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Gallez A, Nys G, Wuidar V, Dias Da Silva I, Taziaux M, Kinet V, Tskitishvili E, Noel A, Foidart JM, Piel G, Fillet M, Péqueux C. Comparison of Estetrol Exposure between Women and Mice to Model Preclinical Experiments and Anticipate Human Treatment. Int J Mol Sci 2023; 24:ijms24119718. [PMID: 37298669 DOI: 10.3390/ijms24119718] [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: 05/03/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Estetrol (E4) is a natural estrogen with promising therapeutic applications in humans. The European Medicines Agency and the Food and Drug Administration have approved the use of 15 mg E4/3 mg drospirenone for contraceptive indication. Phase III clinical trials with 15-20 mg E4 for the relief of climacteric complaints are currently running. Relevant data from preclinical animal models are needed to characterize the molecular mechanisms and the pharmacological effects of E4 and possibly to reveal new therapeutic applications and to anticipate potential adverse effects. Therefore, it is important to design experimental procedures in rodents that closely mimic or anticipate human E4 exposure. In this study, we compared the effects of E4 exposure after acute or chronic administration in women and mice. Women who received chronic E4 treatment per os at a dose of 15 mg once daily reached a steady state within 6 to 8 days, with a mean plasma concentration of 3.20 ng/mL. Importantly, with subcutaneous, intraperitoneal or oral administration of E4 in mice, a stable concentration over time that would mimic human pharmacokinetics could not be achieved. The use of osmotic minipumps continuously releasing E4 for several weeks provided an exposure profile mimicking chronic oral administration in women. Measurements of the circulating concentration of E4 in mice revealed that the mouse equivalent dose necessary to mimic human treatment does not fit with the allometric prediction. In conclusion, this study highlights the importance of precise definition of the most appropriate dose and route of administration to utilize when developing predictive preclinical animal models to mimic or anticipate specific human treatment.
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Affiliation(s)
- Anne Gallez
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Gwenaël Nys
- Center for Interdisciplinary Research on Medicines (CIRM), Laboratory for the Analysis of Medicines, University of Liège, Avenue Hippocrate 15, 4000 Liège, Belgium
| | - Vincent Wuidar
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Isabelle Dias Da Silva
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Mélanie Taziaux
- Mithra Pharmaceuticals, Rue Saint-Georges 5/7, 4000 Liège, Belgium
| | - Virginie Kinet
- Mithra Pharmaceuticals, Rue Saint-Georges 5/7, 4000 Liège, Belgium
| | - Ekaterine Tskitishvili
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Agnès Noel
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Jean-Michel Foidart
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
| | - Géraldine Piel
- Center for Interdisciplinary Research on Medicines (CIRM), Laboratory of Pharmaceutical Technology and Biopharmacy, University of Liège, Avenue Hippocrate 15, 4000 Liège, Belgium
| | - Marianne Fillet
- Center for Interdisciplinary Research on Medicines (CIRM), Laboratory for the Analysis of Medicines, University of Liège, Avenue Hippocrate 15, 4000 Liège, Belgium
| | - Christel Péqueux
- Laboratory of Biology, Tumor and Development Biology, GIGA-Cancer, University of Liège, B23, Avenue Hippocrate 13, 4000 Liège, Belgium
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2
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Tskitishvili E, Palazzo C, Foidart JM, Piel G, Pequeux C. Use of Liposome-encapsulated estetrol for treatment of Neonatal Hypoxic-Ischemic encephalopathy. Brain Res 2023; 1809:148369. [PMID: 37061081 DOI: 10.1016/j.brainres.2023.148369] [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: 08/08/2022] [Revised: 10/11/2022] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
Estetrol (E4) is a natural estrogen synthesized only during pregnancy. It has strong neuroprotective and antioxidative activities. The aim of the present study was to define the neuroprotective potency of E4 encapsulated either in liposome (Lipo-E4) or in drug-in cyclodextrin (HP-β-CD) in liposome (DCL) system, and compare them with a single use of E4. In vitro studies were performed in an oxidative stress model of primary hippocampal neuronal cell cultures, followed by the lactate dehydrogenase activity and cell proliferation assays. In vivo studies were conducted by using a model of neonatal hypoxic-ischemic encephalopathy in immature rat pups. Brain samples were studied by (immuno)histochemistry for the detection of survived cells, expression of microtubule-associated protein-2, myelin basic protein, doublecortin and vascular-endothelial growth factor. Concentrations of glial fibrillary acidic protein in blood serum were studied by ELISA. In vitro, cell proliferation was significantly up-regulated in cultures treated either by DCL-E4 or E4 compared to the control cells, whereas DCL-E4 treated cells had significantly higher survival rate than the cells treated by E4 alone. Evaluation of brain samples showed that DCL-E4 and a high dose of E4 alone significantly preserve the grey and the white matter loses, and diminish GFAP expression in blood. Although DCL-E4 and E4 have similar effect on neurogenesis in the hippocampus and the cortex, DCL-E4 treatment significantly up-regulates angiogenesis in the hippocampus compared to a single use of E4. Present work reveals for the first time that liposome-encapsulated E4 might be a better alternative to a single use of E4.
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Affiliation(s)
- Ekaterine Tskitishvili
- Laboratory of Developmental Biology and Tumors, GIGA-Cancer, Department of Clinical Sciences, Faculty of Medicine, University of Liège, Belgium.
| | - Claudio Palazzo
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
| | - Jean-Michel Foidart
- Laboratory of Developmental Biology and Tumors, GIGA-Cancer, Department of Clinical Sciences, Faculty of Medicine, University of Liège, Belgium
| | - Géraldine Piel
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
| | - Christel Pequeux
- Laboratory of Developmental Biology and Tumors, GIGA-Cancer, Department of Clinical Sciences, Faculty of Medicine, University of Liège, Belgium
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Durán-Carabali LE, Da Silva JL, Colucci ACM, Netto CA, De Fraga LS. Protective effect of sex steroid hormones on morphological and cellular outcomes after neonatal hypoxia-ischemia: A meta-analysis of preclinical studies. Neurosci Biobehav Rev 2023; 145:105018. [PMID: 36572200 DOI: 10.1016/j.neubiorev.2022.105018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
Sex steroid hormones play an important role in fetal development, brain functioning and neuronal protection. Growing evidence highlights the positive effects of these hormones against brain damage induced by neonatal hypoxia-ischemia (HI). This systematic review with meta-analysis aims to verify the efficacy of sex steroid hormones in preventing HI-induced brain damage in rodent models. The protocol was registered at PROSPERO and a total of 22 articles were included. Moderate to large effects were observed in HI animals treated with sex steroid hormones in reducing cerebral infarction size and cell death, increasing neuronal survival, and mitigating neuroinflammatory responses and astrocyte reactivity. A small effect was evidenced for cognitive function, but no significant effect for motor function; moreover, a high degree of heterogeneity was observed. In summary, data suggest that sex steroid hormones, such as progesterone and 17β estradiol, improve morphological and cellular outcomes following neonatal HI. Further research is paramount to examine neurological function during HI recovery and standardization of methodological aspects is imperative to reduce the risk of spurious findings.
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Affiliation(s)
- L E Durán-Carabali
- Graduate Program in Biological Sciences: Physiology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - J L Da Silva
- Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A C M Colucci
- Graduate Program in Biological Sciences: Physiology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - C A Netto
- Graduate Program in Biological Sciences: Physiology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L S De Fraga
- Graduate Program in Biological Sciences: Physiology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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4
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Antonelli A, Giannini A, Chedraui P, Monteleone P, Caretto M, Genazzani AD, Mannella P, Simoncini T, Genazzani AR. Mood disorders and hormonal status across women's life: a narrative review. Gynecol Endocrinol 2022; 38:1019-1027. [PMID: 36433781 DOI: 10.1080/09513590.2022.2149730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Depressive disorders and anxiety states represent one of the most frequent psychiatric pathologies occurring transiently in vulnerable women throughout their life, from puberty to menopause. It is now known that sex hormones play a key role on the nervous system, interfering with neuronal plasticity and enhancing the processes of learning, memory, cognition, and mood. Numerous mechanisms are at the base of these processes, displaying interactions between estrogen and serotoninergic, dopaminergic, and GABAergic receptors at the central level. Therefore, given the sexual steroids fluctuations throughout the entire female lifespan, and considering the role played by sex hormones at the central level, it is not surprising to observe the onset of mood or neurodegenerative disorders over time. This is especially true for women in hormonal transition phase, such as puberty, postpartum and the menopausal transition. Moreover, all these conditions are characterized by hormone withdrawal, imbalance, or modifications due to menopausal hormone therapies or contraceptives which could prompt to a deterioration of mood and cognition impairment or to an improvement in the quality of life. More studies are needed to better understand the hormone-related effects on the nervous system, and the underlying pathways involved in transitional or chronic mood disorders, to promote new patient-specific therapeutic strategies more effective than the current ones and tailored according to the individual need and women's life period.
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Affiliation(s)
- Alice Antonelli
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
- Facultad de Ciencias de la Salud, Universidad Católica "Nuestra Señora de la Asunción", Asunción, Paraguay
| | - Patrizia Monteleone
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro D Genazzani
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Gérard C, Arnal JF, Jost M, Douxfils J, Lenfant F, Fontaine C, Houtman R, Archer DF, Reid RL, Lobo RA, Gaspard U, Coelingh Bennink HJT, Creinin MD, Foidart JM. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol 2022; 15:121-137. [PMID: 35306927 DOI: 10.1080/17512433.2022.2054413] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Estrogens used in women's healthcare have been associated with increased risks of venous thromboembolism (VTE) and breast cancer. Estetrol (E4), an estrogen produced by the human fetal liver, has recently been approved for the first time as a new estrogenic component of a novel combined oral contraceptive (E4/drospirenone [DRSP]) for over a decade. In phase 3 studies, E4/DRSP showed good contraceptive efficacy, a predictable bleeding pattern, and a favorable safety and tolerability profile. AREAS COVERED This narrative review discusses E4's pharmacological characteristics, mode of action, and the results of preclinical and clinical studies for contraception, as well as for menopause and oncology. EXPERT OPINION Extensive studies have elucidated the properties of E4 that underlie its favorable safety profile. While classical estrogens (such as estradiol) exert their actions via both activation of nuclear and membrane estrogen receptor α (ERα), E4 presents a specific profile of ERα activation: E4 binds and activates nuclear ERα but does not induce the activation of membrane ERα signaling pathways in specific tissues. E4 has a small effect on normal breast tissue proliferation and minimally affects hepatic parameters. This distinct profile of ERα activation, uncoupling nuclear and membrane activation, is unique.
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Affiliation(s)
- Céline Gérard
- Department Research and Development, Estetra Srl, an Affiliate Company of Mithra Pharmaceuticals, Liège, Belgium
| | - Jean-François Arnal
- CHU de Toulouse, Université Toulouse III, Toulouse, France.,INSERM-UPS UMR U1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Maud Jost
- Department Research and Development, Estetra Srl, an Affiliate Company of Mithra Pharmaceuticals, Liège, Belgium
| | - Jonathan Douxfils
- Qualiblood S.a, Namur, Belgium.,Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Françoise Lenfant
- CHU de Toulouse, Université Toulouse III, Toulouse, France.,INSERM-UPS UMR U1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Coralie Fontaine
- CHU de Toulouse, Université Toulouse III, Toulouse, France.,INSERM-UPS UMR U1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | | | | | - Robert L Reid
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Canada
| | - Rogerio A Lobo
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Ulysse Gaspard
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
| | | | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Sacramento, USA
| | - Jean-Michel Foidart
- Department Research and Development, Estetra Srl, an Affiliate Company of Mithra Pharmaceuticals, Liège, Belgium.,Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
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6
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Palazzo C, Laloy J, Delvigne AS, Nys G, Fillet M, Dogne JM, Pequeux C, Foidart JM, Evrard B, Piel G. Development of injectable liposomes and drug-in-cyclodextrin-in-liposome formulations encapsulating estetrol to prevent cerebral ischemia of premature babies. Eur J Pharm Sci 2018; 127:52-59. [PMID: 30308312 DOI: 10.1016/j.ejps.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/25/2018] [Accepted: 10/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Claudio Palazzo
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liege, Liege, Belgium
| | - Julie Laloy
- Département de Pharmacie, Namur Nanosafety Centre, NARILIS, University of Namur, Namur, Belgium
| | - Anne-Sophie Delvigne
- Département de Pharmacie, Namur Nanosafety Centre, NARILIS, University of Namur, Namur, Belgium
| | - Gwenael Nys
- Analysis of Medicines Laboratory, CIRM, University of Liege, Liege, Belgium
| | - Marianne Fillet
- Analysis of Medicines Laboratory, CIRM, University of Liege, Liege, Belgium
| | - Jean-Michel Dogne
- Département de Pharmacie, Namur Nanosafety Centre, NARILIS, University of Namur, Namur, Belgium
| | - Christel Pequeux
- Tumor and Development Biology Laboratory, University of Liege, Liege, Belgium
| | - Jean-Michel Foidart
- Tumor and Development Biology Laboratory, University of Liege, Liege, Belgium
| | - Brigitte Evrard
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liege, Liege, Belgium
| | - Geraldine Piel
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liege, Liege, Belgium.
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Comparison of nanofluidic and ultra-high performance liquid chromatography-tandem mass spectrometry for high sensitive pharmacokinetic studies of estrogens starting from whole blood microsampling. J Chromatogr A 2017; 1524:160-168. [DOI: 10.1016/j.chroma.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
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8
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Santen RJ, Stuenkel CA, Davis SR, Pinkerton JV, Gompel A, Lumsden MA. Managing Menopausal Symptoms and Associated Clinical Issues in Breast Cancer Survivors. J Clin Endocrinol Metab 2017; 102:3647-3661. [PMID: 28934376 DOI: 10.1210/jc.2017-01138] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Review evidence to guide management of menopausal signs and symptoms in women after breast cancer and make recommendations accordingly. EVIDENCE Randomized controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies. BACKGROUND Symptoms and clinical problems associated with estrogen depletion-sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia, and osteoporosis-confront the estimated 9.3 million breast cancer survivors globally. RECOMMENDATIONS Following breast cancer, women should not generally be treated with menopausal hormone therapy or tibolone but should optimize lifestyle. Women with moderate to severe symptoms may benefit from mind-brain behavior or nonhormone, pharmacologic therapy. The selective serotonin/noradrenaline reuptake inhibitors and gabapentenoid agents improve VMS and quality of life. For osteoporosis, nonhormonal agents are available. Treatment of VVA remains an area of unmet need. Low-dose vaginal estrogen is absorbed in small amounts with blood levels remaining within the normal postmenopausal range but could potentially stimulate occult breast cancer cells, and although poorly studied, is not generally advised, particularly for those on aromatase inhibitors. Intravaginal dehydroepiandrosterone and oral ospemiphene have been approved to treat dyspareunia, but safety after breast cancer has not been established. Vaginal laser therapy is being used for VVA but efficacy from sham-controlled studies is lacking. Therapies undergoing development include lasofoxifene, neurokinin B inhibitors, stellate ganglion blockade, vaginal testosterone, and estetrol. CONCLUSIONS Nonhormone options and therapies are available for treatment of estrogen depletion symptoms and clinical problems after a diagnosis of breast cancer. Individualization of treatment is essential.
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Affiliation(s)
- Richard J Santen
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903
| | - Cynthia A Stuenkel
- Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California 92093
| | - Susan R Davis
- School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia
| | - JoAnn V Pinkerton
- Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, Virginia 22903
| | - Anne Gompel
- Hopitaux Universitaires Port Royal-Cochin Unite de Gynecologie Endocrinienne, Paris Descartes University, Paris 75014, France
| | - Mary Ann Lumsden
- Department of Medicine, Dentistry and Nursing, University of Glasgow School of Medicine, Glasgow G31 2ER, Scotland
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9
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Whole blood microsampling for the quantitation of estetrol without derivatization by liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal 2017; 140:258-265. [DOI: 10.1016/j.jpba.2017.02.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/23/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022]
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10
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Oh CS, Kim SH, Lee J, Rhee KY. Impact of remote ischaemic preconditioning on cerebral oxygenation during total knee arthroplasty. Int J Med Sci 2017; 14:115-122. [PMID: 28260986 PMCID: PMC5332839 DOI: 10.7150/ijms.17227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023] Open
Abstract
Background: Ischaemic reperfusion injury (IRI) after tourniquet release during total knee arthroplasty (TKR) is related to postoperative cerebral complications. Remote ischaemic preconditioning (RIPC) is known to minimise IRI in previous studies. Thus, we evaluated the effect of RIPC on regional cerebral oxygenation after tourniquet release during TKR. Methods: Patients undergoing TKR were randomly allocated to not receive RIPC (control group) and to receive RIPC (RIPC group). Regional cerebral oxygenation and pulmonary oxygenation were assessed up to 24 h postoperatively. The changes in serum cytokine and lactate dehydrogenase (LDH) levels were assessed and arterial blood gas analysis was performed. Total transfusion amounts and postoperative bleeding were also examined. Results: In total, 72 patients were included in the final analysis. Regional cerebral oxygenation (P < 0.001 in the left side, P = 0.003 in the right side) with pulmonary oxygenation (P = 0.001) was significantly higher in the RIPC group. The serum LDH was significantly lower in the RIPC group at 1 h and 24 h postoperatively (P < 0.001). The 24 h postoperative transfusion (P = 0.002) and bleeding amount (P < 0.001) were significantly lower in the RIPC group. Conclusions: RIPC increased cerebral oxygenation after tourniquet release during TKR by improving pulmonary oxygenation. Additionally, RIPC decreased the transfusion and bleeding amount with the serum LDH level.
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Affiliation(s)
- Chung-Sik Oh
- Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Korea
| | - Seong-Hyop Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Korea;; Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Jaemoon Lee
- Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Young Rhee
- Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Korea;; Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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11
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Tskitishvili E, Pequeux C, Munaut C, Viellevoye R, Nisolle M, Noël A, Foidart JM. Estrogen receptors and estetrol-dependent neuroprotective actions: a pilot study. J Endocrinol 2017; 232:85-95. [PMID: 27799463 PMCID: PMC5118942 DOI: 10.1530/joe-16-0434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 01/16/2023]
Abstract
Estetrol (E4) has strong antioxidative, neurogenic and angiogenic effects in neural system resulting in the attenuation of neonatal hypoxic-ischemic encephalopathy. We aimed to define the role of estrogen receptors in E4-dependent actions in neuronal cell cultures and prove the promyelinating effect of E4. In vitro the antioxidative and cell survival/proliferating effects of E4 on H2O2-induced oxidative stress in primary hippocampal cell cultures were studied using different combinations of specific inhibitors for ERα (MPP dihydrochloride), ERβ (PHTTP), GPR30 (G15) and palmytoilation (2-BR). LDH activity and cell survival assays were performed. In vivo the promyelinating role of different concentrations of E4 (1 mg/kg/day, 5 mg/kg/day, 10 mg/kg/day, 50 mg/kg/day) was investigated using the hypoxic-ischemic brain damage model in the 7-day-old immature rats before/after the induction of hypoxic-ischemic insult. Myelin basic protein (MBP) immunostaining was performed on brain coronal sections. Our results show that LDH activity is significantly upregulated in cell cultures where the E4's effect was completely blocked by concomitant treatment either with ERα and ERβ inhibitors (MPP and PHTPP, respectively), or ERα and ERβ inhibitors combined with 2-BR. Cell survival is significantly downregulated in cell cultures where the effect of E4 was blocked by ERβ inhibitor (PHTTP) alone. The blockage of GRP30 receptor did affect neither LDH activity nor cell survival. MBP immunostaining is significantly upregulated in E4-pretreated groups at a concentration of 5 mg/kg/day and 50 mg/kg/day E4, whereas the MBP-positive area OD ratio is significantly increased in all the E4-treated groups. E4's antioxidative actions mostly depend on ERα and ERβ, whereas neurogenesis and possibly promyelinating activities might be realized through ERβ.
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Affiliation(s)
- Ekaterine Tskitishvili
- Department of Obstetrics and Gynecology/Department of Clinical SciencesLaboratory of Development Biology and Tumor, GIGA-Cancer, University of Liege, Liege, Belgium
| | - Christel Pequeux
- Department of Obstetrics and Gynecology/Department of Clinical SciencesLaboratory of Development Biology and Tumor, GIGA-Cancer, University of Liege, Liege, Belgium
| | - Carine Munaut
- Department of Obstetrics and Gynecology/Department of Clinical SciencesLaboratory of Development Biology and Tumor, GIGA-Cancer, University of Liege, Liege, Belgium
| | - Renaud Viellevoye
- Department of PediatricsNeonatal Intensive Care Unit, University of Liege, CHR de la CITADELLE, Liege, Belgium
| | - Michelle Nisolle
- Department of Obstetrics and GynecologyUniversity of Liege, CHR de la CITADELLE, Liege, Belgium
| | - Agnes Noël
- Department of Obstetrics and Gynecology/Department of Clinical SciencesLaboratory of Development Biology and Tumor, GIGA-Cancer, University of Liege, Liege, Belgium
| | - Jean-Michel Foidart
- Department of Obstetrics and Gynecology/Department of Clinical SciencesLaboratory of Development Biology and Tumor, GIGA-Cancer, University of Liege, Liege, Belgium
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