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Mahboubi-Rabbani M, Abdolghaffari AH, Ghesmati M, Amini A, Zarghi A. Selective COX-2 inhibitors as anticancer agents: a patent review (2018-2023). Expert Opin Ther Pat 2024:1-25. [PMID: 38958471 DOI: 10.1080/13543776.2024.2373771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION COX-2 is a crucial enzyme in the manufacture of prostaglandins. The enzyme's metabolites might have an important function as regulators of the inflammatory response and other medical conditions such as cancer. Selective COX-2 inhibitors are believed to enhance or reverse the response of cancer chemotherapeutics. AREAS COVERED This study addresses the chemical structures as well as the antitumor activity of new COX-2 inhibitors produced in the recent five years, aiming to provide an insight into the mechanism of COX-2 induced PGE2 powerful signal in cancer development. EXPERT OPINION The significance of selective COX-2 inhibitors as an efficient superfamily of compounds with anti-inflammatory, anti-Alzheimer's, anti-Parkinson's disease, and anticancer properties has piqued the passion of academics in the field of drug development. Long-term usage of selective COX-2 inhibitors, such as celecoxib has been proven in clinical trials to lower the incidence of several human malignancies. Furthermore, celecoxib has the potential to greatly increase the effectiveness of chemotherapy. Our extensive understanding of selective COX-2 inhibitor SAR may aid in the development of safer and more effective selective COX-2 inhibitors as cancer chemopreventive agents. This review focuses on the different structural classes of selective COX-2 inhibitors, with a particular emphasis on their SAR.
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Affiliation(s)
- Mohammad Mahboubi-Rabbani
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Amir Hossein Abdolghaffari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mahsa Ghesmati
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Amini
- Department of Medicinal Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Zarghi
- Department of Medicinal Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Isakovich R, Cates VC, Pentz BA, Bird JD, Vanden Berg ER, de Freitas EM, Nysten CE, Leacy JK, O'Halloran KD, Brutsaert TD, Sherpa MT, Day TA. Using modified Fenn diagrams to assess ventilatory acclimatization during ascent to high altitude: Effect of acetazolamide. Exp Physiol 2024; 109:1080-1098. [PMID: 38747161 PMCID: PMC11215491 DOI: 10.1113/ep091748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/12/2024] [Indexed: 07/02/2024]
Abstract
High altitude (HA) ascent imposes systemic hypoxia and associated risk of acute mountain sickness. Acute hypoxia elicits a hypoxic ventilatory response (HVR), which is augmented with chronic HA exposure (i.e., ventilatory acclimatization; VA). However, laboratory-based HVR tests lack portability and feasibility in field studies. As an alternative, we aimed to characterize area under the curve (AUC) calculations on Fenn diagrams, modified by plotting portable measurements of end-tidal carbon dioxide (P ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) against peripheral oxygen saturation (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) to characterize and quantify VA during incremental ascent to HA (n = 46). Secondarily, these participants were compared with a separate group following the identical ascent profile whilst self-administering a prophylactic oral dose of acetazolamide (Az; 125 mg BID; n = 20) during ascent. First, morningP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ andS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ measurements were collected on 46 acetazolamide-free (NAz) lowland participants during an incremental ascent over 10 days to 5160 m in the Nepal Himalaya. AUC was calculated from individually constructed Fenn diagrams, with a trichotomized split on ranked values characterizing the smallest, medium, and largest magnitudes of AUC, representing high (n = 15), moderate (n = 16), and low (n = 15) degrees of acclimatization. After characterizing the range of response magnitudes, we further demonstrated that AUC magnitudes were significantly smaller in the Az group compared to the NAz group (P = 0.0021), suggesting improved VA. These results suggest that calculating AUC on modified Fenn diagrams has utility in assessing VA in large groups of trekkers during incremental ascent to HA, due to the associated portability and congruency with known physiology, although this novel analytical method requires further validation in controlled experiments. HIGHLIGHTS: What is the central question of this study? What are the characteristics of a novel methodological approach to assess ventilatory acclimatization (VA) with incremental ascent to high altitude (HA)? What is the main finding and its importance? Area under the curve (AUC) magnitudes calculated from modified Fenn diagrams were significantly smaller in trekkers taking an oral prophylactic dose of acetazolamide compared to an acetazolamide-free group, suggesting improved VA. During incremental HA ascent, quantifying AUC using modified Fenn diagrams is feasible to assess VA in large groups of trekkers with ascent, although this novel analytical method requires further validation in controlled experiments.
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Affiliation(s)
- Rodion Isakovich
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Valerie C. Cates
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Brandon A. Pentz
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Jordan D. Bird
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Emily R. Vanden Berg
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Emily M. de Freitas
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Cassandra E. Nysten
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Jack K. Leacy
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
- Department of Physiology, School of Medicine, College of Medicine & HealthUniversity Cork CollegeCorkIreland
| | - Ken D. O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & HealthUniversity Cork CollegeCorkIreland
| | | | | | - Trevor A. Day
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
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Kamp-Jensen C, Donslund LN, Styrishave B, Jensen RH, Westgate CSJ. Exposure to topiramate and acetazolamide causes endocrine disrupting effects in female rats during estrus. Toxicol Appl Pharmacol 2024; 486:116919. [PMID: 38580201 DOI: 10.1016/j.taap.2024.116919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a disease characterized by elevated intracranial pressure (ICP) and is a disease of young females. The first line pharmacological treatments include acetazolamide and topiramate and given the nature of IIH patients and the dosing regimen of these drugs, their effect on the endocrine system is important to evaluate. We aimed to assess the effects of acetazolamide and topiramate on steroid profiles in relevant endocrine tissues. METHODS Female Sprague Dawley rats received chronic clinically equivalent doses of acetazolamide or topiramate by oral gavage and were sacrificed in estrus. Tissue specific steroid profiles of lateral ventricle CP, 4th ventricle CP, CSF, serum, uterine horn and fundus, ovaries, adrenal glands and pituitary glands were assessed by quantitative targeted LC-MS/MS. We determined luteinizing hormone (LH) and follicle stimulating hormones (FSH) levels in paired serum by ELISA. RESULTS Topiramate increased the concentration of estradiol and decreased the concentration of DHEA in lateral choroid plexus. Moreover, it decreased the concentration of androstenediol in the pituitary gland. Topiramate increased serum LH. Acetazolamide decreased progesterone levels in serum and uterine fundus and increased corticosteroid levels in the adrenal glands. CONCLUSION These results demonstrate that both acetazolamide and topiramate have endocrine disrupting effects in rats. Topiramate primarily targeted the choroid plexus and the pituitary gland while acetazolamide had broader systemic effects. Furthermore, topiramate predominantly targeted sex hormones, whereas acetazolamide widely affected all classes of hormones. A similar effect in humans has not yet been documented but these concerning findings warrants further investigations.
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Affiliation(s)
- Christina Kamp-Jensen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
| | - Louise Norgil Donslund
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark
| | - Bjarne Styrishave
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark..
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
| | - Connar Stanley James Westgate
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
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Grønbæk-Thygesen M, Hartmann-Petersen R. Cellular and molecular mechanisms of aspartoacylase and its role in Canavan disease. Cell Biosci 2024; 14:45. [PMID: 38582917 PMCID: PMC10998430 DOI: 10.1186/s13578-024-01224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/24/2024] [Indexed: 04/08/2024] Open
Abstract
Canavan disease is an autosomal recessive and lethal neurological disorder, characterized by the spongy degeneration of the white matter in the brain. The disease is caused by a deficiency of the cytosolic aspartoacylase (ASPA) enzyme, which catalyzes the hydrolysis of N-acetyl-aspartate (NAA), an abundant brain metabolite, into aspartate and acetate. On the physiological level, the mechanism of pathogenicity remains somewhat obscure, with multiple, not mutually exclusive, suggested hypotheses. At the molecular level, recent studies have shown that most disease linked ASPA gene variants lead to a structural destabilization and subsequent proteasomal degradation of the ASPA protein variants, and accordingly Canavan disease should in general be considered a protein misfolding disorder. Here, we comprehensively summarize the molecular and cell biology of ASPA, with a particular focus on disease-linked gene variants and the pathophysiology of Canavan disease. We highlight the importance of high-throughput technologies and computational prediction tools for making genotype-phenotype predictions as we await the results of ongoing trials with gene therapy for Canavan disease.
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Affiliation(s)
- Martin Grønbæk-Thygesen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
| | - Rasmus Hartmann-Petersen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
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Rathi V, Sagi SSK, Yadav AK, Kumar M, Varshney R. Quercetin prophylaxis protects the kidneys by modulating the renin-angiotensin-aldosterone axis under acute hypobaric hypoxic stress. Sci Rep 2024; 14:7617. [PMID: 38556603 PMCID: PMC10982295 DOI: 10.1038/s41598-024-58134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
The study presented here aims at assessing the effects of hypobaric hypoxia on RAAS pathway and its components along with mitigation of anomalies with quercetin prophylaxis. One hour prior to hypobaric hypoxia exposure, male SD rats were orally supplemented with quercetin (50 mg/kg BW) and acetazolamide (50 mg/kg BW) and exposed them to 25,000 ft. (7,620 m) in a simulated environmental chamber for 12 h at 25 ± 2 °C. Different biochemical parameters like renin activity, aldosterone, angiotensin I, ACE 2 were determined in plasma. As a conventional response to low oxygen conditions, oxidative stress parameters (ROS and MDA) were elevated along with suppressed antioxidant system (GPx and catalase) in plasma of rats. Quercetin prophylaxis significantly down regulated the hypoxia induced oxidative stress by reducing plasma ROS & MDA levels with efficient enhancement of antioxidants (GPx and Catalase). Further, hypoxia mediated regulation of renin and ACE 2 proves the outstanding efficacy of quercetin in repudiating altercations in RAAS cascade due to hypobaric hypoxia. Furthermore, differential protein expression of HIF-1α, NFκB, IL-18 and endothelin-1 analyzed by western blotting approves the biochemical outcomes and showed that quercetin significantly aids in the reduction of inflammation under hypoxia. Studies conducted with Surface Plasmon Resonance demonstrated a binding among quercetin and ACE 2 that indicates that this flavonoid might regulate RAAS pathway via ACE 2. Henceforth, the study promotes the prophylaxis of quercetin for the better adaptability under hypobaric hypoxic conditions via modulating the RAAS pathway.
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Affiliation(s)
- Vaishnavi Rathi
- Defence Institute of Physiology and Allied Sciences, DRDO, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Sarada S K Sagi
- Defence Institute of Physiology and Allied Sciences, DRDO, Lucknow Road, Timarpur, New Delhi, 110054, India.
| | - Amit Kumar Yadav
- Department of Biophysics, All India Institute of Medical Science, Delhi, India
| | - Manoj Kumar
- Department of Biophysics, All India Institute of Medical Science, Delhi, India
| | - Rajeev Varshney
- Defence Institute of Physiology and Allied Sciences, DRDO, Lucknow Road, Timarpur, New Delhi, 110054, India
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Patrician A, Anholm JD, Ainslie PN. A narrative review of periodic breathing during sleep at high altitude: From acclimatizing lowlanders to adapted highlanders. J Physiol 2024. [PMID: 38534039 DOI: 10.1113/jp285427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Periodic breathing during sleep at high altitude is almost universal among sojourners. Here, in the context of acclimatization and adaptation, we provide a contemporary review on periodic breathing at high altitude, and explore whether this is an adaptive or maladaptive process. The mechanism(s), prevalence and role of periodic breathing in acclimatized lowlanders at high altitude are contrasted with the available data from adapted indigenous populations (e.g. Andean and Tibetan highlanders). It is concluded that (1) periodic breathing persists with acclimatization in lowlanders and the severity is proportional to sleeping altitude; (2) periodic breathing does not seem to coalesce with poor sleep quality such that, with acclimatization, there appears to be a lengthening of cycle length and minimal impact on the average sleeping oxygen saturation; and (3) high altitude adapted highlanders appear to demonstrate a blunting of periodic breathing, compared to lowlanders, comprising a feature that withstands the negative influences of chronic mountain sickness. These observations indicate that periodic breathing persists with high altitude acclimatization with no obvious negative consequences; however, periodic breathing is attenuated with high altitude adaptation and therefore potentially reflects an adaptive trait to this environment.
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Affiliation(s)
- Alexander Patrician
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - James D Anholm
- Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, BC, Canada
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Bays HE, Hsia DS, Nguyen LT, Peterson CA, Varghese ST. Effects of phentermine / topiramate extended-release, phentermine, and placebo on ambulatory blood pressure monitoring in adults with overweight or obesity: A randomized, multicenter, double-blind study. OBESITY PILLARS (ONLINE) 2024; 9:100099. [PMID: 38304225 PMCID: PMC10831272 DOI: 10.1016/j.obpill.2024.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
Background A fixed-dose combination of phentermine and extended-release topiramate (PHEN/TPM - approved for weight management) has demonstrated in-clinic reduction of blood pressure (BP). Ambulatory BP monitoring (ABPM) may be a better predictor of cardiovascular disease risk than in-clinic BP. Methods This randomized, multicenter, double-blind study enrolled 565 adults with overweight/obesity. Inclusion criteria included participants willing to wear ABPM device for 24 h. Exclusion criteria included screening blood pressure >140/90 mmHg and antihypertensive medications not stable for 3 months prior to randomization. Participants received placebo (n = 184), phentermine 30 mg; (n = 191), or PHEN 15 mg/TPM 92 mg; (n = 190). 24-hour ABPM was performed at baseline and at week 8. The primary endpoint was mean 24-h systolic BP (SBP) as measured by ABPM, in the per protocol population. Results Participants were mostly female (73.5 %) and White (81.6 %), with a mean age of 53.4 years; 32.4 % had no hypertension diagnosis or treatment, 62.5 % had hypertension using 0 to 2 antihypertensive medications, and 5.1 % had hypertension using ≥ 3 antihypertensive medications. Baseline mean SBP/diastolic BP (DBP) was 123.9/77.6 mmHg. At week 8, mean SBP change was -0.1 mmHg (placebo), +1.4 mmHg (phentermine 30 mg), and -3.3 mmHg (PHEN/TPM). Between-group difference for PHEN/TPM versus placebo was -3.2 mmHg (95 % CI: -5.48, -0.93 mmHg; p = 0.0059). The between-group difference for PHEN/TPM versus phentermine 30 mg was -4.7 mmHg (95 % CI: -6.96, -2.45 mmHg; p < 0.0001). Common (>2 % in any treatment group) adverse events (i.e., dry mouth, constipation, nausea, dizziness, paresthesia, dysgeusia, headache, COVID-19, urinary tract infection, insomnia, and anxiety) were mostly mild or moderate. Conclusions In this randomized, multicenter, double-blind ABPM study, PHEN/ TPM reduced SBP compared to either placebo or phentermine 30 mg (Funding: Vivus LLC; ClinicalTrials.gov: NCT05215418).
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Liu M, Jiao X, Li R, Li J, Wang L, Wang L, Wang Y, Lv C, Huang D, Wei R, Wang L, Ji X, Guo X. Effects of acetazolamide combined with remote ischemic preconditioning on risk of acute mountain sickness: a randomized clinical trial. BMC Med 2024; 22:4. [PMID: 38166913 PMCID: PMC10762951 DOI: 10.1186/s12916-023-03209-7] [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: 07/03/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to determine whether and how the combination of acetazolamide and remote ischemic preconditioning (RIPC) reduced the incidence and severity of acute mountain sickness (AMS). METHODS This is a prospective, randomized, open-label, blinded endpoint (PROBE) study involving 250 healthy volunteers. Participants were randomized (1:1:1:1:1) to following five groups: Ripc (RIPC twice daily, 6 days), Rapid-Ripc (RIPC four times daily, 3 days), Acetazolamide (twice daily, 2 days), Combined (Acetazolamide plus Rapid-Ripc), and Control group. After interventions, participants entered a normobaric hypoxic chamber (equivalent to 4000 m) and stayed for 6 h. The primary outcomes included the incidence and severity of AMS, and SpO2 after hypoxic exposure. Secondary outcomes included systolic and diastolic blood pressure, and heart rate after hypoxic exposure. The mechanisms of the combined regime were investigated through exploratory outcomes, including analysis of venous blood gas, complete blood count, human cytokine antibody array, ELISA validation for PDGF-AB, and detection of PDGF gene polymorphisms. RESULTS The combination of acetazolamide and RIPC exhibited powerful efficacy in preventing AMS, reducing the incidence of AMS from 26.0 to 6.0% (Combined vs Control: RR 0.23, 95% CI 0.07-0.70, P = 0.006), without significantly increasing the incidence of adverse reactions. Combined group also showed the lowest AMS score (0.92 ± 1.10). Mechanistically, acetazolamide induced a mild metabolic acidosis (pH 7.30 ~ 7.31; HCO3- 18.1 ~ 20.8 mmol/L) and improved SpO2 (89 ~ 91%) following hypoxic exposure. Additionally, thirty differentially expressed proteins (DEPs) related to immune-inflammatory process were identified after hypoxia, among which PDGF-AB was involved. Further validation of PDGF-AB in all individuals showed that both acetazolamide and RIPC downregulated PDGF-AB before hypoxic exposure, suggesting a possible protective mechanism. Furthermore, genetic analyses demonstrated that individuals carrying the PDGFA rs2070958 C allele, rs9690350 G allele, or rs1800814 G allele did not display a decrease in PDGF-AB levels after interventions, and were associated with a higher risk of AMS. CONCLUSIONS The combination of acetazolamide and RIPC exerts a powerful anti-hypoxic effect and represents an innovative and promising strategy for rapid ascent to high altitudes. Acetazolamide improves oxygen saturation. RIPC further aids acetazolamide, which synergistically regulates PDGF-AB, potentially involved in the pathogenesis of AMS. TRIAL REGISTRATION ClinicalTrials.gov NCT05023941.
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Affiliation(s)
- Moqi Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xueqiao Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Rui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jialu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lu Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Liyan Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Yishu Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Chunmei Lv
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Dan Huang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Ran Wei
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Liming Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Haapanen S, Angeli A, Tolvanen M, Emameh RZ, Supuran CT, Parkkila S. Cloning, characterization, and inhibition of the novel β-carbonic anhydrase from parasitic blood fluke, Schistosoma mansoni. J Enzyme Inhib Med Chem 2023; 38:2184299. [PMID: 36856011 PMCID: PMC9980027 DOI: 10.1080/14756366.2023.2184299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Schistosoma mansoni is an intestinal parasite with one β-class carbonic anhydrase, SmaBCA. We report the sequence enhancing, production, catalytic activity, and inhibition results of the recombinant SmaBCA. It showed significant catalytic activity on CO2 hydration in vitro with kcat 1.38 × 105 s-1 and kcat/Km 2.33 × 107 M-1 s-1. Several sulphonamide inhibitors, from which many are clinically used, showed submicromolar or nanomolar inhibitory effects on SmaBCA. The most efficient inhibitor with a KI of 43.8 nM was 4-(2-amino-pyrimidine-4-yl)-benzenesulfonamide. Other effective inhibitors with KIs in the range of 79.4-95.9 nM were benzolamide, brinzolamide, topiramate, dorzolamide, saccharin, epacadostat, celecoxib, and famotidine. The other tested compounds showed at least micromolar range inhibition against SmaBCA. Our results introduce SmaBCA as a novel target for drug development against schistosomiasis, a highly prevalent parasitic disease.
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Affiliation(s)
- Susanna Haapanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,CONTACT Susanna Haapanen Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
| | - Andrea Angeli
- Neurofarba Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Sesto Fiorentino, Italy
| | - Martti Tolvanen
- Department of Computing, University of Turku, Turku, Finland
| | - Reza Zolfaghari Emameh
- Department of Energy and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Claudiu T. Supuran
- Neurofarba Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Sesto Fiorentino, Italy
| | - Seppo Parkkila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Fimlab Ltd, Tampere University Hospital, Tampere, Finland
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Wang L, Zhou B, Yang C, Pan S, Huang Y, Wang J. The Effect of Ultrahigh Altitude on the Mental Health of Civil Servants in Western China Based on Propensity Score Matching. High Alt Med Biol 2023; 24:193-200. [PMID: 34324381 DOI: 10.1089/ham.2020.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Wang, Luyao, Bo Zhou, Chenghui Yang, Shuya Pan, Yulan Huang, and Jinyu Wang. The effect of ultrahigh altitude on the mental health of civil servants in western China based on propensity score matching. High Alt Med Biol. 24:193-200, 2023. Objective: This study aims to analyze the net effect of ultrahigh altitude on the mental health of civil servants in western China after adjusting for sociodemographic factors. Methods: A cross-sectional study was performed to survey the mental health of 2,939 civil servants working at an altitude of more than 1,500 m in 13 areas of the Tibetan Qiang Autonomous Prefecture of Ngawa using the Insomnia Severity Index Questionnaire, 7-item Generalized Anxiety Disorder Scale, and Patient Health Questionnaire-9. Ultrahigh altitude refers to an area above 3,500 m above sea level, which may have an impact on the sleep and mood of residents. Therefore, our research was divided into two groups based on altitude (ultrahigh altitude >3,500 m; high altitude = 1,500-3,400 m). Propensity score matching (PSM) was used to control for sociodemographic factors and compare the differences in mental health between the two groups. Results: After kernel matching, the mean bias of the covariates was reduced from 21.6 to 1.8. The severity of insomnia, depression, and anxiety in civil servants at ultrahigh altitudes was still significantly greater than that in civil servants at high altitudes after controlling for sociodemographic factors, and the average treatment effects on the treated were 1.39, 1.35, and 0.80, respectively; the results were significant (α < 0.01). PSM regression analysis further showed that for every 100 m increase in altitude, the severity of anxiety, depression, and insomnia increased by 0.042 points (p < 0.001), 0.063 points (p < 0.001), and 0.070 points (p < 0.001), respectively, all of which were higher than those obtained with ordinary least squares regression. Conclusion: Ultrahigh altitude significantly increases the severity of insomnia, depression, and anxiety after adjusting for sociodemographic factors.
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Affiliation(s)
- Luyao Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Chenghui Yang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shuya Pan
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yulan Huang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jinyu Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
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11
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McKeown DJ, Stewart GM, Kavanagh JJ. The severity of acute hypoxaemia determines distinct changes in intracortical and spinal neural circuits. Exp Physiol 2023; 108:1203-1214. [PMID: 37548581 PMCID: PMC10988465 DOI: 10.1113/ep091224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
The purpose of this study was to examine how two common methods of continuous hypoxaemia impact the activity of intracortical circuits responsible for inhibition and facilitation of motor output, and spinal excitability. Ten participants were exposed to 2 h of hypoxaemia at 0.13 fraction of inspired oxygen (F I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol) and 80% of peripheral capillary oxygen saturation (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol) using a simulating altitude device on two visits separated by a week. Using transcranial magnetic and peripheral nerve stimulation, unconditioned motor evoked potential (MEP) area, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), and F-wave persistence and area were assessed in the first dorsal interosseous (FDI) muscle before titration, after 1 and 2 h of hypoxic exposure, and at reoxygenation. The clamping protocols resulted in differing reductions inS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ by 2 h (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol: 81.9 ± 1.3%,F I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol: 90.6 ± 2.5%). Although unconditioned MEP peak to peak amplitude and area did not differ between the protocols, SICI duringF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping was significantly lower at 2 h compared toS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping (P = 0.011) and baseline (P < 0.001), whereas ICF was higher throughout theF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping compared toS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping (P = 0.005). Furthermore, a negative correlation between SICI andS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (rrm = -0.56, P = 0.002) and a positive correlation between ICF andS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (rrm = 0.69, P = 0.001) were determined, where greater reductions inS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ correlated with less inhibition and less facilitation of MEP responses. Although F-wave area progressively increased similarly throughout the protocols (P = 0.037), persistence of responses was reduced at 2 h and reoxygenation (P < 0.01) during theS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol compared to theF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol. After 2 h of hypoxic exposure, there is a reduction in the activity of intracortical circuits responsible for inhibiting motor output, as well as excitability of spinal motoneurones. However, these effects can be influenced by other physiological responses to hypoxia (i.e., hyperventilation and hypocapnia). NEW FINDINGS: What is the central question of this study? How do two common methods of acute hypoxic exposure influence the excitability of intracortical networks and spinal circuits responsible for motor output? What is the main finding and its importance? The excitability of spinal circuits and intracortical networks responsible for inhibition of motor output was reduced during severe acute exposure to hypoxia at 2 h, but this was not seen during less severe exposure. This provides insight into the potential cause of variance seen in motor evoked potential responses to transcranial magnetic stimulation (corticospinal excitability measures) when exposed to hypoxia.
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Affiliation(s)
- Daniel J. McKeown
- Neural Control of Movement LaboratoryMenzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Department of PsychologyFaculty of Society and DesignBond UniversityGold CoastQueenslandAustralia
| | - Glenn M. Stewart
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Justin J. Kavanagh
- Neural Control of Movement LaboratoryMenzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
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12
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Prosperi P, Verratti V, Taverna A, Rua R, Bonan S, Rapacchiale G, Bondi D, Di Giulio C, Lorkowski J, Spacone A. Ventilatory function and oxygen delivery at high altitude in the Himalayas. Respir Physiol Neurobiol 2023:104086. [PMID: 37257573 DOI: 10.1016/j.resp.2023.104086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
This study aimed to evaluate changes in lung function assessed by spirometry and blood gas content in healthy high-altitude sojourners during a trek in the Himalayas. A group of 19 Italian adults (11 males and 8 females, mean age 43 ±15 years, and BMI 24.2 ±3.7kg/m2) were evaluated as part of a Mount Everest expedition in Nepal. Spirometry and arterial blood gas content were evaluated at baseline in Kathmandu (≈1400m), at the Pyramid Laboratory - Observatory (peak altitude of ≈5000m), and on return to Kathmandu 2-3 days after arrival at each site. All participants took 250mg of acetazolamide per os once daily during the ascent. We found that arterial hemoglobin saturation, O2 and CO2 partial pressures, and the bicarbonate level all decreased (in all cases, p<0.001 with R2=0.70-0.90), while pHa was maintained stable at the peak altitude. Forced vital capacity (FVC) remained stable, while forced expiratory volume in 1sec (FEV1) decreased (p=0.010, n2p=0.228), resulting in a lower FEV1/FVC ratio (p<0.001, n2p=0.380). The best predictor for acute mountain sickness was the O2 partial pressure at the peak altitude (p=0.004, R2=0.39). Finger pulse oximetry overestimated peripheral saturation relative to arterial saturation. We conclude that high-altitude hypoxia alters the respiratory function and the oxygen saturation of the arterial blood hemoglobin. Additionally, air rarefaction and temperature reduction, favoring hypoxic bronchoconstriction, could affect respiration. Pulse oximetry seems not enough to assist medical decisions at high altitudes.
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Affiliation(s)
- Pierpaolo Prosperi
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Alberto Taverna
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy.
| | - Riccardo Rua
- Department of Anesthesia, Critical Care, and Emergency, University of Turin, 10126 Turin, Italy.
| | - Sofia Bonan
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Giorgia Rapacchiale
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Camillo Di Giulio
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Jacek Lorkowski
- Department of Orthopedics, Traumatology, and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Pol.
| | - Antonella Spacone
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
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13
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Dorbabu A. Pyrazole/pyrazoline as an excellent pharmacophore in the design of carbonic anhydrase inhibitors (2018-2022). Arch Pharm (Weinheim) 2023; 356:e2200562. [PMID: 36599496 DOI: 10.1002/ardp.202200562] [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: 10/25/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
Carbonic anhydrase (CA) is a metalloenzyme that catalyzes the interconversion between carbon dioxide and water and dissociated ions of carbonic acid. In addition, CA performs various other functions in animals and plants, depending on the part of the living being. CAs have been found in almost all organisms. Besides, CAs are associated with several diseases, such as glaucoma, obesity, epilepsy, cancer, and so on. CAs are also involved in tumor cell growth and angiogenesis. Thus, inhibition of CA may be an attractive way of control of such diseases. Hence, CA inhibitors have been designed and developed to cure CA-associated diseases. Some examples of approved CA inhibitors are dorzolamide, methazolamide, brinzolamide, and dichlorphenamide. Furthermore, various heterocyclic scaffolds were utilized for the design of CA inhibitors. Among those, pyrazole/pyrazoline derivatives have exhibited greater potency toward CA inhibition. Hence, research that took place in the field of drug design and discovery of CA inhibition has been systematically reviewed and collated. Alongside, the structure-activity relationship has been described, followed by a description of the most potent molecules and their structural features.
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Affiliation(s)
- Atukuri Dorbabu
- SRMPP Government First Grade College, Huvina Hadagali, India
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14
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Sharma P, Mohanty S, Ahmad Y. A study of survival strategies for improving acclimatization of lowlanders at high-altitude. Heliyon 2023; 9:e14929. [PMID: 37025911 PMCID: PMC10070159 DOI: 10.1016/j.heliyon.2023.e14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Human Acclimatization and therapeutic approaches are the core components for conquering the physiological variations at high altitude (≥2500 m) exposure. The declined atmospheric pressure and reduced partial pressure of oxygen at high altitudes tend to decrease the temperature by several folds. Hypobaric hypoxia is a major threat to humanity at high altitudes, and its potential effects include altitude mountain sickness. On severity, it may lead to the development of conditions like high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE) and cause unexpected physiological changes in the healthy population of travelers, athletes, soldiers, and low landers while sojourning at high altitude. Previous investigations have been done on long-drawn-out acclimatization strategies such as the staging method to prevent the damage caused by high-altitude hypobaric Hypoxia. Inherent Limitations of this strategy hamper the daily lifestyle and time consuming for people. It is not suitable for the rapid mobilization of people at high altitudes. There is a need to recalibrate acclimatization strategies for improving health protection and adapting to the environmental variations at high altitudes. This narrative review details the geographical changes and physiological changes at high altitudes and presents a framework of acclimatization, pre-acclimatization, and pharmacological aspects of high-altitude survival to enhance the government efficacy and capacity for the strategic planning of acclimatization, use of therapeutics, and safe de-induction from high altitude for minimizing the life loss. It's simply too ambitious for the importance of the present review to reduce life loss, and it can be proved as the most essential aspect of the preparatory phase of high-altitude acclimatization in plateau regions without hampering the daily lifestyle. The application of pre-acclimatization techniques can be a boon for people serving at high altitudes, and it can be a short bridge for the rapid translocation of people at high altitudes by minimizing the acclimatization time.
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Affiliation(s)
- Poornima Sharma
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Swaraj Mohanty
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Yasmin Ahmad
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
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15
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Doherty CJ, Chang JC, Thompson BP, Swenson ER, Foster GE, Dominelli PB. The Impact of Acetazolamide and Methazolamide on Exercise Performance in Normoxia and Hypoxia. High Alt Med Biol 2023; 24:7-18. [PMID: 36802203 DOI: 10.1089/ham.2022.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Doherty, Connor J., Jou-Chung Chang, Benjamin P. Thompson, Erik R. Swenson, Glen E. Foster, and Paolo B. Dominelli. The impact of acetazolamide and methazolamide on exercise performance in normoxia and hypoxia. High Alt Med Biol. 24:7-18, 2023.-Carbonic anhydrase (CA) inhibitors are commonly prescribed for acute mountain sickness (AMS). In this review, we sought to examine how two CA inhibitors, acetazolamide (AZ) and methazolamide (MZ), affect exercise performance in normoxia and hypoxia. First, we briefly describe the role of CA inhibition in facilitating the increase in ventilation and arterial oxygenation in preventing and treating AMS. Next, we detail how AZ affects exercise performance in normoxia and hypoxia and this is followed by a discussion on MZ. We emphasize that the overarching focus of the review is how the two drugs potentially affect exercise performance, rather than their ability to prevent/treat AMS per se, their interrelationship will be discussed. Overall, we suggest that AZ hinders exercise performance in normoxia, but may be beneficial in hypoxia. Based upon head-to-head studies of AZ and MZ in humans on diaphragmatic and locomotor strength in normoxia, MZ may be a better CA inhibitor when exercise performance is crucial at high altitude.
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Affiliation(s)
- Connor J Doherty
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jou-Chung Chang
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Benjamin P Thompson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Washington, USA
- Medical Service, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Glen E Foster
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Reiser AE, Furian M, Lichtblau M, Buergin A, Schneider SR, Appenzeller P, Mayer L, Muralt L, Mademilov M, Abdyraeva A, Aidaralieva S, Muratbekova A, Akylbekov A, Sheraliev U, Shabykeeva S, Sooronbaev TM, Ulrich S, Bloch KE. Effect of acetazolamide on visuomotor performance at high altitude in healthy people 40 years of age or older-RCT. PLoS One 2023; 18:e0280585. [PMID: 36662903 PMCID: PMC9858039 DOI: 10.1371/journal.pone.0280585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Altitude travel is increasingly popular also for middle-aged and older tourists and professionals. Due to the sensitivity of the central nervous system to hypoxia, altitude exposure may impair visuomotor performance although this has not been extensively studied. Therefore, we investigated whether a sojourn at moderately high altitude is associated with visuomotor performance impairments in healthy adults, 40y of age or older, and whether this adverse altitude-effect can be prevented by acetazolamide, a drug used to prevent acute mountain sickness. METHODS In this randomized placebo-controlled parallel-design trial, 59 healthy lowlanders, aged 40-75y, were assigned to acetazolamide (375 mg/day, n = 34) or placebo (n = 25), administered one day before ascent and while staying at high altitude (3100m). Visuomotor performance was assessed at 760m and 3100m after arrival and in the next morning (post-sleep) by a computer-assisted test (Motor-Task-Manager). It quantified deviation of a participant-controlled cursor affected by rotation during target tracking. Primary outcome was the directional error during post-sleep recall of adaptation to rotation estimated by multilevel linear regression modeling. Additionally, adaptation, immediate recall, and correct test execution were evaluated. RESULTS Compared to 760m, assessments at 3100m with placebo revealed a mean (95%CI) increase in directional error during adaptation and immediate recall by 1.9° (0.2 to 3.5, p = 0.024) and 1.1° (0.4 to 1.8, p = 0.002), respectively. Post-sleep recall remained unchanged (p = NS), however post-sleep correct test execution was 14% less likely (9 to 19, p<0.001). Acetazolamide improved directional error during post-sleep recall by 5.6° (2.6 to 8.6, p<0.001) and post-sleep probability of correct test execution by 36% (30 to 42, p<0.001) compared to placebo. CONCLUSION In healthy individuals, 40y of age or older, altitude exposure impaired adaptation to and immediate recall and correct execution of a visuomotor task. Preventive acetazolamide treatment improved visuomotor performance after one night at altitude and increased the probability of correct test execution compared to placebo. CLINICALTRIALS.GOV IDENTIFIER ClinicalTrials.gov NCT03536520.
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Affiliation(s)
- Aurelia E. Reiser
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Aline Buergin
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Simon R. Schneider
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Paula Appenzeller
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Laura Mayer
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Maamed Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Ainura Abdyraeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Shoira Aidaralieva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Aibermet Muratbekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Azamat Akylbekov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Ulan Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Saltanat Shabykeeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Talant M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Konrad E. Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
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Guo Q, Li X, Li W, Wang R, Zhao A, Wang Z. A Pharmacodynamic Evaluation of the Protective Effects of Roxadustat Against Hypoxic Injury at High Altitude. Drug Des Devel Ther 2023; 17:75-85. [PMID: 36686057 PMCID: PMC9851060 DOI: 10.2147/dddt.s390975] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate roxadustat's preventive effects on hypoxia damage in the quick ascent to high altitude. Methods The roxadustat (7.8 mg/kg, 15.6 mg/kg, and 31.2 mg/kg) and control groups of BALB/C mice were distributed at random. To evaluate roxadustat's anti-hypoxic effectiveness at the recommended dose, an atmospheric pressure closed hypoxic experiment was used. Wistar rats were randomly assigned to groups that received normal oxygen, hypoxic, acetazolamide, or roxadustat in order to evaluate the protective effects against hypoxic damage. Animal blood was obtained for arterial blood-gas analysis, inflammatory factors, and the identification of oxidative stress indicators. Animal tissues were removed for pathological investigation. Results In each group, the mice's survival time was noticeably extended compared to the normal oxygen group. The medium dose had the best time extension rate at 19.05%. Blood SatO2 and PaO2 were significantly higher in the roxadustat group compared to the hypoxic group. Erythrocyte content, hemoglobin content, and hematocrit were also significantly higher. Plasma levels of IL-6, TNF-α, and IFN-γ were also significantly lower in the roxadustat group. Roxadustat can also improve the level of oxidative stress in the tissues of hypoxic rats. According to the results of HE staining, roxadustat could greatly lessen the harm done to rat heart, brain, lung, liver, and kidney tissue as a result of hypoxia. Conclusion Roxadustat can greatly reduce inflammation, oxidative stress, and tissue damage brought on by hypoxia, showing that it can significantly enhance the body's ability to adapt to high altitude exposure.
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Affiliation(s)
- Qianwen Guo
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China,School of Pharmacy, Gansu University of Traditional Chinese Medicine, Lanzhou, People’s Republic of China
| | - Xue Li
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China
| | - Wenbin Li
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China,Correspondence: Wenbin Li, Key Laboratory of the Plateau of the Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, 730050, People’s Republic of China, Tel +86-931 8994654, Fax +86-931 2662722, Email ;
| | - Rong Wang
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China
| | - Anpeng Zhao
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China
| | - Zihan Wang
- Pharmacy of the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, People’s Republic of China,School of Pharmacy, Gansu University of Traditional Chinese Medicine, Lanzhou, People’s Republic of China
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18
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Cates VC, Bruce CD, Marullo AL, Isakovich R, Saran G, Leacy JK, O′Halloran KD, Brutsaert TD, Sherpa MT, Day TA. Steady-state chemoreflex drive captures ventilatory acclimatization during incremental ascent to high altitude: Effect of acetazolamide. Physiol Rep 2022; 10:e15521. [PMID: 36461658 PMCID: PMC9718940 DOI: 10.14814/phy2.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023] Open
Abstract
Ventilatory acclimatization (VA) is important to maintain adequate oxygenation with ascent to high altitude (HA). Transient hypoxic ventilatory response tests lack feasibility and fail to capture the integrated steady-state responses to chronic hypoxic exposure in HA fieldwork. We recently characterized a novel index of steady-state respiratory chemoreflex drive (SSCD), accounting for integrated contributions from central and peripheral respiratory chemoreceptors during steady-state breathing at prevailing chemostimuli. Acetazolamide is often utilized during ascent for prevention or treatment of altitude-related illnesses, eliciting metabolic acidosis and stimulating respiratory chemoreceptors. To determine if SSCD reflects VA during ascent to HA, we characterized SSCD in 25 lowlanders during incremental ascent to 4240 m over 7 days. We subsequently compared two separate subgroups: no acetazolamide (NAz; n = 14) and those taking an oral prophylactic dose of acetazolamide (Az; 125 mg BID; n = 11). At 1130/1400 m (day zero) and 4240 m (day seven), steady-state measurements of resting ventilation (V̇I ; L/min), pressure of end-tidal (PET )CO2 (Torr), and peripheral oxygen saturation (SpO2 ; %) were measured. A stimulus index (SI; PET CO2 /SpO2 ) was calculated, and SSCD was calculated by indexing V̇I against SI. We found that (a) both V̇I and SSCD increased with ascent to 4240 m (day seven; V̇I : +39%, p < 0.0001, Hedges' g = 1.52; SSCD: +56.%, p < 0.0001, Hedges' g = 1.65), (b) and these responses were larger in the Az versus NAz subgroup (V̇I : p = 0.02, Hedges' g = 1.04; SSCD: p = 0.02, Hedges' g = 1.05). The SSCD metric may have utility in assessing VA during prolonged stays at altitude, providing a feasible alternative to transient chemoreflex tests.
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Affiliation(s)
- Valerie C. Cates
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Christina D. Bruce
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Anthony L. Marullo
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
- Department of Physiology. School of MedicineUniversity Cork CollegeCorkIreland
| | - Rodion Isakovich
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Gurkarn Saran
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Jack K. Leacy
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
- Department of Physiology. School of MedicineUniversity Cork CollegeCorkIreland
| | - Ken D. O′Halloran
- Department of Physiology. School of MedicineUniversity Cork CollegeCorkIreland
| | | | | | - Trevor A. Day
- Department of Biology, Faculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
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19
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Pathophysiology and Therapy of High-Altitude Sickness: Practical Approach in Emergency and Critical Care. J Clin Med 2022; 11:jcm11143937. [PMID: 35887706 PMCID: PMC9325098 DOI: 10.3390/jcm11143937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/26/2022] Open
Abstract
High altitude can be a hostile environment and a paradigm of how environmental factors can determine illness when human biological adaptability is exceeded. This paper aims to provide a comprehensive review of high-altitude sickness, including its epidemiology, pathophysiology, and treatments. The first section of our work defines high altitude and considers the mechanisms of adaptation to it and the associated risk factors for low adaptability. The second section discusses the main high-altitude diseases, highlighting how environmental factors can lead to the loss of homeostasis, compromising important vital functions. Early recognition of clinical symptoms is important for the establishment of the correct therapy. The third section focuses on high-altitude pulmonary edema, which is one of the main high-altitude diseases. With a deeper understanding of the pathogenesis of high-altitude diseases, as well as a reasoned approach to environmental or physical factors, we examine the main high-altitude diseases. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
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20
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Jing L, Wu N, Zhang J, Da Q, Ma H. Protective effect of 5,6,7,8-Tetrahydroxyflavone on high altitude cerebral edema in rats. Eur J Pharmacol 2022; 928:175121. [PMID: 35777443 DOI: 10.1016/j.ejphar.2022.175121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
High altitude cerebral edema (HACE) is a potentially life-threatening disease encountered at high altitudes. However, effective methods for HACE prophylaxis are limited. Convincing evidence confirms that oxidative stress induced by hypobaric hypoxia (HH) is one of the main factors that account for the development of HACE. 5,6,7,8-Tetrahydroxyflavone (THF), a flavone with four consecutive OH groups in ring A, exhibited excellent antioxidant activity in vitro and could attenuate HH induced injury in vivo. The aim of this study was to investigate the protective effect of THF against HACE and its underlying mechanisms. THF administration significantly suppressed HH induced oxidative stress by reducing the formation of hydrogen peroxide and malondialdehyde, by increasing the levels of glutathione and superoxide dismutase in brain tissue. Simultaneously, THF administration inhibited inflammatory responses by decreasing the levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in serum and brain tissue. In addition, THF administration mitigated the energy metabolism disorder induced by HACE as evidenced by decreased levels of lactic acid, lactate dehydrogenase and pyruvate kinase as well as increased ATP levels and ATPase activities. Furthermore, THF administration decreased the expression of matrix metalloproteinase-9, aquaporin 4, hypoxia-inducible factor-1α and vascular endothelial growth factor, which attenuated blood-brain barrier (BBB) disruption and brain edema. Additionally, THF administration improved HACE induced cognitive dysfunction. These results show that THF is a promising agent in the prevention and treatment of HACE.
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Affiliation(s)
- Linlin Jing
- Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China; Department of Pharmacy, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, 730050, China.
| | - Ningzi Wu
- Department of Pharmacy, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, 730050, China
| | - Jie Zhang
- Department of Pharmacy, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, 730050, China
| | - Qingyue Da
- Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China; Department of Pharmacy, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, 730050, China
| | - Huiping Ma
- Department of Pharmacy, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, 730050, China.
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21
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Drago S, Campodónico J, Sandoval M, Berendsen R, Buijze GA. Voluntary Increase of Minute Ventilation for Prevention of Acute Mountain Sickness. Int J Sports Med 2022; 43:971-977. [PMID: 35760082 DOI: 10.1055/a-1832-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study evaluated the feasibility and efficacy of voluntary sustained hyperventilation during rapid ascent to high altitude for the prevention of acute mountain sickness (AMS). Study subjects (n=32) were volunteer participants in a 2-day expedition to Mount Leoneras (4954 m), starting at 2800m (base camp at 4120 m). Subjects were randomized to either: 1) an intervention group using the voluntary hyperventilation (VH) technique targeting an end-tidal CO2 (ETCO2)<20 mmHg; or 2) a group using acetazolamide (AZ). During the expedition, respiratory rate (28±20 vs. 18±5 breaths/min, mean±SD, P<0.01) and SpO2 (95%±4% vs. 89%±5%, mean±SD, P<0.01) were higher, and ETCO2 (17±4 vs. 26±4 mmHg, mean±SD, P<0.01) was lower in the VH group compared to the AZ group - as repeatedly measured at equal fixed intervals during the ascent - showing the feasibility of the VH technique. Regarding efficacy, the incidence of 6 (40%) subjects registering an LLS score≥3 in the VH group was non-inferior to the 3 (18%) subjects in the acetazolamide group (P=0.16, power 28%). Voluntary increase in minute ventilation is a feasible technique, but - despite the underpowered non-inferiority in this small-scale proof-of-concept trial - it is not likely to be as effective as acetazolamide to prevent AMS.
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Affiliation(s)
- Sebastian Drago
- Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile.,Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Juan Campodónico
- Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.,Grupo de rescate médico en montaña (GREMM), Santiago, Chile
| | - Mario Sandoval
- Sport Medicine Department; Clínica MEDS, Santiago, Chile
| | - Remco Berendsen
- Anesthesia, Leiden University Medical Center, Leiden, Netherlands
| | - Geert Alexander Buijze
- Orthopaedic Surgery and Sports Medicine, Clinique Générale, Annecy, France.,Orthopaedic Surgery, Lapeyronie Hospital, Montpellier University Medical Center, Montpellier, France.,Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
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22
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Sen IM, Goel N, Aditya A, Bhukkal I, Sharma A. Effect of Orogastric Acetazolamide on Optic Nerve Sheath Diameter in Patients Undergoing Laparoscopic Donor Nephrectomies: A Randomized, Double-Blind Trial. Cureus 2022; 14:e24454. [PMID: 35573555 PMCID: PMC9099160 DOI: 10.7759/cureus.24454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Laparoscopic Live Donor Nephrectomy(LLDN) is becoming an increasingly frequent procedure. The rise in intracranial pressure(ICP) during LLDN has not been measured yet. ICP can be evaluated by measuring ultrasonographic optic nerve sheath diameter(ONSD). Acetazolamide has been found to provide effective analgesia following LLDN. It also helps lowering the raised ICP. Therefore, we planned to study effect of orogastric Acetazolamide on ONSD in patients undergoing LLDN. Methods Forty Donors scheduled for LLDN were randomized preoperatively either into Group A receiving acetazolamide 5mg/kg or Group S receiving normal saline. ONSD was measured at time points:Time 0: In supine position before induction of GA, Time 1: 5 minutes after induction of GA but before giving orogastric acetazolamide, Time 2: 10 minutes after creating pneumoperitoneum, Time 3: 60 minutes after creating pneumoperitoneum, Time 4: Towards end of surgery, just before taking out specimen in modified flank position, Time 5: after extubating in supine position. Results Mean ONSD of left eye(4.42 ± 0.48) in Group S was significantly more than mean ONSD of left eye(4.16 ± 0.15; p-0.036) in Group A at 10 mins after creating pneumoperitoneum in modified flank position. Mean ONSD showed significant increase in group S at 10 and 60 minutes(4.374 ± 0.433mm in group S vs 4.151 ± 0.168 in group A; p-0.042 at 10 mins and 4.336 ± 0.301mm in group S vs 4.149 ± 0.282mm in group A; p-0.050 at 60 mins) after creating pneumoperitoneum as compared to group A. Conclusion Orogastric acetazolamide 5 mg/kg was found to be beneficial in preventing rise in ONSD from 10 minutes to 1 hour of creating pneumoperitoneum in patients undergoing laparoscopic donor nephrectomy under general anaesthesia. Acetazolamide was also found to be effective in reducing postoperative pain.
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Affiliation(s)
- Indu M Sen
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Nitika Goel
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashish Aditya
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ishwar Bhukkal
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashish Sharma
- Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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23
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Zelmanovich R, Pierre K, Felisma P, Cole D, Goldman M, Lucke-Wold B. High Altitude Cerebral Edema: Improving Treatment Options. BIOLOGICS (BASEL, SWITZERLAND) 2022; 2:81-91. [PMID: 35425940 PMCID: PMC9006955 DOI: 10.3390/biologics2010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High altitude illness in its most severe form can lead to high altitude cerebral edema (HACE). Current strategies have focused on prevention with graduated ascents, pharmacologic prophylaxis, and descent at first signs of symptoms. Little is understood regarding treatment with steroids and oxygenation being commonly utilized. Pre-clinical studies with turmeric derivatives have offered promise due to its anti-inflammatory and antioxidant properties, but they warrant validation clinically. Ongoing work is focused on better understanding the disease pathophysiology with an emphasis on the glymphatic system and venous outflow obstruction. This review highlights what is known regarding diagnosis, treatment, and prevention, while also introducing novel pathophysiology mechanisms warranting further investigation.
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Affiliation(s)
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Patrick Felisma
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Dwayne Cole
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Matthew Goldman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
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24
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McKenna ZJ, Gorini Pereira F, Gillum TL, Amorim FT, Deyhle MR, Mermier CM. High altitude exposures and intestinal barrier dysfunction. Am J Physiol Regul Integr Comp Physiol 2022; 322:R192-R203. [PMID: 35043679 DOI: 10.1152/ajpregu.00270.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gastrointestinal complaints are often reported during ascents to high altitude (> 2500 m), though their etiology is not known. One potential explanation is injury to the intestinal barrier which has been implicated in the pathophysiology of several diseases. High altitude exposures can reduce splanchnic perfusion and blood oxygen levels causing hypoxic and oxidative stress. These stressors might injure the intestinal barrier leading to consequences such as bacterial translocation and local/systemic inflammatory responses. The purpose of this mini review is to 1) discuss the impact of high-altitude exposures on intestinal barrier dysfunction, and 2) present medications and dietary supplements which may have relevant impacts on the intestinal barrier during high-altitude exposures. There is a small but growing body of evidence which shows that acute exposures to high altitudes can damage the intestinal barrier. Initial data also suggests that prolonged hypoxic exposures can compromise the intestinal barrier through alterations in immunological function, microbiota, or mucosal layers. Exertion may worsen high-altitude related intestinal injury via additional reductions in splanchnic circulation and greater hypoxemia. Collectively these responses can result in increased intestinal permeability and bacterial translocation causing local and systemic inflammation. More research is needed to determine the impact of various medications and dietary supplements on the intestinal barrier during high-altitude exposures.
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Affiliation(s)
- Zachary J McKenna
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Felipe Gorini Pereira
- Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, United States
| | - Trevor L Gillum
- Department of Kinesiology, California Baptist University, Riverside, CA, United States
| | - Fabiano Trigueiro Amorim
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Michael R Deyhle
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Christine M Mermier
- Department of Health, Exercise, and Sport Sciences, University of New Mexico, Albuquerque, NM, United States
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25
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Elucidating the combined effect of intermittent hypoxia training and acetazolamide on hypoxia induced hematological and physiological changes. Curr Res Physiol 2022; 5:327-337. [PMID: 35880035 PMCID: PMC9307424 DOI: 10.1016/j.crphys.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
As the number of people travelling to altitude increases, the risk of life threatening medical emergencies also increases. It is important that we have effective strategies to minimize the risk of altitude illness. In this study, an attempt was made to investigate the combined effect of non-pharmacological (Intermittent hypoxia training; IHT) and pharmacological (acetazolamide; ACZ) intervention as a prophylactic strategy in order to minimize the risk of high altitude hypoxic related problems using rats as an animal model. Male Sprague Dawley rats were subjected to IHT for 4 h consecutively for 5 days at 12% FiO2 under normobaric conditions with and without oral ACZ administration at 25 mg/kg body weight. Validation of the intervention was performed by exposing the rats to extreme hypoxia (EH) at 8% FiO2 to further assess the effect of IHT and ACZ on hypoxic acclimatization. The principal findings of this study is that the combined effect of IHT and ACZ improves the arterial oxygenation by alterations in hemodynamics and in blood gasometry, thereby resulting into an increase in the oxygen carrying capacity of the blood with increase in SpO2 (peripheral oxygen saturation). The present study showed that the combined effect of IHT with ACZ could be refined as a prophylactic measure for better outcomes during altitude ascent and rapid altitude acclimatization rather than IHT or ACZ alone. Combination of IHT with ACZ attenuates the inhibitory effect of respiratory alkalosis. It also minimizes pathological changes in hematology and blood gas. The strategy improved the oxygen carrying capacity of the blood by increasing SpO2. Thus, it leads to ventilatory Acclimatization. The combined treatment could be refined as a prophylactic measure for altitude maladies.
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26
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Darling AM, Richey RE, Akins JD, Saunders EFH, Matthew Brothers R, Greaney JL. Cerebrovascular reactivity is blunted in young adults with major depressive disorder: The influence of current depressive symptomology. J Affect Disord 2021; 295:513-521. [PMID: 34509066 PMCID: PMC8667006 DOI: 10.1016/j.jad.2021.08.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In middle-aged adults with depression, cerebral vasodilatory reactivity is blunted; however, this has not been examined in treatment-naïve young adults with major depressive disorder (MDD). We tested the hypothesis that cerebrovascular reactivity would be blunted in young adults (18-30 yrs) with MDD compared to healthy non-depressed adults (HA) and would be attenuated to a greater extent in adults with symptomatic MDD (sMDD) compared to adults with MDD in remission (euthymic MDD; eMDD). METHODS Sixteen adults with MDD [21±3yrs; n = 8 sMDD (6 women); n = 8 eMDD (5 women)] and 14 HA (22±3yrs; 9 women) participated. End-tidal carbon dioxide concentration (PETCO2; capnograph), beat-to-beat mean arterial pressure (MAP; finger photoplethysmography), middle cerebral artery blood velocity (MCAv; transcranial Doppler ultrasound), and internal carotid artery (ICA) diameter and blood velocity (Doppler ultrasound) were continuously measured during baseline and rebreathing-induced hypercapnia. Cerebrovascular reactivity was calculated as the relative increase in vascular conductance during hypercapnia. RESULTS In adults with MDD, cerebrovascular reactivity in the MCA (∆39±9 HA vs. ∆31±13% MDD, p = 0.04), but not the ICA (∆36±24 HA vs. ∆34±18% MDD, p = 0.84), was blunted compared to HA. In the MCA, cerebrovascular reactivity was reduced in adults with sMDD compared to adults with eMDD (∆36±11 eMDD vs. ∆25±13% sMDD, p = 0.02). LIMITATIONS The cross-sectional nature approach limits conclusions regarding the temporal nature of this link. CONCLUSION These data indicate that MCA cerebrovascular reactivity is blunted in young adults with MDD and further modulated by current depressive symptomology, suggesting that the management of depressive symptomology may secondarily improve cerebrovascular health.
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Affiliation(s)
- Ashley M Darling
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Rauchelle E Richey
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States; Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - John D Akins
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Jody L Greaney
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States.
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Gao D, Wang Y, Zhang R, Zhang Y. Efficacy of acetazolamide for the prophylaxis of acute mountain sickness: A systematic review, meta-analysis, and trial sequential analysis of randomized clinical trials. Ann Thorac Med 2021; 16:337-346. [PMID: 34820021 PMCID: PMC8588948 DOI: 10.4103/atm.atm_651_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) is a benign and self-limiting syndrome, but can progress to life-threatening conditions if leave untreated. This study aimed to assess the efficacy of acetazolamide for the prophylaxis of AMS, and disclose factors that affect the treatment effect of acetazolamide. METHODS Randomized controlled trials comparing the use of acetazolamide versus placebo for the prevention of AMS were included. The incidence of AMS was our primary endpoint. Meta-regression analysis was conducted to explore factors that associated with acetazolamide efficacy. Trial sequential analyses were conducted to estimate the statistical power of the available data. RESULTS A total of 22 trials were included. Acetazolamide at 125, 250, and 375 mg/bid significantly reduced incidence of AMS compared to placebo. TAS indicated that the current evidence was adequate confirming the efficacy of acetazolamide at 125, 250, and 375 mg/bid in lowering incidence of AMS. There was no evidence of an association between efficacy and dose of acetazolamide, timing at start of acetazolamide treatment, mode of ascent, AMS assessment score, timing of AMS assessment, baseline altitude, and endpoint altitude. CONCLUSION Acetazolamide is effective prophylaxis for the prevention of AMS at 125, 250, and 375 mg/bid. Future investigation should focus on personal characteristics, disclosing the correlation between acetazolamide efficacy and body mass, height, degree of prior acclimatization, individual inborn susceptibility, and history of AMS.
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Affiliation(s)
- Daiquan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rujiang Zhang
- Department of Neurology, The People's Hospital of RuiLi, Yunnan, China
| | - Yunzhou Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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28
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Aggul AG, Taslimi P, Kuzu M, Uzun N, Bilginer S, Gulcin I. Oleuropein and Verbascoside - Their Inhibition Effects on Carbonic Anhydrase and Molecular Docking Studies. J Oleo Sci 2021; 70:1275-1283. [PMID: 34483220 DOI: 10.5650/jos.ess21106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recently, carbonic anhydrase (CA, E.C.4.2.1.1) inhibitors from natural product have paved the way for novel drug design in the treatment and prevention of some global diseases such as glaucoma, diabetes, and cancer. For this purpose, the inhibition effects of oleuropein and verbascoside from olive (Olea europaea L.) oil on human carbonic anhydrase I, and II (hCA I, and II) isoenzymes were evaluated in the current study. The inhibition effects of both natural compounds were determined by the esterase activity (in vitro). IC50 value of oleuropein and verbascoside was calculated as 1.57 and 1.73 µM for hCA I isoenzyme, respectively. At the same manner, K i values were determined as 1.25 ± 0.42 and 2.00 ± 0.42 µM, respectively. Then, IC50 value of each compound for hCA II isoenzyme was calculated as 2.23 and 1.90 µM, respectively. Similarly, K i values were determined as 2.37 ± 0.87 µM and 1.49 ± 0.33 µM, respectively. Also, the inhibitory effects and potent binding mechanisms of oleuropein and verbascoside on hCA I, and II isoenzymes were realized by molecular docking studies. Consequently, both natural phenolic compounds demonstrated the potent inhibition profiles against the both isoenzymes. Therefore, we believe that these results may break new ground in the drug development for the treatment of some global disorders.
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Affiliation(s)
- Ahmet Gokhan Aggul
- Agri Ibrahim Cecen University, Faculty of Pharmacy, Department of Biochemistry
| | - Parham Taslimi
- Bartin University, Faculty of Science, Department of Biotechnology
| | - Muslum Kuzu
- Karabuk University, Faculty of Health Sciences, Department of Nutrition and Dietetics
| | - Naim Uzun
- Agri Ibrahim Cecen University, Faculty of Pharmacy, Department of Biochemistry
| | - Sinan Bilginer
- Ataturk University, Faculty of Pharmacy, Department of Pharmaceutical Chemistry
| | - Ilhami Gulcin
- Ataturk University, Faculty of Science, Department of Chemistry
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29
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Sethi KK, Mishra KMA, Verma SM, Vullo D, Carta F, Supuran CT. Synthesis and Human Carbonic Anhydrase I, II, IX, and XII Inhibition Studies of Sulphonamides Incorporating Mono-, Bi- and Tricyclic Imide Moieties. Pharmaceuticals (Basel) 2021; 14:ph14070693. [PMID: 34358123 PMCID: PMC8308639 DOI: 10.3390/ph14070693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 01/18/2023] Open
Abstract
New derivatives were synthesised by reaction of amino-containing aromatic sulphonamides with mono-, bi-, and tricyclic anhydrides. These sulphonamides were investigated as human carbonic anhydrases (hCAs, EC 4.2.1.1) I, II, IX, and XII inhibitors. hCA I was inhibited with inhibition constants (Kis) ranging from 49 to >10,000 nM. The physiologically dominant hCA II was significantly inhibited by most of the sulphonamide with the Kis ranging between 2.4 and 4515 nM. hCA IX and hCA XII were inhibited by these sulphonamides in the range of 9.7 to 7766 nM and 14 to 316 nM, respectively. The structure-activity relationships (SAR) are rationalised with the help of molecular docking studies.
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Affiliation(s)
- Kalyan K. Sethi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam 781101, India;
- Correspondence: (K.K.S.); (C.T.S.)
| | - KM Abha Mishra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam 781101, India;
| | - Saurabh M. Verma
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi 835215, India;
| | - Daniela Vullo
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
| | - Fabrizio Carta
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
| | - Claudiu T. Supuran
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
- Correspondence: (K.K.S.); (C.T.S.)
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30
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Christou H, Michael Z, Spyropoulos F, Chen Y, Rong D, Khalil RA. Carbonic anhydrase inhibition improves pulmonary artery reactivity and nitric oxide-mediated relaxation in sugen-hypoxia model of pulmonary hypertension. Am J Physiol Regul Integr Comp Physiol 2021; 320:R835-R850. [PMID: 33826428 PMCID: PMC8285620 DOI: 10.1152/ajpregu.00362.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary hypertension (PH) is a serious disease with pulmonary arterial fibrotic remodeling and limited responsiveness to vasodilators. Our data suggest that mild acidosis induced by carbonic anhydrase inhibition could ameliorate PH, but the vascular mechanisms are unclear. We tested the hypothesis that carbonic anhydrase inhibition ameliorates PH by improving pulmonary vascular reactivity and relaxation mechanisms. Male Sprague-Dawley rats were either control normoxic (Nx), or injected with Sugen 5416 (20 mg/kg, sc) and subjected to hypoxia (9% O2) (Su + Hx), or Su + Hx treated with acetazolamide (ACTZ, 100 mg/kg/day, in drinking water). After measuring the hemodynamics, right ventricular hypertrophy was assessed by Fulton's Index; vascular function was measured in pulmonary artery, aorta, and mesenteric arteries; and pulmonary arteriolar remodeling was assessed in lung sections. Right ventricular systolic pressure and Fulton's Index were increased in Su + Hx and reduced in Su + Hx + ACTZ rats. Pulmonary artery contraction to KCl and phenylephrine were reduced in Su + Hx and improved in Su + Hx + ACTZ. Acetylcholine (ACh)-induced relaxation and nitrate/nitrite production were reduced in pulmonary artery of Su + Hx and improved in Su + Hx + ACTZ. ACh relaxation was blocked by nitric oxide (NO) synthase and guanylate cyclase inhibitors, supporting a role of NO-cGMP. Sodium nitroprusside (SNP)-induced relaxation was reduced in pulmonary artery of Su + Hx, and ACTZ enhanced relaxation to SNP. Contraction/relaxation were not different in aorta or mesenteric arteries of all groups. Pulmonary arterioles showed wall thickening in Su + Hx that was ameliorated in Su + Hx + ACTZ. Thus, amelioration of pulmonary hemodynamics during carbonic anhydrase inhibition involves improved pulmonary artery reactivity and NO-mediated relaxation and may enhance responsiveness to vasodilator therapies in PH.
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Affiliation(s)
- Helen Christou
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Zoe Michael
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fotios Spyropoulos
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yunfei Chen
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dan Rong
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Raouf A Khalil
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Berg P, Svendsen SL, Sorensen MV, Schreiber R, Kunzelmann K, Leipziger J. The molecular mechanism of CFTR- and secretin-dependent renal bicarbonate excretion. J Physiol 2021; 599:3003-3011. [PMID: 33963548 DOI: 10.1113/jp281285] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/12/2021] [Indexed: 11/08/2022] Open
Abstract
This review summarizes the newly discovered molecular mechanism of secretin-stimulated urine HCO3 - excretion and the role of cystic fibrosis transmembrane conductance regulator (CFTR) in renal HCO3 - excretion. The secretin receptor is functionally expressed in the basolateral membrane of the HCO3 - -secreting β-intercalated cells of the collecting duct. Here it activates a fast and efficient secretion of HCO3 - into the urine serving to normalize metabolic alkalosis. The ability to acutely increase renal base excretion is entirely dependent on functional pendrin (SLC26A4) and CFTR, and both proteins localize to the apical membrane of the β-intercalated cells. In cystic fibrosis mice and patients, this function is absent or markedly reduced. We discuss that the alkaline tide, namely the transient urine alkalinity after a meal, has now received a clear physiological explanation.
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Affiliation(s)
- Peder Berg
- Department of Biomedicine, Physiology, Health, Aarhus University, Aarhus, Denmark
| | - Samuel L Svendsen
- Department of Biomedicine, Physiology, Health, Aarhus University, Aarhus, Denmark
| | - Mads Vaarby Sorensen
- Department of Biomedicine, Physiology, Health, Aarhus University, Aarhus, Denmark
| | - Rainer Schreiber
- Department of Physiology, University of Regensburg, Regensburg, Germany
| | - Karl Kunzelmann
- Department of Physiology, University of Regensburg, Regensburg, Germany
| | - Jens Leipziger
- Department of Biomedicine, Physiology, Health, Aarhus University, Aarhus, Denmark
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Cobb AB, Levett DZH, Mitchell K, Aveling W, Hurlbut D, Gilbert-Kawai E, Hennis PJ, Mythen MG, Grocott MPW, Martin DS. Physiological responses during ascent to high altitude and the incidence of acute mountain sickness. Physiol Rep 2021; 9:e14809. [PMID: 33904650 PMCID: PMC8077104 DOI: 10.14814/phy2.14809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland‐dwelling volunteers followed an identical ascent profile on staggered treks. Self‐reported symptoms of AMS were recorded daily using the Lake Louise score (mild 3–4; moderate‐severe ≥5), alongside measurements of physiological variables (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2) and blood pressure) before and after a standardised Xtreme Everest Step‐Test (XEST). The overall occurrence of AMS among participants was 73.5% (23.2% mild, 50.3% moderate–severe). There was no difference in gender, age, previous AMS, weight or body mass index between participants who developed AMS and those who did not. Participants who had not previously ascended >5000 m were more likely to get moderate‐to‐severe AMS. Participants who suffered moderate‐to‐severe AMS had a lower resting SpO2 at 3500 m (88.5 vs. 89.6%, p = 0.02), while participants who suffered mild or moderate‐to‐severe AMS had a lower end‐exercise SpO2 at 3500 m (82.2 vs. 83.8%, p = 0.027; 81.5 vs. 83.8%, p < 0.001 respectively). Participants who experienced mild AMS had lower end‐exercise RR at 3500 m (19.2 vs. 21.3, p = 0.017). In a multi‐variable regression model, only lower end‐exercise SpO2 (OR 0.870, p < 0.001) and no previous exposure to altitude >5000 m (OR 2.740, p‐value 0.003) predicted the development of moderate‐to‐severe AMS. The Xtreme Everest Step‐Test offers a simple, reproducible field test to help predict AMS, albeit with relatively limited predictive precision.
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Affiliation(s)
- Alexandra B Cobb
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Denny Z H Levett
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kay Mitchell
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Wynne Aveling
- Anaesthetic Department, University College London Hospital, London, UK
| | - Daniel Hurlbut
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Edward Gilbert-Kawai
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Philip J Hennis
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Monty G Mythen
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Michael P W Grocott
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel S Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Intensive Care Unit, University Hospitals Plymouth, Plymouth, UK.,Peninsula Medical School, University of Plymouth, Plymouth, UK
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Modulation of Tubular pH by Acetazolamide in a Ca 2+ Transport Deficient Mice Facilitates Calcium Nephrolithiasis. Int J Mol Sci 2021; 22:ijms22063050. [PMID: 33802660 PMCID: PMC8002449 DOI: 10.3390/ijms22063050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Proximal tubular (PT) acidosis, which alkalinizes the urinary filtrate, together with Ca2+ supersaturation in PT can induce luminal calcium phosphate (CaP) crystal formation. While such CaP crystals are known to act as a nidus for CaP/calcium oxalate (CaOx) mixed stone formation, the regulation of PT luminal Ca2+ concentration ([Ca2+]) under elevated pH and/or high [Ca2+] conditions are unknown. Since we found that transient receptor potential canonical 3 (TRPC3) knockout (KO; -/-) mice could produce mild hypercalciuria with CaP urine crystals, we alkalinized the tubular pH in TRPC3-/- mice by oral acetazolamide (0.08%) to develop mixed urinary crystals akin to clinical signs of calcium nephrolithiasis (CaNL). Our ratiometric (λ340/380) intracellular [Ca2+] measurements reveal that such alkalization not only upsurges Ca2+ influx into PT cells, but the mode of Ca2+ entry switches from receptor-operated to store-operated pathway. Electrophysiological experiments show enhanced bicarbonate related current activity in treated PT cells which may determine the stone-forming phenotypes (CaP or CaP/CaOx). Moreover, such alkalization promotes reactive oxygen species generation, and upregulation of calcification, inflammation, fibrosis, and apoptosis in PT cells, which were exacerbated in absence of TRPC3. Altogether, the pH-induced alteration of the Ca2+ signaling signature in PT cells from TRPC3 ablated mice exacerbated the pathophysiology of mixed urinary stone formation, which may aid in uncovering the downstream mechanism of CaNL.
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Gao D, Wang Y, Zhang R, Zhang Y. Efficacy of Acetazolamide for the Prophylaxis of Acute Mountain Sickness: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials. Am J Med Sci 2021; 361:635-645. [PMID: 33587912 DOI: 10.1016/j.amjms.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute mountain sickness (AMS) is a benign and self-limiting syndrome but can progress to life-threatening conditions if leave untreated. This study aimed to assess the efficacy of acetazolamide for the prophylaxis of AMS and disclose potential factors that affect the treatment effect of acetazolamide. MATERIALS AND METHODS Randomized controlled trials comparing the use of acetazolamide versus placebo for the prevention of AMS were included. The incidence of AMS was the primary endpoint. Meta-regression analysis was conducted to explore potential factors associated with acetazolamide efficacy. Trial sequential analysis (TSA) was conducted to estimate the statistical power of the available data. RESULTS A total of 22 trials were included. Acetazolamide at 125, 250, and 375 mg/ twice daily (bid) significantly reduced incidence of AMS compared to placebo. TAS indicated that the current evidence was adequate confirming the efficacy of acetazolamide at 125, 250, and 375 mg/bid in lowering incidence of AMS. There was no evidence of an association between efficacy and dose of acetazolamide, timing at start of acetazolamide treatment, mode of ascent, AMS assessment score, timing of AMS assessment, baseline altitude, and endpoint altitude. CONCLUSION Acetazolamide is effective prophylaxis for the prevention of AMS in doses of 125, 250, and 375 mg/bid. Future investigations should focus on personal characteristics, disclosing the correlation between acetazolamide efficacy and body mass, height, degree of prior acclimatization, individual inborn susceptibility, and history of AMS.
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Affiliation(s)
- Daiquan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Rujiang Zhang
- Department of Neurology, The People's Hospital of RuiLi, Yunnan, China
| | - Yunzhou Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China.
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Quade BN, Parker MD, Occhipinti R. The therapeutic importance of acid-base balance. Biochem Pharmacol 2021; 183:114278. [PMID: 33039418 PMCID: PMC7544731 DOI: 10.1016/j.bcp.2020.114278] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on the pharmacokinetic properties of drugs. Our review considers all major organ systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.
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Affiliation(s)
- Bianca N Quade
- Department of Physiology and Biophysics, The State University of New York, The University at Buffalo, Buffalo, NY 14203, USA
| | - Mark D Parker
- Department of Physiology and Biophysics, The State University of New York, The University at Buffalo, Buffalo, NY 14203, USA; Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; State University of New York Eye Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rossana Occhipinti
- Department of Physiology and Biophysics, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA.
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A Randomized Controlled Trial of the Lowest Effective Dose of Acetazolamide for Acute Mountain Sickness Prevention. Am J Med 2020; 133:e706-e715. [PMID: 32479750 DOI: 10.1016/j.amjmed.2020.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acetazolamide is the most common medication used for acute mountain sickness prevention, with speculation that a reduced dose may be as efficacious as standard dosing with fewer side effects. METHODS This double-blind, randomized, controlled noninferiority trial compared acetazolamide 62.5 mg twice daily to the standard dose acetazolamide 125 mg twice daily starting the evening prior to ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (ie, headache, Lake Louise Questionnaire ≥3, and another symptom). RESULTS A total of 106 participants were analyzed, with 51 (48%) randomized to 125 mg and 55 (52%) to 62.5 mg, with a combined acute mountain sickness incidence of 53 (50%) and mean severity of 3 (± 2.1). The 62.5-mg group failed to fall within the prespecified 26% noninferiority margin for acute mountain sickness incidence (62.5 mg = 30 [55%] vs 125 mg = 23 [45%], 95% confidence interval [CI] -11% to 30%). Participants in the 62.5-mg group had a higher risk of acute mountain sickness (odds ratio = 1.5, 95% CI 0.7-3.2) and moderate acute mountain sickness (odds ratio = 1.8, 95% CI 0.6-5.9), with a number needed to harm (NNH) of 9, with a number needed to treat (NNT) in the 125-mg group of 4.8. Increased acute mountain sickness incidence and symptom severity corresponded to lower weight-based and body mass index dosing, with similar side effects between groups. CONCLUSION Acetazolamide 62.5 mg twice daily failed to demonstrate equal effectiveness to 125 mg twice daily for prevention of acute mountain sickness. With increased risk and no demonstrable symptomatic or physiologic benefits, acetazolamide 62.5 mg twice daily should not be recommended for acute mountain sickness prevention.
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IntraOmmaya compartmental radioimmunotherapy using 131I-omburtamab-pharmacokinetic modeling to optimize therapeutic index. Eur J Nucl Med Mol Imaging 2020; 48:1166-1177. [PMID: 33047248 DOI: 10.1007/s00259-020-05050-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Radioimmunotherapy (RIT) delivered through the cerebrospinal fluid (CSF) has been shown to be a safe and promising treatment for leptomeningeal metastases. Pharmacokinetic models for intraOmmaya antiGD2 monoclonal antibody 131I-3F8 have been proposed to improve therapeutic effect while minimizing radiation toxicity. In this study, we now apply pharmacokinetic modeling to intraOmmaya 131I-omburtamab (8H9), an antiB7-H3 antibody which has shown promise in RIT of leptomeningeal metastases. METHODS Serial CSF samples were collected and radioassayed from 61 patients undergoing a total of 177 intraOmmaya administrations of 131I-omburtamab for leptomeningeal malignancy. A two-compartment pharmacokinetic model with 12 differential equations was constructed and fitted to the radioactivity measurements of CSF samples collected from patients. The model was used to improve anti-tumor dose while reducing off-target toxicity. Mathematical endpoints were (a) the area under the concentration curve (AUC) of the tumor-bound antibody, AUC [CIAR(t)], (b) the AUC of the unbound "harmful" antibody, AUC [CIA(t)], and (c) the therapeutic index, AUC [CIAR(t)] ÷ AUC [CIA(t)]. RESULTS The model fit CSF radioactivity data well (mean R = 96.4%). The median immunoreactivity of 131I-omburtamab matched literature values at 69.1%. Off-target toxicity (AUC [CIA(t)]) was predicted to increase more quickly than AUC [CIAR(t)] as a function of 131I-omburtamab dose, but the balance of therapeutic index and AUC [CIAR(t)] remained favorable over a broad range of administered doses (0.48-1.40 mg or 881-2592 MBq). While antitumor dose and therapeutic index increased with antigen density, the optimal administered dose did not. Dose fractionization into two separate injections increased therapeutic index by 38%, and splitting into 5 injections by 82%. Increasing antibody immunoreactivity to 100% only increased therapeutic index by 17.5%. CONCLUSION The 2-compartmental pharmacokinetic model when applied to intraOmmaya 131I-omburtamab yielded both intuitive and nonintuitive therapeutic predictions. The potential advantage of further dose fractionization warrants clinical validation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT00089245.
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Toussaint CM, Kenefick RW, Petrassi FA, Muza SR, Charkoudian N. Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent. High Alt Med Biol 2020; 22:5-13. [PMID: 32975448 DOI: 10.1089/ham.2019.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Toussaint, Claudia M., Robert W. Kenefick, Frank A. Petrassi, Stephen R. Muza, and Nisha Charkoudian. Altitude, acute mountain sickness, and acetazolamide: recommendations for rapid ascent. High Alt Med Biol. 22:5-13, 2021. Background: Sea level natives ascending rapidly to altitudes above 1,500 m often develop acute mountain sickness (AMS), including nausea, headaches, fatigue, and lightheadedness. Acetazolamide (AZ), a carbonic anhydrase inhibitor, is a commonly used medication for the prevention and treatment of AMS. However, there is continued debate about appropriate dosing, particularly when considering rapid and physically demanding ascents to elevations above 3,500 m by emergency medical and military personnel. Aims: Our goal in the present analysis was to evaluate and synthesize the current literature regarding the use of AZ to determine the most effective dosing for prophylaxis and treatment of AMS for rapid ascents to elevations >3,500 m. These circumstances are specifically relevant to military and emergency medical personnel who often need to ascend rapidly and perform physically demanding tasks upon arrival at altitude. Methods: We conducted a literature search from April 2018 to February 2020 using PubMed, Google Scholar, and Web of Science to identify randomized controlled trials that compared AZ with placebo or other treatment with the primary endpoint of AMS incidence and severity. We included only research articles/studies that focused on evaluation of AZ use during rapid ascent. Results: Four doses of AZ (125, 250, 500, and 750 mg daily) were identified as efficacious in decreasing the incidence and/or severity of AMS during rapid ascents, with evidence of enhanced effectiveness with higher doses. Conclusions: For military, emergency medical, or other activities involving rapid ascent to altitudes >3,500 m, doses 500-750 mg/day within 24 hours of altitude exposure appear to be the most effective for minimizing symptoms of AMS.
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Affiliation(s)
- Claudia M Toussaint
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA.,Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Robert W Kenefick
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Frank A Petrassi
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Stephen R Muza
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Preparation of 1,3,4-oxadiazoles and 1,3,4-thiadiazoles via chemoselective сyclocondensation of electrophilically activated nitroalkanes to (thio)semicarbazides or thiohydrazides. Chem Heterocycl Compd (N Y) 2020. [DOI: 10.1007/s10593-020-02775-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Khatri R, Gupta RK, Vats P, Bansal V, Yadav AK, Reddy PK, Bharadwaj A, Chaudhary P, Sharma S, Bajaj AC, Deskit P, Dass D, Baburaj TP, Singh SB, Kumar B. Subclinical elevated B-type Natriuretic Peptide (BNP) indicates endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. Life Sci 2020; 260:118408. [PMID: 32926931 PMCID: PMC7486215 DOI: 10.1016/j.lfs.2020.118408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Aims Baseline elevated B-type Natriuretic Peptide (BNP) has been found in high altitude pulmonary edema susceptible population. Exaggerated pulmonary vascular response to hypoxia may be related to endothelial dysfunction in hypoxia susceptible. We hypothesize that baseline BNP levels can predict hypoxia susceptibility in healthy individuals. Main methods The pulmonary vascular response to hypoxia was compared in 35 male healthy individuals divided into two groups based on BNP levels (Group 1 ≤ 15 and Group 2 > 15 pg/ml). Acute normobaric hypoxia was administered to both the groups, to confirm hypoxia susceptibility in Group 2. Key findings Unlike Group 1, Group 2 had elevated post hypoxia BNP levels (26 vs 33.5 pg/ml, p = 0.002) while pulmonary artery pressure was comparable. A negative correlation with tissue oxygen consumption (delta pO2) and compartmental fluid shift was seen in Group 1 only. Endothelial dysfunction in Group 2 resulted in reduced vascular compliance leading to elevation of mean blood pressure on acute hypoxia exposure. BNP showed a positive correlation with endothelial dysfunction in Group 2 and has been linked to pre-diabetic disorder (HbA1c 6 ± 0.44%) and may additionally represent a lower cross-sectional area of vascular bed related to vascular remodeling mediated by chronic hypoxia. Significance Hypoxia susceptibility in healthy individuals may be related to endothelial dysfunction that limits vascular compliance during hypoxic stress. BNP level showed positive correlation with HbA1c (r = 0.49, p = 0.04) and negative correlation with delta pO2 (r = −0.52, p = 0.04) can predict reduced microvascular compliance due to endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. BNP levels≤15 pg/ml at sea level is indicative of hypoxia resistance.
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Affiliation(s)
- Rahul Khatri
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Rajinder K Gupta
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India.
| | - Praveen Vats
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Vishal Bansal
- Vallabhbhai Patel Chest Institute (VPCI), Delhi University, New Delhi, Delhi 110007, India
| | - Anand Kumar Yadav
- Vallabhbhai Patel Chest Institute (VPCI), Delhi University, New Delhi, Delhi 110007, India
| | - Prasanna K Reddy
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Abhishek Bharadwaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Pooja Chaudhary
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Shivani Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Amir Chand Bajaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Padma Deskit
- Sonam Norboo Memorial (S.N.M.) Hospital, Leh-Ladakh, Jammu and Kashmir 194101, India
| | - Deepak Dass
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Thiruthara P Baburaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Shashi Bala Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
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Alam P, Amlal S, Thakar CV, Amlal H. Acetazolamide causes renal [Formula: see text] wasting but inhibits ammoniagenesis and prevents the correction of metabolic acidosis by the kidney. Am J Physiol Renal Physiol 2020; 319:F366-F379. [PMID: 32657159 PMCID: PMC7509283 DOI: 10.1152/ajprenal.00501.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022] Open
Abstract
Carbonic anhydrase (CAII) binds to the electrogenic basolateral Na+-[Formula: see text] cotransporter (NBCe1) and facilitates [Formula: see text] reabsorption across the proximal tubule. However, whether the inhibition of CAII with acetazolamide (ACTZ) alters NBCe1 activity and interferes with the ammoniagenesis pathway remains elusive. To address this issue, we compared the renal adaptation of rats treated with ACTZ to NH4Cl loading for up to 2 wk. The results indicated that ACTZ-treated rats exhibited a sustained metabolic acidosis for up to 2 wk, whereas in NH4Cl-loaded rats, metabolic acidosis was corrected within 2 wk of treatment. [Formula: see text] excretion increased by 10-fold in NH4Cl-loaded rats but only slightly (1.7-fold) in ACTZ-treated rats during the first week despite a similar degree of acidosis. Immunoblot experiments showed that the protein abundance of glutaminase (4-fold), glutamate dehydrogenase (6-fold), and SN1 (8-fold) increased significantly in NH4Cl-loaded rats but remained unchanged in ACTZ-treated rats. Na+/H+ exchanger 3 and NBCe1 proteins were upregulated in response to NH4Cl loading but not ACTZ treatment and were rather sharply downregulated after 2 wk of ACTZ treatment. ACTZ causes renal [Formula: see text] wasting and induces metabolic acidosis but inhibits the upregulation of glutamine transporter and ammoniagenic enzymes and thus suppresses ammonia synthesis and secretion in the proximal tubule, which prevented the correction of acidosis. This effect is likely mediated through the inhibition of the CA-NBCe1 metabolon complex, which results in cell alkalinization. During chronic ACTZ treatment, the downregulation of both NBCe1 and Na+/H+ exchanger 3, along with the inhibition of ammoniagenesis and [Formula: see text] generation, contributes to the maintenance of metabolic acidosis.
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Affiliation(s)
- Perwez Alam
- Division of Nephrology and Kidney C.A.R.E, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sihame Amlal
- Division of Nephrology and Kidney C.A.R.E, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Charuhas V Thakar
- Division of Nephrology and Kidney C.A.R.E, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Hassane Amlal
- Division of Nephrology and Kidney C.A.R.E, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
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Giovane RA, Rezai S, Cleland E, Henderson CE. Current pharmacological modalities for management of novel coronavirus disease 2019 (COVID-19) and the rationale for their utilization: A review. Rev Med Virol 2020; 30:e2136. [PMID: 32644275 PMCID: PMC7361252 DOI: 10.1002/rmv.2136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
SARS‐CoV‐2 has caused a pandemic which is putting strain on the health‐care system and global economy. There is much pressure to develop both preventative and curative therapies for SARS‐CoV‐2 as there is no evidence to support therapies to improve outcomes in patients with SARS‐CoV‐2. Medications that inhibit certain steps of virus life cycle that are currently used to treat other illnesses such as Malaria, Ebola, HIV and Hepatitis C are being studied for use against SARS‐CoV‐2. To date, data is limited for medications that facilitate clinical improvement of COVID‐19 infections.
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Affiliation(s)
- Richard A Giovane
- Department of Family Medicine, Regional Medical Center of Central Alabama, Greenville, Alabama, USA
| | - Shadi Rezai
- Department of OB/GYN, Valley Community Healthcare, North Hollywood, California, USA
| | - Ellen Cleland
- Department of Family Medicine, University of Alabama, Tuscaloosa, Alabama, USA
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43
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Leacy JK, Linares AM, Zouboules SM, Rampuri ZH, Bird JD, Herrington BA, Mann LM, Soriano JE, Thrall SF, Kalker A, Brutsaert TD, O'Halloran KD, Sherpa MT, Day TA. Cardiorespiratory hysteresis during incremental high‐altitude ascent–descent quantifies the magnitude of ventilatory acclimatization. Exp Physiol 2020; 106:139-150. [DOI: 10.1113/ep088488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jack K. Leacy
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
- Department of Physiology School of Medicine College of Medicine & Health University College Cork Cork Ireland
| | - Andrea M. Linares
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Shaelynn M. Zouboules
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Zahrah H. Rampuri
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Jordan D. Bird
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Brittney A. Herrington
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Leah M. Mann
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Jan E. Soriano
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Scott F. Thrall
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
| | - Anne Kalker
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
- Radboud University Nijmegen The Netherlands
| | | | - Ken D. O'Halloran
- Department of Physiology School of Medicine College of Medicine & Health University College Cork Cork Ireland
| | | | - Trevor A. Day
- Department of Biology Faculty of Science and Technology Mount Royal University Calgary Alberta Canada
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44
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Otani S, Miyaoka Y, Ikeda A, Ohno G, Imura S, Watanabe K, Kurozawa Y. Evaluating Health Impact at High Altitude in Antarctica and Effectiveness of Monitoring Oxygen Saturation. Yonago Acta Med 2020; 63:163-172. [PMID: 32884435 DOI: 10.33160/yam.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
Background The Japanese Antarctic Research Expedition (JARE) has been conducting research activities in inland Antarctica, which is extremely cold dryland covered with a thick ice sheet. This environment may cause a health disorder called acute mountain sickness (AMS). To improve the safety of expedition members, we evaluated the impact of extreme environmental conditions on human health and the effectiveness of monitoring of hypoxia for the early detection of AMS. Methods In total, 9 members from JARE 59 were studied. Dome Fuji Station (Dome F), located 3,810 m above sea level (ASL), was the destination of the research party. We analyzed daily AMS scores (higher values correspond to more severe AMS-related symptoms), physiological findings, and percutaneous arterial blood oxygen saturation (SpO2) during the inland activity. We also determined the factors related to AMS scores. Results The average AMS score on arrival at Dome F was significantly higher than that at the departure point (560 m ASL). The average SpO2 level was significantly lower than that at other points. The SpO2 level correlated negatively with the AMS score in Spearman's rank correlation. Generalized estimating equations analysis showed that the AMS score was negatively associated with SpO2 level and positively associated with age. Conclusion Hypoxia is a contributory factor to AMS which we can easily assess by measuring the SpO2 level with a pulse oximeter. SpO2 monitoring is a potentially useful health management tool for members in inland Antarctic expeditions. In addition, our results are helpful for understanding physiological responses and health issues in extreme environments.
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Affiliation(s)
- Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Hokkaido University, Sapporo 060-8648, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Giichiro Ohno
- Department of Surgery, Tokatsu Hospital, Nagareyama 270-0153, Japan.,National Institute of Polar Research, Tachikawa 190-8518, Japan
| | - Satoshi Imura
- National Institute of Polar Research, Tachikawa 190-8518, Japan
| | | | - Youichi Kurozawa
- Division of Health Administration and Promotion, Department of Social Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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45
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Methazolamide in high-altitude illnesses. Eur J Pharm Sci 2020; 148:105326. [PMID: 32251722 DOI: 10.1016/j.ejps.2020.105326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022]
Abstract
As a carbonic anhydrase inhibitor and a methylated lipophilic analogue of acetazolamide, Methazolamide has higher lipid solubility, less plasma protein binding and renal excretion, and fewer side effects, compared to acetazolamide. Methazolamide can increase systemic metabolic acidosis and sequentially improve ventilation and oxygenation level. The increased oxygenation level leads to reduced reactive oxygen species (ROS) production, relived cerebral edema, mitigated hypoxic pulmonary vasoconstriction, abrogated hypoxic fatigue, and decreased excessive erythrocytosis. In addition to the effect as a carbonic anhydrase inhibitor, methazolamide directly activates the transcription factor anti-oxidative nuclear factor-related factor 2 (Nrf2) and inhibits interleukin-1β (IL-1β) release. These pharmacological functions of methazolamide are beneficial for the prevention and treatment of high-altitude illnesses. Besides, methazolamide causes less fatigue side effects than acetazolamide does. It is also worth noting that several studies suggested that a lower dose of methazolamide has similar prophylaxis and treatment efficacy in acute mountain sickness (AMS) to a higher dose of acetazolamide. Given methazolamide's advantages over acetazolamide, methazolamide may thus represent an alternative for acetazolamide when taken for high-altitude illnesses prophylaxis and treatment. However, more in-depth clinical trials are needed to fully evaluate this efficacy of methazolamide.
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Subudhi AW, Evero O, Reitinger J, Davis C, Gronewold J, Nichols AJ, Van‐Houten SJ, Roach RC. Combined methazolamide and theophylline improves oxygen saturation but not exercise performance or altitude illness in acute hypobaric hypoxia. Exp Physiol 2020; 106:117-125. [DOI: 10.1113/ep088461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/29/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Andrew W. Subudhi
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Human Physiology and Nutrition University of Colorado Colorado Springs Colorado Springs CO USA
| | - Oghenero Evero
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Jeremy Reitinger
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Christopher Davis
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Jeffrey Gronewold
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Andrew J. Nichols
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Robert C. Roach
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
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N-Quinary heterocycle-4-sulphamoylbenzamides exert anti-hypoxic effects as dual inhibitors of carbonic anhydrases I/II. Bioorg Chem 2020; 100:103931. [PMID: 32450385 DOI: 10.1016/j.bioorg.2020.103931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 01/05/2023]
Abstract
Acute mountain sickness (AMS) affects approximately 25-50% of newcomers to high altitudes. Two human carbonic anhydrase isoforms, hCA I and II, play key roles in developing high altitude illnesses. However, the only FDA-approved drug for AMS is acetazolamide (AAZ), which has a nearly 100 times weaker inhibitory activity against hCA I (Ki = 1237.10 nM) than hCA II (Ki = 13.22 nM). Hence, developing potent dual hCA I/II inhibitors for AMS prevention and treatment is a critical medical need. Here we identified N-quinary heterocycle-4-sulphamoylbenzamides as potent hCA I/II inhibitors. The newly designed compounds 2b, 5b, 5f, 6d, and 6f possessed the desired inhibitory activities (hCA I: Ki = 16.95-52.71 nM; hCA II: Ki = 8.61-18.64 nM). Their hCA I inhibitory capacity was 22- to 76-fold stronger than that of AAZ. Relative to the control group for survival in a mouse model of hypoxia, 2b and 6d prolonged the survival time of mice by 21.7% and 29.3%, respectively, which was longer than those of AAZ (6.5%). These compounds did not display any apparent toxicity in vitro and in vivo. In addition, docking simulations suggested that the quinary aromatic heterocycle groups stabilised the interaction between hCA I/II and the inhibitors, which could be further exploited in structure optimization studies. Hence, future functional studies may confirm 2b and 6d as potential clinical candidate compounds with anti-hypoxic activity against AMS.
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48
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Respiratory conditions in coronavirus disease 2019 (COVID-19): Important considerations regarding novel treatment strategies to reduce mortality. Med Hypotheses 2020; 140:109760. [PMID: 32344310 PMCID: PMC7175905 DOI: 10.1016/j.mehy.2020.109760] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
A novel virus named 2019 novel coronavirus (2019-nCoV/SARS-CoV-2) causes symptoms that are classified as coronavirus disease (COVID-19). Respiratory conditions are extensively described among more serious cases of COVID-19, and the onset of acute respiratory distress syndrome (ARDS) is one of the hallmark features of critical COVID-19 cases. ARDS can be directly life-threatening because it is associated with low blood oxygenation levels and can result in organ failure. There are no generally recognized effective treatments for COVID-19, but treatments are urgently needed. Anti-viral medications and vaccines are in the early developmental stages and may take many months or even years to fully develop. At present, management of COVID-19 with respiratory and ventilator support are standard therapeutic treatments, but unfortunately such treatments are associated with high mortality rates. Therefore, it is imperative to consider novel new therapeutic interventions to treat/ameliorate respiratory conditions associated with COVID-19. Alternate treatment strategies utilizing clinically available treatments such as hyperbaric oxygen therapy (HBOT), packed red blood cell (pRBC) transfusions, or erthropoiesis-stimulating agent (ESA) therapy were hypothesized to increase oxygenation of tissues by alternative means than standard respiratory and ventilator treatments. It was also revealed that alternative treatments currently being considered for COVID-19 such as chloroquine and hydroxychloroquine by increasing hemoglobin production and increasing hemoglobin availability for oxygen binding and acetazolamine (for the treatment of altitude sickness) by causing hyperventilation with associated increasing levels of oxygen and decreasing levels of carbon dioxide in the blood may significantly ameliorate COVID-19 respiratory symptoms. In conclusion, is recommend, given HBOT, pRBC, and ESA therapies are currently available and routinely utilized in the treatment of other conditions, that such therapies be tried among COVID-19 patients with serious respiratory conditions and that future controlled-clinical trials explore the potential usefulness of such treatments among COVID-19 patients with respiratory conditions.
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49
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Limmer M, de Marées M, Platen P. Effects of daily ingestion of sodium bicarbonate on acid-base status and anaerobic performance during an altitude sojourn at high altitude: a randomized controlled trial. J Int Soc Sports Nutr 2020; 17:22. [PMID: 32307012 PMCID: PMC7168960 DOI: 10.1186/s12970-020-00351-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/03/2020] [Indexed: 01/18/2023] Open
Abstract
Background The present study investigated the effects of chronic sodium bicarbonate (NaHCO3) ingestion on a single bout of high-intensity exercise and on acid-base balance during 7-day high-altitude exposure. Methods Ten recreationally active subjects participated in a pre-test at sea level and a 7-day hiking tour in the Swiss Alps up to 4554 m above sea level. Subjects received either a daily dose of 0.3 g/kg NaHCO3 solution (n = 5) or water as a placebo (n = 5) for 7 days. Anaerobic high-intensity exercise performance was assessed using the portable tethered sprint running (PTSR) test under normoxic and hypoxic conditions (3585 m). PTSR tests assessed overall peak force, mean force, and fatigue index. Blood lactate levels and blood gas parameters were assessed pre- and post-PTSR. Urinary pH and blood gas parameters were further analyzed daily at rest in early morning samples under normoxic and hypoxic conditions. Results There were no significant differences between the bicarbonate and control group in any of the PTSR-related parameters. However, urinary pH (p = 0.003, ηp2 = 0.458), early morning blood bicarbonate concentration (p < 0.001, ηp2 = 0.457) and base excess (p = 0.002, ηp2 = 0.436) were significantly higher in the bicarbonate group compared with the control group under hypoxic conditions. Conclusions These results indicate that oral NaHCO3 ingestion does not ameliorate the hypoxia-induced impairment in anaerobic, high-intensity exercise performance, represented by PTSR-related test parameters, under hypobaric, hypoxic conditions, but the maximal performance measurements may have been negatively affected by other factors, such as poor implementation of PTSR test instructions, pre-acclimatization, the time course of hypoxia-induced renal [HCO3−] compensation, changes in the concentrations of intra- and extracellular ions others than [H+] and [HCO3−], or gastrointestinal disturbances caused by NaHCO3 ingestion. However, chronic NaHCO3 ingestion improves blood bicarbonate concentration and base excess at altitude, which partially represent the blood buffering capacity.
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Affiliation(s)
- Mirjam Limmer
- Department of Sports Medicine and Sports Nutrition, Ruhr-Universität Bochum, Gesundheitscampus Nord 10, 44801, Bochum, Germany. .,Institute of Outdoor Sports and Environmental Science, German Sport University Cologne, Cologne, Germany.
| | - Markus de Marées
- Department of Sports Medicine and Sports Nutrition, Ruhr-Universität Bochum, Gesundheitscampus Nord 10, 44801, Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-Universität Bochum, Gesundheitscampus Nord 10, 44801, Bochum, Germany
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50
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Joyce KE, Delamere J, Bradwell S, Myers SD, Ashdown K, Rue C, Lucas SJ, Thomas OD, Fountain A, Edsell M, Myers F, Malein W, Imray C, Clarke A, Lewis CT, Newman C, Johnson B, Cadigan P, Wright A, Bradwell A. Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria. BMJ Open Sport Exerc Med 2020; 6:e000662. [PMID: 32341794 PMCID: PMC7173992 DOI: 10.1136/bmjsem-2019-000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Proteinuria increases at altitude and with exercise, potentially as a result of hypoxia. Using urinary alpha-1 acid glycoprotein (α1-AGP) levels as a sensitive marker of proteinuria, we examined the impact of relative hypoxia due to high altitude and blood pressure-lowering medication on post-exercise proteinuria. Methods Twenty individuals were pair-matched for sex, age and ACE genotype. They completed maximal exercise tests once at sea level and twice at altitude (5035 m). Losartan (100 mg/day; angiotensin-receptor blocker) and placebo were randomly assigned within each pair 21 days before ascent. The first altitude exercise test was completed within 24–48 hours of arrival (each pair within ~1 hour). Acetazolamide (125 mg two times per day) was administrated immediately after this test for 48 hours until the second altitude exercise test. Results With placebo, post-exercise α1-AGP levels were similar at sea level and altitude. Odds ratio (OR) for increased resting α1-AGP at altitude versus sea level was greater without losartan (2.16 times greater). At altitude, OR for reduced post-exercise α1-AGP (58% lower) was higher with losartan than placebo (2.25 times greater, p=0.059) despite similar pulse oximetry (SpO2) (p=0.95) between groups. Acetazolamide reduced post-exercise proteinuria by approximately threefold (9.3±9.7 vs 3.6±6.0 μg/min; p=0.025) although changes were not correlated (r=−0.10) with significant improvements in SpO2 (69.1%±4.5% vs 75.8%±3.8%; p=0.001). Discussion Profound systemic hypoxia imposed by altitude does not result in greater post-exercise proteinuria than sea level. Losartan and acetazolamide may attenuate post-exercise proteinuria, however further research is warranted.
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Affiliation(s)
- Kelsley E Joyce
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - John Delamere
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susie Bradwell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Medical School, East Surrey Hospital, Redhill, Surrey, UK
| | - Stephen David Myers
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Kimberly Ashdown
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Carla Rue
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Samuel Je Lucas
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - Owen D Thomas
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Amy Fountain
- Research & Development, Binding Site Group Ltd, Edgbaston, Birmingham, UK
| | - Mark Edsell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,St. George's University Hospital, University of London, London, UK
| | - Fiona Myers
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK
| | - Will Malein
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Chris Imray
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alex Clarke
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Chrisopher T Lewis
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Academic Foundation Programme, NHS Highland, Inverness, United Kingdom
| | - Charles Newman
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Brian Johnson
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,BASEM, Doncaster, UK
| | - Patrick Cadigan
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - Alexander Wright
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Medical School, University of Birmingham, Birmingham, UK
| | - Arthur Bradwell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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