mRNA: the therapeutics of the future! (or, 2021 the way research is going…)

Today’s top selling drugs are mostly biologics, which means proteins (e.g., monoclonal antibodies) being used as medicine. The global therapeutic monoclonal antibody market was valued at approximately US$115.2 billion in 2018, and is expected to generate revenue of $150 billion by the end of 2019, and $300 billion by 20251. Thus, the market for therapeutic antibody drugs has experienced an explosive growth with new drugs being approved for treating various human diseases, including many cancers, autoimmune, metabolic and infectious diseases, which have increasingly fewer adverse effects due to their high specificity. 

But, these types of treatments carry their own limitations. Besides of a long period of development, they can only access the extracellular space, the serum. Yet, ~2/3 of the human proteome are intracellular or transmembrane proteins; which means that biologics cannot treat disorders that are caused by these types of proteins. 

As such, an alternative mechanism to make these proteins is needed in order to go further in the advancement of therapeutics. 

One such mechanism, is to supply the mRNA that encodes that protein. As such, any protein can become a drug. And, since only the coding region varies from mRNA-drug to mRNA-drug; once the delivery vehicle problem is resolved (e.g., using lipid nanoparticles), the development of new mRNA drugs should be quite fast in comparison with other types of medicine.

The other positive aspect of mRNA as therapeutics, is that it can be used in many different types of modalities: prophylactic vaccines, cancer vaccines, intertumoral immune-oncologicals, localized regenerative therapeutics, systemic secreted medicine, and cell surface therapeutics…

Another positive aspect of mRNA-drugs is that several mRNAs can be delivered at once, like in the case of prophylactic vaccines (e.g., Moderna Therapeutics Cytomegalovirus (CMV) mRNA vaccine delivers 6 different mRNAs to encode a multiprotein complex). 

Or, another possibility, is the personalization of cancer vaccines, where different patient-specific neoepitopes are sequenced, and mRNA is created that encodes those 20-35 specific tumour-neoepitopes. 

Those mRNAs can also encode cytokines, that are able to boost the immune system to attack a tumour, like intertumoral immune-oncologicals therapeutics. 

In the field of localized regenerative therapeutics, there is currently a project between Moderna Therapeuticsand AstraZeneca in Phase II clinical trials, where Vascular Endothelial Growth Factor-A (VEGFA) mRNA is injected NAKED, without lipid nanoparticles, directly into the heart muscle of patients with a recent Myocardial Infarction (MI) to help rebuild blood vessels. 

Of course, many challenges still exist. 

mRNA needs to be rightly sequenced and be made at high purity. It also needs to have the ability to avoid the innate immune sensors, like Toll-like receptors (TLR) in the endoplasmic reticulum, and RIG-I/MDA-5-like receptors in the cytoplasm. What researchers do to avoid the first ones (TLRs) is to use a Pseudouridine, which looks like a Uridine and still base-pairs, but escapes TLR recognition. To avoid the RIG-I/MDA-5-like receptors, researchers need to highly purify the therapeutic mRNA, so that no double-stranded RNA exists (or, reengineer T7 RNA polymerase not to produce dsRNA at all).

The next step on making a good mRNA-drug is to find an efficient delivery method. For that, most therapeutics will need some sort of mRNA encapsulation with Lipid nanoparticles, which are akin to endogenous lipid transport complexes, similar to Very-Low Density Lipoproteins (VLDLs).

Finally, in order to make a good mRNA-drug, there needs to be knowledge on how to engineer the best mRNA sequence for a particular purpose. As such, there needs to be translation initiation fidelity, so that it always starts in the right place and there’s faithful decoding; and, also, the ribosome needs to stop in the right place. There needs to be high translation efficiency, a functional mRNA half-life, and hit the correct cell type, by putting off-logic gates, like microRNAs target sites in the 3’prime UTR and causing the mRNA to be degraded in case it hits an undesired cell type. Also, the mRNAs need to be tailored to the protein type (e.g., secreted, mitochondrial).

So, let’s see what the future brings from mRNA therapeutics…

References:

1          Lu, R.-M. et al. Development of therapeutic antibodies for the treatment of diseases. Journal of Biomedical Science 27, 1, doi:10.1186/s12929-019-0592-z (2020).

Personalized Cancer Vaccines: the future is here!

In humans, anti-tumour immunity is usually very effective, because our T-cells (a type of a white blood cell) can detect the presence of specific cancer neoantigens. These are short chains of aminoacids (peptides) that appear due to tumour-specific mutations, and mark the cancer cell as foreign. They are highly immunogenic, because they are not present in normal tissues; and therefore, evade central thymic tolerance and activate our immune system to destroy them.

Although neoantigens were long-envisioned as optimal targets for an anti-tumour immune response, their efficient discovery and evaluation only became possible recently, with the availability of massive parallel sequencing for detection of all coding mutations within tumours; and, of machine learning approaches to reliably predict those mutated peptides with high-affinity binding of autologous human leukocyte antigen (HLA) molecules. 

It has been shown that vaccination with these specific neoantigens can expand the pre-existing neoantigen-specific T-cell populations; and, induce a broader repertoire of new T-cell specificities in cancer patients. This can actually tip the intra-tumoral balance, in favour of an enhanced tumour control. 

Research studies now demonstrate the feasibility, safety, and immunogenicity of vaccines that target up to 20 predicted personal tumour neoantigens (e.g.Melanoma Neovax anti-PD11). Vaccine-induced polyfunctional CD4+ and CD8+ T-cells can target unique tumour neoantigens; and, not only that, these T-cells can have persistent memory. This because, studies from the Dana-Farber Cancer Institute and Dr. Catherine Wu’s lab, show that patients have a continuous response 5-7-years later after the initial vaccination, with a second-wave of immune response that shows epitope spreading from the initial epitope. What this means, is that the patient immune system was able to recognize and target tumour cells, even when they try to disguise themselves years later.

Researchers have gone further: at Genocea Biosciences they are developing precision neoantigen selection with their branded ATLAS platform. They can optimize the set of neoantigens for inclusion in the vaccine, by excluding inhibitory antigens (called Inhibigens) that suppress the patient’s immune system, blocking the internal growth of the tumour cells.

Neoantigen

References:

1          Ott, P. A. et al. An immunogenic personal neoantigen vaccine for patients with melanoma. Nature 547, 217-221, doi:10.1038/nature22991 (2017).

Theanine and Caffeine: the yin-yang of green tea and brain waves

Theanine was discovered in 1949 by the Japanese researcher Yajiro Sakato1, as a new amide in the water extract of the Japanese green tea Gyokuro (玉 露) – also called “precious dew” due to its dark green colour and high price in Japanese markets, because of its unique characteristic taste of sweetness and “umami”2.

The green tea leaves from specialized varieties of the tea plant Camellia sinensis (Ericales plants) have enormous amounts of theanine, which they absorb from the roots of the plant depending on the nitrogen supply of the soil3, 4. A soil that is rich in nitrogen will promote the biosynthesis of the non-protein aminoacid L-Theanine from Glutamic Acid and Ethylamine (by the enzyme theanine synthetase)2. Since the commercial price of green tea is almost directly proportional to its theanine content, to obtain theanine-rich, good quality green tea leaves, a large amount of nitrogen fertilizer must be supplied to the cultivated plants throughout the growth period (with problematic effects on the environment)2.

Theanine is then transported via the xylem fluid, from the roots to the young bushes leaves. And, because light is necessary to the conversion of theanine into cathechins in the leaves of the plant, when Camellia sinensis bushes are protected from direct sunlight for a couple of weeks just before harvest, they have a high theanineamino acid content2. Even though cathechins are polyphenols with known antioxidant properties, they are also responsible for the astringent flavour of green tea. So, for an optimum taste, cathechins must be balanced with theanines. With less sunlight, there is less photosynthesis and leaf senescence; and, less theanine being converted into catechin, keeping the unique sweet-umami flavor characteristic of Gyokuro green tea.

Theanine is also known as N5-ethyl-L-glutamine due to its structural similarities to L-glutamic acid, which is the most abundant excitatory neurotransmitter in our brains5. Researchers think that L-theanine mechanism of action might be mediated by glutamate receptors, and it might act as a partial agonist for the N-methyl-D-aspartate receptor6

Theanine has known relaxing and anxiolytic effects, via the induction of the slow alpha-brain waves in the occipital and parietal regions of the human brain7. Plus, it doesn’t have any additive or side effects that are usually associated with conventional sleep inducers. 

There is only one IF…. 

In addition to L-TheanineCamellia sinensis leaves grown in the shade also have a high level of caffeine8, which decreases slow brain activity and keeps us awake (by increasing beta-wave activity). This because, the buds and young leaves of Camellia plants contain more caffeine than mature leaves8. As such, besides a high level of theanineGyokuro or Matcha green tea powder (which goes through the same shade process before harvest), also have high levels of caffeine

What is interesting, is that this dual effect of L-Theanine and Caffeine in Gyokuro or Matcha green tea powder, seem to have a synergistic effect in decreasing mind wandering and enhancing our attention to target stimuli9, 10. This was shown in a very small randomized clinical trial, that used functional Magnetic Resonance Imaging (fMRI) to scan the brains of subjects, after they ingested L-Theanine and Caffeine supplements while performing a visual task. 

So, if we want to focus and stay awake: a cup of Gyokuro or Matcha, will keep our attention sharp as a Japanese sword. 

If, on the other hand, we are not feeling very calm, anxiety is setting in, or if sleep is taking too long because the news are only “so-so” at the moment: 200-400mg of L-theanine could help us keep the zen mood, and have a good night sleep11.

The discovery of Theanine

References:

1.         Sakato Y. Studies on the Chemical Constituents of Tea

Part III. On a New Amide <b>Theanine</b>. Nippon Nōgeikagaku Kaishi. 1950;23:262-267.

2.         Ashihara H. Occurrence, biosynthesis and metabolism of theanine (γ-glutamyl-L-ethylamide) in plants: a comprehensive review. Nat Prod Commun. 2015;10:803-10.

3.         Ruan J, Haerdter R and Gerendás J. Impact of nitrogen supply on carbon/nitrogen allocation: a case study on amino acids and catechins in green tea [Camellia sinensis (L.) O. Kuntze] plants. Plant Biol (Stuttg). 2010;12:724-34.

4.         Huang H, Yao Q, Xia E and Gao L. Metabolomics and Transcriptomics Analyses Reveal Nitrogen Influences on the Accumulation of Flavonoids and Amino Acids in Young Shoots of Tea Plant ( Camellia sinensis L.) Associated with Tea Flavor. J Agric Food Chem. 2018;66:9828-9838.

5.         Unno K, Furushima D, Hamamoto S, Iguchi K, Yamada H, Morita A, Horie H and Nakamura Y. Stress-Reducing Function of Matcha Green Tea in Animal Experiments and Clinical Trials. Nutrients. 2018;10:1468.

6.         Sebih F, Rousset M, Bellahouel S, Rolland M, de Jesus Ferreira MC, Guiramand J, Cohen-Solal C, Barbanel G, Cens T, Abouazza M, Tassou A, Gratuze M, Meusnier C, Charnet P, Vignes M and Rolland V. Characterization of l-Theanine Excitatory Actions on Hippocampal Neurons: Toward the Generation of Novel N-Methyl-d-aspartate Receptor Modulators Based on Its Backbone. ACS Chem Neurosci. 2017;8:1724-1734.

7.         Kobayashi K, Nagato Y, Aoi N, Juneja LR, Kim M, Yamamoto T and Sugimoto S. Effects of L-Theanine on the Release of &alpha;-Brain Waves in Human Volunteers. Nippon Nōgeikagaku Kaishi. 1998;72:153-157.

8.         Ashihara H and Suzuki T. Distribution and biosynthesis of caffeine in plants. Front Biosci. 2004;9:1864-76.

9.         Kahathuduwa CN, Dhanasekara CS, Chin SH, Davis T, Weerasinghe VS, Dassanayake TL and Binks M. l-Theanine and caffeine improve target-specific attention to visual stimuli by decreasing mind wandering: a human functional magnetic resonance imaging study. Nutr Res. 2018;49:67-78.

10.       Hidese S, Ogawa S, Ota M, Ishida I, Yasukawa Z, Ozeki M and Kunugi H. Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients. 2019;11:2362.

11.       Williams JL, Everett JM, D’Cunha NM, Sergi D, Georgousopoulou EN, Keegan RJ, McKune AJ, Mellor DD, Anstice N and Naumovski N. The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review. Plant Foods Hum Nutr. 2020;75:12-23.

Stroke or heart infarct?

According to a recent study by Daghlas and colleagues1, compared to sleeping 6 to 9 h/night, short sleepers have a 20% higher risk of having a heart attack; but, if you are a long sleeper (i.e., sleeping >9h/night), than your chances are even worse, because your risk increases to 34%. Even though the researchers don’t know the underlying cause for such susceptibilities, they claim sleeping too much or too little boosts inflammation in the body, which is associated with the development of heart disease. If you have a genetic predisposition for heart disease, this study found that sleeping between 6-9h, actually reduces your risk of having a heart attack by 18%, which is actually very good news, since not only diet and exercise can help you keep your heart healthy. More and more data, supports the evidence that we should consider sleep to be an adjustable and controllable risk factor for our good heath status2.

Speaking of diet, another study published recently in the Journal of the American Heart Association by Hyunju Kim and his team3, showed that healthy plant‐based diets, which are higher in whole grains, fruits, vegetables, nuts, legumes, tea, and coffee, and lower in animal foods, were associated with a lower risk of cardiovascular disease mortality and all‐cause mortality. Of course, they didn’t explore if the quality of plant foods (either healthy plant foods, or less-healthy plant foods) within the “framework of plant‐based diets” would be associated with cardiovascular disease and all‐cause mortality in the general population.

But, what is intriguing is that, another recent study by Tammy Tong and colleagues4, examined the associations of vegetarianism with risks of ischemic heart disease (i.e., coronary artery disease) and stroke. The results of this study showed that vegetarians had 20% higher rates of total stroke than meat eaters – which was equivalent to 3x more cases of stroke over 10 years; and, the associations for stroke did not soothe after adjustments to other disease risk factors. As the authors of the study say, vegetarian and vegan diets have become increasingly popular in recent years, partly due to perceived health benefits, as well as concerns about the environment and animal welfare; but, what the evidence suggests, is that vegetarians might have different disease risks compared with non-vegetarians. The study group of vegetarians and vegans in this cohort had lower circulating levels of several nutrients (e.g., vitamin B12, vitamin D, essential amino acids, and long chain n-3 polyunsaturated fatty acids), and differences in some of these nutritional factors could contribute to the increased stroke risk. Not only that, but a number of studies in Japan5, 6, showed that individuals with very low intake of animal products, also had an increased incidence and mortality from hemorrhagic and total stroke, implying that some factors connected with animal food intake might be protective for stroke. 

Its like Yin and Yang from ancient Chinese philosophy. Rather than opposing, or standing at the sides, our health and life is made of complementary forces that interact to form a dynamic system. It’s all about balance and balancing the sides (and diets).

All in life is balance
Balancing life’s way

References:

1.         Daghlas I, Dashti HS, Lane J, Aragam KG, Rutter MK, Saxena R and Vetter C. Sleep Duration and Myocardial Infarction. Journal of the American College of Cardiology. 2019;74:1304-1314.

2.         Tobaldini E, Fiorelli EM, Solbiati M, Costantino G, Nobili L and Montano N. Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence. Nat Rev Cardiol. 2019;16:213-224.

3.         Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J and Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc. 2019;8:e012865.

4.         Tong TYN, Appleby PN, Bradbury KE, Perez-Cornago A, Travis RC, Clarke R and Key TJ. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019;366:l4897.

5.         Kinjo Y, Beral V, Akiba S, Key T, Mizuno S, Appleby P, Yamaguchi N, Watanabe S and Doll R. Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan. J Epidemiol. 1999;9:268-74.

6.         Sauvaget C, Nagano J, Allen N, Grant EJ and Beral V. Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol. 2003;32:536-43.

Habenula, the Master of the Brain

The Habenula, is an area of our brains close to the pineal gland, that is involved in pain processing, reproductive behaviour, nutrition, sleep-wake cycles and stress responses, among other things1. A professor I used to know always said the Habenula was the Master of the Brain… and, indeed, recent research has provided evidence that this tiny bundle of nerves is able to produce Dimethyltryptamine (DMT), a psychedelic drug, “cousin” to the famous LySergic acid Diethylamide (LSD). 

DMT is internally bio-synthesized by the enzymes Aromatic-L-Amino acid DeCarboxylase (AADC) and Indolethylamine-N-Methyltransferase (INMT). Dean and colleagues2 were able to identify INMT messenger RNA in human tissues, by using a RNAscope in situ assay system; a highly sensitive technique, which proved for the first time a clear-cut identification of DMT and its enzymes in human brain. 

Outstanding, was the discovery that there was a significant increase of DMT levels in the rat brain after stimulation of experimental cardiac arrest; showing for the first time, that the brain is capable of synthesizing and releasing DMT under stress. 

This ultimately raises the possibility that this phenomenon may also occur in human brains, when we experience situations of extreme stress. The researchers attest that the cardiac arrest-induced increase of DMT may be related to “near-death experiences”, as reported by Timmermann and collegues3. This group recently reported that human subjects given exogenous DMT, experienced “near-death”-like mental states, including the subjective feeling of transcending one’s body and entering an alternative realm, perceiving and communicating with ‘entities’, and themes related to death and dying.

It’s unbelievable that the more we know about how our body and brain functions, the more I realize that our mind is a construction of our organic biological nature.

What we sometimes perceive as a mystical experience is probably just rooted in an organic mechanism that is tricking our minds into a “trip”.

Into the light

References:

1.         Namboodiri VM, Rodriguez-Romaguera J and Stuber GD. The habenula. Curr Biol. 2016;26:R873-R877.

2.         Jon G. Dean TL, Sean Huff, Ben Sheler, Steven A. Barker, Rick J. Strassman, Michael M. Wang & Jimo Borjigin Biosynthesis and Extracellular Concentrations of N,N-dimethyltryptamine (DMT) in Mammalian Brain. Scientific Reports. 2019;9.

3.         Timmermann C, Roseman L, Williams L, Erritzoe D, Martial C, Cassol H, Laureys S, Nutt D and Carhart-Harris R. DMT Models the Near-Death Experience. Front Psychol. 2018;9:1424.

Underwater banquet!

Cabal, is a term defined in the Merriam-Webster dictionary, as the contrived scheme of a group of persons secretly united in a plot (as to overturn a government, for example). 

But, if you talk in terms of Biology, cabals are also a series of synergistic venom peptides essential for the capture of prey. One animal venom can be a complex mixture of 10-200+ short chains of amino acids linked by bonds (peptides), working in a concerted mode to regulate physiological function, with very potent and precise molecular targets1.

For example, cone snails, a small venomous marine mollusk that hunts fish and worms, has ~850 species identified, with each expressing many thousands of unique peptides that selectively target a diverse range of voltage- and ligand-gated ion-channels, transporters and G-protein couple receptors2

These tiny wonders of nature have the ability to switch between predatory and defensive venom regimes. For example, if they just want to stunt a predator causing a flaccid paralysis, they will produce venom that has high levels of muscle blockers (motor cabal), and that inhibit sodium channels and nicotinic acetylcholine receptors. But, if in the mean time, they change their minds and intend to eat the prey, they use a combination of peptides that cause a rigid paralysis. This lightning-strike cabal has excitatory peptides that inhibit potassium channels and delay inactivation of sodium channels, causing the prey to lie “dead” until it is happily digested in an underwater banquet.

But, how does the cone snail decide whether it is fear or hunger that it’s “feeling” in that moment?

The simple neuronal circuit of the cone snail shifts from a contented state of inertia, to an active motion, stimulated by internal hunger and an appetite stimulus – just like us, slushing from the couch to the fridge looking for our night prey… The hunting activity of the Conus is then organized by a basic set of behavioral transitions. Once the cone snail detects a fish, through sensory signals, it becomes much more active and moves towards the fish extending its rostrum– a massive funnel formed by the muscular walls of the snail sheath; and, a long, thin trunk extends out in the open, where a harpoon-like tooth shoots out to pierce the skin of the fish3 – imagine if we could actually do the same to that bag of cookies that is lying in the shelve right next to the couch.

The active feeding of the cone snail tends to inhibit the avoidance, and the snail changes to a prevention mood once its appetite is satisfied4

Cone snail

Reference:

1.         Angell Y, Holford M and Moos WH. Building on Success: A Bright Future for Peptide Therapeutics. Protein Pept Lett. 2018;25:1044-1050.

2.         Himaya SWA, Mari F and Lewis RJ. Accelerated proteomic visualization of individual predatory venoms of Conus purpurascens reveals separately evolved predation-evoked venom cabals. Sci Rep. 2018;8:330.

3.         Olivera BM, Seger J, Horvath MP and Fedosov AE. Prey-Capture Strategies of Fish-Hunting Cone Snails: Behavior, Neurobiology and Evolution. Brain Behav Evol. 2015;86:58-74.

4.         Gillette R and Brown JW. The Sea Slug, Pleurobranchaea californica: A Signpost Species in the Evolution of Complex Nervous Systems and Behavior. Integr Comp Biol. 2015;55:1058-69.

Alcohol or Melatonin?

In 1958, in the Yale laboratories, A.B. Lerner and colleagues isolated melatonin from the pineal gland of bovines1. They were surprised that after 40 years of research they had finally found the active component that lightened the frog skin color, inhibiting the darkening effect of the Melanocyte Stimulating Hormone (MSH); hence the name, Melatonin1. Disappointingly, the skin lightening properties of melatonin could not be further demonstrated and the project was abandoned2. In the 90’s, melatonin got back on the coolness charts of science, with Reppert and Weaver calling it “Madness” in a Cell article in 1995. During this time, it was discovered its function in regulating the seasonal and circadian rhythms3, the presence of its specific G-coupled receptors in different tissues4; and, its antioxidant properties5. Since then, melatonin has been widely studied and continues to wonder over its broad range of therapeutic effects. From helping on jet-lag relief6, with insomnia7, being an anti-aging agent8, neuro-protective9, and also, improving cardiovascular diseases10: melatonin-madness continues until today.

Melatonin is widely accepted as a nutritional supplement being prescribed for sleep regulation in jetlag and adult sleep disorders; but in 2011 the U.S.A Food and Drug Administration (FDA), issued a warning to a company selling “relaxation brownies”, stating that the synthetic melatonin used in them hasn’t been proved safe as a food additive. Most commercial products are offered at dosages of 1-3mg of melatonin, which causes a spike of melatonin in the blood, reaching much higher levels than those that are naturally produced in the body somewhere between 50 and 200 pg/mL.

But, why use synthetic melatonin when this molecule is present in appetizing plants, nuts, fruits, meats, beverages and other foods11? The levels of melatonin in foods are much lower than those given as a nutritional supplement; but it has been proven that eating such foods drastically increases the circulating melatonin levels in the range of physiological concentrations, which peak at nighttime12, 13.

Maldonado and colleagues have shown that different types of beers are rich in melatonin; and, the more melatonin they have got, the greater is their alcoholic degree14. No wonder some people claim that beer makes them sleepy. But, Molfino15and I have made the same question: if the volunteers were sleepy, was it because of the melatonin or an alcoholic-mediated effect? So far, there’s still no answer to that question.

But, Garcia-Moreno and Maldonado’s group have shown, that Barley, which is malted and grounded in the early brewing process, and Yeast, during the second fermentation, are the largest contributors to the enrichment of beer with melatonin16. From this, we can deduct that not only beer has melatonin, but whatever drink where fermentation occurs, will also be rich in it. Logically, wine was also found to be a rich source of the Madness-molecule. In fact, beer has around 0,09 ng/mL while wine is up to 129,5 ng/mL11. And again, Rodriguez-Naranjo and colleagues showed that melatonin is formed during the alcoholic fermentation, because it is absent in the grapes and musts17.

 

References:

    1. Lerner ABC, J.D.; Takahashi, Y.; Lee, T.H.; Mori, W. Isolation of melatonin, a pineal factor that lightens melanocytes. J Am Chem Soc. 1958;80:2587.
    2. Jiki Z, Lecour S and Nduhirabandi F. Cardiovascular Benefits of Dietary Melatonin: A Myth or a Reality? Front Physiol. 2018;9:528.
    3. Arendt J. Melatonin and the pineal gland: influence on mammalian seasonal and circadian physiology. Rev Reprod. 1998;3:13-22.
    4. Reppert SM, Godson C, Mahle CD, Weaver DR, Slaugenhaupt SA and Gusella JF. Molecular characterization of a second melatonin receptor expressed in human retina and brain: the Mel1b melatonin receptor. Proc Natl Acad Sci U S A. 1995;92:8734-8.
    5. Hardeland R, Reiter RJ, Poeggeler B and Tan DX. The significance of the metabolism of the neurohormone melatonin: antioxidative protection and formation of bioactive substances. Neurosci Biobehav Rev. 1993;17:347-57.
    6. Sletten TL, Magee M, Murray JM, Gordon CJ, Lovato N, Kennaway DJ, Gwini SM, Bartlett DJ, Lockley SW, Lack LC, Grunstein RR, Rajaratnam SMW and Delayed Sleep on Melatonin Study G. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial. PLoS Med. 2018;15:e1002587.
    7. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia-Borreguero D, Gjerstad M, Goncalves M, Hertenstein E, Jansson-Frojmark M, Jennum PJ, Leger D, Nissen C, Parrino L, Paunio T, Pevernagie D, Verbraecken J, Weess HG, Wichniak A, Zavalko I, Arnardottir ES, Deleanu OC, Strazisar B, Zoetmulder M and Spiegelhalder K. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26:675-700.
    8. Day D, Burgess CM and Kircik LH. Assessing the Potential Role for Topical Melatonin in an Antiaging Skin Regimen. J Drugs Dermatol. 2018;17:966-969.
    9. Zhao Z, Lu C, Li T, Wang W, Ye W, Zeng R, Ni L, Lai Z, Wang X and Liu C. The protective effect of melatonin on brain ischemia and reperfusion in rats and humans: in vivo assessment and a randomized controlled trial. J Pineal Res. 2018:e12521.
    10. Liu Y, Li LN, Guo S, Zhao XY, Liu YZ, Liang C, Tu S, Wang D, Li L, Dong JZ, Gao L and Yang HB. Melatonin improves cardiac function in a mouse model of heart failure with preserved ejection fraction. Redox Biol. 2018;18:211-221.
    11. Meng X, Li Y, Li S, Zhou Y, Gan RY, Xu DP and Li HB. Dietary Sources and Bioactivities of Melatonin. Nutrients. 2017;9.
    12. Sae-Teaw M, Johns J, Johns NP and Subongkot S. Serum melatonin levels and antioxidant capacities after consumption of pineapple, orange, or banana by healthy male volunteers. J Pineal Res. 2013;55:58-64.
    13. Reiter RJ, Manchester LC and Tan DX. Melatonin in walnuts: influence on levels of melatonin and total antioxidant capacity of blood. Nutrition. 2005;21:920-4.
    14. Maldonado MD, Moreno H and Calvo JR. Melatonin present in beer contributes to increase the levels of melatonin and antioxidant capacity of the human serum. Clin Nutr. 2009;28:188-91.
    15. Molfino A, Laviano A and Rossi Fanelli F. Sleep-inducing effect of beer: a melatonin- or alcohol-mediated effect? Clin Nutr. 2010;29:272.
    16. Garcia-Moreno H, Calvo JR and Maldonado MD. High levels of melatonin generated during the brewing process. J Pineal Res. 2013;55:26-30.
    17. Rodriguez-Naranjo MI, Gil-Izquierdo A, Troncoso AM, Cantos-Villar E and Garcia-Parrilla MC. Melatonin is synthesised by yeast during alcoholic fermentation in wines. Food Chem. 2011;126:1608-13.