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Li X, Wei S, Wu H, Zhang Q, Zhao Z, Mei S, Feng W, Wu Y. Population pharmacokinetics of oxcarbazepine active metabolite in Chinese children with epilepsy. Eur J Pediatr 2023; 182:4509-4521. [PMID: 37493972 DOI: 10.1007/s00431-023-05092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
Oxcarbazepine (OXC) is an antiepileptic drug whose efficacy is largely attributed to its monohydroxy derivative metabolite (MHD). Nevertheless, there exists significant inter-individual variability in both the pharmacokinetics and therapeutic response of this drug. The objective of this study is to explore the impact of patients' characteristics and genetic variants on MHD clearance in a population pharmacokinetic (PPK) model of Chinese pediatric patients with epilepsy. The PPK model was developed using a nonlinear mixed effects modeling method based on 231 MHD plasma concentrations obtained from 185 children with epilepsy. The one-compartment model and combined residual model were established to describe the pharmacokinetics of MHD. Forward addition and backward elimination were employed to evaluate the impact of covariates on the model parameters. The model was evaluated using goodness-of-fit, bootstrap, visual predictive checks, and normalized prediction distribution errors. In the two final PPK models, age, estimated glomerular filtration rate (eGFR), and a combined genotype of six variants (rs1045642, rs2032582, rs7668282, rs2396185, rs2304016, rs1128503) were found to significantly reduce inter-individual variability for MHD clearance. The inter-individual clearance equals to 1.38 × (Age/4.74)0.29 × (eGFR/128.66)0.25 × eθABCB-UGT-SCN-INSR for genetic variants included model and 1.30 × (Age/4.74)0.30 × (eGFR/128.66)0.23 for model without genetic variants. The precision of all parameters was deemed acceptable, and the model exhibited good predictability while remaining stable and effective. Conclusion: Age, eGFR, and genotype may play a significant role in MHD clearance in children with epilepsy. The developed PPK models hold potential utility in facilitating oxcarbazepine dose adjustment in pediatric patients. What is Known: • The adjustment of the oxcarbazepine regimen remains difficult due to the considerable inter- and intra-individual variability of oxcarbazepine pharmacokinetics. • Body weight and co-administration with enzyme-inducing antiepileptic drugs emerge as the most influential factors contributing to the pharmacokinetics of MHD. What is New: • A positive correlation was observed between eGFR and the clearance of MHD in pediatric patients with epilepsy. • We explored the influence of genetic polymorphisms on MHD clearance and identified a combined genotype (ABCB-UGT-SCN-INSR) that exhibited a significant association with MHD concentration.
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Affiliation(s)
- Xingmeng Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Shifeng Wei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Han Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Qiang Zhang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China.
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China.
| | - Weixing Feng
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
| | - Yun Wu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
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Yang Q, Hu Y, Zhang X, Zhang X, Dai H, Li X. Population pharmacokinetics of oxcarbazepine 10-monohydroxy derivative in Chinese adult epileptic patients. Eur J Hosp Pharm 2023; 30:e90-e96. [PMID: 35787526 PMCID: PMC10086726 DOI: 10.1136/ejhpharm-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Oxcarbazepine (OXC) is metabolised to active 10-monohydroxy derivative (MHD) after oral administration. Using this fact we aimed to develop an MHD population pharmacokinetic (PPK) model in Chinese adult epileptic patients to facilitate the clinical implementation of model-guided individualised drug therapy. METHODS We collected blood samples from Chinese adult epileptic patients taking OXC at the Second Affiliated Hospital of Zhejiang University School of Medicine. We used high performance liquid chromatography (HPLC-MS/MS) with tandem mass spectrometry to detect MHD concentrations in the blood samples. We collected various data from patients including their demographic, pathological, and physiological information. MassARRAY method was used to detect ABCC2, ABCB1, SCN8A, SCN1A, SCN2A, SCN3A, UGT1A9, and UGT2B7 gene polymorphisms. We used a nonlinear mixed-effects modelling method to develop the PPK model and we predicted dosing regimens through simulation. RESULT In total we collected 164 blood samples from 118 patients. We found that a one-compartment model with first-order absorption better described the in vivo MHD pharmacokinetics. UGT2B7 gene (rs7439366) site mutation and the combined use of valproic acid enhanced the MHD clearance rate. We divided patients into groups based on the UGT2B7 genotype and whether they were also using valproic acid at the same time. Individualised OXC dosing regimens were proposed for different subgroups of patients. CONCLUSION In Chinese adult epileptic patients, individualised drug administration can be facilitated using a PPK model of OXC. TRIAL REGISTRATION NUMBER ChiCTR-OOC-17012141.
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Affiliation(s)
- QiaoWei Yang
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
- Department of Pharmacy, Sanmen People's Hospital, Taizhou, Zhejiang Province, People's Republic of China
| | - Yan Hu
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - XuanLing Zhang
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, Beijing, China
| | - XiaoMin Zhang
- Department of Pharmacy, Sanmen People's Hospital, Taizhou, Zhejiang Province, People's Republic of China
| | - Haibin Dai
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xingang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, Beijing, China
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Chen YT, Wang CY, Yin YW, Li ZR, Lin WW, Zhu M, Jiao Z. Population pharmacokinetics of oxcarbazepine: a systematic review. Expert Rev Clin Pharmacol 2021; 14:853-864. [PMID: 33851561 DOI: 10.1080/17512433.2021.1917377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Oxcarbazepine is commonly used as first-line treatment for partial and generalized tonic-clonic seizures. Owing to the high pharmacokinetic variability, several population pharmacokinetic models have been developed for oxcarbazepine to explore potential covariates that affect its pharmacokinetic variation. AREAS COVERED This review summarizes the published population pharmacokinetic studies of oxcarbazepine in children and adults available in PubMed and Embase databases. The quality of the retrieved studies was evaluated, and significant covariates that may have an impact on the dosage regimen of oxcarbazepine were explored. EXPERT OPINION The pharmacokinetics of oxcarbazepine was founded to be affected by body weight and co-administration with enzyme inducers. Pediatric patients require a higher dose per kilogram than adults because children generally have a higher clearance than adults. Moreover, to maintain the target concentration, patients co-administrate with enzyme inducers need a higher dose than monotherapy due to higher clearance in those patients. Because limited information is available for exposure-response relationship, additional pharmacokinetic/pharmacodynamics investigations of oxcarbazepine need to be conducted to optimize the dosage regimen in clinical practice.
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Affiliation(s)
- Yue-Ting Chen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chen-Yu Wang
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Wei Yin
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zi-Ran Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-Wei Lin
- Department of Pharmacy, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Min Zhu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zheng Jiao
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Glomerular Filtration Rate Is a Major Predictor of Clearance of Oxcarbazepine Active Metabolite in Adult Chinese Epileptic Patients: A Population Pharmacokinetic Analysis. Ther Drug Monit 2019; 41:665-673. [DOI: 10.1097/ftd.0000000000000644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Chen CY, Zhou Y, Cui YM, Yang T, Zhao X, Wu Y. Population pharmacokinetics and dose simulation of oxcarbazepine in Chinese paediatric patients with epilepsy. J Clin Pharm Ther 2019; 44:300-311. [PMID: 30636182 DOI: 10.1111/jcpt.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Chao-Yang Chen
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Ying Zhou
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Yi-Min Cui
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Ting Yang
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Xia Zhao
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Ye Wu
- Department of Pediatrics; Peking University First Hospital; Beijing China
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Zhang J, Zhang H, Zhao L, Gu J, Feng Y, An H. Population pharmacokinetic modeling of flurbiprofen, the active metabolite of flurbiprofen axetil, in Chinese patients with postoperative pain. J Pain Res 2018; 11:3061-3070. [PMID: 30555252 PMCID: PMC6280896 DOI: 10.2147/jpr.s176475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Flurbiprofen axetil, a lipid-microsphere-carrier targeting preparation, is a non-steroidal anti-inflammatory drug indicated for the treatment of postoperative pain. Aim The aim of the study was to develop a population pharmacokinetic (PPK) model of flurbiprofen, the active metabolite of flurbiprofen axetil, and optimize the treatment of flurbiprofen axetil in Chinese patients. Methods A total of 144 therapeutic drug-monitoring samples of flurbiprofen axetil from 72 patients were included in this study. The pharmacologically active metabolite flurbiprofen was used as the analytical target and determined 5–45 minutes after intravenous administration. The PPK model for flurbiprofen was developed using Phoenix NLME 1.3 with a nonlinear mixed-effect model. Bootstrap and visual predictive checks were used simultaneously to validate the final PPK model. Potential covariates of age, sex, body weight, height, and body-mass index were tested for PK parameters. Results The PPK model of flurbiprofen was explained by a one-compartment model with first-order elimination, in which a hypothetical-effect compartment was linked to a PK compartment. Population mean values of PK parameters estimated in the final model were θKe=0.0015/h, θVd=7.91 L, and θCL=1.55 L/h. Analysis of covariates showed that height and weight influenced the Ke of flurbiprofen. The final model was proved to be robust. Conclusion The final PPK model was demonstrated to be appropriate and effective, and can be used to assess the PK parameters of flurbiprofen in Chinese patients with postoperative pain.
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Affiliation(s)
- Jingru Zhang
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China, ; .,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Hong Zhang
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China, ;
| | - Libo Zhao
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Jian Gu
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China, ;
| | - Haiyan An
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China, ;
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Antunes NDJ, van Dijkman SC, Lanchote VL, Wichert-Ana L, Coelho EB, Alexandre Junior V, Takayanagui OM, Tozatto E, van Hasselt JGC, Della Pasqua O. Population pharmacokinetics of oxcarbazepine and its metabolite 10-hydroxycarbazepine in healthy subjects. Eur J Pharm Sci 2017; 109S:S116-S123. [PMID: 28528287 DOI: 10.1016/j.ejps.2017.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 01/11/2023]
Abstract
Oxcarbazepine is indicated for the treatment of partial or generalised tonic-clonic seizures. Most of the absorbed oxcarbazepine is converted into its active metabolite, 10-hydroxycarbazepine (MHD), which can exist as R-(-)- and S-(+)-MHD enantiomers. Here we describe the influence of the P-glycoprotein (P-gp) inhibitor verapamil, on the disposition of oxcarbazepine and MHD enantiomers, both of which are P-gp substrates. Healthy subjects (n=12) were randomised to oxcarbazepine or oxcarbazepine combined with verapamil at doses of 300mg b.i.d. and 80mg t.i.d., respectively. Blood samples (n=185) were collected over a period of 12h post oxcarbazepine dose. An integrated PK model was developed using nonlinear mixed effects modelling using a meta-analytical approach. The pharmacokinetics of oxcarbazepine was described by a two-compartment model with absorption transit compartments and first-order elimination. The concentration-time profiles of both MHD enantiomers were characterised by a one-compartment distribution model. Clearance estimates (95% CI) were 84.9L/h (69.5-100.3) for oxcarbazepine and 2.0L/h (1.9-2.1) for both MHD enantiomers. The volume of distribution was much larger for oxcarbazepine (131L (97-165)) as compared to R-(-)- and S-(+)-MHD (23.6L (14.4-32.8) vs. 31.7L (22.5-40.9), respectively). Co-administration of verapamil resulted in a modest increase of the apparent bioavailability of oxcarbazepine by 12% (10-28), but did not affect parent or metabolite clearances. Despite the evidence of comparable systemic levels of OXC and MHD following administration of verapamil, differences in brain exposure to both moieties cannot be excluded after P-glycoprotein inhibition.
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Affiliation(s)
- Natalicia de Jesus Antunes
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Sven C van Dijkman
- Division of Pharmacology, Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Vera Lucia Lanchote
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Lauro Wichert-Ana
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Eduardo Barbosa Coelho
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Veriano Alexandre Junior
- Department of Neurobehavioural Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | | | - Eduardo Tozatto
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - J G Coen van Hasselt
- Division of Pharmacology, Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Oscar Della Pasqua
- Division of Pharmacology, Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Clinical Pharmacology & Therapeutic Group, School of Life and Medical Sciences, University College London, London, UK.
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Rodrigues C, Chiron C, Rey E, Dulac O, Comets E, Pons G, Jullien V. Population pharmacokinetics of oxcarbazepine and its monohydroxy derivative in epileptic children. Br J Clin Pharmacol 2017; 83:2695-2708. [PMID: 28771787 DOI: 10.1111/bcp.13392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 06/27/2017] [Accepted: 07/30/2017] [Indexed: 12/31/2022] Open
Abstract
AIMS Oxcarbazepine is an antiepileptic drug with an activity mostly due to its monohydroxy derivative metabolite (MHD). A parent-metabolite population pharmacokinetic model in children was developed to evaluate the consistency between the recommended paediatric doses and the reference range for trough concentration (Ctrough ) of MHD (3-35 mg l-1 ). METHODS A total of 279 plasma samples were obtained from 31 epileptic children (age 2-12 years) after a single dose of oxcarbazepine. Concentration-time data were analysed with Monolix 4.3.2. The probability to obtain Ctrough between 3-35 mg l-1 was determined by Monte Carlo simulations for doses ranging from 10 to 90 mg kg-1 day-1 . RESULTS A parent-metabolite model with two compartments for oxcarbazepine and one compartment for MHD best described the data. Typical values for oxcarbazepine clearance, central and peripheral distribution volume and distribution clearance were 140 l h-1 70 kg-1 , 337 l 70 kg-1 , 60.7 l and 62.5 l h-1 , respectively. Typical values for MHD clearance and distribution volume were 4.11 l h-1 70 kg-1 and 54.8 l 70 kg-1 respectively. Clearances and distribution volumes of oxcarbazepine and MHD were related to body weight via empirical allometric models. Enzyme-inducing antiepileptic drugs (EIAEDs) increased MHD clearance by 29.3%. Fifty-kg children without EIAEDs may need 20-30 mg kg-1 day-1 instead of the recommended target maintenance dose (30-45 mg kg-1 day-1 ) to obtain Ctrough within the reference range. By contrast, 10-kg children with EIAEDs would need 90 mg kg-1 day-1 instead of the maximum recommended dose of 60 mg kg-1 day-1 . CONCLUSION This population pharmacokinetic model of oxcarbazepine supports current dose recommendations, except for 10-kg children with concomitant EIAEDs and 50-kg children without EIAEDs.
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Affiliation(s)
- Christelle Rodrigues
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France
| | - Catherine Chiron
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France
| | - Elisabeth Rey
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France
| | - Olivier Dulac
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France
| | - Emmanuelle Comets
- INSERM, IAME, UMR1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, CIC 1414, Université Rennes 1, Rennes, France
| | - Gérard Pons
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France
| | - Vincent Jullien
- INSERM U1129, Paris, France.,Paris Descartes University, CEA, Gif-sur-Yvette, France.,Service de Pharmacologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
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