Bioguided Isolation of Active Compounds from Rhamnus alaternus against Methicillin-Resistant Staphylococcus aureus (MRSA) and Panton-Valentine Leucocidin Positive Strains (MSSA-PVL)

Despite intensified efforts to develop an effective antibiotic, S. aureus is still a major cause of mortality and morbidity worldwide. The multidrug resistance of bacteria has considerably increased the difficulties of scientific research and the concomitant emergence of resistance is to be expected. In this study we have investigated the in vitro activity of 15 ethanol extracts prepared from Moroccan medicinal plants traditionally used for treatment of skin infections. Among the tested species I. viscosa, C. oxyacantha, R. tinctorum, A. herba alba, and B. hispanica showed moderate anti-staphylococcal activity. However, R. alaternus showed promising growth-inhibitory effects against specific pathogenic bacteria especially methicillin-susceptible Staphylococcus aureus Panton-Valentine leucocidin positive (MSSA-PVL) and methicillin-resistant S. aureus (MRSA). The bioguided fractionation of this plant using successive chromatographic separations followed by nuclear magnetic resonance (NMR) and mass spectrometry (MS) including EIMS and HREIMS analysis yielded the emodin (1) and kaempferol (2). Emodin being the most active with MICs ranging between 15.62 and 1.95 µg/mL and showing higher activity against the tested strains in comparison with the crude extract, its mechanism of action and the structure-activity relationship were interestingly discussed. The active compound has not displayed toxicity toward murine macrophage cells. The results obtained in the current study support the traditional uses of R. alaternus and suggest that this species could be a good source for the development of new anti-staphylococcal agents.


Introduction
According to the WHO, 50,000 persons around the world are dying every day because of infectious diseases. In the World Health Report, more than 17 million deaths out of a All solvents used were of analytical grade from Sigma-Aldrich. Silicagel 60 F 254 (Merck -Darmstadt, Germany) plates (20 × 20 cm) supported on aluminum sheet were used for thin-layer chromatography (TLC) separations. Silicagel 60 (Fluka-chemie GmbH) for column chromatography was obtained from Sigma-Aldrich. For the purification procedure, Silica gel 60 (particle size 15-40 and 63-200 µm, Macherey-Nagel) was used for column chromatography (CC), while silica gel 60 F254 was used for analytical TLC. The developed TLC plates were visualized by UV light and then spraying with HOAc-H 2 SO 4 -H 2 O (80:16:4) system, followed by heating at 100 • C during 3 min. 1 H NMR spectrum was carried out on a Bruker Avance 600 spectrometer, with the pulse sequences given by Bruker. The electron impact mass spectrometry (EIMS) and high-resolution electron ionization mass spectrometry (HREIMS) were measured on an LCT Premier XE Micromass Electrospray Spectrometer.

Plant Material and Extraction
Plants were collected from the Atlas Mountains of Imouzzer region-Morocco in July, 2017 and were identified by Pr EL OUALIDI. J. and Pr IBN TATTOU. M. Each plant part was extracted by 6 h maceration with ethanol (96%) (1:10 w/v) at room temperature with continuous stirring at 500 rpm and then air-dried and ground to a powder. A voucher specimen of the active species was conserved under the reference number "RAB107343" in the Herbarium of the Scientific Institute, Rabat, Morocco.

Bacterial Strains
There are a multitude of Staphylococcus aureus strains, each one has specific characteristics. To this end, it is necessary to link each selected strain to specific effects. The strains selected for the present study are characterized by several properties, considering the community of origin, the antibiogram profile, and the absence or presence of PVL toxin, therefore, four strains were selected: three clinical isolates: S. aureus (Sa), S. aureus (MRSA348), S. aureus PVL (SaPVL+), and a methicillin-resistant reference strain (MRSA (ATCC29213)). All strains with a verified antibiogram profile (Tables S1 and S2) are resistant to methicillin except for the toxigenic strain (SaPVL+) which is sensitive. The antibiogram profile of the studied strains was identified at the Laboratory of Bacteriology in Fez-Morocco. In addition, these strains are often involved in cutaneous infections and other invasive infectious diseases.

Antibacterial Testing
In the present work, the evaluation of anti-staphylococcal activity was carried out by a combination of diffusion and dilution methods. After evaluating of the sensitivity of the strains toward DMSO, the fifteen ethanolic extracts that were previously dissolved at a concentration of 50 mg/mL in 2% (v/v) DMSO were screened against the four strains of S. aureus previously described.

Inoculum's Preparation
Revivification of bacteria was performed by subculturing the agar plate surface Luria-Bertani (LB) and incubated at 37 • C for 18 to 24 h. The microbial inoculums were obtained from fresh colonies through the direct colony suspension method. Hence, 1 to 2 colonies were suspended in a sterile saline solution (NaCl 0.9%) and adjusted to 0.5 McFarland scale (10 8 CFU/mL).

Agar Well Diffusion Assay
The preliminary screening of different extracts was carried out using the well diffusion method. The agar surface was inoculated by spreading 1 mL of the bacterial suspension. A vertical hole of 6 mm was punched aseptically and a volume of 80 to 100 µL of each extract at 50 mg/mL was introduced into each well. Finally, the plates were incubated for 24 h at 37 • C.

Agar Dilution Assay
Since the tested extracts are colored, they may mask the detection of the microbial growth in the liquid medium. For this reason, the agar dilution method was performed for the MIC determination as described by Balouiri et al. [23] with slight modifications. This method consists of incorporating the extract at varying concentrations into the agar medium before its solidification (50 • C). Thus, different concentrations of the crude extracts were prepared in diluted DMSO, then 1 mL of each dilution was incorporated into 9 mL of sterile LB to get a serial two-fold dilutions ranging from 16 to 0.5 mg/mL. The obtained mixture was well shaken and distributed into Petri dishes. After the medium solidification, the agar surface was inoculated by spots of 5 µL of the inoculum of 10 5 CFU/mL. The plates were incubated for 24 h at 37 • C. A control was performed without extract. Using different mixtures of organic solvents, a preliminary study of polarity was performed to select the optimal eluent system. After checking up the TLC under UV, the best separation was obtained with a mixture of ethyl acetate: methanol: distillated water (8:1:1). Thus, this mobile phase was used for further experiments including bioautography and chromatographic separations.

Bioguided Fractionation and Purification of
The immersion bioautography procedure was performed on Silica gel TLC plates F 254 . Chromatograms were aseptically cut and placed in 9 cm × 9 cm sterile square Petri dishes and exposed to UV light for 30 min. The crude extract (1 mg/mL) was applied to the chromatograms and eluted with the previous mobile phase. The developed TLC plates were dried and coated with 15 mL of inoculated bacterial medium (10 6 CFU/mL). After medium solidification, the Petri dishes were incubated at 37 • C for 24 h. Inhibitory zones were detected under UV light of 365 and 254 nm [24,25].

Separation and Isolation of Pure Compounds
To isolate the active compounds detected by bioautography against the four S. aureus strains, 8 g of the crude extract was dissolved in ethanol and subjected to silica gel column chromatography eluted with ethyl acetate: methanol: distillated water (8:1:1). This afforded forty-six fractions combined into twelve fractions based on the TLC profile and coded from F1 to F12. According to the antibacterial assay, F3 (175.9 mg) and F6 (31.5 mg) were the most active and were further chromatographed on a silica column eluted with a mixture of dichloromethane/acetone (CH 2 Cl 2 / Me 2 CO) of increasing polarity. As results, subfraction F3A yielded compound 1 (2.5 mg) while subfraction F6B yielded compound 2 (16.6 mg) [26]. The process of this bioguided fractionation is illustrated in Figure 1.

Bioautography
Using different mixtures of organic solvents, a preliminary study of polarity was performed to select the optimal eluent system. After checking up the TLC under UV, the best separation was obtained with a mixture of ethyl acetate: methanol: distillated water (8:1:1). Thus, this mobile phase was used for further experiments including bioautography and chromatographic separations.
The immersion bioautography procedure was performed on Silica gel TLC plates F254. Chromatograms were aseptically cut and placed in 9 cm×9 cm sterile square Petri dishes and exposed to UV light for 30 min. The crude extract (1 mg/mL) was applied to the chromatograms and eluted with the previous mobile phase. The developed TLC plates were dried and coated with 15 mL of inoculated bacterial medium (10 6 CFU/mL). After medium solidification, the Petri dishes were incubated at 37 °C for 24 h. Inhibitory zones were detected under UV light of 365 and 254 nm [24,25].

Separation and Isolation of Pure Compounds
To isolate the active compounds detected by bioautography against the four S. aureus strains, 8 g of the crude extract was dissolved in ethanol and subjected to silica gel column chromatography eluted with ethyl acetate: methanol: distillated water (8:1:1). This afforded forty-six fractions combined into twelve fractions based on the TLC profile and coded from F1 to F12. According to the antibacterial assay, F3 (175.9 mg) and F6 (31.5 mg) were the most active and were further chromatographed on a silica column eluted with a mixture of dichloromethane/acetone (CH2Cl2/ Me2CO) of increasing polarity. As results, subfraction F3A yielded compound 1 (2.5 mg) while subfraction F6B yielded compound 2 (16.6 mg) [26]. The process of this bioguided fractionation is illustrated in Figure 1.

Chemical Structures Characterization
The various chromatographic purification steps led to the isolation of two pure natural compounds. Samples of these both compounds were dissolved in appropriate deuterated solvents to be analyzed by 1 H NMR, EIMS and HREIMS using Bruker Avance 600 spec-trometer and an LCT Premier XE Micromass Electrospray Spectrometer. In addition, the obtained spectrums were compared with those previously reported in literature.

MIC Determination of Fractions and Pure Compounds
The MICs of samples obtained from fractionation were determined using the broth microdilution assay using modified 96-well plate following the recommendations published by CLSI for the effective assessment of the antimicrobial potency of natural products (Clinical and Laboratory Standards Institute 2009). In 96-well plates, a 1 2 dilution range of fractions (0.78125-500 µg/mL) and pure compounds (0.48827-250 µg/mL) was considered. The plates were then inoculated with 50 µL of the bacterial suspension adjusted to a density of 5 × 10 5 UFC/mL. The growth control contained 50 µL of bacterial suspension and 50 µL of LB medium, while the negative control contained 100 µL of LB medium. The plates were incubated at 37 • C for 24 h. MIC values were determined after the addition of 10 µL of resazurin 0.015% (w/v) to each well and the plate was re-incubated at 37 • C for 2 h.

Cytotoxicity Assay
Cytotoxicity test was performed as described by Sifaoui et al. [27], different concentrations of compounds (1) were incubated with the J774A.1 murine macrophage cell line cultured in RPMI medium supplemented with 10% fetal bovine serum (10 5 cells/mL) for 24 h at 37 • C in a 5% CO 2 atmosphere. The viability of the macrophages was determined with the AlamarBlue reagent. Dose response curves were plotted and the CC 50 was obtained. The analyses were performed in triplicate.

Preliminary Antistaphylococcal Screening
In the present work, ethanolic extracts of fifteen plants used in traditional medicine for treatment of infectious diseases such as skin infections, in the Central North of Morocco [28], were evaluated. Leaves of Ammi majus, Artemisia herba alba, Cistus salviifolius, Globularia alypum, Inula viscosa, Lavandula dentata, Nerium oleander, and Rhamnus alaternus; aerial parts of Crataegus oxyacantha and Urtica dioica; roots of Alkanna tintoria, Berberis hispanica, Ephedra altissima and Rubia tinctorum; seeds of Juniperus oxycedrus. The anti-staphylococcal activity of the extracts was determined using the well-diffusion method against clinical isolate and reference strains of S. aureus with distinct characteristics and different antibiogram profiles. The diameters of the inhibitory zones were measured (in mm). The results obtained showed that among the fifteen ethanolic extracts tested, six extracts were active against the target strains, but with different inhibitory zones. Qualitatively, the ethanolic extracts of B. hispanica and R. alaternus showed the best activity against all strains, with a more remarkable susceptibility of Sa and MRSA (ATCC29213) compared to SaPVL+ and MRSA348 (Table 1).

MIC Determination
The six active extracts were subjected to MIC determination using agar diffusion method. According to the results presented in Table 2, the extracts showed varying degrees of activity against the different strains of S. aureus. The extract of R. alaternus showed the best inhibitory effect with a MIC of 0.5 mg/mL against Sa and MRSA (ATCC29213), and 1.0 mg/mL against SaPVL+ and MRSA348. The other extracts showed MICs between 4 and 16 mg/mL.  The serial dilution ranges from 16 to 0.25 mg/mL; the positive control (spots of 5 µL of the bacterial suspension on the agar medium) showed normal growth.
Based on the results of qualitative and quantitative tests, the best anti-staphylococcal effect was obtained by the extract of R. alaternus. Therefore, this plant was selected for further assays aimed at isolating and identifying the compounds responsible for this activity.

Bioguided Fractionation and Identification of Active Compounds
To isolate the compounds involved in the promising activity of R. alaternus against S. aureus, the ethanolic extract was subjected to a bioguided fractionation-alternating chemical and biological tests, followed by several separations and chromatographic purification steps. As a result, forty-six fractions were collected, combined according to their TLC profiles into twelve fractions (F1-F12) and tested against S. aureus strains. The MIC determination of the fractions obtained was performed using the microdilution method with resazurin as a staphylococcal viability indicator at a concentration ranging from 500 to 0.7812 µg/mL. The results obtained are presented in Table 3. As expected from the preliminary results of the bioautography which showed optimal zones of inhibition, fractions F3 (175.9 mg) and F6 (31.5 mg) were the most active with MICs between 31.5 and 200 µg/mL. SaPVL+, MRSA348, and MRSA (ATCC29213) showed the same susceptibility level to both fractions, while Sa was the most susceptible to F3 with a MIC of 31.5 µg/mL, but the least susceptible to F6 with a MIC of 200 µg/mL. Based on the results obtained, only the active fractions (F3 and F6) were selected for further purification using other silica gel chromatographic columns leading to the isolation of two pure natural compounds. The sub-fraction of F3 gave compound (1) (2.5 mg), and the purification of F6 gave compound (2) (16.6 mg).
NMR analyses ( 1 H and 13 C) of these compounds led to the identification of emodin (1) kaempferol (2) (Figure 2). The spectroscopic data from the NMR spectra ( Figures S3  and S4) corroborate those previously reported in the literature [29,30]. In addition, mass spectrometry analyses were performed to confirm the structures obtained ( Figures S5-S8).  Based on the results obtained, only the active fractions (F3 and F6) were selected for further purification using other silica gel chromatographic columns leading to the isolation of two pure natural compounds. The sub-fraction of F3 gave compound (1) (2.5 mg), and the purification of F6 gave compound (2) (16.6 mg).
NMR analyses ( 1 H and 13 C) of these compounds led to the identification of emodin (1) kaempferol (2) (Figure 2). The spectroscopic data from the NMR spectra (S 5 and 6) corroborate those previously reported in the literature [29,30]. In addition, mass spectrometry analyses were performed to confirm the structures obtained (S 7,8,9 and 10). After confirmation of the chemical structures of the two compounds, the determination of MICs and BMCs was performed by the microdilution method still using resazurin as an indicator of staphylococcal viability at a concentration range from 250-0.4882 µ g/mL. In addition, the cytotoxic profile of the active compound was evaluated using Al-amarBlue as an indicator of murine macrophage viability (Table 4).  After confirmation of the chemical structures of the two compounds, the determination of MICs and BMCs was performed by the microdilution method still using resazurin as an indicator of staphylococcal viability at a concentration range from 250-0.4882 µg/mL. In addition, the cytotoxic profile of the active compound was evaluated using AlamarBlue as an indicator of murine macrophage viability (Table 4).  Table 4, we can note that emodin strongly inhibited the growth of the tested strains with a MIC of 15.63 µg/mL against SaPVL+, MRSA348, and MRSA (ATCC29213), and a much lower MIC against Sa (1.95 µg/mL). However, kaempferol was not active at the concentration tested (>250 µg/mL).

Cytotoxicity Assay
The in vitro cytotoxicity of emodin as the active compound was evaluated by calculating the percentage of living macrophage cells regarding different concentrations. Subsequently, the curve obtained allows the calculation of CC 50 s corresponding to the concentration of the compound for which there is a 50% reduction in cell viability compared to untreated macrophages. The determination of the CC 50 s allows the calculation of the selectivity index. The results showed that emodin was not toxic on the J774A.1 macrophage cell line (CC 50 > 100 µg/mL).

Discussion
S. aureus is one of the pathogens involved in a wide clinical spectrum. The emergence of multidrug-resistant and toxigenic strains is a serious public health problem. A multitude of studies have confirmed that the rate of infections worldwide is progressively increasing with the rise of drug resistance and that clinical anti-infective treatment of resistant strains has become more difficult [31,32] especially when the infections are caused by methicillinresistant and/or Panton-Valentine leukocidin positive strains. Indeed, MRSA strains were once largely confined to hospitals, health care services, and patients attending these facilities, known as HA-MRSA. Unfortunately, new strains of MRSA, often referred to as community-associated MRSA (CA-MRSA) strains, appear to be rapidly disseminated in the population and infect people with and without hospital exposure [33]. These CA-MRSA strains participate in widespread severe MRSA infections [34,35].
Therefore, a special interest was taken in the search for new compounds of natural origin. In the present work, screening tests on different strains of S. aureus showed that among the fifteen ethanolic extracts prepared from various plant species, the ethanolic extract of R. alaternus was the most active against the four target strains of S. aureus. We suppose that these results could be explained, on the one hand, by the differences in the permeability of the cell walls to secondary metabolites, and on the other hand, by the differences in the chemical composition of the plants leading to a different mechanism of action. In other words, the extract may contain one or more compounds that are specifically more effective against various strains of S. aureus characterized by different pathogenic and resistant profiles. Despite the antibacterial potential of R. alaternus in the present study, very limited data are available in the literature regarding its antimicrobial effect, especially the anti-staphylococcal activity. It was reported that evaluation of the antibacterial activity of nine extracts and fractions of the leaves of R. alaternus showed that this species exhibits a broad spectrum of antibacterial activity against a wide list of pathogens including a reference strain of S. aureus (ATCC25923). Only ethyl acetate extracts, total flavonoid oligomers, and the ethyl acetate fraction obtained from freezedrying of the aqueous extract showed antibiotic activity against S. aureus with MIC values ranging from 70 to 150 µg/mL; phytochemical screening of these extracts revealed their richness in flavonoids and phenolic compounds [36]. Kosalec et al. have also evaluated the antimicrobial potential of methanolic bark extracts of four species of Rhamnus genus against several bacteria, dermatophytes, and yeasts. They have demonstrated that the extract of R. alaternus inhibited the growth of S. aureus but with a MIC of 2.5 mg/mL and the analysis of the anthraquinone profile revealed the presence of chrysophanol as the main compound, emodin and physion [37]. Although in these studies the leaves and bark of R. alaternus inhibited the growth of S. aureus, in both studies the characterization and purification of the bioactive compounds responsible for the activity was not completed and the antibacterial activity was only tested on reference strains which do not really reflect the reality of clinical strains.
In contrast to antibacterial activities, the literature has focused much more on other previously documented pharmacological properties of R. alaternus. These studies have allowed the characterization of a large list of bioactive compounds but especially antioxidants. Purification procedures have highlighted the presence of flavonols such as kaempferol, rhamnetin and rhamnocitrin [16], anthocyanins [17] and anthraquinones such as emodin [18,19]. The identification of the compounds responsible for the anti-staphylococcal activity of R. alaternus in this work was performed by a bio-guided fractionation, spectroscopic and spectrometric analysis which confirms the abundance of anthraquinones and flavonoids. Our purification process identified emodin belonging to the anthraquinone family and kaempferol to the group of flavonoids, which agree with the literature. Furthermore, we have shown that emodin is the compound responsible for the antibacterial potential of R. alaternus showing a promising activity (MIC up to 1.95 µg/mL) with a non-toxic concentration toward murine macrophages.
Indeed, emodin is a secondary metabolite with a wide range of biological properties in vitro and in vivo: anticancer, antioxidant, anti-inflammatory, antiviral, antiallergic, antibacterial, etc., [38]. Although our study is the first to report the antibacterial effect of emodin isolated from R. alaternus, this compound is well-known for its anti-staphylococcal potential when isolated from other plants. Basu et al. have shown that emodin isolated from Ventilago madraspatana bark was active against S. aureus with an MIC of 90 µg/mL higher than the value reported in our study [39]. Chukwujekwu et al. have reported that emodin isolated from the roots of Cassia occidentalis is the responsible compound for the antimicrobial activity of the ethanolic extract especially against S. aureus with a MIC of 3.9 µg/mL highlighting a more interesting effect than the reference antibiotic, neomycin [40]. On the other hand, it was shown that emodin purified from the roots and rhizomes of Rheum officinale affected the thermogenic curves of S. aureus growth by improving the antimicrobial effect [41]. Similar effects were noted against MRSA and MSSA. Cao et al. have identified emodin as the active compound in Polygoni cuspidati extract. Among the seven major compounds purified, only emodin showed significant activity against a clinical strain of MRSA while causing morphological alterations of the cell wall [42]. Ji et al. have conducted a proteomic study to compare the effect of emodin on MRSA and MSSA strains. They have demonstrated that after treatment of both strains with emodin, protein expression levels were altered by multiple similar mechanisms of action in MRSA than in MSSA namely induction of pyruvate pathway imbalance, inhibition of protein synthesis, and suppression of DNA synthesis, in addition to membrane alterations [43]. In fact, these mechanisms of the action exerted by emodin have been widely confirmed in the literature [44][45][46].
By cross-analysis of the biological and phytochemical data, we can hypothesize the chemical nature of the bioactive compound in the present study, the activity and selectivity of emodin toward S. aureus strains may be related, for example, to functional groups on the phenyl ring of the compound. These findings were confirmed by the researchers. A structure-activity relationship (SAR) study indicated that the hydroxyl groups and the methyl group in the emodin backbone were crucial for anti-MRSA activity and the presence of an iodine atom or an ethylamine group on the aromatic ring improved the activity with higher selectivity index [47]. Furthermore, another study showed that the structure of emodin was strongly involved in the antimicrobial activity. The substitution at position 2 of emodin was detrimental to the antibacterial activity, while the unsaturation of the substitute was important for the activity. Thus, increasing the aliphatic chain length of the methoxyl group at position 3 increases the lipophilicity of the compound, which increases its ability to integrate the bacterial cell wall, which becomes permeable [48].
Nevertheless, emodin's low solubility, poor bioavailability, and oral absorption limit its development into a pharmaceutical product. Several researchers have conducted in vivo trials on the pharmacokinetics of emodin in order to improve its solubility and oral bioavailability by following different approaches such as inhibition of crystallization, glucurono-conjugation, and addition of solubility enhancers such as cyclodextrin A and nanoparticles or combination of emodin with other molecules such as piperine and antibiotics [49][50][51][52][53][54].
In the present work, we have also shown that kaempferol was not active at the tested concentration, which corroborates the study reported by Falcão-Silva et al. where they have indicated that kaempferol glycoside isolated from Herissantia tiubae did not show relevant activity against S. aureus (MIC = 256 µg/mL), but rather this compound modulated the activity of antibiotics, which in combination with antibiotics, reduced MIC values by enhancing the putative efflux pump inhibitory effect in the bacteria [55].
Another important point to discuss in the present work is the evaluation of different strains of S. aureus. In fact, we cannot say that methicillin-resistant or multidrug-resistant strains are the only ones involved in invasive infections, but rather they limit the choice of antibiotic therapy. In this context, several studies have compared the involvement of methicillin-susceptible strains (MSSA) and MRSA in different infections. Ding et al. have evaluated whether there was a difference between breast abscesses caused by MRSA and MSSA. They have noted a dominance of MSSA isolates (N = 132) over MRSA (N = 39), but there was no significant difference in antibiotic use rate, cure rate, and median number of aspirations performed to cure [56]. However, in a prospective study, it was noted that MSSA caused 79% of infections, while MRSA caused only 21% concluding that during the study period MSSA was the main cause of invasive S. aureus infections but the classical virulence toxin PVL was rare in these isolates [57]. Furthermore, Sapri et al. have demonstrated that the most virulent genes, such as PVL, were more frequently found in MSSA than in MRSA. Taken together, these data with specific S. aureus strains, the authors have suspected an inverse relationship between resistance and virulence in S. aureus [58]. In other words, multidrug-resistant strains tend to harbor fewer virulent genes, while MSSA strains are more virulent but susceptible to antibiotics. This hypothesis was previously confirmed by Cameron et al., exploring available clinical and experimental data, they have shown that many major steps in the evolution of resistance in S. aureus are accompanied by virulence alterations [59]. However, other researchers have reported that increased virulence and the development of antibiotic resistance often occur almost simultaneously, but in complex genetic relationships [60].

Conclusions
Among the 15 plants selected for the in vitro inhibition of MRSA and MSSA-PVL, R. alaternus was the most active. The bioguided fractionation of the extract of this plant yielded emodin as the active compound without inducing toxicity toward murine macrophages. However, further in vivo pharmacological research will be required to fully understand the pharmacokinetics of the active compound, to improve its solubility and to evaluate a possible synergistic interaction with other compounds leading to an effective antistaphylococcal formulation.

Patent
Results about fraction 5 (Data not shown) have been subjected to a patent.