1
|
Friuli V, Maggi L, Bruni G, Caso F, Bini M. Hydroxyapatite Nanorods Based Drug Delivery Systems for Bumetanide and Meloxicam, Poorly Water Soluble Active Principles. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:113. [PMID: 38202568 PMCID: PMC10780568 DOI: 10.3390/nano14010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
Poorly water-soluble drugs represent a challenge for the pharmaceutical industry because it is necessary to find properly tuned and efficient systems for their release. In this framework, organic-inorganic hybrid systems could represent a promising strategy. A largely diffused inorganic host is hydroxyapatite (HAP, Ca10(PO4)6(OH)2), which is easily synthesized with different external forms and can adsorb different kinds of molecules, thereby allowing rapid drug release. Hybrid nanocomposites of HAP nanorods, obtained through hydrothermal synthesis, were prepared with two model pharmaceutical molecules characterized by low and pH-dependent solubility: meloxicam, a non-steroidal anti-inflammatory drug, and bumetanide, a diuretic drug. Both hybrids were physically and chemically characterized through the combined use of X-ray powder diffraction, scanning electron microscopy with energy-dispersive spectroscopy, differential scanning calorimetry, and infrared spectroscopy measurements. Then, their dissolution profiles and hydrophilicity (contact angles) in different media as well as their solubility were determined and compared to the pure drugs. This hybrid system seems particularly suitable as a drug carrier for bumetanide, as it shows higher drug loading and good dissolution profiles, while is less suitable for meloxicam, an acid molecule.
Collapse
Affiliation(s)
- Valeria Friuli
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy;
| | - Lauretta Maggi
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy;
| | - Giovanna Bruni
- Department of Chemistry, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy; (G.B.); (F.C.); (M.B.)
- CSGI—Department of Chemistry, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy
| | - Francesca Caso
- Department of Chemistry, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy; (G.B.); (F.C.); (M.B.)
| | - Marcella Bini
- Department of Chemistry, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy; (G.B.); (F.C.); (M.B.)
- CSGI—Department of Chemistry, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy
- National Reference Centre for Electrochemical Energy Storage (GISEL)—INSTM, Via G. Giusti 9, 50121 Firenze, Italy
| |
Collapse
|
2
|
Chen C, Fan P, Zhang L, Xue K, Hu J, Huang J, Lu W, Xu J, Xu S, Qiu G, Ran J, Gan S. Bumetanide Rescues Aquaporin-4 Depolarization via Suppressing β-Dystroglycan Cleavage and Provides Neuroprotection in Rat Retinal Ischemia-Reperfusion Injury. Neuroscience 2023; 510:95-108. [PMID: 36493910 DOI: 10.1016/j.neuroscience.2022.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Aquaporin-4 (AQP4) regulates retinal water homeostasis and participates in retinal oedema pathophysiology. β-dystroglycan (β-DG) is responsible for AQP4 polarization and can be cleaved by matrix metalloproteinase-9 (MMP9). Retinal oedema induced by ischemia-reperfusion (I/R) injury is an early complication. Bumetanide (BU) has potential efficacy against cytotoxic oedema. Our study investigated the effects of β-DG cleavage on AQP4 and the roles of BU in a rat retinal I/R injury model. The model was induced by applying 110 mm Hg intraocular pressure to the anterior eye chamber. BU and U0126 (a selective ERK inhibitor) were intraperitoneally administered 15 and 30 min, respectively, before I/R induction. Rhodamine isothiocyanate extravasation detection, quantitative real-time PCR, transmission electron microscopy, hematoxylin-eosin staining, immunofluorescence staining, western blotting, and TUNEL staining were performed. AQP4 lost its polarization in the retinal perivascular domain as a result of β-DG cleavage. BU rescued AQP4 depolarization, suppressed AQP4 protein expression, attenuated retinal cytotoxic oedema, and downregulated β-DG and AQP4 mRNA expression. BU suppressed glial responses and mitochondria-mediated apoptotic protein expression, including that of Caspase-3 and Cyto C, raised the Bcl-2/Bax ratio, and lowered the number of apoptotic cells in the retina. Both BU and U0126 downregulated p-ERK and MMP9 expression. Thus, BU treatment suppressed β-DG cleavage, recovered AQP4 polarization partially via inhibiting ERK/MMP9 signaling pathway, and possess potential neuroprotective efficacy in the rat retinal ischemia-reperfusion injury model.
Collapse
Affiliation(s)
- Chunyan Chen
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Ping Fan
- Department of Gynecology and Obstetrics of The Fifth People's Hospital of Chongqing, PR China
| | - Lirong Zhang
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Kaige Xue
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Jiaheng Hu
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Juan Huang
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Weitian Lu
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Jin Xu
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Shiye Xu
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Guoping Qiu
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Jianhua Ran
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China
| | - Shengwei Gan
- Institute of Neuroscience, Basic Medicine College of Chongqing Medical University, Chongqing, PR China.
| |
Collapse
|
3
|
Ivandini TA, Einaga Y. Electrochemical Sensing Applications Using Diamond Microelectrodes. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2021. [DOI: 10.1246/bcsj.20210296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Tribidasari A. Ivandini
- Department of Chemistry, Faculty of Mathematics and Science, Universitas Indonesia, Kampus UI Depok, Jakarta 16424, Indonesia
| | - Yasuaki Einaga
- Department of Chemistry, Faculty of Science and Technology, Keio University, Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
| |
Collapse
|
4
|
Tátrai P, Erdő F, Dörnyei G, Krajcsi P. Modulation of Urate Transport by Drugs. Pharmaceutics 2021; 13:pharmaceutics13060899. [PMID: 34204277 PMCID: PMC8235739 DOI: 10.3390/pharmaceutics13060899] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Serum urate (SU) levels in primates are extraordinarily high among mammals. Urate is a Janus-faced molecule that acts physiologically as a protective antioxidant but provokes inflammation and gout when it precipitates at high concentrations. Transporters play crucial roles in urate disposition, and drugs that interact with urate transporters either by intention or by accident may modulate SU levels. We examined whether in vitro transporter interaction studies may clarify and predict such effects. METHODS Transporter interaction profiles of clinically proven urate-lowering (uricosuric) and hyperuricemic drugs were compiled from the literature, and the predictive value of in vitro-derived cut-offs like Cmax/IC50 on the in vivo outcome (clinically relevant decrease or increase of SU) was assessed. RESULTS Interaction with the major reabsorptive urate transporter URAT1 appears to be dominant over interactions with secretory transporters in determining the net effect of a drug on SU levels. In vitro inhibition interpreted using the recommended cut-offs is useful at predicting the clinical outcome. CONCLUSIONS In vitro safety assessments regarding urate transport should be done early in drug development to identify candidates at risk of causing major imbalances. Attention should be paid both to the inhibition of secretory transporters and inhibition or trans-stimulation of reabsorptive transporters, especially URAT1.
Collapse
Affiliation(s)
- Péter Tátrai
- Solvo Biotechnology, Science Park, Building B2, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
| | - Franciska Erdő
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, H-1083 Budapest, Hungary;
| | - Gabriella Dörnyei
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, H-1088 Budapest, Hungary;
| | - Péter Krajcsi
- Solvo Biotechnology, Science Park, Building B2, 4-20 Irinyi József utca, H-1117 Budapest, Hungary;
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, H-1083 Budapest, Hungary;
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, H-1088 Budapest, Hungary;
- Correspondence:
| |
Collapse
|
5
|
Ben-Ari Y, Delpire E. Phenobarbital, midazolam, bumetanide, and neonatal seizures: The devil is in the details. Epilepsia 2021; 62:935-940. [PMID: 33534145 PMCID: PMC8035263 DOI: 10.1111/epi.16830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/21/2022]
Abstract
Kaila, Löscher, and colleagues report that phenobarbital (PHB) and midazolam (MDZ) attenuate neonatal seizures following birth asphyxia, but the former only when applied before asphyxia and the latter before or after the triggering insult. In contrast, the NKCC1 chloride importer antagonist bumetanide (BUM) had no effect whether applied alone or with PHB. The observations are compelling and in accord with earlier studies. However, there are several general issues that deserve discussion. What is the clinical relevance of these data and the validity of animal models of encephalopathic seizures? Why is it that although they act on similar targets, these agents have different efficacy? Are both PHB and MDZ actions restricted to γ-aminobutyric acidergic (GABAergic) mechanisms? Why is BUM inefficient in attenuating seizures but capable of reducing the severity of other brain disorders? We suggest that the relative failure of antiepileptic drugs (AEDs) to treat this severe life-threatening condition is in part explicable by the recurrent seizures that shift the polarity of GABA, thereby counteracting their effects on their target. AEDs might be efficient after a few seizures but not recurrent ones. In addition, PHB and MDZ actions are not limited to GABA signals. BUM efficiently attenuates autism symptomatology notably in patients with tuberous sclerosis but does not reduce the recurrent seizures, illustrating the uniqueness of epilepsies. Therefore, the efficacy of AEDs to treat babies with encephalopathic seizures will depend on the history and severity of the seizures prior to their administration, challenging a universal common underlying mechanism.
Collapse
Affiliation(s)
- Yehezkel Ben-Ari
- Neurochlore, Fundamental Research Department, Ben-Ari Institute of Neuroarcheology (IBEN), Marseille, France.,Correspondence should be addressed to Dr. Yehezkel Ben-Ari, , Address: Neurochlore, Parc Scientifique et Technologique de Luminy, Bâtiment Beret-Delaage, Zone Luminy Biotech Entreprises, Case 922, 163 avenue de Luminy, 13288 Marseille Cedex 9. Phone number: +33 (0)4 86 94 85 02
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University Medical School, Nashville, TN 37232, USA
| |
Collapse
|
6
|
Mollajani R, Joghataei MT, Tehrani-Doost M. Bumetanide Therapeutic Effect in Children and Adolescents With Autism Spectrum Disorder: A Review Study. Basic Clin Neurosci 2019; 10:433-441. [PMID: 32284832 PMCID: PMC7149950 DOI: 10.32598/bcn.9.10.380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/10/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction: Autism Spectrum Disorder (ASD) is characterized by several impairments in communications and social interactions, as well as restricted interests or stereotyped behaviors. Interventions applied for this disorder are based on multi-modal approaches, including pharmacotherapy. No definitive cure or medication has been introduced so far; therefore, researchers still investigate potential drugs for treating ASD. One of the new medications introduced for this purpose is bumetanide. The present article aimed to review the efficacy of this drug on the core symptoms of ASD and its potential side effects. Methods: We searched all papers reported on pharmacokinetics, pharmacodynamics, efficacy, and adverse effects of bumetanide on animal models and humans with ASD. The papers were extracted from the main databases of PubMed, Web of Science, and Scopus. Results: The findings revealed that cortical neurons have high Chloride ion (Cl−)i and excitatory actions of gamma-aminobutyric acid in the valproic acid animal model with ASD and mice with fragile X syndrome. Bumetanide, which has been introduced as a diuretic, is also a high-affinity-specific Na+−K+−Cl− cotransporter (NKCC1) antagonist that can reduce Cl− level. The results also indicate that bumetanide can attenuate behavioral features of autism in both animal and human models. Moreover, the studies showed that such medication could activate fusiform face area in individuals with ASD while viewing emotional faces. Also, recent findings suggest that a dose of 1 mg/d of this drug, taken twice daily, might be the best compromise between safety and efficacy. Conclusion: Recent studies provided some evidence that bumetanide can be a novel pharmacological agent in treating core symptoms of ASD. Future studies are required to confirm the efficacy of this medication in individuals with ASD.
Collapse
Affiliation(s)
- Raheleh Mollajani
- Cognitive Neuroscience Institute for Cognitive Science Studies, Tehran, Iran
| | - Mohamad Taghi Joghataei
- Department of Anatomy and Neuroscience, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehrani-Doost
- Research Center for Cognitive and Behavioral Sciences, Tehran university of Medial Sciences, Tehran, Iran
| |
Collapse
|
7
|
Kelly L, Almutairi MM, Kursan S, Pacheco R, Dias-Junior E, Castrop H, Di Fulvio M. Impaired glucose tolerance, glucagon, and insulin responses in mice lacking the loop diuretic-sensitive Nkcc2a transporter. Am J Physiol Cell Physiol 2019; 317:C843-C856. [PMID: 31365295 DOI: 10.1152/ajpcell.00144.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Na+K+2Cl- cotransporter-2 (Nkcc2, Slc12a1) is abundantly expressed in the kidney and its inhibition with the loop-diuretics bumetanide and furosemide has been linked to transient or permanent hyperglycemia in mice and humans. Notably, Slc12a1 is expressed at low levels in hypothalamic neurons and in insulin-secreting β-cells of the endocrine pancreas. The present study was designed to determine if global elimination of one of the Slc12a1 products, i.e., Nkcc2 variant a (Nkcc2a), the main splice version of Nkcc2 found in insulin-secreting β-cells, has an impact on the insulin and glucagon secretory responses and fuel homeostasis in vivo. We have used dynamic tests of glucose homeostasis in wild-type mice and mice lacking both alleles of Nkcc2a (Nkcc2aKO) and assessed their islet secretory responses in vitro. Under basal conditions, Nkcc2aKO mice have impaired glucose homeostasis characterized by increased blood glucose, intolerance to the sugar, delayed/blunted in vivo insulin and glucagon responses to glucose, and increased glycemic responses to the gluconeogenic substrate alanine. Further, we provide evidence of conserved quantitative secretory responses of Nkcc2aKO islets within a context of increased islet size related to hyperplastic/hypertrophic glucagon- and insulin-positive cells (α-cells and β-cells, respectively), normal total islet Cl- content, and reduced β-cell expression of the Cl- extruder Kcc2.
Collapse
Affiliation(s)
- Lisa Kelly
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| | - Mohammed M Almutairi
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| | - Shams Kursan
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| | - Romario Pacheco
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| | - Eduardo Dias-Junior
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| | - Hayo Castrop
- Institute of Physiology, University of Regensburg, Regensburg Germany
| | - Mauricio Di Fulvio
- Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio
| |
Collapse
|
8
|
Einaga Y. Development of Electrochemical Applications of Boron-Doped Diamond Electrodes. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2018. [DOI: 10.1246/bcsj.20180268] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Yasuaki Einaga
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
| |
Collapse
|
9
|
Ilkhanizadeh S, Sabelström H, Miroshnikova YA, Frantz A, Zhu W, Idilli A, Lakins JN, Schmidt C, Quigley DA, Fenster T, Yuan E, Trzeciak JR, Saxena S, Lindberg OR, Mouw JK, Burdick JA, Magnitsky S, Berger MS, Phillips JJ, Arosio D, Sun D, Weaver VM, Weiss WA, Persson AI. Antisecretory Factor-Mediated Inhibition of Cell Volume Dynamics Produces Antitumor Activity in Glioblastoma. Mol Cancer Res 2018; 16:777-790. [PMID: 29431617 PMCID: PMC5932284 DOI: 10.1158/1541-7786.mcr-17-0413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/13/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Abstract
Interstitial fluid pressure (IFP) presents a barrier to drug uptake in solid tumors, including the aggressive primary brain tumor glioblastoma (GBM). It remains unclear how fluid dynamics impacts tumor progression and can be targeted therapeutically. To address this issue, a novel telemetry-based approach was developed to measure changes in IFP during progression of GBM xenografts. Antisecretory factor (AF) is an endogenous protein that displays antisecretory effects in animals and patients. Here, endogenous induction of AF protein or exogenous administration of AF peptide reduced IFP and increased drug uptake in GBM xenografts. AF inhibited cell volume regulation of GBM cells, an effect that was phenocopied in vitro by the sodium-potassium-chloride cotransporter 1 (SLC12A2/NKCC1) inhibitor bumetanide. As a result, AF induced apoptosis and increased survival in GBM models. In vitro, the ability of AF to reduce GBM cell proliferation was phenocopied by bumetanide and NKCC1 knockdown. Next, AF's ability to sensitize GBM cells to the alkylating agent temozolomide, standard of care in GBM patients, was evaluated. Importantly, combination of AF induction and temozolomide treatment blocked regrowth in GBM xenografts. Thus, AF-mediated inhibition of cell volume regulation represents a novel strategy to increase drug uptake and improve outcome in GBM. Mol Cancer Res; 16(5); 777-90. ©2018 AACR.
Collapse
Affiliation(s)
- Shirin Ilkhanizadeh
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Hanna Sabelström
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | | | - Aaron Frantz
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - Wen Zhu
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aurora Idilli
- Institute of Biophysics, CNR and FBK, Trento, Italy
- CIBIO, University of Trento, Trento, Italy
| | - Jon N Lakins
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Christin Schmidt
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - David A Quigley
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Trenten Fenster
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - Edith Yuan
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - Jacqueline R Trzeciak
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - Supna Saxena
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
| | - Olle R Lindberg
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Janna K Mouw
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sergey Magnitsky
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Mitchel S Berger
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Joanna J Phillips
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Daniele Arosio
- Institute of Biophysics, CNR and FBK, Trento, Italy
- CIBIO, University of Trento, Trento, Italy
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valerie M Weaver
- Department of Surgery, University of California, San Francisco, San Francisco, California
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - William A Weiss
- Department of Neurology, University of California, San Francisco, San Francisco, California
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Anders I Persson
- Department of Neurology, University of California, San Francisco, San Francisco, California.
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Sandler Neurosciences Center, University of California, San Francisco, San Francisco, California
- Brain Tumor Research Center (BTRC) at the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| |
Collapse
|
10
|
Ben-Ari Y. NKCC1 Chloride Importer Antagonists Attenuate Many Neurological and Psychiatric Disorders. Trends Neurosci 2017; 40:536-554. [PMID: 28818303 DOI: 10.1016/j.tins.2017.07.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 12/23/2022]
Abstract
In physiological conditions, adult neurons have low intracellular Cl- [(Cl-)I] levels underlying the γ-aminobutyric acid (GABA)ergic inhibitory drive. In contrast, neurons have high (Cl-)I levels and excitatory GABA actions in a wide range of pathological conditions including spinal cord lesions, chronic pain, brain trauma, cerebrovascular infarcts, autism, Rett and Down syndrome, various types of epilepsies, and other genetic or environmental insults. The diuretic highly specific NKCC1 chloride importer antagonist bumetanide (PubChem CID: 2461) efficiently restores low (Cl-)I levels and attenuates many disorders in experimental conditions and in some clinical trials. Here, I review the mechanisms of action, therapeutic effects, promises, and pitfalls of bumetanide.
Collapse
Affiliation(s)
- Yehezkel Ben-Ari
- New INMED, Aix-Marseille University, Campus Scientifique de Luminy, Marseilles, France.
| |
Collapse
|
11
|
Ogata G, Ishii Y, Asai K, Sano Y, Nin F, Yoshida T, Higuchi T, Sawamura S, Ota T, Hori K, Maeda K, Komune S, Doi K, Takai M, Findlay I, Kusuhara H, Einaga Y, Hibino H. A microsensing system for the in vivo real-time detection of local drug kinetics. Nat Biomed Eng 2017; 1:654-666. [PMID: 31015607 DOI: 10.1038/s41551-017-0118-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 06/30/2017] [Indexed: 01/21/2023]
Abstract
Real-time recording of the kinetics of systemically administered drugs in in vivo microenvironments may accelerate the development of effective medical therapies. However, conventional methods require considerable analyte quantities, have low sampling rates and do not address how drug kinetics correlate with target function over time. Here, we describe the development and application of a drug-sensing system consisting of a glass microelectrode and a microsensor composed of boron-doped diamond with a tip of around 40 μm in diameter. We show that, in the guinea pig cochlea, the system can measure-simultaneously and in real time-changes in the concentration of bumetanide (a diuretic that is ototoxic but applicable to epilepsy treatment) and the endocochlear potential underlying hearing. In the rat brain, we tracked the kinetics of the drug and the local field potentials representing neuronal activity. We also show that the actions of the antiepileptic drug lamotrigine and the anticancer reagent doxorubicin can be monitored in vivo. Our microsensing system offers the potential to detect pharmacological and physiological responses that might otherwise remain undetected.
Collapse
Affiliation(s)
- Genki Ogata
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan.,Center for Transdisciplinary Research, Niigata University, Niigata, 950-2181, Japan
| | - Yuya Ishii
- Department of Chemistry, Faculty of Science and Technology, Keio University, Yokohama, 223-8522, Japan
| | - Kai Asai
- Department of Chemistry, Faculty of Science and Technology, Keio University, Yokohama, 223-8522, Japan
| | - Yamato Sano
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Fumiaki Nin
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan.,Center for Transdisciplinary Research, Niigata University, Niigata, 950-2181, Japan
| | - Takamasa Yoshida
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan.,Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Taiga Higuchi
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan
| | - Seishiro Sawamura
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan
| | - Takeru Ota
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan
| | - Karin Hori
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan
| | - Kazuya Maeda
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Shizuo Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.,Division of Otolaryngology-Head and Neck Surgery, Yuaikai Oda Hospital, Kashima, Saga, 849-1311, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, 589-8511, Japan
| | - Madoka Takai
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan
| | - Ian Findlay
- Laboratoire des Cellules Cardiaques et Vasculaires, CNRS ERL 7368, Faculté des Sciences, Université François-Rabelais, Tours, 37200, France
| | - Hiroyuki Kusuhara
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Yasuaki Einaga
- Department of Chemistry, Faculty of Science and Technology, Keio University, Yokohama, 223-8522, Japan. .,JST-ACCEL, Tokyo, 812-8582, Japan.
| | - Hiroshi Hibino
- Department of Molecular Physiology, Niigata University School of Medicine, Niigata, 951-8510, Japan. .,Center for Transdisciplinary Research, Niigata University, Niigata, 950-2181, Japan.
| |
Collapse
|
12
|
Effects of bumetanide on neurobehavioral function in children and adolescents with autism spectrum disorders. Transl Psychiatry 2017; 7:e1056. [PMID: 28291262 PMCID: PMC5416661 DOI: 10.1038/tp.2017.10] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/17/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
In animal models of autism spectrum disorder (ASD), the NKCC1 chloride-importer inhibitor bumetanide restores physiological (Cl-)i levels, enhances GABAergic inhibition and attenuates electrical and behavioral symptoms of ASD. In an earlier phase 2 trial; bumetanide reduced the severity of ASD in children and adolescents (3-11 years old). Here we report the results of a multicenter phase 2B study primarily to assess dose/response and safety effects of bumetanide. Efficacy outcome measures included the Childhood Autism Rating Scale (CARS), the Social Responsive Scale (SRS) and the Clinical Global Impressions (CGI) Improvement scale (CGI-I). Eighty-eight patients with ASD spanning across the entire pediatric population (2-18 years old) were subdivided in four age groups and randomized to receive bumetanide (0.5, 1.0 or 2.0 mg twice daily) or placebo for 3 months. The mean CARS value was significantly improved in the completers group (P: 0.015). Also, 23 treated children had more than a six-point improvement in the CARS compared with only one placebo-treated individual. Bumetanide significantly improved CGI (P: 0.0043) and the SRS score by more than 10 points (P: 0.02). The most frequent adverse events were hypokalemia, increased urine elimination, loss of appetite, dehydration and asthenia. Hypokalemia occurred mainly at the beginning of the treatment at 1.0 and 2.0 mg twice-daily doses and improved gradually with oral potassium supplements. The frequency and incidence of adverse event were directly correlated with the dose of bumetanide. Therefore, bumetanide improves the core symptoms of ASD and presents a favorable benefit/risk ratio particularly at 1.0 mg twice daily.
Collapse
|
13
|
Ben-Ari Y, Damier P, Lemonnier E. Failure of the Nemo Trial: Bumetanide Is a Promising Agent to Treat Many Brain Disorders but Not Newborn Seizures. Front Cell Neurosci 2016; 10:90. [PMID: 27147965 PMCID: PMC4830840 DOI: 10.3389/fncel.2016.00090] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
The diuretic bumetanide failed to treat acute seizures due to hypoxic ischemic encephalopathy (HIE) in newborn babies and was associated with hearing loss (NEMO trial, Pressler et al., 2015). On the other hand, clinical and experimental observations suggest that the diuretic might provide novel therapy for many brain disorders including Autism Spectrum Disorders (ASD), schizophrenia, Rett syndrome, and Parkinson disease. Here, we discuss the differences between the pathophysiology of severe recurrent seizures in the neonates and neurological and psychiatric disorders stressing the uniqueness of severe seizures in newborn in comparison to other disorders.
Collapse
Affiliation(s)
- Yehezkel Ben-Ari
- INMED - Institut National de la Santé et de la Recherche Médicale U901, Aix-Marseille University Marseilles, France
| | - Philippe Damier
- Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 0004 Nantes, France
| | | |
Collapse
|
14
|
Khanna A, Kahle KT, Walcott BP, Gerzanich V, Simard JM. Disruption of ion homeostasis in the neurogliovascular unit underlies the pathogenesis of ischemic cerebral edema. Transl Stroke Res 2013; 5:3-16. [PMID: 24323726 DOI: 10.1007/s12975-013-0307-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/22/2013] [Accepted: 11/06/2013] [Indexed: 02/06/2023]
Abstract
Cerebral edema is a major cause of morbidity and mortality following ischemic stroke, but its underlying molecular pathophysiology is incompletely understood. Recent data have revealed the importance of ion flux via channels and transporters expressed in the neurogliovascular unit in the development of ischemia-triggered cytotoxic edema, vasogenic edema, and hemorrhagic conversion. Disruption of homeostatic mechanisms governing cell volume regulation and epithelial/endothelial ion transport due to ischemia-associated energy failure results in the thermodynamically driven re-equilibration of solutes and water across the CSF-blood and blood-brain barriers that ultimately increases the brain's extravascular volume. Additionally, hypoxia, inflammation, and other stress-triggered increases in the functional expression of ion channels and transporters normally expressed at low levels in the neurogliovascular unit cause disruptions in ion homeostasis that contribute to ischemic cerebral edema. Here, we review the pathophysiological significance of several molecular mediators of ion transport expressed in the neurogliovascular unit, including targets of existing FDA-approved drugs, which might be potential nodes for therapeutic intervention.
Collapse
|
15
|
Li Y, Cleary R, Kellogg M, Soul JS, Berry GT, Jensen FE. Sensitive isotope dilution liquid chromatography/tandem mass spectrometry method for quantitative analysis of bumetanide in serum and brain tissue. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 879:998-1002. [PMID: 21414852 DOI: 10.1016/j.jchromb.2011.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 02/01/2011] [Accepted: 02/11/2011] [Indexed: 11/25/2022]
Abstract
We have developed and validated a simple and sensitive stable isotope dilution liquid chromatography/tandem mass spectrometric (LC-MS/MS) method for the quantification of bumetanide in human serum. Samples were prepared with a simple acetonitrile based protein precipitation. The supernatant was then analyzed directly using LC-MS/MS. Chromatographic separation was achieved on a C18 reversed phase column using a methanol and water gradient. The detection was performed in selected reaction monitoring (SRM) mode via a positive electrospray ionization (ESI) interface. The method had a lower limit of quantification (LLOQ) of 1 ng/mL, linearity up to 1250 ng/mL, intra- and inter-day precision less than 10%, and accuracy within ±10%. This method was also demonstrated to be suitable for the analysis of bumetanide in rat serum and brain tissue. Bumetanide concentrations in rat serum and brain were determined for samples collected at several intervals following intraperitoneal (i.p.) injection of bumetanide, and were used to calculate bumetanide permeability through the blood-brain barrier.
Collapse
Affiliation(s)
- Yijun Li
- Division of Genetics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
16
|
Ameer B, Burlingame MB. Determination of Bumetanide in Human Plasma and Urine by High-Performance Liquid Chromatography with Fluorescence Detection. ANAL LETT 2009. [DOI: 10.1080/00032718808066514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Barbara Ameer
- a Department of Pharmacy , Practice College of Pharmacy J. Hillis Miller Health Center Gainesville , Florida , 32610
| | - Mark B. Burlingame
- a Department of Pharmacy , Practice College of Pharmacy J. Hillis Miller Health Center Gainesville , Florida , 32610
| |
Collapse
|
17
|
Hori Y, Katou A, Tsubaki M, Kanai K, Nakao R, Hoshi F, Itoh N, Higuchi SI. Assessment of diuretic effects and changes in plasma aldosterone concentration following oral administration of a single dose of furosemide or azosemide in healthy dogs. Am J Vet Res 2008; 69:1664-9. [DOI: 10.2460/ajvr.69.12.1664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Vormfelde SV, Burckhardt G, Zirk A, Wojnowski L, Brockmöller J. Pharmacogenomics of diuretic drugs: data on rare monogenic disorders and on polymorphisms and requirements for further research. Pharmacogenomics 2003; 4:701-34. [PMID: 14596636 DOI: 10.1517/phgs.4.6.701.22817] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This review summarizes the current status of our knowledge about the role of pharmacogenetic variation in response to diuretics and suggests future research topics for the field. Genes with a role in the pharmacokinetics of most diuretics are renal drug transporters, especially OAT1, OAT3 and OCT2 (genes SLC22A6, SLC22A8 and SLC22A2) whereas variants in carbonic anhydrase (CA), cytochrome P450 enzymes and sulfotransferases are relevant only for specific substances. Genes on the pharmacodynamic side include the primary targets of thiazide, loop, K+-sparing and aldosterone antagonistic diuretics: NCC, NKCC2, ENaC and the mineralocorticoid receptor (genes SLC12A3, SLC12A1, SCNN1A, B, G and NR3C2). Rare variants of these proteins cause Gitelman’s syndrome, Bartter’s syndrome, Liddle’s syndrome or pregnancy-induced hypertension. Polymorphisms in these and in associated proteins such as GNB3, α-adducin and angiotensin-converting enzyme (ACE) seem to be clinically relevant. In conclusion, first knowledge has evolved that efficacy of diuretic drugs may be determined by genetic polymorphisms in genes determining pharmacokinetics and pharmacodynamics of this drug class. In the future, the selection of a diuretic drug or the dosing schedules may be individually chosen based on pharmacogenetic parameters, however, many questions remain to be answered before this fantasy becomes reality.
Collapse
Affiliation(s)
- Stefan Viktor Vormfelde
- Department of Clinical Pharmacology & Department of Vegetative Physiology, Georg August University Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Selection of appropriate diuretic therapy in children is hampered by a lack of age-specific pharmacokinetic and pharmacodynamic data, especially in premature neonates. Well-designed clinical trials in neonates, infants, and younger children are necessary prerequisites to safer and more efficacious diuretic therapy.
Collapse
Affiliation(s)
- T G Wells
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock
| |
Collapse
|
20
|
Gengo FM, Gabos C. Central nervous system considerations in the use of beta-blockers, angiotensin-converting enzyme inhibitors, and thiazide diuretics in managing essential hypertension. Am Heart J 1988; 116:305-10. [PMID: 2899389 DOI: 10.1016/0002-8703(88)90105-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The most common mild side effects occurring with use of beta-blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors for blood pressure control are central nervous system symptoms, specifically lethargy, sedation, and fatigue. These symptoms affect 5% to 10% of patients taking these drugs. The mechanism by which beta-blockers may induce central nervous system effects is uncertain. Relative lipophilicity as a factor affecting penetrance of the blood-brain barrier has not proved to be a reliable predictor of whether the drug will cause such disturbances. Comparisons of atenolol (hydrophilic) and metoprolol (lipophilic) have shown no differences between these drugs with respect to side effects of the central nervous system. The incidence of central nervous system effects with angiotensin-converting enzyme inhibitors is similar to that for most beta-blockers. The precise role of the angiotensin-converting enzyme in the central nervous system is not well defined. Most thiazide diuretics are not associated with major complications of the central nervous system, although electrolyte imbalance may occasionally lead to complaints of neurologic symptoms. Because the incidence of central nervous system effects with these three classes of drugs is so low, concern for the side effects of the central nervous system is not a prime consideration in the choice of an initial antihypertensive agent.
Collapse
Affiliation(s)
- F M Gengo
- Department of Pharmacy, School of Pharmacy, State University of New York, Buffalo
| | | |
Collapse
|
21
|
Abstract
The effect of bumetanide on carbohydrate metabolism was studied in mice. Intraperitoneal injection of 50 or 100 mg bumetanide/kg body weight resulted in an acute and transient hyperglycaemia. Pretreatment with 240 mg probenecid/kg body weight reduced the diuretic effect but potentiated the hyperglycaemic effect of bumetanide (50 mg/kg body weight). The glucose tolerance was impaired, and there was an elevated serum glucose and glucose/insulin ratio 2 h after a single injection of bumetanide (100 mg/kg body weight). It is suggested that bumetanide has an acute effect on carbohydrate metabolism in mice that is not secondary to diuresis and that the reduced glucose tolerance may, at least in part, be due to a reduced capacity to secrete insulin.
Collapse
Affiliation(s)
- P E Sandström
- Department of Histology and Cell Biology, University of Umeå, Sweden
| |
Collapse
|
22
|
Abstract
The more potent "loop" diuretics are being used with increasing frequency. The elderly constitute a growing portion of the population undergoing treatment with diuretics. The alterations in renal function and pharmacokinetics in the elderly (over 60 years of age) may result in the development of certain adverse effects. In patients over 70 years old, there is a progressive decline in overall renal function, resulting in a more than 50% decrease in glomerular filtration rate. Most of the pharmacokinetic changes in the elderly consist of alterations resulting in enhanced plasma levels of any given drug; diminished hepatic drug extraction, detoxification/metabolism or prodrug conversion; decreased renal excretion of drug; and diminished volume of distribution of drug. Adverse reactions to diuretics may be grouped into metabolic changes (e.g., hypokalemia), physiologic alteration (e.g., volume contraction), toxic manifestation (e.g., interstitial nephritis) and allergic or idiosyncratic phenomena (e.g., rash or thrombocytopenia). There is general agreement that significant hypokalemia, particularly among elderly patients receiving digitalis glycosides, is significant and requires therapy. Diuretic-associated hypokalemia reflects the potency and duration of action of a diuretic, factors modulating potassium balance including dietary intake and concurrent medical processes. The short duration of action and greater natriuresis relative to kaliuresis characteristic of loop diuretics may result in a lesser degree of hypokalemia than that seen with traditional thiazide diuretics.
Collapse
|
23
|
Abstract
The loop diuretics inhibit a transport system that moves sodium, potassium and chloride across cell membranes of many tissues, including the thick ascending loop of Henle. This inhibitory effect is responsible for their natriuretic effect. Of the agents available for clinical use, bumetanide is the most powerful; it has an in vitro transport inhibitory potency and an in vivo natriuretic effectiveness that is approximately 50-fold that of furosemide. This increased potency and the consequent decreased dose requirement give bumetanide the potential for increased effectiveness and decreased incidence of adverse effects.
Collapse
|
24
|
Shepherd AN, Bouchier IA. The influence of ascites on the pharmacokinetics of piretanide in cirrhotic patients. Eur J Clin Pharmacol 1985; 28:581-3. [PMID: 4043200 DOI: 10.1007/bf00544070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The pharmacokinetics of piretanide, a new loop diuretic, were studied in seven patients with severe liver disease before and after resolution of ascites. The time to maximum concentration was significantly prolonged by the presence of ascites. Tmax after relief of ascites was similar to that seen for normal volunteers. Area under the curves, bioavailability, volumes of distribution and elimination half-lives did not change after resolution of the ascites: two patients in whom diuretic resistant ascites occurred showed similar pharmacokinetics to that of the diuretic responders. Reduced responsiveness to piretanide therapy in patients with gross ascites does not appear to be the result of decreased bioavailability.
Collapse
|
25
|
Abstract
We assessed the handling of and response to oral bumetanide (1.0 and 2.0 mg) and to furosemide (40 and 80 mg) in 20 patients with stable, compensated congestive heart failure (CHF), comparing the two drugs and, in addition, examining differences from normal subjects. Bumetanide and furosemide were similar in time course of absorption, but patients with CHF had considerably prolonged absorption compared to normal subjects causing attainment of lower peak concentrations of drug. In both CHF and normal subjects, more bumetanide than furosemide was absorbed. The elimination half-life of furosemide was approximately twice that of bumetanide, and both were about two times longer than respective values in normal subjects. "Dose"-response curves were shifted downward from normal with both drugs. In patients with CHF, overall response did not differ between bumetanide and furosemide. The two drugs exhibit subtle differences, the clinical importance of which appears to be negligible from this study. Importantly, however, both drugs showed delayed absorption causing attainment of peak urinary excretion rates of diuretic two- to threefold lower than in normal subjects. This effect along with the abnormal responsivity of the tubule may contribute to the "resistance" to oral doses of diuretics observed clinically even though no quantitative malabsorption of drug occurs.
Collapse
|
26
|
Vlasses PH, Larijani GE. Commentary 4. Pharmacotherapy 1984. [DOI: 10.1002/j.1875-9114.1984.tb03352.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
27
|
Skoutakis VA, Wojciechowski NJ, Carter CA. Commentary 3. Pharmacotherapy 1984. [DOI: 10.1002/j.1875-9114.1984.tb03351.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Halstenson CE, Matzke GR. Bumetanide: a new loop diuretic (Bumex, Roche Laboratories). DRUG INTELLIGENCE & CLINICAL PHARMACY 1983; 17:786-97. [PMID: 6357686 DOI: 10.1177/106002808301701101] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bumetanide is a recently introduced diuretic that inhibits sodium transport in the thick ascending limb of the loop of Henle. It is structurally and pharmacologically similar to furosemide, but is approximately 40 times as potent on a milligram-for-milligram basis. After oral administration, it is rapidly absorbed, with peak serum concentrations attained at approximately 30 minutes. Its pharmacokinetic parameters are similar to those of furosemide. Bumetanide has demonstrated efficacy in the management of edema associated with congestive heart failure, hepatic cirrhosis, and renal insufficiency. Bumetanide has demonstrated an adverse-reaction profile similar to that of furosemide, although the incidence of hypochloremia and hypokalemia is greater with bumetanide. The incidence of hyperglycemia and ototoxicity is greater with furosemide. The principal indication for bumetanide may be in patients with increased risk of ototoxicity. Cost considerations should relegate bumetanide to a secondary role for the treatment of sodium and fluid retention in most clinical settings.
Collapse
|