Four-week safety and efficacy study of dorzolamide, a novel, active topical carbonic anhydrase inhibitor

OBJECTIVE

To investigate the activity and local and systemic safety of the topical carbonic anhydrase inhibitor, dorzolamide hydrochloride.

DESIGN

Four-week, double-masked, randomized, placebo-controlled, parallel, three-center study.

SETTING

Referral centers.

PATIENTS

Forty-eight patients with bilateral open angle glaucoma or ocular hypertension and intraocular pressure (IOP) greater than 22 mm Hg entered the study. Two of 28 patients receiving dorzolamide and two of 20 patients receiving placebo were withdrawn due to adverse experiences.

INTERVENTION

Dorzolamide (2%) or placebo to each eye three times daily for 4 weeks.

MAIN OUTCOME MEASURES

Diurnal IOP curves; ophthalmologic evaluations including corneal ultrasound pachymetry and endothelial cell count; and systemic evaluations including vital signs, blood chemistries, complete blood cell counts, urinalysis, electrocardiogram, and drug and carbonic anhydrase activity levels in red blood cells.

RESULTS

Mean IOP at morning trough (8 AM) decreased from 27.1 mm Hg at baseline to 23.5 mm Hg on day 29 with dorzolamide (-13.3%) compared with a decrease from 27.1 mm Hg to 26.4 mm Hg with placebo (-2.3%). Peak activity occurred 2 hours after administration, with IOP decreasing from 26.8 mm Hg at baseline to 21.8 mm Hg on day 29 with dorzolamide (-18.4%) vs 26.1 mm Hg to 25.5 (-2.4%) with placebo. Mean corneal thickness was slightly increased for the dorzolamide-treated group compared with the placebo-treated group (0.009 mm vs 0.001 mm, respectively, P < .05) and changes in endothelial cell counts were similar (-24 cells/mm2 vs -27 cells/mm2, respectively, P > .25). Mean carbonic anhydrase isoenzyme II activity in red blood cells decreased to 21% of baseline in dorzolamide-treated patients. There were no clinically significant differences in ocular or laboratory parameters between the dorzolamide and placebo groups.

CONCLUSIONS

Dorzolamide demonstrated significant IOP lowering activity over 4 weeks. It was well tolerated and there were no clinically significant changes in ocular or systemic safety parameters.

TGF beta inhibits rat thyroid cell proliferation without alterations in the expression of TSH-induced cell cycle-related genes

Transforming growth factor beta (TGF beta) is a secreted polypeptide factor that is thought to play a major role in the regulation of proliferation of many cell types and various differentiation processes. TGF beta acts on thyroid cells by inhibiting cell proliferation and expression of differentiation markers, such as thyroglobulin production and iodide uptake. Exponentially growing thyroid cells cultures accumulate mostly in G0/G1 after exposure to TGF beta for 48 hours. TGF beta inhibits the TSH induced transition of quiescent thyroid cell from the G0 to the S phase. These effects on the thyroid cell growth, however, are not mediated by changes in the TSH-induced cell cycle-related genes expression; both immediate early and progression genes expression is unaffected by the TGF beta treatment.

Tetanus immunity in a partially vaccinated population of children in a district of Naples (Secondigliano)

A general opinion is that compliance with the compulsory immunization programme of children is excellent in Italy. We have studied antitetanus immunity in relation to vaccination history in a sample of 444 school children born between 1977 and 1981 in a district of Naples. Information on vaccination history was collected by interviewing the parents and validated using the official vaccination certificates. Titration of antibodies against tetanus was carried out by the immunoenzymatic method. 0.9% of our study subjects had not been vaccinated at all and only 21.2% had received 4 vaccine doses. In 18 children the presence of antitetanus antibodies was not detected; 14 of them had received one or more doses of vaccine. The lack of compliance with the vaccination programme was associated with a remarkable delay in administering the tetanus vaccine. In the population reported here, the percentage of subjects only partially covered is higher than that found in other regions of Italy.

Decline in the exposure to hepatitis A and B infections in children in Naples, Italy

In May 1988, the hepatitis A antibody (anti-HAV) and hepatitis B virus (HBV) markers were studied by radioimmunoassay in 484 apparently healthy children between the ages of 7 and 12, attending a primary school in Naples, Italy. The overall anti-HAV prevalence was 11.2%, increasing from 5.2 in 7-year-old children to 28.2% in children between the ages of 11 and 12 years old. The overall prevalence of the hepatitis B surface antigen (HBsAg) and of other HBV markers were 0.8 and 6.8 respectively. Compared with a similar previous study conducted in Naples in 1980, the results show a significant reduction in the prevalence of anti-HAV in each of the two age-groups (P less than 0.01), in the prevalence of any HBV marker in the 11 to 12-year-old group, as well as in the total population (P less than 0.05). The findings of the present study indicate that today, children in Naples are less exposed to the hepatitis A virus than in the past, most likely because of improvements in both the socioeconomic conditions and in health education during recent years. These same reasons, as well as decreased family size and a lower prevalence of HBeAg among HBsAg carriers could explain the decline, although to a lesser degree, of exposure to HBV infection.

Chromosomes of older humans are more prone to aminopterine-induced breakage

We have adopted a simplified version of the "cell hybrid cotransfer method" to test the hypothesis that human lymphocytes derived from elderly individuals have a higher chromosome instability. Peripheral blood lymphocytes from "old" male individuals and "young" controls were fused with a Chinese hamster cell line (CHO-YH21), yielding 10 HAT-resistant rodent-human clones from the old propositi and 22 from the young controls (HAT = hypoxanthine/aminopterin/thymidine). Both series of hybrid clones were analyzed with respect to the retention of the enzyme glucose-6-phosphate dehydrogenase and the surface antigen MIC2 identified by monoclonal antibody 12E7, two human X chromosome-linked markers located at opposite ends of the X chromosome. Cell hybrid clones with an X chromosome from a young control retained both markers in about 70% of the cells. In contrast, cell hybrid clones with an X chromosome from an old donor retained the MIC2 marker in only 30% of their cells. Slot-blot hybridization studies have established that the observed loss of the MIC2 marker is due to loss of the coding gene, not to suppression of its expression. Similar hybridization studies with molecular probes specific for other regions of the X chromosome suggest preferential chromosomal breakage sites. T lymphocytes from old donors were also found to have an LD50 for aminopterine significantly lower than the concentration of this drug in the HAT medium used to grow the hybrids, suggesting that the higher level of gene loss observed in the X chromosomes from old donors may be directly related to their increased sensitivity to the clastogenic effect of aminopterine. We speculate that the higher rate of chromosomal breakage and of marker loss observed along the "old-age" X chromosomes could be the result of "molecular scars" accumulated with aging at sites of constitutive chromosomal fragility.

The human genes for hemophilia A and hemophilia B flank the X chromosome fragile site at Xq27.3

Two DNA recombinant clones, shown by separate studies to contain DNA sequences homologous to the genes coding for the human blood coagulation Factors VIII and IX, were hybridized in situ to metaphases or prometaphases derived from patients with the fragile-X syndrome and from a normal control. The results of these experiments indicate that (i) both genes are located in the subtelomeric region of the long arm of the human X chromosome flanking the fragile site at Xq27.3, (ii) the resolution of this localization is approximately 0.5% the length of the human haploid genome, i.e., 1.8 X 10(7) bp, (iii) the linear order of loci within the above region is Factor IX-fragile site-Factor VIII-Xqter. Both the localization and the linear order of these loci have been confirmed by Southern blotting studies using the same molecular probes and a panel of rodent-human somatic cell hybrids known to have retained different segments of the human X chromosome. The findings described herein and the knowledge that Factor IX deficiency recombines freely with at least two loci of the G6PD cluster support our hypothesis that the chromosomal region which includes the fragile-X site is normally a region of high meiotic recombination.

Genes controlling gp25/30 cell-surface molecules map to chromosomes X and Y and escape X-inactivation

The monoclonal antibody AbO13 defines a cell-surface antigen that is expressed on most cultured human cells, but not on rodent cells. AbO13 precipitates glycoproteins of 25,000 and 30,000 mol. wt. from lysates of [3H]glucosamine-labeled human cells. Results of the serological typing of a panel of 25 rodent-human somatic cell hybrid clones show that reactivity with AbO13 segregates with the human X and Y chromosomes. The presence of either of these chromosomes is sufficient for O13 expression on the hybrid cell surface. Analysis of hybrid clones containing human X chromosomes with karyotypically defined deletions permitted the regional assignment of the X-linked gene locus controlling the expression of O13 to Xp22-pter. In addition, AbO13 is reactive with Chinese hamster-human hybrids derived from fibroblasts of a 49,XXXXX individual that contained only inactivated copies of the human X chromosome. These results suggest that the X-linked locus determining the expression of O13 is not subject to X-inactivation.