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Initial deterioration and intravenous methylprednisolone therapy in patients with myasthenia gravis. J Neurol Sci 2020; 412:116740. [PMID: 32145521 DOI: 10.1016/j.jns.2020.116740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/15/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In myasthenia gravis (MG) patients on intravenous methylprednisolone (IVMP) therapy, initial deterioration should be carefully monitored because it may cause myasthenic crisis. The aim of this study was to investigate the onset, duration and related factors of initial deterioration from the first IVMP in MG patients. METHODS A total dose of IVMP in the first cycle of 750 mg or less, over 750 to 1500 mg, and over 1500 to 3000 mg was used in the analysis. Initial deterioration was evaluated in qualitative and quantitative evaluation and was defined as an increase of 2 or more points on the The Myasthenia Gravis Activities of Daily Living (MG-ADL) scale after the start of IVMP therapy in the quantitative evaluation. RESULTS We enrolled 51 mainly mild MG patients. The mode of onset of initial deterioration from the first IVMP treatment was day 4 in the qualitative and quantitative evaluation. In addition, the mode of duration was 3 days. In multiple logistic regression analysis, factors related to initial deterioration were MGFA classification with overall disease duration up to just before IVMP and thymectomy before IVMP in both the qualitative and the quantitative evaluation (p < .001). One to four cycles of IVMP improved the MG-ADL score at hospital discharge from that at the start of IVMP (p < .001). CONCLUSION Disease severity and thymectomy before IVMP are related to initial deterioration in MG patients. IVMP can be repeated after initial deterioration weekly in most patients.
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Gadkari M, Makiya MA, Legrand F, Stokes K, Brown T, Howe K, Khoury P, Hu Z, Klion A, Franco LM. Transcript- and protein-level analyses of the response of human eosinophils to glucocorticoids. Sci Data 2018; 5:180275. [PMID: 30512017 PMCID: PMC6278693 DOI: 10.1038/sdata.2018.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022] Open
Abstract
Glucocorticoids are first-line agents for the treatment of many eosinophil-associated disorders; however, their effects on human eosinophils remain poorly understood. To gain an unbiased, genome-wide view of the early transcriptional effects of glucocorticoids on human eosinophils in vivo, RNA sequencing was performed on purified blood eosinophils obtained before and 30, 60, and 120 minutes after administration of a single dose of oral prednisone (1 mg/kg) to three unrelated healthy subjects with hypereosinophilia of unknown significance. The resulting dataset is of high quality and suitable for differential expression analysis. Flow cytometry and qPCR were then performed on three additional cohorts of human subjects, to validate the key findings at the transcript and protein levels. The resulting datasets provide a resource for understanding the response of circulating human eosinophils to glucocorticoid administration.
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Affiliation(s)
- Manasi Gadkari
- Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room 138, Bethesda, MD 20892, USA
| | - Michelle A. Makiya
- Human Eosinophil Section, Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room B1-28, Bethesda, MD 20892, USA
| | - Fanny Legrand
- Human Eosinophil Section, Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room B1-28, Bethesda, MD 20892, USA
| | - Kindra Stokes
- Human Eosinophil Section, Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room B1-28, Bethesda, MD 20892, USA
| | - Thomas Brown
- Clinical Parasitology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health. 10 Center Drive, Building 10, Room 6D44, Bethesda, MD 20892, USA
| | - Katherine Howe
- Laboratory of Clinical Immunology and Microbiology. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Building 10, Room 12C103, Bethesda, MD 20892, USA
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room B1-28, Bethesda, MD 20892, USA
| | - Zonghui Hu
- Bioinformatics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD 20892, USA
| | - Amy Klion
- Human Eosinophil Section, Laboratory of Parasitic Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room B1-28, Bethesda, MD 20892, USA
| | - Luis M. Franco
- Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Memorial Drive, Building 4, Room 138, Bethesda, MD 20892, USA
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Setoguchi S, Watase D, Matsunaga K, Yamakawa H, Goto S, Terada K, Ohe K, Enjoji M, Karube Y, Takata J. Antitumor Effects and Delivery Profiles of Menahydroquinone-4 Prodrugs with Ionic or Nonionic Promoiety to Hepatocellular Carcinoma Cells. Molecules 2018; 23:molecules23071738. [PMID: 30013007 PMCID: PMC6100056 DOI: 10.3390/molecules23071738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/14/2018] [Accepted: 07/15/2018] [Indexed: 12/26/2022] Open
Abstract
Hepatocellular carcinoma (HCC) shows poor prognosis owing to its very frequent recurrence even after curative treatment. Thus, an effective and safe long-term chemopreventive agent is strongly in demand. Menahydroquinone-4 (MKH) is an active form of menaquinone-4 (MK-4, vitamin K₂) that is involved in the synthesis of vitamin K-dependent proteins in the liver. We hypothesized that efficient delivery of MKH might be critical to regulate HCC proliferation. The discovery of a suitable prodrug targeting HCC in terms of delivery and activation could reduce the clinical dose of MK-4 and maximize efficacy and safety. We previously showed that MKH dimethylglycinate (MKH-DMG) enables effective delivery of MKH into HCC cells and exhibits strong antitumor effects compared with MK-4. In this study, we prepared anionic MKH hemi-succinate (MKH-SUC) and non-ionic MKH acetate (MKH-ACT), in addition to cationic MKH-DMG, and evaluated MKH delivery profiles and antitumor effects in vitro. MKH-SUC showed the highest uptake and the most efficient release of MKH among the examined compounds and exhibited rapid and strong antitumor effects. These results indicate that MKH-SUC might have a good potential as an MKH delivery system for HCC that overcomes the limitations of MK-4 as a clinical chemopreventive agent.
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Affiliation(s)
- Shuichi Setoguchi
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Daisuke Watase
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Kazuhisa Matsunaga
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Hirofumi Yamakawa
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Shotaro Goto
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Kazuki Terada
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Kenji Ohe
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Munechika Enjoji
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Yoshiharu Karube
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Jiro Takata
- Faculty of Pharmaceutical Sciences, Fukuoka University, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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Vertiz-Hernandez A, Castaneda-Hernandez G, Martinez-Cruz A, Cruz-Antonio L, Grijalva I, Guizar-Sahagun G. L-arginine reverses alterations in drug disposition induced by spinal cord injury by increasing hepatic blood flow. J Neurotrauma 2008; 24:1855-62. [PMID: 18159997 DOI: 10.1089/neu.2007.0375] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
High hepatic extraction drugs--such as phenacetin, methylprednisolone, and cyclosporine--exhibit an increased bioavailability after acute spinal cord injury (SCI) due to an impaired clearance. For these drugs, metabolic clearance depends on hepatic blood flow. Thus, it is possible that pharmacokinetic alterations can be reversed by increasing liver perfusion. Therefore, we evaluated the effect of L-arginine, a nitric oxide precursor, on the pharmacokinetics of a prototype drug with high hepatic extraction, and on hepatic microvascular blood flow (MVBF) after acute SCI. Pharmacokinetics of i.v. phenacetin was studied in rats 24 h after a severe T-5 spinal cord contusion; animals being pretreated with L-arginine 100 mg/kg i.v. or vehicle. MVBF was assessed under similar experimental conditions using laser Doppler flowmetry. SCI significantly altered phenacetin pharmacokinetics. Clearance was significantly reduced, resulting in a prolonged half-life and an increase in bioavailability, while volume of distribution was decreased. Pharmacokinetic alterations were reversed when injured rats were pretreated with L -arginine. It was also observed that L-arginine significantly increased hepatic MVBF in injured rats, notwithstanding it exhibited a limited effect on sham-injured animals. Our data hence suggest that L-arginine is able to reverse SCI-induced alterations in phenacetin pharmacokinetics due to an impaired hepatic MVBF, likely by increased nitric oxide synthesis leading to vasodilation. Further studies are warranted to examine the potential usefulness of nitric oxide supplementation in a clinical setting.
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Seikku P, Raivio T, Jänne OA, Neuvonen PJ, Holmberg C. Methylprednisolone exposure in pediatric renal transplant patients. Am J Transplant 2006; 6:1451-8. [PMID: 16686770 DOI: 10.1111/j.1600-6143.2006.01316.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Glucocorticoid (GC) dosing is commonly based on body mass or surface area in children, although the drug effects appear to correlate with steroid exposure, rather than dose. We compared the area under the serum concentration-time curve (AUC) of methylprednisolone (MP) with a recombinant cell bioassay measuring serum glucocorticoid bioactivity (GBA), in prediction of side effects in 16 pediatric patients (5.4-18.4 years of age) 2.0-14.9 years after renal transplantation (TX). They received 0.3 mg/kg of MP orally and timed blood samples were drawn up to 8 h postdose. Serum MP concentrations correlated moderately with GBA (r= 0.65, p < 0.0001) with best linear fit at 6 and 8 h (r= 0.72, 0.79, respectively, p < 0.001). MP-AUC(t = 0-8) and GBA(t = 6) were significantly greater in patients who gained excessive weight soon after TX. Change in growth after TX was inversely correlated with MP-AUC (r= 0.73, p < 0.05) and GBA(t = 6) (r= 0.62, p < 0.05). No correlation of MP-AUC or GBA was found with blood glucose or serum lipid concentrations, glomerular filtration rate, bone mineral density or graft histology. In conclusion, GC exposure varies individually and dosing should be adjusted accordingly to control the adverse effects. GBA might provide a complementary tool for monitoring GC exposure but further studies are needed.
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Affiliation(s)
- P Seikku
- Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki, Finland
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Genty V, Dine G, Dufer J. Phenotypical alterations induced by glucocorticoids resistance in RPMI 8226 human myeloma cells. Leuk Res 2004; 28:307-13. [PMID: 14687627 DOI: 10.1016/j.leukres.2003.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Resistance to glucocorticoids (GCs) frequently appears during treatment of hematological malignancies. This study investigates the phenotypical alterations observed in human myeloma cell sublines resistant to glucocorticoids. Using the RPMI8226 cell line, the cytotoxic efficiencies of four glucocorticoids, and the phenotypes of isolated resistant sublines were analyzed. Methyl-prednisolone and dexamethasone exhibited the higher toxic effects on RPMI8226 cells. All corticoids were able to induce drug-resistance. Resistant sublines showed an increased expression of the alpha-isoform of the glucocorticoid receptors (GRs), and specific modulations in CD23, CD38, CD44 and CD58 expressions. Thus, glucocorticoid resistance in RPMI8226 cells is accompanied by significant phenotypical alterations that could be implicated in survival enhancement to therapy and/or tumor spreading.
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Affiliation(s)
- Vincent Genty
- Institut Biotechnologique de Troyes, 11 rue Marie Curie, 10000 Troyes, France.
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Yates CR, Vysokanov A, Mukherjee A, Ludden TM, Tolley E, Meduri GU, Dalton JT. Time-variant increase in methylprednisolone clearance in patients with acute respiratory distress syndrome: a population pharmacokinetic study. J Clin Pharmacol 2001; 41:415-24. [PMID: 11304898 DOI: 10.1177/00912700122010276] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methylprednisolone (MP) disposition was evaluated in 20 individuals who participated in an ongoing randomized, double-blind, placebo-controlled study designed to evaluate the efficacy of MP in the treatment of acute respiratory distress syndrome (ARDS). MP (1 mg/kg) was given as a loading infusion over 30 minutes followed by a 1 mg/kg/day continuous i.v. infusion. Patients were switched to oral MP upon restoration of oral intake. MP plasma concentrations (n = 110) were determined using a specific HPLC method. Population pharmacokinetic analysis was performed using nonlinear mixed-effects models, implemented in NONMEM, version V. MP plasma concentration data were described by a one-compartment open model with a time-dependent, non-linear increase in the clearance (CL) of MP during the course of therapy. Initial clearance of MP (CLo) in ARDS patients at the start of therapy increased to a maximal value (CLmax) after approximately 7 days. The estimate of CLmax was similar to the CL of MP in healthy individuals reported previously. Population mean estimates (+/- SE) of parameters in the model were as follows: CLo = 13.2 +/- 2.4 L/h, CLmax = 25.0 +/- 3.6 L/h, time of half-maximal increase in CL (T50) = 41.1 +/- 8.2 h, gamma (Hill coefficient) = 3.8 +/- 0.6, and volume of distribution (Vd) = 137 +/- 30.2 L. Disease progression indices and patient demographics were evaluated as covariates, and no significant correlation was found. Means (+/- SD) of plasma protein binding differed between healthy individuals (72% +/- 4%) and ARDS patients (46% +/- 11%) (p < 0.001). The pharmacokinetics of MP in ARDS patients has not been described previously.
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Affiliation(s)
- C R Yates
- University of Tennessee, Memphis, USA
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Chronic Intrathecal Administration of Dexamethasone Sodium Phosphate: Pharmacokinetics and Neurotoxicity in an Animal Model. Neurosurgery 2000. [DOI: 10.1097/00006123-200001000-00034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kroin JS, Schaefer RB, Penn RD. Chronic Intrathecal Administration of Dexamethasone Sodium Phosphate: Pharmacokinetics and Neurotoxicity in an Animal Model. Neurosurgery 2000. [DOI: 10.1093/neurosurgery/46.1.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeffrey S. Kroin
- Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | | | - Richard D. Penn
- Department of Neurosurgery, Rush Medical College, Chicago, Illinois
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Law RC, Massey SR. Peri-operative steroid supplementation. Anaesthesia 1999; 54:393-5. [PMID: 10455845 DOI: 10.1046/j.1365-2044.1999.00862.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rohatagi S, Barth J, Möllmann H, Hochhaus G, Soldner A, Möllmann C, Derendorf H. Pharmacokinetics of methylprednisolone and prednisolone after single and multiple oral administration. J Clin Pharmacol 1997; 37:916-25. [PMID: 9505983 DOI: 10.1002/j.1552-4604.1997.tb04266.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The pharmacokinetics of methylprednisolone and prednisolone were evaluated in 24 healthy men after oral administration of single and multiple doses for 3 days. For each drug, 6 different administration regimens with doses ranging from 1 to 80-mg of methylprednisolone and 1.25 to 100-mg of prednisolone, and administration intervals ranging from 3 to 24 hours for both were investigated. Plasma was assayed using a normal phase high-performance liquid chromatography (HPLC) method. Methylprednisolone showed linear pharmacokinetics with no apparent dose or time dependency. Prednisolone showed marked dose dependency with higher clearance and volume of distribution for higher doses. This can be explained by its saturable protein binding of plasma, because unbound clearance and unbound volume of distribution were not dose-dependent. After multiple administration, prednisolone showed significant time-dependent pharmacokinetics with increased unbound clearance and increased unbound volume of distribution. Due to the complicated pharmacokinetic properties of prednisolone, it is extremely difficult to determine the dose needed to obtain a desired target concentration. The pharmacokinetics of methylprednisolone are more predictable because methylprednisolone concentrations are proportional to dose, and no determination of plasma protein binding is needed.
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Affiliation(s)
- S Rohatagi
- College of Pharmacy, University of Florida, Gainesville 32610, USA
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