First clinical evaluation of ganstigmine in patients with probable Alzheimer's disease

The objective of this study was to evaluate the safety, tolerability, maximum tolerated dose, pharmacokinetics, and pharmacodynamics of five fixed doses of ganstigmine (CHF 2819) in patients with probable Alzheimer's disease (AD). This randomized, double-blind, placebo-controlled trial evaluated five dose levels (5, 7.5, 10, 12.5, and 15 mg) administered orally once daily for 7 days. Adverse events and continuous telemetry were collected on successive panels of six patients (five active, one placebo). Acetylcholinesterase, butyrylcholinesterase, and plasma drug levels were measured. A total of 29 patients were randomized and 18 completed the study. A total of seven patients, including five of five in the 12.5-mg panel, discontinued because of adverse events. Four patients were withdrawn administratively from the first panel while an episode of atrial fibrillation (the only serious adverse event) was investigated. This panel was then repeated. Mild, transient headache or nausea were the most commonly reported adverse events. Multiple moderate adverse events in the 12.5-mg panel (including nausea, vomiting, and anorexia) led to the decision not to proceed with a 15-mg panel. Ten milligrams was determined to be the maximum tolerated dose. Ganstigmine exhibited nonlinear pharmacokinetics, was absorbed rapidly, and reached peak concentrations within 1 hour. Acetylcholinesterase inhibition was dose dependent and lasted as long as 24 hours. Ganstigmine, a novel cholinesterase inhibitor, was well tolerated within a dosing range of 5 to 10 mg. Once-daily dosing is supported by data on acetylcholinesterase inhibition.

Supplement use in the adolescent athlete

Use of dietary supplements has become common practice among adolescent athletes in the United States. Concern has arisen regarding safety in adolescents in light of the fact that supplements are not required to meet usual US Food and Drug Administration requirements for standard pharmaceuticals. Furthermore, advertised ergogenic gains are based on little or no scientific evidence. Creatine, anabolic steroids, androstenedione, dehydroepiandrosterone, caffeine, ephedrine-type alkaloids, calcium beta-hydroxy-beta-methybutyrate, and human growth hormone are reviewed. Although some studies have indicated performance benefit in particular athletic situations, there are few available data in adolescents. Furthermore, the few safety studies of these supplements do not include adolescents. Adolescents may be at particular risk when using anabolic steroids and caffeine-ephedra combinations. Research has demonstrated effective education programs can reduce adolescents' intentions to use dietary supplements.

Non-nutrient bioactive substances of pulses

Pulses supply many bioactive substances found in minor amounts in food, but which may have significant metabolic and/or physiological effects. These compounds have long been classified as antinutritional factors, but many studies have reconsidered their impact on health. Some could play a role in the prevention of the major diseases of affluent societies. As these compounds can be beneficial or adverse, depending on conditions, an assessment of their various physiological effects is necessary to determine whether they should be preserved or eliminated in each main nutritional situation.

The association between Viadent use and oral leukoplakia--results of a matched case-control study

OBJECTIVES

Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent mouthrinse or Viadent toothpaste was commonly used by them. A hypothesis was developed that Viadent or a component of Viadent caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent products.

METHODS

A matched case-control study was designed to test the hypothesis that use of Viadent products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use.

RESULTS

An age difference was seen between cases and controls, the cases being older (P < .001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent products was a risk indicator for oral leukoplakia (odds ratio = 10.0; 95% confidence interval = 2.0, 89.2).

CONCLUSIONS

Viadent use is a risk indicator for oral leukoplakia, confirming our previous findings.

New sources of dietary myosmine uptake from cereals, fruits, vegetables, and milk

Myosmine has been regarded as a specific tobacco alkaloid until investigations pointed out that nuts and nut products constitute a significant source of myosmine. In the present study it is shown that the occurrence of myosmine is widespread throughout a large number of plant families. Using a method for extraction practicable for all examined foods, quantitative analysis through internal standard addition showed nanograms per gram amounts. Positively tested edibles were staple foods such as maize, rice, wheat flour, millet, potato, and milk and also cocoa, popcorn, tomato, carrot, pineapple, kiwi, and apples. No myosmine was detectable in other vegetables and fruits such as lettuce, spinach, cucumber, onion, banana, tangerines, and grapes. Myosmine is easily nitrosated giving rise to a DNA adduct identical to the esophageal tobacco carcinogen N-nitrosonornicotine. Therefore, the role of dietary myosmine in esophageal adenocarcinoma should be further investigated.

[A clinical research on oxymatrine for the treatment of chronic hepatitis B]

OBJECTIVE

To investigate the clinical effect of oxymatrine on chronic viral hepatitis B and to look for new methods for treating hepatitis B.

METHODS

Multi-center, controlled study was used. In this study, 196 patients were allocated to oxymatrine, oxymatrine with Ara-AMP, IFN-a1b, and glucose groups to observe ALT, AST and viral marker changes.

RESULTS

At the end of treatment, the rate of normal ALT, the negative rate of HBV DNA and HBeAg, and the positive rate of HBeAb were similar in oxymatrine, oxymatrine with Ara-AMP, and IFN-a1b groups. It was higher than that of glucose group. After 12 months follow up, the total effective rate is 40.8%, 60.8% and 43.1% in oxymatrine, oxymatrine with Ara-AMP, and IFN-a1b groups, respectively.

CONCLUSIONS

Oxymatrine, oxymatrine with Ara-AMP, and IFN-a1b are effective to treat hepatitis B with a good negative rate of HBV DNA and HBeAg and positive rate of HBeAb.

In vitro activity of Triclisia patens and some bisbenzylisoquinoline alkaloids against Leishmania donovani and Trypanosoma brucei brucei

In the search for antiprotozoal compounds from natural sources, Triclisia patens displayed activity against L. donovani promastigotes (IC(50) = 1.5 microg/mL) and T. b. brucei blood stream trypomastigote forms (IC(50) = 31.25 microg/mL). In addition, a total of 20 bisbenzylisoquinoline alkaloids were screened for antileishmanial and antitrypanosomal activity in vitro. Fangchinoline (IC(50) = 0.39 microM) was found to be as active as the standard pentamidine against Leishmania donovani promastigotes. Phaeanthine was three-fold more active (IC(50) = 2.41 microM; 1.5 microg/mL) than the standard drug Pentostam against L. donovani amastigotes, but at this concentration was toxic to murine macrophages. In contrast, cocsoline (IC(50) = 12.3 microM; 6.76 microg/mL) was as active as Pentostam, and was not toxic to macrophages at this concentration. Thalisopidine showed the strongest activity (IC(50) = 1.14 microM) against Trypanosoma brucei brucei blood stream form trypomastigotes, but was less active than pentamidine.

The Arctic Alzheimer mutation enhances sensitivity to toxic stress in human neuroblastoma cells

The E693G (Arctic) mutation of the amyloid precursor protein was recently found to lead to early-onset Alzheimer's disease in a Swedish family. In the present study, we report that the Arctic mutation decreases cell viability in human neuroblastoma cells. The cell viability, as measured by the MTT assay and propidium iodide staining, was further compromised following exposure to calcium ionophore A23187, microtubule-binding colchicine or oxidative stress inducer hydrogen peroxide. The manner of cell death was found to be apoptotic. During apoptosis, cells with the Arctic mutation also decreased their secretion of beta-secretase cleaved amyloid precursor protein. The enhanced sensitivity to toxic stress in cells with the Arctic mutation most likely contributes to the pathogenic pathway leading to Alzheimer's disease.

[Effects of higeramine on hemodynamics and its tolerability and safety, an experimental study]

OBJECTIVE

To investigate the effects of higeramine (HG) on hemodynamics and its tolerability and safety so as to see if it can be used in cardiac loading test, and to compare the hemodynamic effects of HG and dobutamine (DB).

METHODS

Six dogs were infused intrevenously with HG in escalating doses from l microgram/kg/min through 2 microgram/kg/min and to 4 microgram/kg/min, each dose being given for 5 minutes. Then the dogs were infused intravenously with DB at the escalating doses from 5 microgram/kg/min through 10 microgram/kg/min to 20 microgram/kg/min, each dose being given for 5 minutes. Heart rate (HR), blood pressure (BP), cardiac output (CO), myocardial oxygen consumption (MOC), and coronary blood flow (CBF) were measured at the beginning of test and by the end of each dose-infusion. Electrocardiography was conducted in the meantime. Left ventricular ejection fraction (LVEF) was measured with radionuclide equilibrium ventriculography. Another 8 dogs were given HG at the escalating doses from 1 microgram/kg/min up to 500 microgram/kg/min, each dose being infused for 3 minutes, to observe the tolerability and safety of HG, HR, BP, and ECG were monitored during the test.

RESULTS

Intravenous administration of HG results in significant inotropic and chronotropic effects on the heart. HR, MOC, CO and CBF all increased in a dose-dependent manner in both HG and DB tests. HG did not cause significant change in systolic blood pressure (SBP), but a slight decrease in diastolic blood pressure (DBP) was found. HR increased steeply to the peak, and then remained at a plateau level. No significant ECG abnormality was seen except a few occasional premature ventricular beats. No dog died during the study.

CONCLUSION

HG can be used in pharmacological stress test with remarkable tolerability and safety even at the dosage of 500 microgram/kg/min without serious adverse effect. It can be used as an alternative agent to DB under appropriate circumstances.

Three cases of angel's trumpet tea-induced psychosis in adolescent substance abusers

An increase of intoxications in persons using alkaloid-containing ornamental plants (mainly angel's trumpet) for their hallucinogenic effects and easy and cheap availability is registered. It is mainly adolescents who are experimenting with these plants. In addition to severe vegetative anticholinergic symptoms, the clinical picture is often dominated by a toxic psychosis with hallucinations, disturbances of orientation, and psychomotoric agitation, aggression, or anxiety. Three cases of severe psychotic pictures with only mild or completely missing vegetative symptoms after ingestion of angel's trumpet tea are reported. Caused by the increasing spreading of angel's trumpet shrubberies in Europe and North America, intoxications with large numbers of fatalities have to be expected in the future. The taxonomical, pharmacological, and clinical aspects of angel's trumpet-induced disorders are discussed. Knowledge of the clinical picture is important for correct diagnosis and treatment. Prevention by mass media should mainly focus on the medical fatalities of abuse and not emphasize the hallucinogenic effects, presumably increasing unwanted interest for these plants among youths.

Taxanes in Taxus baccata pollen: cardiotoxicity and/or allergenicity?

Diterpenic alkaloids belonging to taxine (yield: 0.18 % dry weight) and taxoids (paclitaxel, baccatine III and 10-deacetylbaccatine III, cumulated yield: 0.004 % dry weight) were isolated from Taxus baccata L. pollen. Moreover, taxoids conjugated to macromolecules were also detected by ELISA. According to these data and to semi-quantitative measurements of pollen production, a hundred-year-old yew during its flowering time releases several grams of taxanes contained in 16 to 20 kg of pollen. Toxicity assays on mice indicated that any risk of acute toxicity resulting from Taxus pollen inhalation and subsequent taxine absorption is unlikely. On the other hand, anti-paclitaxel IgG were above all detected in sera of subjects displaying hypersensitivity reactions during the pollination periods of Taxus sp. and Betula sp. This natural anti-paclitaxel IgG acquisition by individuals living in the distribution areas of these trees could be at the origin of atopic manifestations. We also postulate that such a natural sensitization could have a marked influence on the tolerance to anticancer taxoids.

Sanguinaria-related leukoplakia: epidemiologic and clinicopathologic features of a recently described entity

An association between the use of Viadent toothpaste and/or mouthwash and the development of leukoplakia oral mucosal lesions has been described recently. Discontinuing the Viadent products may result in resolution of the leukoplakia, although frequently this is not the case. In order to corroborate the earlier study and to provide further insight regarding the clinical features of this process, a case-control study was conducted. A significant association was seen between the use of Viadent products and the development of oral leukoplakia. Furthermore, leukoplakias affecting sites other than the buccal vestibule also were associated with the use of these products.

The association between Viadent use and oral leukoplakia

Recently, leukoplakia of the maxillary vestibule was described in patients with no traditional risk factors but who had used Viadent products. We designed a case-control study to evaluate the hypothesis that Viadent users were more likely to have lesions. One hundred and forty-eight cases and controls were identified through the Section of Oral and Maxillofacial Pathology. Cases and controls were administered a questionnaire about Viadent use and other known risks. Results of crude, stratified, and logistic regression analyses showed that use of Viadent products was a risk indicator for leukoplakia (adjusted OR = 9.7, 95% CI = 4.7-21.6), with a strong dose-response relation.

Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives

Betel quid (BQ)-chewing is a popular oral habit with potential links to the occurrence of oral cancer. Many of the literature-based studies reveal that areca nut (AN) extract may demonstrate mutagenic and genotoxic effects, in addition to inducing preneoplastic as well as neoplastic lesions in experimental animals. Areca nut should, thus, be highly suspected as a human carcinogen. Toxicity studies relating to AN-contained polyphenols and tannins are not conclusive, with both carcinogenic and anti-carcinogenic effects being reported. The mutagenicity and genotoxicity of areca alkaloids has been detected by many short-term assays. However, their genotoxicity to oral fibroblasts and keratinocytes, the target cells of BQ, has not been identified. It would thus appear that AN toxicity is not completely due to its polyphenol, tannin and alkaloid content. The single agent which is responsible for AN carcinogenicity awaits further clarification. Reactive oxygen species produced during auto-oxidation of AN polyphenols in the BQ-chewer's saliva, are crucial in the initiation and promotion of oral cancer. Nitrosation of areca alkaloids also produces AN-specific nitrosamines, that have been demonstrated to be mutagenic, genotoxic and are capable of inducing tumors in experimental animals. Arecaidine and AN extract are further suggested to be tumor promoters. Antioxidants such as glutathione and N-acetyl-L-cysteine can potentially prevent such AN-elicited cytotoxicity. Further studies are needed to delineate the metabolism of AN ingredient and their roles in the multi-step chemical carcinogenesis, in order to enhance the success of the future chemoprevention of oral cancer and oral submucous fibrosis.

Ukrain (NSC-631570) in the treatment of pancreas cancer

The aim of this study was to investigate the effects of Ukrain in the treatment of pancreatic cancer. Most patients with advanced pancreas cancer experience pain and have to limit their daily activities because of tumor-related symptoms. Currently, there is no satisfactory treatment for pancreas cancer. The 12-month survival rate is approximately 18% for patients treated with gemcitabine and only around 2% for those treated with 5-fluorouracil. Between January 1, 1996 and December 31, 1999 42 patients with advanced symptomatic pancreas cancer were randomly assigned to receive either vitamin C (5.4 g every second day, repeated 10 times) and Ukrain (10 mg every second day, repeated 10 times) (21 patients), or vitamin C (5.4 g every second day x 10) and normal saline (10 ml) (control group, 21 patients). The primary measure of efficacy was overall survival. Other evaluation criteria included change in body weight, pain intensity (measured by analgesic consumption) and Kamofsky performance status. The one-year survival was 81% in the Ukrain group compared with 14% in the control group. The 2-year survival was 43% in the Ukrain group compared with 5% in the control group. In a recent study of 126 patients treated with gemcitabine or 5-fluorouracil, none of the patients survived beyond 19 months. The longest survival in the Ukrain group was 54 months after the start of therapy (from March 1996 to date). The last follow-up of other patients was on September 6, 2000. Median survival was 17.17 months for Ukrain-treated patients and 6.97 months for the control group and mean survival was 21.86 and 8.92 months for the Ukrain and control groups, respectively (p = 0.001). Ukrain treatment was well tolerated. We conclude that Ukrain prolongs survival of pancreas cancer patients. To determine whether and to what extent this drug can be used as standard therapy in pancreas cancer, a phase III study should be carried out.

Results of Ukrain monotherapy of prostate cancer

This study included 15 patients with newly diagnosed prostate cancer with an average age of 71 years (62-85 years). The patients received Ukrain at a total dose of 100 mg (10 mg intravenously every second day, 10 injections altogether). After two to three injections of Ukrain, all the patients noted considerable subjective improvements in their state. Ukrain increased the amount of total T-lymphocytes, including "active" T-lymphocytes, decreased the content of T-suppressors and increased that of T helpers, correspondingly raising the T helper/T-suppressor ratio. Our results undoubtedly indicate the efficacy of Ukrain in the treatment of prostate cancer.

Comparison of the efficacy of different doses of Ukrain in the combined treatment of breast cancer

The aim of this study was to compare the efficacy of different Ukrain doses in the combined treatment of 75 patients with breast cancer. The patients were divided into three groups: groups I and II (25 patients each) were treated with 50 mg and 100 mg of Ukrain, respectively, before surgery; group III (25 patients) served as control (without Ukrain treatment). Clinical observations, biochemical, hormonal and immunologic indices indicated that both doses of Ukrain had a similar beneficial effect on patient outcome and may be indicated in the presurgical treatment of patients with breast cancer.

Ukrain treatment in a patient with metastatic renal cell carcinoma extending to the vena cava inferior. Case report

A 52-year-old man with renal cell carcinoma was treated with surgery and chemotherapy (vinblastine). Ukrain was administered after tumor progression to the vena cava inferior and appearance of liver metastasis. The drug induced a complete remission, which has lasted 32 months since the first therapy course.

Ukrain treatment of a patient with retroperitoneal synovial sarcoma. Case report

A 23-year-old woman, diagnosed with a synovial sarcoma of the peritoneum, underwent an operation for tumor extraction. In the postoperative period, Ukrain was injected i.v. at a dose of 10 mg on alternate days, for a total of 10 injections. After a 2-month break, this schedule was repeated. Ukrain treatment was well tolerated by the patient and there were no complications in the postoperative period. The following changes in immunohematological parameters were observed: increased total leucocytes, T lymphocytes and T helpers. Nearly 4 years after Ukrain therapy, the patient is in complete remission.

Retrospective study of Ukrain treatment in 203 patients with advanced-stage tumors

A total of 203 advanced-stage cancer patients suffering from different types of cancer who had exhausted all conventional forms of therapy were treated with the novel antitumor drug Ukrain over a period of 2.5 years at the Villa Medica Clinic in Germany. Seventy-six patients (37.4%) were simultaneously treated with regional deep hyperthermia in which tumor tissue was heated to > 42.5 degrees C. Patients also received complementary oncological treatment with selen, cimetidine, thyme extract and vitamin A. In view of the advanced stage of the disease, the results of therapy were surprising. Forty-one patients (20.2%) achieved total remission, 122 (60.1%) partial remission and only 40 (19.7%) did not respond to treatment. The highest response rates were in patients with seminoma (three out of four patients had total remission and one had partial remission) and in prostate cancer [14 out of 20 patients (70%) achieved total remissions and five achieved partial remission].

Phase I trial of 72-hour continuous infusion UCN-01 in patients with refractory neoplasms

PURPOSE

To define the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of the novel protein kinase inhibitor, UCN-01 (7-hydroxystaurosporine), administered as a 72-hour continuous intravenous infusion (CIV).

PATIENTS AND METHODS

Forty-seven patients with refractory neoplasms received UCN-01 during this phase I trial. Total, free plasma, and salivary concentrations were determined; the latter were used to address the influence of plasma protein binding on peripheral tissue distribution. The phosphorylation state of the protein kinase C (PKC) substrate alpha-adducin and the abrogation of DNA damage checkpoint also were assessed.

RESULTS

The recommended phase II dose of UCN-01 as a 72-hour CIV is 42.5 mg/m(2)/d for 3 days. Avid plasma protein binding of UCN-01, as measured during the trial, dictated a change in dose escalation and administration schedules. Therefore, nine patients received drug on the initial 2-week schedule, and 38 received drug on the recommended 4-week schedule. DLTs at 53 mg/m(2)/d for 3 days included hyperglycemia with resultant metabolic acidosis, pulmonary dysfunction, nausea, vomiting, and hypotension. Pharmacokinetic determinations at the recommended dose of 42.5 mg/m(2)/d for 3 days included mean total plasma concentration of 36.4 microM (terminal elimination half-life range, 447 to 1176 hours), steady-state volume of distribution of 9.3 to 14.2 L, and clearances of 0.005 to 0.033 L/h. The mean total salivary concentration was 111 nmol/L of UCN-01. One partial response was observed in a patient with melanoma, and one protracted period ( > 2.5 years) of disease stability was observed in a patient with alk-positive anaplastic large-cell lymphoma. Preliminary evidence suggests UCN-01 modulation of both PKC substrate phosphorylation and the DNA damage-related G(2) checkpoint.

CONCLUSION

UCN-01 can be administered safely as an initial 72-hour CIV with subsequent monthly doses administered as 36-hour infusions.

UCN-01 Kyowa Hakko Kogyo Co

Kyowa Hakko Kogyo is developing UCN-01, a selective but non-specific inhibitor of kinases with good activity against protein kinase C (PKC) and the cyclin-dependent kinases (CDKs). This hydroxylated derivative of staurosporine has potential for the treatmentfor cancer [154087], [311028], and may be useful in the treatment of chronic lymphocytic leukemia [312089]. It is in phase I clinical trials [321641], [326004], [326256]. At the 11th NCI-EORTC-AACR Symposium (Amsterdam, November 2000), a presentation was made on UCN-01. In the initial clinical trial, in which UCN-01 was administered by continuous infusion for 72 h, a prolonged half-life of 600 h was observed. The MTD was 42.5 mg/m2/day x 3. One patient with refractory melanoma achieved a partial response, another patient with refractory anaplastic large cell lymphoma had no evaluable diseasefor more than three years [391376].

Herbal hepatotoxicity: an expanding but poorly defined problem

Alternative therapies, including herbal remedies, are popular in the general population and even more so among patients with liver disease. The use of such products is now well established in western society and is no longer confined to traditional medicine practitioners in Asia, Africa and the Middle-East. Their perceived benefits remain generally unproven and concern about adverse effects is leading to closer scrutiny of these products. Herbal hepatotoxicity has been recognized for many years, but new agents are constantly being identified. The varied manifestations of liver injury include steatosis, acute and chronic hepatitis, hepatic fibrosis, zonal or diffuse hepatic necrosis, bile duct injury, veno-occlusive disease, acute liver failure requiring liver transplantation and carcinogenesis. Potential interactions between herbal medicines and conventional drugs may interfere with patient management. Concurrent use of such products is not often disclosed unless specifically sought after and can lead to perpetuation of the liver injury. The present review focuses on emerging herbal hepatotoxins, newer patterns of liver injury among the older agents and provides an updated tabulation of the adverse effects of major herbal hepatotoxins. Key issues of diagnosis and prevention of this growing problem are addressed. Continued public education, physician awareness and more stringent licensing are required to tackle this growing problem.