A randomized prospective study of gonadotrophin with or without gonadotrophin-releasing hormone agonist for treatment of unexplained infertility

The use of gonadotrophin-releasing hormone agonist (GnRHa) in combination with human menopausal gonadotrophin (HMG) for ovulation induction has been advocated for the treatment, particularly by in-vitro fertilization (IVF) of various types of infertility. The present study was designed to compare the clinical efficacy of HMG alone with a short protocol of GnRHa/HMG for treatment of unexplained infertility. A total of 91 couples with unexplained infertility were randomly assigned to one of two treatments; either HMG with intra-uterine insemination (IUI) (45 patients, 62 cycles) or GnRHa/HMG with IUI (46 patients, 69 cycles) treatments. Progesterone concentrations on the day of human chorionic gonadotrophin (HCG) administration were significantly higher in HMG (1.5 +/- 0.9 ng/ml) versus GnRHa/HMG (0.8 +/- 0.6 ng/ml; P < 0.05) cycles. Furthermore, GnRHa suppressed the occurrences of premature luteinization (GnRHa/HMG 5.8% and HMG 24.2% respectively). However, there were no significant differences in HMG dose requirements, plasma oestradiol concentrations or follicular development on the day of HCG administration between the two groups. Nor were any significant differences found in the pregnancy rates between the two treatment protocols (GnRHa/HMG 13.0% and HMG 11.3% respectively). Our results suggest no beneficial effect of GnRHa/HMG compared to HMG alone for the treatment of unexplained infertility, based on pregnancy rates.

Immunoglobulin prophylaxis against human T cell lymphotropic virus type II in rabbits

Hyperimmune globulins, I-IgG and II-IgG, prepared from healthy persons seropositive for human T cell lymphotropic virus (HTLV) types I and II, respectively, were tested for their prophylactic effect against HTLV-II infection in rabbits. Three groups (A, B, and C) of 3 female rabbits each were used. Group A rabbits were inoculated intravenously with HTLV-II-carrying rabbit lymphoid cell line RII. Group B and C rabbits were immunized, respectively, with II-IgG and I-IgG and challenged with RII cells 24 h later. All group A and C rabbits seroconverted for HTLV-II after 2 weeks, but all group B rabbits were protected from HTLV-II infection. Gene amplification by polymerase chain reaction revealed the presence of HTLV-II provirus sequences in all group A and C rabbits but in none of the group B rabbits. These findings indicate that passive immunization with II-IgG is effective in preventing HTLV-II infection and that there is no cross-neutralization between HTLV-I and -II.

Comparison of the pharmacokinetics of E2020, a new compound for Alzheimer's disease, in healthy young and elderly subjects

E2020, a central-acting cholinesterase inhibitor, is now under clinical development as a potential therapeutic agent for senile dementia of Alzheimer type. In the current study, the authors compared the pharmacokinetics of this drug after single oral administration in 12 healthy young volunteers (20-27 years of age) and 6 elderly volunteers (65-82 years of age). The subjects received a single 2-mg oral dose of E2020 after a meal. Blood samples for determination of the drug level were collected over 168 hours after drug administration and were measured by specific high-pressure liquid chromatography methods with ultraviolet detection. E2020 was generally well tolerated by all subjects of both groups. The plasma elimination half-life of the beta-phase (t 1/2 beta) and time to maximum peak plasma concentration (tmax) were significantly longer in the elderly than in the young: t 1/2 beta, 103.8 +/- 40.6 versus 59.7 +/- 16.1 hours; and tmax, 5.2 +/- 2.8 versus 3.4 +/- 1.5 hours, respectively. There were no statistically significant differences in maximum peak plasma concentration and area under the curve between the two groups. The mean (+/- standard deviation) oral clearance (Cl/F) in the elderly (9.1 +/- 2.4 L/h) was similar to that in the young (10.6 +/- 2.7 L/h). The volume of distribution in the steady state (Vdss/F) was significantly larger in the elderly than that in the young: 1217.2 +/- 223.2 versus 852.5 +/- 147.7 L, respectively. These results suggested that the drug was absorbed more slowly and distributed more widely and thoroughly, but that its clearance from the body is essentially unaffected by age.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of E2020, a new compound for Alzheimer's disease, in healthy male volunteers

E2020 is a new cholinesterase inhibitor with a novel chemical structure, which is under clinical investigation for use in Alzheimer's disease in Japan and the USA. Three separate studies were conducted to evaluate the safety and to establish the pharmacokinetic profile of E2020 after oral administration to healthy male subjects. E2020 was administered as: (1) single oral doses (0.3 mg, 1 mg, 2 mg, 5 mg, 8 mg and 10 mg) in a fasting condition, (2) a single oral dose (2 mg) after a meal and (3) repeated oral doses (2 mg once daily for 21 days). The concentrations of E2020 and its metabolites in plasma, serum, urine and feces were determined by HPLC methods with UV detection. E2020 was generally well tolerated by all subjects. In the single-dose study, there was a linear relationship between dose and mean AUC. The mean plasma half-life was about 50 hours and was dose-independent. The total clearance and renal clearance of E2020 were also dose-independent and the mean values after 10 mg dosing were 9.7 l/hour and 0.86 l/hour, respectively. The cumulative total urinary and fecal excretion of the sum of unchanged E2020 and its metabolites at 264 hours after the administration of the single 10-mg-dose was 36.1% and 8.6% of the dose, respectively. The mean serum protein binding was 92.6%. No effect of food intake on the pharmacokinetics was observed. Evaluation of the mean trough levels and AUC0-24 of E2020 indicated that a steady-state was achieved after approximately 2 weeks of daily dosing.

Association between high grade ventricular arrhythmia and extent of left ventricular hypertrophy in hypertrophic cardiomyopathy

The association between the extent of left ventricular (LV) hypertrophy and severity of ventricular or atrial arrhythmias are examined. Two-dimensional echocardiography and 24-h Holter electrocardiography monitoring were performed in 60 patients with hypertrophic cardiomyopathy (HCM). According to the distribution of the LV hypertrophy, the patients were divided into three groups: 1. Apical hypertrophy (APH), 2. Septal hypertrophy, and 3. Extensive hypertrophy. Ventricular arrhythmias were found in 82% of the patients and supraventricular arrhythmias were detected in 70% of the patients. Lown grade III and IV arrhythmias occurred significantly more frequently in patients with extensive than with septal hypertrophy. Lown grade III to IV arrhythmias did not occur in patients with APH. Present results show a significant association between the extent of LV hypertrophy and the severity of ventricular arrhythmias in HCM.

Phase I study of E1040, a new parenteral cephem antibiotic

The safety and pharmacokinetics of E1040, a new injectable cephem antibiotic, were evaluated in healthy volunteers. In single-dose studies, 125, 250, 500, 1000 and 2000 mg of E1040 were administered by I.V. infusion over 1 hour. Results of 5 minutes I.V. infusions of 500, 1000 and 2000 mg of the drug were also studied. Plasma concentration-time profiles were well suited to a two-compartment open model. The half-life of elimination from plasma was 1.85 +/- 0.16 hours, and the Cmax and AUC paralleled the doses given. The mean urinary recovery within the first 24 hours was 85.7 +/- 6.43% of the dose. In a multiple-dose study, 2000 mg of E1040 (I.V. over 1 hour) was administered every 12 hours (total 9 times) and no abnormal accumulation of the drug in plasma was observed. There were no significant differences in plasma levels or in urinary recoveries between single- and multiple-dose regimens. There were no subjective or objective abnormal findings definitely attributable to the drug except that one subject given 250 mg over 1 hour reported diarrhea, and another complained of nausea during the infusion of 2000 mg over 5 minutes. From these results E1040 was concluded to be safe and well tolerated.

Identification of the collagen-binding domain of vitronectin using monoclonal antibodies

Vitronectin is a 75 kilodalton (kDa) cell-adhesive glycoprotein found in animal blood and connective tissue, also termed serum spreading factor, S-protein, and epibolin. It promotes attachment and spreading of animal cells on tissue culture dishes, and it also binds to collagen. We established four mouse hybridoma lines producing monoclonal antibodies (M1, M2, M4 and M5) to human vitronectin. By immunoblotting, both epitopes recognized by M4 and M5 were suggested to exist in the amino terminal 5 kDa portion of vitronectin, and both M1 and M2 bound to the adjacent 35 kDa portion. Cell spreading on vitronectin-coated dishes was inhibited by M4 = M5 greater than M1, but not by M2. Collagen binding to vitronectin was inhibited by M2 greater than M4 = M5, but not by M1. These results indicate that the collagen-binding site is located near the cell-binding site in the amino terminal half of vitronectin. Independent inhibition of vitronectin binding to the cell and to collagen by these monoclonal antibodies will provide a potential tool to dissect the structure and function of vitronectin.

Biopharmaceutical characteristics of a suppository base containing poly (oxyethylene)-poly (oxypropylene) copolymer, Unilube. I. Effects of a suppository base containing Unilube 70DP-950B on release and rectal absorption of aminopyrine in rabbit

The rectal absorption of aminopyrine (AP) from a three-component-system suppository base (TCS), which is a mixture of oleaginous base, water-soluble base and the poly-(oxyethylene) poly-(oxypropylene) block copolymer, Unilube, was investigated. Albino rabbits were used as the animal model. The bioavailability of oleaginous base and water-soluble base (polyethylene glycol 4000) were 44.3% and 82.6%, respectively. The time to reach maximum plasma concentration (Tmax) of the oleaginous and the water-soluble bases were 21.0 +/- 8.2 min and 33.0 +/- 16.4 min, respectively. When TCS was used, its Tmax was 30 min and increasing the amount of Unilube in the base from 5% (w/w) to 20% (w/w) decreased the bioavailability from 100.4% to 47.2%. The softening temperature of TCS was 55-57 degrees C. Collectively, TCS containing 5% of Unilube gave significantly higher bioavailability than the other bases without softening until 57 degrees C. Also, the results of the two different release tests were compared with the results of an animal experiment in this paper.

Pharmacokinetic study of deuterium-labelled coenzyme Q10 in man

The pharmacokinetics of coenzyme Q10 (CoQ10) in man was studied by utilizing deuterium-labelled coenzyme Q10 (d5-CoQ10). The absence of an isotope effect in the disposition of d5-CoQ10 in man was confirmed from the plasma concentration time curves after simultaneous oral dosing of d5-CoQ10 and unlabelled CoQ10. After oral administration of 100 mg of d5-CoQ10 to 16 healthy male subjects, the mean plasma CoQ10 level attained a peak of 1.004 +/- 0.370 micrograms/ml at 6.5 +/- 1.5 h after administration, and the terminal elimination half-life was 33.19 +/- 5.32 h. In most of the subjects, plasma d5-CoQ10 showed a second peak at 24 h after dosing. This unusual plasma level curve was well described by a newly proposed compartment model based upon the assumption that absorbed CoQ10 is taken up by the liver and then transferred mainly to VLDL and redistributed from the liver to the systemic blood.

[Studies on prophylaxis and therapy of pivmecillinam against post-prostatectomy urinary tract infection]

Patients received pivmecillinam (PMPC) after prophylactic use of various antimicrobial chemotherapeutic agents following prostatectomy, and their clinical responses were assessed for effectiveness in the treatment and prevention of postoperative infection. The data were also analyzed to explore the relationship between bacterial isolates obtained during the postoperative course and the antimicrobial agents administered prophylactically against postoperative infection. Therapeutic effect of PMPC: Treatment of postoperative infections with PMPC was effective in 36 (53.7%) out of 67 patients who had undergone prostatectomy. Prophylactic effect of PMPC: The use of PMPC provided effective prevention of infection in 22 (64.7%) out of 34 patients from whom no bacterial pathogen had been isolated before postoperative antimicrobial chemotherapy. Therapeutic responses to PMPC, compared between different types of operative procedure: There was little or no difference in therapeutic effectiveness of PMPC against postoperative infection when compared between two types of operative procedure, transurethral prostatectomy and subcapsular removal of the prostate. Incidence and types of bacterial isolates following prophylactic chemotherapy with various agents after prostatectomy: Possibly because cephapirin (CEPR) and ticarcillin (TIPC) were mainly administered, alone or in combination, for prophylaxis against postoperative infection, Serratia and Pseudomonas were most frequently isolated. The findings offer suggestions as to the appropriate combination of antimicrobial agents to be used for prophylactic purposes. Effectiveness of PMPC in the presence or absence of a preoperative indwelling urethral catheter: The use of PMPC was more effective both in the treatment and prevention of postoperative infection in cases without preoperative indwelling urethral catheterization than in those with it.

Modification of immune response by cinnarizine

Effects of cinnarizine on immune response in mice were investigated. Mice were orally administered with cinnarizine and were immunized with sheep red blood cells (SRBC) intravenously. Numbers of plaque forming cells (PFC) to SRBC in spleen of these mice were assayed and delayed-type hypersensitivity (DTH) response to SRBC was measured. 1) PFC response in immunization with 5 X 10(6) cells/mouse of SRBC was enhanced by administration of 25 mg/kg of cinnarizine, while the response in immunization with 5 X 10(8) cells/mouse was suppressed by 25 to 200 mg/kg of cinnarizine. 2) From study on timing of administration, suppression of PFC response by 6.25 to 200 mg/kg of cinnarizine was observed at 24 hr. after the immunization. 3) 12.5 to 200 mg/kg of cinnarizine suppressed polyclonal B cell activation induced by lipopolysaccharide (LPS). 4) Colchicine induced suppressor T cell inactivation was prevented by administration of 50 mg/kg of cinnarizine and it was suggested that cinnarizine may induce suppressor T cells from the study of adoptive cell transfer system. 5) 50 mg/kg of cinnarizine showed the suppression of DTH response in expression phase, but not in induction phase. It was concluded that immune responses in mice were modified by cinnarizine.

The effect of assay methods on plasma levels and pharmacokinetics of theophylline: HPLC and EIA

1 The effects of two assay methods, HPLC and EIA, on theophylline plasma levels (n = 254) and pharmacokinetics (n = 6) were examined on blood samples obtained from asthmatic patients and normal adult male volunteers. 2 The standard curves obtained and the plasma level values during plasma level monitoring of theophylline measured with two methods are well correlated each other within concentration range of 2.5 to 20.0 microgram/ml (P less than 0.001). EIA, however in general, appears to give a lower value than HPLC. 3 The values of plasma theophylline half-life and clearance analyzed using a two-compartment open system model were found different between the two assay methods and dissimilar to those previously reported by using ultraviolet method. 4 The sampling end-point and/or assay sensitivity particularly to measure a lower level of theophylline (less than 2.5 microgram/ml) can influence the pharmacokinetics for a potent bronchodilator with a narrow therapeutic margin, theophylline.

Analysis of estrogen glucuronides. I--Characterization of estrogen glucuronides by gas chromatography mass spectrometry

The mass spectral characterization of nine kinds of estrogen glucuronides was investigated. The glucuronides were analysed after conversion to n-propyl ester-O-TMS ether derivatives by gas chromatography mass spectrometry. The fragmentation of these derivatives is discussed using deuterium labels and TMS-d9 imidazole. A clear-cut difference was found between aliphatic and aromatic glucuronic acid conjugates. In particular the [M - 362]+- fragment ion was characteristic in the mass spectra of estrogen 3-glucuronides. On the other hand, four isomers of estriol and 16-epiestriol glucuronides containing an aliphatic acetal linkage were also characterized by the fragment ions of m/e value 204, 345, 415, and 431 and their relative intensities. Thus, all nine estrogen glucuronides were discriminated mass spectrometrically.