Use of atorvastatin in systemic lupus erythematosus in children and adolescents

OBJECTIVE

Statins reduce atherosclerosis and cardiovascular morbidity in the general population, but their efficacy and safety in children and adolescents with systemic lupus erythematosus (SLE) are unknown. This study was undertaken to determine the 3-year efficacy and safety of atorvastatin in preventing subclinical atherosclerosis progression in pediatric-onset SLE.

METHODS

A total of 221 participants with pediatric SLE (ages 10-21 years) from 21 North American sites were enrolled in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus study, a randomized double-blind, placebo-controlled clinical trial, between August 2003 and November 2006 with 36-month followup. Participants were randomized to receive atorvastatin (n=113) or placebo (n=108) at 10 or 20 mg/day depending on weight, in addition to usual care. The primary end point was progression of mean-mean common carotid intima-media thickening (CIMT) measured by ultrasound. Secondary end points included other segment/wall-specific CIMT measures, lipid profile, high-sensitivity C-reactive protein (hsCRP) level, and SLE disease activity and damage outcomes.

RESULTS

Progression of mean-mean common CIMT did not differ significantly between treatment groups (0.0010 mm/year for atorvastatin versus 0.0024 mm/year for placebo; P=0.24). The atorvastatin group achieved lower hsCRP (P=0.04), total cholesterol (P<0.001), and low-density lipoprotein (P<0.001) levels compared with placebo. In the placebo group, CIMT progressed significantly across all CIMT outcomes (0.0023-0.0144 mm/year; P<0.05). Serious adverse events and critical safety measures did not differ between groups.

CONCLUSION

Our results indicate that routine statin use over 3 years has no significant effect on subclinical atherosclerosis progression in young SLE patients; however, further analyses may suggest subgroups that would benefit from targeted statin therapy. Atorvastatin was well tolerated without safety concerns.

[MRI and prostatic cancer: measurements of kinetic perfusion parameters of gadolinium with a computerized-aided diagnostic tool (CAD)]

OBJECTIVES

To assess with a CAD in the peripheral (ZP) and transitional (ZT) zones the areas with modifications of the kinetic parameter Kep (ratio of exchanges between vascular compartment and extravascular extracellular spaces) in prostatic cancers with DCE MRI before radical prostatectomy.

METHODS

Forty-two consecutive patients (mean age 67 years, mean PSA: 8.9 ng/ml) with a prostatic cancer proved after a set of 12 biopsies underwent, before radical prostatectomy, a dynamic MRI (1.5T) with a surface coil after injection of gadolinium. We look with a CAD for foci of voxels with an abnormal Kep in ZP and/or in ZT. Foci of abnormal voxels computerized were compared with histological results of radical prostatectomies: prostates were shared in 12 sectors (six peripheral and six central) and a total of 504 sectors were studied. The links between prostatic capsule and foci of voxels with elevated Kep were systematically evaluated. The location and the local extension of the various cancerous foci were estimated. A comparison with the results of the T2W and T1 DCE MRI sequences without use of the CAD was made.

RESULTS

Eighty-eight percent of investigated patients revealed at least a cancerous focus associated with a group of pathological voxels. Hundred and seventy-eight of the 504 investigated prostatic sectors revealed a cancerous lesion after radical prostatectomy (RP) and 116 a focus of voxels with a pathological Kep being linked to 71 isolated lesions, some of them filling several sectors (47 peripheral and 24 transitional). The automatic research with the software of foci of voxels with a parameter Kep more than 2,2 per minute to detect a cancerous lesion had a sensitivity by sector less than the reading without CAD (69% in ZP and 58% in ZT against respectively, 85 and 66% (p<0.01) but seemed more specific: 98% in PZ and 95% in ZT against respectively, 80 and 82% (p<0.01). After RP, 16 cancers were classified Pt2, 10 Pt2R+ and 16 Pt3. The CAD had a better accuracy (74%) than T2W MRI (60%) to look for an extracapsular extension (EPE) or a risk of positive margins: 86% of extraprostatic extension and 60% of positive margins were near a focus of pathological voxels.

CONCLUSIONS

CAD allowed a computerized qualitative and quantitative study of DCE MRI. It identified and localized with a good specificity the significant foci. A focus of voxels with elevated Kep against the capsule increased significantly the risk of an extraprostatic extension or a positive margin after radical prostatectomy.

The effect of undecanones and their derivatives on tumor angiogenesis and VEGF content

The in vivo effects of some derivatives of aliphatic ketones (2-undecanone, 3-undecanone, 4-undecanone and their derivatives) on L-1 sarcoma tumor angiogenesis and VEGF content were studied in Balb/c mice. Mice that inhaled 10% solution of 3-undecanone(3-on) or 1% solution of 2-undecanone propylene acetal (Acpr2) for 3 days after tumor cells implantation, presented lower neovascular response measured by tumor-induced cutaneous angiogenesis test (TIA) and lower tumor VEGF content in 5-days tumors, than non-inhaled controls. Other substances presented various effects on tumor VEGF concentration and angiogenesis. Histological examination of lesions collected from mice inhaled Acpr2, or non-inhaled controls, revealed small diffused areas of necrosis in the former group. In both groups, slight to moderate inflammatory infiltrations were seen at the tumor's margin. In Acpr2 group, there were less small blood vessels at tumor's margin than in the control group.

Decreased expression of integrins by hematopoietic cells in patients with rheumatoid arthritis and anemia: relationship with bone marrow cytokine levels

BACKGROUND AND OBJECTIVES

In order to gain a better insight into the pathogenesis of the anemia of chronic disease (ACD) accompanying rheumatoid arthritis, we analyzed the density of the integrins very late antigen (VLA) 4 and VLA-5 on the surface of erythroblasts from bone marrow in patients with rheumatoid arthritis. We also measured the concentration of interleukin (IL) 3 and tumor necrosis factor (TNF) alpha in bone marrow. Finally, we analyzed the relationship between integrin expression on hematopoietic cells and the degree of anemia and concentration of cytokines in bone marrow in patients with rheumatoid arthritis.

RESULTS

Patients with rheumatoid arthritis who also had ACD were found to have lower hemoglobin levels and higher C-reactive protein and erythrocyte sedimentation rate compared to patients who had rheumatoid arthritis without ACD or osteoarthritis of the hip. The mean bone marrow concentration of IL-3 was elevated in patients with rheumatoid arthritis and ACD compared to those without ACD or patients with osteoarthritis. IL-3 concentration in bone marrow showed a significant negative correlation with VLA-4 and VLA-5 expression on erythroblasts, but only in patients with rheumatoid arthritis and ACD.

CONCLUSION

Patients with rheumatoid arthritis and ACD have abnormal erythroblasts (decreased VLA density), possibly through an effect on early stages of erythroblast development. Increased levels of IL-3 and the negative correlation between IL-3 concentration in bone marrow and expression of the integrins VLA-4 and VLA-5 may suggest positive feedback between erythroblasts and IL-3, probably associated with decreased sensitivity of bone marrow erythroblasts to IL-3.

Écho-Doppler et cancer de la prostate: option ou nécessité ?

PURPOSE

To evaluate the value of power Doppler sonography (PDS) in patients with a serum PSA level greater than 3.5 ng/ml and note the advantages of PDS in management of biopsy cores and staging in prostate cancer.

MATERIAL AND METHODS

A group of 579 patients with a serum PSA level greater than 3.5 ng/ml underwent sextant biopsies. PDS of the prostate was performed in all patients before biopsy indication. Patients underwent six initial sextant biopsies without Doppler. In 141 patients who retained an elevated serum PSA level, an additional series of six to eight ultrasound-guided biopsies with Doppler were indicated. A total of 299 cancers were diagnosed (126 palpable) after initial biopsies and 85 (13 palpable) after additional biopsies. One hundred seven patients with localized cancer (48 palpable) underwent a radical prostatectomy.

RESULTS

An echographic or vascular anomaly was detected in 335 patients; after biopsies this anomaly corresponded to 260 cancers, 39 of which were not visible (false-negative Doppler results). The negative predictive value was 84% and there was no significant relation between PSA level and negative predictive value. After initial biopsies, if an abnormal Doppler signal was present the risk of having positive additional biopsies was 83%. Abnormal disoriented irregular vessels were present in 69% of patients with a Gleason score of 7 or higher versus 31% in patients with a Gleason score less than 7 (p<0.01). Twenty out of 39 patients with T1c cancer invisible with PDS and not palpable (13% of all cancers) underwent a radical prostatectomy. Eleven of 16 cancers with a Gleason score of 6 or less were found insignificant, but in two cases the lesion was advanced (p<0.01). Of cancers with a tumor vessel crossing the capsule, 71% presented an extraprostatic extension (Se: 37.5%, Spe: 93%, PPV: 71%, NPV: 78%) (p<0.01).

CONCLUSION

In prostatic cancer, PDS allows evaluation of aggressiveness features and can optimize the number of useful biopsy cores.

Comparison of in vitro hepatic models for the prediction of metabolic interaction between simvastatin and naringenin

The study of potential interaction at a very early stage of drug development requires suitable in vitro models that describe drug interactions both qualitatively and quantitatively. The purpose of this work was to help assessing the predictive value of in vitro drug interaction test with liver microsomal fractions and hepatocytes by determination of enzymatic parameters such as the inhibition constant (Ki) and the intrinsic clearance (Clint). This study was conducted to compare different methods of Ki calculation and to determine the most suitable parameter for describing drug interactions. The metabolic interaction between SV and NRG was used as a model to help verifying the suitability of the in vitro model for predicting the kind and degree of metabolic drug interactions. The method of Ki calculation using linearized versions of Michaelis Menten equations based on the simultaneous non linear regressions and the "km app" approach accurately estimated the Ki values. The linear representation of an inherently non linear relationship was only used to establish the mechanism of inhibition and the Clint could be used to predict drug interactions. To further prediction in humans, it seems likely that the simultaneous application of both systems, microsomal fractions and hepatocytes will yield conclusions.

Free radical scavenging and skin penetration of troxerutin and vitamin derivatives

BACKGROUND

By its 'protective function', human skin is a potential target for the production of free radicals. The role played by topically applied antioxidants as inhibitors of oxidative stress damage was felt to be worth investigation.

OBJECTIVE

To investigate the free radical scavenging (superoxide, hydroxyl and peroxyl radicals) and skin penetration of troxerutin in association with ascorbyl palmitate and alpha-tocopheryl succinate, esters of two vitamins commonly used in skin care products.

METHODS

The compounds' scavenging activities, in a concentration-dependent manner, were as follows: hydroxyl radicals in a Fenton-based assay; superoxide radicals in a hypoxanthine/xanthine oxidase system; and lipid peroxidation inhibition of liver microsomes was induced by 2,2'-azobis-(2-amidinopropane) dihydrochloride (ABAP).

RESULTS

A synergic action was observed between alpha-tocopheryl succinate and troxerutin for hydroxyl radical scavenging, between the three compounds for superoxide scavenging and between troxerutin and ascorbyl palmitate in lipid peroxidation inhibition.

CONCLUSION

Using a stripping method, it was shown that the three substances, incorporated in a pharmaceutical preparation, permeated through human epidermis. Thus, this association can improve skin care products for preventing free radical-mediated damage.

Basic principles for the treatment of the rheumatoid hand

This article discusses the overall approach to rheumatoid arthritis patients requiring surgery of the hand. Many rheumato-orthopedic operations do not require the skills of a specially trained orthopedic surgeon. What is essential is familiarity with the basic operative techniques in surgery of the rheumatoid hand. Reduced resistance to infection due to the effects of pharmaceutical agents and the progress of rheumatoid arthritis itself requires particularly delicate treatment of tissue and preventive use of antibiotics.

[Power Doppler and 3D vascular sonography of intraprostatic blood supply: assessment criteria and value for the diagnostic and clinical staging of prostatic cancer]

OBJECTIVES

To compare the value of Power Doppler Sonography (PDS) and B mode sonography in the diagnosis of prostate cancer and to assess the value of PDS to assess cell differentiation as a function of the degree of blood supply and to specify capsular effraction of the cancer.

PATIENTS

133 patients, divided into 2 groups, were investigated: one group consisted of 41 patients with no suspicion of cancer (15 control subjects and 26 patients with acute prostatitis) and a second group consisted of 92 patient with suspected cancer (PSA > 4 ng/ml).

METHODS

Power Doppler sonography with 3D reconstruction was used to calculate a graduated blood supply index from 1 to 3 for nodules of the peripheral zone. Three types of blood supply (A: regular avascular capsule, B: irregular avascular capsule, C: vessels crossing the capsule) were described as a function of the presumed stage of cancer (A: intraprostatic, B: undetermined, C: extraprostatic). Comparison with histology was performed on randomized biopsies (92 cases) and radical prostatectomy specimens (21 cases).

RESULTS

A cancer was diagnosed in 57 of the 92 patients (62%) with suspected cancer. The overall sensitivity of PDS in the initial diagnosis of prostatic cancer was 94.7%, and its specificity was 77.1% (versus 93% and 42.8% for sonography alone, respectively). For a prevalence between 0.4 and 0.9, the PPV ranged from 73.4% to 97.4% and the NPV ranged from 95.6% to 62% (p = 0.02). The correlation between tumour blood supply and Gleason score showed that 20/40 tumours (50%) with a Gleason score > or = 7 had a blood supply index of 3 versus 6/17 (35%) of tumours with a Gleason score < 7 (r = 0.283, p = 0.033). The 3 vascular types, A, B, C, were evaluated prospectively in the detection of capsular effraction. Capsular effraction was detected in one of the 8 cases of type A cancer and in 6 of the 8 cases (75%) of type C cancer.

CONCLUSION

PDS improves the reliability of sonography in the diagnosis and staging of prostate cancer. There is a correlation between tumour blood supply and Gleason score.

In vitro inhibition of simvastatin metabolism in rat and human liver by naringenin

We demonstrated that naringenin (NRG), the aglycon form of naringin present in grapefruit juice inhibits in vitro the metabolism of simvastatin (SV), a HMG-CoA reductase inhibitor. SV undergoes an important first pass metabolism and this is thought to be partly responsible for its low bioavailability after oral administration. SV is a prodrug that requires metabolic activation through hydrolysis by esterases. In addition, SV is a substrate for cytochrome P450 enzymes. NRG, a potent inhibitor of cytochrome P450 enzymes, interferes with the isoenzymes of cytochrome P450 involved in the hepatic metabolism of SV. NRG inhibits the metabolism of SV in rat hepatocytes (the intrinsic clearance of SV decreases from 26.2 microl/min/10(6) cells in absence of NRG to 4.15 microl/min/10(6) cells in presence of 50 microM NRG). This inhibition is more pronounced in hepatocytes (Ki value approximately 5 microM) than in liver microsomes (Ki approximately 23 microM and approximately 30 microM in human and rat liver microsomes respectively). Therefore, the hepatocytes seem to be the best approach for in vitro interaction study between SV and NRG ; and this should be taken into account in the in vitro/in vivo extrapolation. If this interaction were confirmed in man, the doses of SV should be reduced when co-administered with grapefruit juice because of increased bioavailability of SV.

Brassiodol, a new iodised oil for goitrous patients

A new iodised oil, called Brassiodol, is proposed to prevent or eradicate 127I-deficiency disorders. Its original synthesis utilises rapeseed oil as vehicle of iodination, allowing the covalent binding of 127I atoms to all olefin groups of fatty acids (FAs). The final product contains 376 mg 127I/mL, manifests high refractoriness to degradative processes and is well tolerated by goitrous patients. The proposed dosage is 1 mL/year in adults owing to the rapid deiodination and massive 127I leakage of larger amounts in the urinary output. About 300-350 mg 127I may undergo tissue sequestration, insuring appropriate iodine coverage during 9-12 months. Clinical follow-up, hormonal data, and 127I excretory kinetics point to the normalisation of thyroid function within 3 months is stages I and II of the goitrous disease. This iodised oil, characterised by low cost, easy handling and high nutritional efficiency, seems ideally suited to meet public health and economical problems in countries facing severe goitrous areas.

Concentrations of pefloxacin in plasma and tissue after administration as surgical prophylaxis

Plasma and epiploic-fat drug concentrations determined by high-performance liquid chromatography and fat penetration of pefloxacin and its metabolite (norfloxacin) given for antimicrobial prophylaxis were studied in patients scheduled for colorectal surgery. Concentrations of pefloxacin in plasma decreased about 40% from the beginning of the operation to closure of the peritoneum, and corresponding levels in epiploic fat stayed stable. The plasma and tissue norfloxacin concentrations were very low. Concentrations of pefloxacin in tissue were greater than MIC at which 90% of isolates are inhibited for sensitive bacteria (members of the family Enterobacteriaceae). The penetration of pefloxacin into epiploic fat was about 32%.

Iodised rapeseed oil for eradication of severe endemic goitre

Iodised oil is traditionally based on the fatty acids (FAs) of the poppyseed, an expensive commodity. An equipotent but cheaper vehicle would be welcome. Iodination of rapeseed oil yields a product (Brassiodol) with a total iodine content of 376 mg/mL. Brassiodol has been compared with the poppyseed-based Lipiodol in two villages in Chad in the west African goitre belt. A 2 mL dose of Brassiodol is followed by urinary spillover of half the ingested iodine. The other half undergoes tissue sequestration and slow release, allowing protection against iodine deficiency for 9 months and regression of stage I/II goitre for longer than was achieved with Lipiodol. The prolonged protection offered by Brassiodol can be attributed to its unique lipid profile. The urinary output argues that 1 mL should not be exceeded, and at that dose the cost would be only 20 US cents per person per year.

Kinetics of the competitive degradation of deoxyribose and other molecules by hydroxyl radicals produced by the Fenton reaction in the presence of ascorbic acid

The competition method in which the Fenton reaction is employed as an .OH radical generator and deoxyribose as a detecting molecule, has been used to determine the rate constants for reactions of the .OH radical with its scavengers. Nonlinear competition plots were obtained for those scavengers which reacted with the Fenton reagents (Fe2+ or H2O2). Ascorbic acid is believed to overcome this problem. We have investigated the kinetics of deoxyribose degradation by .OH radicals generated by the Fenton reaction in the presence of ascorbic acid, and observed that the inclusion of ascorbic acid in the Fenton system greatly increased the rate of .OH radical generation. As a result, the interaction between some scavengers and the Fenton reagents became negligeable and linear competition plots of A degree/A vs scavenger concentrations were obtained. The effects of experimental conditions such as, the concentrations of ascorbic acid, deoxyribose, H2O2 and Fe(2+)-EDTA, the EDTA/Fe2+ ratio as well as the incubation time, on the deoxyribose degradation and the determination of the rate constant for mercaptoethanol chosen as a reference compound were studied. The small standard error, (6.76 +/- 0.21) x 10(9) M-1s-1, observed for the rate constant values for mercaptoethanol determined under 13 different experimental conditions, indicates the latter did not influence the rate constant determination. This is in fact assured by introducing a term, kx, into the kinetic equation. This term represents the rate of .OH reactions with other reagents such as ascorbic acid, Fe(2+)-EDTA, H2O2 etc. The agreement of the rate constants obtained in this work with that determined by pulse radiolysis techniques for cysteine, thiourea and many other scavengers, suggests that this simple competition method is applicable to a wide range of compounds, including those which react with the Fenton reagents and those whose solubility in water is low.

Stringent regulation of human growth hormone expression in cultured murine C2C12 myoblasts by the E. coli lac repressor

Gene transfer techniques can be used to encode the production of a polypeptide product, such as human growth hormone (hGH), that is missing in an acquired or inherited disease state such as growth hormone deficiency. In one model system, engineered C2C12 myoblasts are injected intramuscularly into a mouse and subsequently secrete hGH into the circulation. In this regard, a gene-expression regulatory system that functions in myoblasts would be of interest. We demonstrate that the Escherichia coli ldc operon system can be used to stringently regulate the expression of hGH in engineered C2C12 myoblasts in tissue culture. A DNA segment encoding hGH was linked to a DNA segment containing an SV40 enhancer and promoter. The latter components were positioned between two synthetic lac operators. Lac repressor expression was driven by a simian cytomegalovirus promoter. In transient co-transfection assays, hGH expression from cultured C2C12 myoblasts could be modulated up to 60-fold (P = 0.002) with the inducing agent, isopropyl-beta-D-thiogalactoside (IPTG). In the absence of IPTG, hGH expression was almost fully repressed. These results show that the components of the E. coli lac operon provide a stringent regulatory system for use in myoblasts. The system might prove to be useful for the regulation of transferred genes in animals.

Evidence for a second site of absorption of veralipride in the human small intestine. Use of a new drug delivery telemetric shuttle

A new telemetric shuttle was used to coadminister veralipride (CAS 66644-81-3) and veralipride-D3 in order to test the assumption that veralipride is absorbed at two sites of the small intestine. Two different pharmacokinetic approaches were used to interpret the obtained data. According to the results, the second site of absorption of veralipride is located at a distance corresponding to 2/3 of the total length of the small intestine.

Gas chromatographic-mass spectrometric determination of ibuprofen enantiomers in human plasma using R(-)-2,2,2-trifluoro-1-(9-anthryl)ethanol as derivatizing reagent

A relatively rapid, inexpensive, sensitive and stereospecific gas chromatographic-mass spectrometric method was developed for the quantification of S(+) and R(-)-ibuprofen in human plasma. This method uses a commercially available internal standard and has no interference from endogenous substances nor metabolites. The method involves derivatization of ibuprofen enantiomers with optically active R(-)-2,2,2-trifluoro-1-(9-anthryl)ethanol using oxalyl chloride as the coupling reagent. The subsequently formed diastereoisomers are separated by gas chromatography and analysed by mass spectrometry using selected-ion monitoring. The assay is successfully applied to a pharmacokinetic study. The simplicity, sensitivity and precision of the method make it convenient for the quantification of ibuprofen enantiomers in biological samples.