Population pharmacokinetics, safety and dosing optimization of voriconazole in patients with liver dysfunction: A prospective observational study

AIMS

Voriconazole is a broad-spectrum antifungal agent for the treatment of invasive fungal infections. There is limited information about the pharmacokinetics and appropriate dosage of voriconazole in patients with liver dysfunction. This study aimed to explore the relationship between voriconazole trough concentration (C_trough ) and toxicity, identify the factors significantly associated with voriconazole pharmacokinetic parameters and propose an optimised voriconazole dosing regimen for patients with liver dysfunction.

METHODS

The study prospectively enrolled 51 patients with 272 voriconazole concentrations. Receiver operating characteristic curves were used to explore the relationship between voriconazole C_trough and toxicity. The pharmacokinetic data was analysed with nonlinear mixed-effects method. Dosing simulations stratified by total bilirubin (TBIL, TBIL-1: TBIL < 51 μmol/L; TBIL-2: 51 μmol/L ≤ TBIL < 171 μmol/L; TBIL-3: TBIL ≥ 171 μmol/L) were performed.

RESULTS

Receiver operating characteristic curve analysis revealed that voriconazole C_trough of ≤ 5.1 mg/L were associated with significantly lower the incidence of adverse events. A 1-compartment pharmacokinetic model with first-order absorption and elimination was used to describe the data. Population pharmacokinetic parameters of clearance, volume of distribution and oral bioavailability were 0.88 L/h, 148.8 L and 88.4%, respectively. Voriconazole clearance was significantly associated with TBIL and platelet count. The volume of distribution increased with body weight. Patients with TBIL-1 could be treated with a loading dose of 400 mg every 12 hours (q12h) for first day, followed by a maintenance dose of 100 mg q12h administered orally or intravenously. TBIL-2 and TBIL-3 patients could be treated with a loading dose of 200 mg q12h and maintenance doses of 50 mg q12h or 100 mg once daily and 50 mg once daily orally or intravenously, respectively.

CONCLUSIONS

Lower doses and longer dosing intervals should be considered for patients with liver dysfunction. TBIL-based dosing regimens provide a practical strategy for achieving voriconazole therapeutic range and therefore maximizing treatment outcomes.

The effect of Clostridium tyrobutyricum Spo0A overexpression in the intestine of mice

Clostridium tyrobutyricum shows probiotic properties and can affect the composition of gut microbiota and regulate the intestinal immune system. Compared with other probiotics, this spore-producing bacterium shows unparalleled advantages in commercial production. In addition to being resistant to extreme living environments for extended periods, its endophytic spores are implicated in inhibiting cancer cell growth. We speculated that C. tyrobutyricum spores can also promote gut health, which mean it can maintain intestinal homeostasis. To date, the beneficial effects of C. tyrobutyricum spores on gut health have not been reported. In this study, a Spo0A-overexpressing C. tyrobutyricum strain was developed to increase spore production, and its probiotic effects on the gut were assessed. Compared with the wild-type, the engineered strain showed significantly increased sporulation rates. Mice administered with the engineered strain exhibited enhanced intestinal villi and the villus height/crypt depth ratio, weight gain and improved Firmicutes/Bacteroidetes ratio to facilitate intestinal homeostasis. This study demonstrated for the first time that enhanced spore production in C. tyrobutyricum can improve intestinal homeostasis, which is advantageous for its commercial application in food and pharmaceutical industry.

FERMT1 promotes gastric cancer progression by activating the NF-κB pathway and predicts poor prognosis

Recent studies have reported that FERMT1, a newly discovered adhesion protein, contributes to an aggressive phenotype in several solid malignancies. However, the function and regulatory mechanism of FERMT1 in gastric cancer remain unknown. We found that FERMT1 was overexpressed in gastric cancer tissues compared with normal tissues. Clinical data analysis indicated that the expression of FERMT1 correlated with the overall survival of gastric cancer patients. Patients with higher FERMT1 expression had lower survival rates than patients with lower FERMT1 expression. We established stable cell lines with FERMT1 knockdown and overexpression. In vitro and in vivo experiments indicated that knockdown of FERMT1 inhibited the proliferation, invasion, metastasis, and epithelial-mesenchymal transition of gastric cancer cells. Mechanistically, FERMT1 was found to activate NF-κB signaling by promoting the degradation of IκBα, thereby promoting gastric cancer. These results provide new evidence of the oncogenic effects of FERMT1 in gastric cancer and suggest that FERMT1 might be a promising target for gastric cancer treatment.

Prunella vulgaris L protects glucocorticoids-induced osteogenesis inhibition in bone marrow mesenchymal stem cells through activating the Smad pathway

OBJECTIVE

To elucidate the role of Prunella vulgaris L (PVL) in protecting glucocorticoids (GC)-induced osteogenesis inhibition, thereafter, protecting the deterioration of osteoporosis (OP).

MATERIALS AND METHODS

Cell Counting Kit-8 (CCK-8) assay was conducted to assess the influence of PVL treatment on MSCs viability. Osteogenesis in MSCs was induced by Dexamethasone (DEX) stimulation. Regulatory effects of PVL on osteogenesis-related gene expressions, ALP activity, and mineralization ability in DEX-induced MSCs were determined. At last, protein levels of p-Smad1/5/9 and total-Smad1/5/9 influenced by DEX and PVL were measured by Western blot.

RESULTS

PVL treatment did not pose a time- or dose-dependent influence on MSCs viability. DEX induction in MSCs downregulated ALP, RUNX2, Bglap, and Osterix. ALP activity and mineralization in DEX-induced MSCs were suppressed. Downregulated osteogenesis-related genes decreased ALP activity and mineralization in MSCs undergoing DEX stimulation were partially reversed by PVL treatment. Moreover, the downregulated p-Smad1/5/9 level in DEX-induced MSCs was elevated by PVL treatment, while total-Smad1/5/9 was not affected.

CONCLUSIONS

PVL alleviated GC-induced suppression in MSCs osteogenesis by activating the Smad pathway, thereafter, protecting the deterioration of OP.

AB0126 EXPRESSION CHARACTERISTICS OF ADENOSINE DEAMINASES ACTING ON RNA-1 IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ITS CORRELATION WITH SERUM IFN-Α

Background:

SLE is a multisystem autoimmune disease characterized by the production of multiple autoantibodies and loss of immunity against autoantigens in various tissues. SLE patients have significantly elevated RNA editing levels and the potential to produce new autoantigens.1ADAR1 is an RNA A-I editing enzyme that converts adenine to hypoxanthine and contributes to SLE pathogenesis.2

Objectives:

Dama demonstrated the upregulation of ADAR1p150 expression in SLE T cells, B cells, PBMCs, and NK cells;3however, the following issues were not reported in detail: 1. specific alterations in ADAR1 expression in PBMCs collected from SLE patients with varying degrees of the disease and its correlation with serum IFN-α levels; 2. association between ADAR1 and clinical indicators; and 3. ADAR1 expression in renal tissue of LN patients. Our study therefore aimed to elucidate the abovementioned points.

Methods:

We used qRT-PCR to determine ADAR1 expression levels in PBMCs and renal tissues of controls and SLE patients. We also conducted immunohistochemical studies to detect positive ADAR1 expression rate in renal cells of controls and LN patients.

Results:

ADAR1 expression was higher in PBMCs of SLE patients than in those of controls and was positively correlated with SLEDAI. When serum IFN-α levels in SLE patients decreased <260.0 pg/mL, ADAR1 expression in PBMCs increased with the increase in IFN-α concentration, and serum IFN-α may regulate ADAR1 level in PBMC in SLE patients, which may require the participation of serum IgG antibody and related immune complex. However, there was no significant difference between the expression in renal tissues in all patients.

Conclusion:

There was a certain correlation between ADAR1 expression and serum IFN-α levels in PBMCs of SLE patients.

References:

[1]Roth SH, Danan-Gotthold M, Ben-Izhak M, et al. Increased RNA Editing May Provide a Source for Autoantigens in Systemic Lupus Erythematosus.Cell Rep2018; 23: 50-57.

[2]Hogg M, Paro S, Keegan LP and O’Connell MA. RNA editing by mammalian ADARs.Adv Genet2011; 73: 87-120.

[3]Laxminarayana D, Khan IU, O’Rourke KS and Giri B. Induction of 150-kDa adenosine deaminase that acts on RNA (ADAR)-1 gene expression in normal T lymphocytes by anti-CD3-epsilon and anti-CD28.Immunology2007; 122: 623-633.

Figure 1.

Analysis of ADAR1 expression levels. a. The ADAR1 expression in PBMCs was higher in SLE patients (n=30) than in healthy controls (n = 30) (p<0.05). b. SLE patients were divided into three groups: NSLE (SLEDAI 0–4, n = 6), LSLE (SLEDAI 5–9, n = 12), and SSLE (SLEDAI ≥10, n = 12) according to SLEDAI score. c. Based on the effect of the disease on the kidneys, the patients were divided into the SLE#group (#:SLE patient group without the kidney involved, n = 17) and LN group (lupus nephritis group, n = 13). d. There was no significant difference observed between the renal tissues of controls (n = 5) and LN patients (n = 10) (p>0.05).

Figure 2.

a. Immunohistochemical image of renal tissues from the two groups (200×). b. There was no significant difference in the ADAR1 cell positive rate between controls (n = 5), LN patients(n = 20), and different pathological subgroups (class III, n = 5; class IV, n = 5; class V, n = 5; class III+IV, n = 5) (p>0.05). c. The positive expression rate of ADAR1 in renal tubular cells was higher than that in glomerular cells both in the two groups (p<0.05).

Figure 3.

a. Correlation between ADAR1 and serum IFN-α levels in PBMCs of SLE patients. b. Correlation between ADAR1p150 and serum IFN-α levels in PBMCs of SLE patients.

Figure 4.

In vitroPBMCs assay. a. Western blot (WB) analysis of ADAR1p150 and ADAR1p110 in PBMCs using different concentrations of IFN-α, combined with 1.5 mg/mL IgG purified from the serum of SLE patients or without it, and cultured for 24 hours. b. The line graph depicts the trend of ADAR1, ADAR1p150, and ADAR1p110 expression with increase in IFN-α concentrationin vitroPBMCs co-cultured with serum IgG from SLE patients.

Disclosure of Interests:

None declared

THU0243 HSA_CIRC_0123190 FUNCTIONS AS A COMPETITIVE ENDOGENOUS RNA TO REGULATE APLNR EXPRESSION BY SPONGING HSA-MIR-483-3P IN LUPUS NEPHRITIS

Background:

Lupus nephritis (LN) is one of the most severe complications of systemic lupus erythematosus (SLE). Circular RNAs(circRNAs) can act as competitive endogenous RNAs (ceRNAs) to regulate gene transcription, which is involved in mechanism of many diseases, such as, autoimmunity diseases. However, the role of circRNA in lupus nephritis has been rarely reported.

Objectives:

In this study, we aim to investigate the clinical value of circRNAs and explore the mechanism of circRNA involvement in the pathogenesis of LN.

Methods:

Renal tissues from three untreated LN patients and three normal controls (NCs) were used to identify differently expressed circRNAs by RNA sequencing (RNA-seq). Validated assays were used by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Correlation analysis and receiver operating characteristic (ROC) curve were used to reveal the clinical value of selected circRNA, miRNA and mRNA. The interactions between circRNA and miRNA, or miRNA and mRNA were further determined by luciferase reporter assay. The degrees of renal fibrosis between the two groups were compared by Masson-trichome staining and immunohistochemistry staining.

Results:

159 circRNAs were significantly dysregulated in LN patients compared with NC group. The expression of hsa_circ_0123190 was significantly decreased in renal tissues of patients with LN (p=0.014), as same as the sequencing results. The area under the ROC curve of hsa_circ_0123190 in renal tissues was 0.820. Bio-informatic analysis and luciferase reporter assay illustrated that hsa_circ_0123190 can act as a sponge for hsa-miR-483-3p which was also validated to interact with APLNR mRNA. APLNR mRNA expression was positively related with chronicity index (CI) of LN (R2=0.452,p=0.033). Finally, the factors of renal fibrosis, especially TGF-β (p=0.018), were more pronounced in the LN group.

Conclusion:

Hsa_circ_0123190 could function as a ceRNA to regulate APLNR expression involved in renal fibrosis by sponging hsa-miR-483-3p in LN

References:

[1]Aljaberi N, Bennett M, Brunner HI, Devarajan P. Proteomic profiling of urine: implications for lupus nephritis. Expert review of proteomics. 2019;16(4):303-13.

[2]Zheng ZH, Zhang LJ, Liu WX, Lei YS, Xing GL, Zhang JJ, et al. Predictors of survival in Chinese patients with lupus nephritis. Lupus. 2012;21(10):1049-56.

[3]Chen LL. The biogenesis and emerging roles of circular RNAs. Nature reviews Molecular cell biology. 2016;17(4):205-11.

[4]Mahmoudi E, Cairns MJ. Circular RNAs are temporospatially regulated throughout development and ageing in the rat. Scientific reports. 2019;9(1):2564.

[5]Liang D, Wilusz JE. Short intronic repeat sequences facilitate circular RNA production. Genes & development. 2014;28(20):2233-47.

[6]Tan WL, Lim BT, Anene-Nzelu CG, Ackers-Johnson M, Dashi A, See K, et al. A landscape of circular RNA expression in the human heart. Cardiovascular research. 2017;113(3):298-309.

[7]Zhao Z, Li X, Jian D, Hao P, Rao L, Li M. Hsa_circ_0054633 in peripheral blood can be used as a diagnostic biomarker of pre-diabetes and type 2 diabetes mellitus. Acta diabetologica. 2017;54(3):237-45.

[8]Ouyang Q, Huang Q, Jiang Z, Zhao J, Shi GP, Yang M. Using plasma circRNA_002453 as a novel biomarker in the diagnosis of lupus nephritis. Molecular immunology. 2018;101(undefined):531-8.

[9]Luan J, Jiao C, Kong W, Fu J, Qu W, Chen Y, et al. CircHLA-C Plays an Important Role in Lupus Nephritis by Sponging miR-150. Molecular therapy Nucleic acids. 2018;10(undefined):245-53.

[10]Kuschnerus K, Straessler ET, Müller MF, Lüscher TF, Landmesser U, Kränkel N. Increased Expression of miR-483-3p Impairs the Vascular Response to Injury in Type 2 Diabetes. Diabetes. 2019;68(2):349-60.

[11]Huang Z, Wu L and Chen L. Apelin/APJ system: A novel potential therapy target for kidney disease. Journal of cellular physiology. 2018;233(5): 3892-900.

Disclosure of Interests:

None declared

Phase dependent encapsulation and release profile of ZIF-based biocomposites

Biocomposites composed of Zeolitic Imidazolate Frameworks (ZIFs) are generating significant interest due to their facile synthesis, and capacity to protect proteins from harsh environments. Here we systematically varied the composition (i.e. relative amounts of ligand (2-methylimidazole), metal precursor (Zn(OAc)2·2H2O), and protein) and post synthetic treatments (i.e. washes with water or water/ethanol) to prepare a series of protein@ZIF biocomposites. These data were used to construct two ternary phase diagrams that showed the synthesis conditions employed gave rise to five different phases including, for the first time, biocomposites based on ZIF-CO3-1. We examined the influence of the different phases on two properties relevant to drug delivery applications: encapsulation efficiency and release profile. The encapsulation efficiencies of bovine serum albumin and insulin were phase dependent and ranged from 75% to 100%. In addition, release profiles showed that 100% protein release varied between 40 and 300 minutes depending on the phase. This study provides a detailed compositional map for the targeted preparation of ZIF-based biocomposites of specific phases and a tool for the straightforward analysis of the crystalline phases of ZIF based materials (web application named "ZIF phase analysis"). These data will facilitate the progress of ZIF bio-composites in the fields of biomedicine and biotechnology.

Predicting the Pharmacokinetic Characteristics of Edaravone Intravenous Injection and Sublingual Tablet Through Modeling and Simulation

PURPOSE

Edaravone is a free-radical scavenger with relatively favorable properties of brain penetration. It has been approved for the indications of acute ischemic stroke and amyotrophic lateral sclerosis (ALS). This study aimed to establish a pharmacokinetic (PK) model to fit the PK profile of edaravone after a single sublingual (SL) dose of a novel edaravone tablet and single IV infusion of injectable edaravone in healthy Chinese volunteers participating in a bioavailability study. The model is expected to be useful for predicting the concentration-time profiles of edaravone following different dosing regimens in a healthy Chinese population. The purposes were to identify an optimal dose and dosing regimen for the new SL formulation and to support future clinical exploration of this tablet product in its approved indications and other therapeutic fields being developed.

METHODS

The PK profiles after a single SL dose or IV infusion of edaravone 30 mg can be well described by a 3-compartment linear disposition model, on which a first-order absorption model with a lag time and a parameter for bioavailability was incorporated to fit the absorption phase of the SL dose. Performance of these PK models was evaluated for goodness of fit, residual trends, visual predictive checks, as well as precision of model predictions against external data. The validated models were employed for simulating the PK profiles of edaravone after a single SL dose of 60 mg and IV infusion of 60 mg for 60 min.

FINDINGS

The resultant estimates support the possibility and feasibility of demonstrating bioequivalence between an SL administration of edaravone 60 mg and the currently approved dosing regimen for ALS (ie, 60 mg IV over 60 min) once per day. The calculation of sample size suggested that the requirement for subject number was acceptable considering the general capacity of a Phase I study center, and so were the procedures defined in the protocol.

IMPLICATION

The models can be further applied to simulate favorable concentration-time profiles in diseases with different underlying courses of oxidative stress, and hence facilitate the optimization of current dosing regimens.

Population pharmacokinetic analysis of intravenous busulfan: GSTA1 genotype is not a predictive factor of initial dose in Chinese adult patients undergoing hematopoietic stem cell transplantation

PURPOSE

This study aimed to develop a population pharmacokinetic (PPK) model to investigate the impact of GSTA1, GSTP1, and GSTM1 genotypes on busulfan pharmacokinetic (PK) variability in Chinese adult patients.

METHODS

Forty-three and 19 adult patients who underwent hematopoietic stem cell transplantation (HSCT) were enrolled for modeling group and validation group, respectively. All patients received twice-daily intravenous busulfan as part of conditioning regimen before HSCT. The PPK model was developed by nonlinear mixed-effect modeling. Covariates investigated were age, sex, actual body weight, body surface area, diagnoses, hepatic function markers, GST genotypes and conditioning regimen.

RESULTS

A total of 488 busulfan concentrations from 43 patients were obtained for the PPK model. The PK of intravenous busulfan was described by one-compartment model with first-order elimination with estimated clearance (CL) of 14.2 L/h and volume of distribution of 64.1 L. Inclusion of GSTA1 genotype as a covariate accounted for 1.1% of the inter-individual variability of busulfan CL (from 17.8% in the basic model to 16.7% in the final model). The accuracy and applicability of the final model were externally validated in the independent group. The difference of busulfan PK between Chinese patients and Caucasian patients existed because of the rarity of haplotype *B in Chinese population.

CONCLUSIONS

Although the GSTA1 genotype-based PPK model of intravenous busulfan was successfully developed and externally validated, the GSTA1 genotype was not considered to be clinically relevant to busulfan CL. We did not suggest the guidance of GSTA1 genotype on initial busulfan dose in Chinese adult patients.