate , amidox , amifostine , aminoglutethimide , aminolevulinic acid , amrubicin , amsacrine , anagrelide , andrographolide , angiogenesis inhibitors , antagonist d , antagonist g , antarelix , anthramycin , anti - dorsalizing morphogenetic protein - 1 , antiestrogen , antineoplaston , antisense oligonucleotides , aphidicolin glycinate , apoptosis gene modulators , apoptosis regulators , apurinic acid , ara - cdp - dl - ptba , arginine deaminase , asparaginase , asperlin , asulacrine , atamestane , atrimustine , axinastatin 1 , axinastatin 2 , axinastatin 3 , azacitidine , azasetron , azatoxin , azatyrosine , azetepa , azotomycin , baccatin iii derivatives , balanol , batimastat , benzochlorins , benzodepa , benzoylstaurosporine , beta lactam derivatives , beta - alethine , betaclamycin b , betulinic acid , bfgf inhibitor , bicalutamide , bisantrene , bisantrene hydrochloride , bisaziridinylspermine , bisnafide , bisnafide dimesylate , bistratene a , bizelesin , bleomycin , bleomycin sulfate , brc / abl antagonists , breflate , brequinar sodium , bropirimine , budotitane , busulfan , buthionine sulfoximine , cactinomycin , calcipotriol , calphostin c , calusterone , camptothecin derivatives , canarypox il - 2 , caracemide , carbetimer , carboplatin , carboxamide - amino - triazole , carboxyamidotriazole , carest m3 , carmustine , earn 700 , cartilage derived inhibitor , carubicin hydrochloride , carzelesin , casein kinase inhibitors , castanospermine , cecropin b , cedefingol , cetrorelix , chlorambucil , chlorins , chloroquinoxaline sulfonamide , cicaprost , cirolemycin , cis - porphyrin , cladribine , clomifene analogs , clotrimazole , collismycin a , collismycin b , combretastatin a4 , combretastatin analog , conagenin , crambescidin 816 , crisnatol , crisnatol mesylate , cryptophycin 8 , cryptophycin a derivatives , curacin a , cyclopentanthraquinones , cycloplatam , cypemycin , cytarabine , cytarabine ocfosfate , cytotytic factor , cytostatin , dacarbazine , dacliximab , dactinomycin , daunorubicin hydrochloride , decitabine , dehydrodidemnin b , deslorelin , dexifosfamide , dexormaplatin , dexrazoxane , dexverapamil , dezaguanine , dezaguanine mesylate , diaziquone , didemnin b , didox , diethylnorspermnine , dihydro - 5 - azacytidine , dioxamycin , diphenyl spiromustine , docosanol , dolasetron , doxifluridine , doxorubicin hydrochloride , droloxifene , droloxifene citrate , dromostanolone propionate , dronabinol , duazomycin , duocarmycin sa , ebselen , ecomustine , edatrexate , edelfosine , edrecolomab , eflomithine , eflornithine hydrochloride , elemene , elsamitrucin , emitefur , enloplatin , enpromate , epipropidine , epirubicin hydrochloride , epristeride , erbulozole , erythrocyte gene therapy vector system , esorubicin hydrochloride , estramustine , estramustine analog , estramustine phosphate sodium , estrogen agonists , estrogen antagonists , etanidazole , etoposide , etoposide phosphate , etoprine , fadrozole , fadrozole hydrochloride , fazarabine , fenretinide , filgrastim , finasteride , flavopiridol , flezelastine , floxuridine , fluasterone , fludarabine , fludarabine phosphate , fluorodaunorunicin hydrochloride , fluorocitabine , forfenimex , formestane , fosquidone , fostriecin , fostriecin sodium , fotemustine , gadolinium texaphyrin , gallium nitrate , galocitabine , ganirelix , gelatinase inhibitors , gemcitabine , gemcitabine hydrochloride , glutathione inhibitors , hepsulfam , heregulin , hexamethylene bisacetamide , hydroxyurea , hypericin , ibandronic acid , idarubicin , idarubicin hydrochloride , idoxifene , idramantone , ifosfamide , ilmofosine , ilomastat , imidazoacridones , imiquimod , immunostimulant peptides , insulin - like growth factor - 1 receptor inhibitor , interferon agonists , interferon alpha - 2a , interferon alpha - 2b , interferon alpha - n1 , interferon alpha - n3 , interferon beta - ia , interferon gamma - ib , interferons , interleukins , iobenguane , iododoxorubicin , iproplatin , irinotecan , irinotecan hydrochloride , iroplact , irsogladine , isobengazole , isohomohalicondrin b , itasetron , jasplakinolide , kahalalide f , lamellarin - n triacetate , lanrmeotide , lanreotide acetate , leinamycin , lenograstim , lentinan sulfate , leptolstatin , leukemia inhibiting factor , leukocyte alpha interferon , leuprolide acetate , leuprolide / estrogen / progesterone , leuprorelin , levamisole , liarozole , liarozole hydrochloride , linear polyamine analog , lipophilic disaccharide peptide , lipophilic platinum compounds , lissoclinamide 7 , lobaplatin , lombricine , lometrexol , lometrexol sodium , lomustine , lonidamine , losoxantrone , losoxantrone hydrochloride , lovastatin , loxoribine , lurtotecan , lutetium texaphyrin , lysofylline , lytic peptides , maitansine , mannostatin a , marimastat , masoprocol , maspin , matrilysin inhibitors , matrix metalloproteinase inhibitors , maytansine , mechlorethamine hydrochloride , megestrol acetate , melengestrol acetate , melphalan , menogaril , merbarone , mercaptopurine , meterelin , methioninase , methotrexate sodium , metoclopramide , metoprine , meturedepa , microalgal protein kinase c inhibitors , mif inhibitor , mifepristone , miltefosine , mirimostim , mismatched double stranded rna , mitindomide , mitocarcin , mitocromin , mitogillin , mitoguazone , mitolactol , mitomalcin , mitomycin , mitomycin analogs , mitonafide , mitosper , mitotane , mitotoxin fibroblast growth factor - saporin , mitoxantrone , mitoxantrone hydrochloride , mofarotene , molgramostim , monoclonal antibody , human chorionic gonadotrophin , monophosphoryl lipid a / myobacterium cell wall sk , mopidamol , multiple drug resistance gene inhibitor , multiple tumor suppressor 1 - based therapy , mustard anticancer agent , mycaperoxide b , mycobacterial cell wall extract , mycophenolic acid , myriaporone , n - acetyldinaline , nafarelin , nagrestip , naloxone / pentazocine , napavin , naphterpin , nartograstim , nedaplatin , nemorubicin , neridronic acid , neutral endopeptidase , nilutamide , nisamycin , nitric oxide modulators , nitroxide antioxidant , nitrullyn , nocodazol , nogalamycin , n - substituted benzamides , 06 - benzylguanine , octreotide , okicenone , oligonucleotides , onapristone , ondansetron , oracin , oral cytokine inducer , ormaplatin , osaterone , oxaliplatin , oxaunomycin , oxisuran , paclitaxel analogs , paclitaxel derivatives , palauamine , palmitoylrhizoxin , pamidronic acid , panaxytriol , panomifene , parabactin , pazelliptine , pegaspargase , peldesine , peliomycin , pentamustine , pentosan polysulfate sodium , pentostatin , pentrozole , peplomycin sulfate , perflubron , perfosfamide , perillyl alcohol , phenazinomycin , phenylacetate , phosphatase inhibitors , picibanil , pilocarpine hydrochloride , pipobroman , piposulfan , pirarubicin , piritrexim , piroxantrone hydrochloride , placetin a , placetin b , plasminogen activator inhibitor , platinum complex , platinum compounds , platinum - triamine complex , plicamycin , plomestane , porfimer sodium , porfiromycin , prednimustine , procarbazine hydrochloride , propyl bis - acridone , prostaglandin j2 , prostatic carcinoma antiandrogen , proteasome inhibitors , protein a - based immune modulator , protein kinase c inhibitor , protein tyrosine phosphatase inhibitors , purine nucleoside phosphorylase inhibitors , puromycin , puromycin hydrochloride , purpurins , pyrazofurin , pyrazoloacridine , pyridoxylated hemoglobin polyoxyethylene conjugate , raf antagonists , raltitrexed , ramosetron , ras farnesyl protein transferase inhibitors , ras inhibitors , ras - gap inhibitor , retelliptine demethylated , rhenium re 186 etidronate , rhizoxin , riboprine , ribozymes , rii retinamide , rnai , rogletimide , rohitukine , romurtide , roquinimex , rubiginone b1 , ruboxyl , safingol , safingol hydrochloride , saintopin , sarcnu , sarcophytol a , sargramostim , sdii mimetics , semustine , senescence derived inhibitor i , sense oligonucleotides , signal transduction inhibitors , signal transduction modulators , simtrazene , single chain antigen binding protein , sizofuran , sobuzoxane , sodium borocaptate , sodium phenylacetate , solverol , somatomedin binding protein , sonermin , sparfosate sodium , sparfosic acid , sparsomycin , spicamycin d , spirogermanium hydrochloride , spiromustine , spiroplatin , splenopentin , spongistatin 1 , squalamine , stem cell inhibitor , stem - cell division inhibitors , stipiamide , streptonigrin , streptozocin , stromelysin inhibitors , sulfinosine , sulofenur , superactive vasoactive intestinal peptide antagonist , suradista , suramin , swainsonine , synthetic glycosaminoglycans , talisomycin , tallimustine , tamoxifen methiodide , tauromustine , tazarotene , tecogalan sodium , tegafur , tellurapyrylium , telomerase inhibitors , teloxantrone hydrochloride , temoporfin , temozolomide , teniposide , teroxirone , testolactone , tetrachlorodecaoxide , tetrazomine , thaliblastine , thalidomide , thiamiprine , thiocoraline , thioguanine , thiotepa , thrombopoictin , thrombopoietin mimetic , thymalfasin , thymopoietin receptor agonist , thymotrinan , thyroid stimulating hormone , tiazofurin , tin ethyl etiopurpurin , tirapazamine , titanocene dichloride , topotecan hydrochloride , topsentin , toremifene citrate , totipotent stem cell factor , translation inhibitors , trestolone acetate , tretinoin , triacetyluridine , triciribine , triciribine phosphate , trimetrexate , trimetrexate glucuronate , triptorelin , tropisetron , tubulozole hydrochloride , turosteride , tyrosine kinase inhibitors , tyrphostins , ubc inhibitors , ubenimex , uracil mustard , uredepa , urogenital sinus - derived growth inhibitory factor , urokinase receptor antagonists , vapreotide , variolin b , velaresol , veramine , verdins , verteporfin , vinblastine sulfate , vincristine sulfate , vindesine , vindesine sulfate , vinepidine sulfate , vinglycinate sulfate , vinleurosine sulfate , vinorelbine , vinorelbine tartrate , vinrosidine sulfate , vinxaltine , vinzolidine sulfate , vitaxin , vorozole , zanoterone , zeniplatin , zilascorb , zinostatin , zinostatin stimalamer , and zorubicin hydrochloride , as well as salts , homologs , analogs , derivatives , enantiomers and / or functionally equivalent compositions thereof . although the present invention has been described in connection with the preferred embodiments , it is to be understood that modifications and variations may be utilized without departing from the principles and scope of the invention , as those skilled in the art will readily understand . ahmad n , fazal h , ayazd m , abbasi m h , mohammad i , fazale l . dengue fever treatment with carica papaya leaves extracts , asian pac j trop biomed . 2011 , 1 ( 4 ): 330 - 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