1
|
Bindra S, Bose K, Thekkantavida AC, Grace Thomas Parambi D, Alsahli TG, Pant M, Pappachen LK, Kim H, Mathew B. FDA-approved drugs containing dimethylamine pharmacophore: a review of the last 50 years. RSC Adv 2024; 14:27657-27696. [PMID: 39224646 PMCID: PMC11367245 DOI: 10.1039/d4ra04730c] [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: 06/29/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Dimethylamine (DMA) derivatives represent a promising class of compounds with significant potential in the field of medicinal chemistry. DMA derivatives exhibit a diverse range of pharmacological activities, including antimicrobial, antihistaminic, anticancer, and analgesic properties. Their unique chemical structure allows for the modulation of various biological targets, making them valuable candidates for the treatment of numerous diseases. Synthetic strategies for the preparation of DMA derivatives vary depending on the desired biological activity and target molecule. Common synthetic routes involve the modification of the DMA scaffold through functional group manipulation, scaffold hopping, or combinatorial chemistry approaches. Therapeutically, DMA derivatives have shown promise in the treatment of infectious diseases, especially bacterial infections. Additionally, by focusing on particular biochemical pathways involved in tumor growth and metastasis, DMA-based drugs have shown anticancer activity. In addition to their direct pharmacological effects, DMA derivatives can serve as valuable tools in drug delivery systems, prodrug design, and molecular imaging techniques, enhancing their utility in medicinal chemistry research. Overall, DMA derivatives represent a versatile class of compounds with immense potential in medicinal chemistry. Further research and development efforts are warranted to explore their full therapeutic capabilities and optimize their clinical utility in the treatment of various diseases. This article outlines the pharmacological properties, synthetic strategies, and therapeutic applications of DMA derivatives of FDA approved drugs, highlighting their importance in drug discovery and development.
Collapse
Affiliation(s)
- Sandeep Bindra
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham Amrita Health Science Campus Kochi 682041 India
| | - Kuntal Bose
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham Amrita Health Science Campus Kochi 682041 India
| | - Amrutha Chandran Thekkantavida
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham Amrita Health Science Campus Kochi 682041 India
| | - Della Grace Thomas Parambi
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University Sakaka Aljouf 72341 Saudi Arabia
| | - Tariq G Alsahli
- Department of Pharmacology, College of Pharmacy, Jouf University Sakaka Aljouf 72341 Saudi Arabia
| | - Manu Pant
- School of Pharmacy, Graphic Era Hill University Dehradun 248002 India
- Graphic Era Hill University (Deemed to be University) Clement Town Dehradun 248002 India
| | - Leena K Pappachen
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham Amrita Health Science Campus Kochi 682041 India
| | - Hoon Kim
- Department of Pharmacy, and Research Institute of Life Pharmaceutical Sciences, Sunchon National University Suncheon 57922 Republic of Korea
| | - Bijo Mathew
- Department of Pharmaceutical Chemistry, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham Amrita Health Science Campus Kochi 682041 India
| |
Collapse
|
2
|
Hägglund S, Andtfolk M, Rosenberg S, Wingren M, Andersson S, Nyholm L. Do you wanna dance? Tales of trust and driving trust factors in robot medication counseling in the pharmacy context. Front Robot AI 2024; 11:1332110. [PMID: 39170902 PMCID: PMC11336249 DOI: 10.3389/frobt.2024.1332110] [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] [Received: 11/02/2023] [Accepted: 07/12/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction: The sustainable implementation of socially assistive robots in a pharmacy setting requires that customers trust the robot. Our aim was to explore young adults' anticipations of and motives for trusting robot medication counseling in a high-stakes scenario. Methods: Through a co-creation approach, we co-designed a prototype application for the Furhat platform together with young adults. In-lab testing of a pharmacy scenario, where the robot provides medication counseling related to emergency contraceptive pills, was conducted to deepen our understanding of some factors driving young adults' initial trust establishment and anticipations of interacting with a robot in a high-stakes scenario. Qualitative data from interviews with six study participants were analyzed using inductive, reflexive thematic analysis and are presented through a narrative approach. Results: We outline five tales of trust characterized by personas. A continuum of different anticipations for consulting a robot in medication counseling is presented, ranging from low to high expectations of use. Driving factors in the initial trust establishment process are position, autonomy, boundaries, shame, gaze, and alignment. Discussion: The article adds to the understanding of the dimensions of the multifaceted trust concept, of driving trust factors, and of the subsequent anticipation to trust robots in a high-stakes pharmacy context.
Collapse
Affiliation(s)
- Susanne Hägglund
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Malin Andtfolk
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Sara Rosenberg
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Mattias Wingren
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Sören Andersson
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Linda Nyholm
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
3
|
Ali M, Ciebiera M, Wlodarczyk M, Alkhrait S, Maajid E, Yang Q, Hsia SM, Al-Hendy A. Current and Emerging Treatment Options for Uterine Fibroids. Drugs 2023; 83:1649-1675. [PMID: 37922098 DOI: 10.1007/s40265-023-01958-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
Uterine fibroids are the most common benign neoplasm of the female reproductive tract in reproductive age women. Their prevalence is age dependent and can be detected in up to 80% of women by the age of 50 years. Patients affected by uterine fibroids may experience a significant physical, emotional, social, and financial toll as well as losses in their quality of life. Unfortunately, curative hysterectomy abolishes future pregnancy potential, while uterine-sparing surgical and radiologic alternatives are variously associated with reduced long-term reproductive function and/or high tumor recurrence rates. Recently, pharmacological treatment against uterine fibroids have been widely considered by patients to limit uterine fibroid-associated symptoms such as heavy menstrual bleeding. This hormonal therapy seemed effective through blocking the stimulatory effects of gonadal steroid hormones on uterine fibroid growth. However, they are contraindicated in women actively pursuing pregnancy and otherwise effective only during use, which is limited because of long-term safety and other concerns. Accordingly, there is an urgent unmet need for safe, durable, and fertility-compatible non-surgical treatment options for uterine fibroids. In this review article, we cover the current pharmacological treatments for uterine fibroids including their comparable efficacy and side effects as well as emerging safe natural compounds with promising anti-uterine fibroid effects.
Collapse
Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, 00-189, Poland
| | - Marta Wlodarczyk
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, Warsaw, 02-097, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Samar Alkhrait
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Elise Maajid
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, 11031, Taiwan
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| |
Collapse
|
4
|
Leelakanok N, Parmontree P, Petchsomrit A, Methaneethorn J. A systematic review and meta-analysis of attitude and knowledge involving emergency oral contraceptive use in patients and healthcare providers. Int J Clin Pharm 2022; 44:873-893. [PMID: 35732860 DOI: 10.1007/s11096-022-01445-0] [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: 03/16/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Levonorgestrel and ulipristal acetate are common emergency oral contraceptives (EOCs). Lack of knowledge and negative attitude toward EOCs pose barriers to the EOCs access and utilization. AIM This study aimed to summarize the studies on the knowledge and attitudes of healthcare providers and patients on the use of EOCs. METHOD A systematic search was conducted from conception to April 2022 using the following databases: CINAHL Complete, MEDLINE, ScienceDirect, Scopus, and Thai Journal Online. Data were extracted independently and were meta-analyzed using DerSimonian and Laird method for the binary random-effects model. RESULTS 121 articles with a total number of 92,484 participants were included. The awareness of levonorgestrel as an EOC was 66.7% while the awareness of ulipristal acetate as an EOC was 36.9%. EOCs users received EOC information mainly from the internet, media, and friends. We found that 32.2% of EOCs users and providers agreed that EOCs acted post-fertilization, and 39.8% of the prescribers know the correct time to take the pill postcoital. Negative attitudes toward EOC use were found in 25.4% of the participants. For example, 39.4% of the participants agreed that EOCs users had increased sexual activity. CONCLUSION The awareness of EOCs was low and misunderstandings or negative attitudes towards the use or prescription of EOCs were still prevalent. Educating healthcare providers, using media as educational tools, and improving education and economics can be useful in improving EOC users' awareness, knowledge, and attitude towards EOCs.
Collapse
Affiliation(s)
- Nattawut Leelakanok
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, 20131, Thailand
| | - Porntip Parmontree
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, 20131, Thailand.
| | - Arpa Petchsomrit
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, 20131, Thailand.,Pharmaceutical Innovations of Natural Products Unit (PhInNat), Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Janthima Methaneethorn
- Pharmacokinetic Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
5
|
Stone RH, Gross S, Reardon B, Young HN. Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia. J Pharm Pract 2021; 36:523-531. [PMID: 34881653 DOI: 10.1177/08971900211052821] [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: 11/16/2022]
Abstract
Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3-6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08-2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists' EC counseling.
Collapse
Affiliation(s)
- Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
| | - Savannah Gross
- 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Brielle Reardon
- Department of Pharmacy, 1466Johns Hopkins Hospital, Baltimore, MD, USA
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
| |
Collapse
|
6
|
Brain reactivity during aggressive response in women with premenstrual dysphoric disorder treated with a selective progesterone receptor modulator. Neuropsychopharmacology 2021; 46:1460-1467. [PMID: 33927343 PMCID: PMC8209206 DOI: 10.1038/s41386-021-01010-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 02/03/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is a psychiatric condition characterized by late luteal phase affective, cognitive, and physical impairment. The disorder causes significant suffering in about 5% of women in their reproductive age. Altered sensitivity of cognitive-affective brain circuits to progesterone and its downstream metabolite allopregnanolone is suggested to underlie PMDD symptomatology. Core mood symptoms include irritability and anger, with aggression being the behavioral outcome of these symptoms. The present study sought to investigate the neural correlates of reactive aggression during the premenstrual phase in women with PMDD, randomized to a selective progesterone receptor modulator (SPRM) or placebo. Self-reports on the Daily Record of Severity of Problems were used to assess PMDD symptoms and gonadal hormone levels were measured by liquid chromatography tandem mass spectrometry. Functional magnetic resonance imaging was performed in 30 women with PMDD, while performing the point subtraction aggression paradigm. Overall, a high SPRM treatment response rate was attained (93%), in comparison with placebo (53.3%). Women with PMDD randomized to SPRM treatment had enhanced brain reactivity in the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex during the aggressive response condition. The fronto-cingulate reactivity during aggressive responses depended on treatment, with a negative relationship between brain reactivity and task-related aggressiveness found in the placebo but not the SPRM group. The findings contribute to define the role of progesterone in PMDD symptomatology, suggesting a beneficial effect of progesterone receptor antagonism, and consequent anovulation, on top-down emotion regulation, i.e., greater fronto-cingulate activity in response to provocation stimuli.
Collapse
|
7
|
Kim O, Park EY, Kwon SY, Shin S, Emerson RE, Shin YH, DeMayo FJ, Lydon JP, Coffey DM, Hawkins SM, Quilliam LA, Cheon DJ, Fernández FM, Nephew KP, Karpf AR, Widschwendter M, Sood AK, Bast RC, Godwin AK, Miller KD, Cho CH, Kim J. Targeting progesterone signaling prevents metastatic ovarian cancer. Proc Natl Acad Sci U S A 2020; 117:31993-32004. [PMID: 33262282 PMCID: PMC7749341 DOI: 10.1073/pnas.2013595117] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Effective cancer prevention requires the discovery and intervention of a factor critical to cancer development. Here we show that ovarian progesterone is a crucial endogenous factor inducing the development of primary tumors progressing to metastatic ovarian cancer in a mouse model of high-grade serous carcinoma (HGSC), the most common and deadliest ovarian cancer type. Blocking progesterone signaling by the pharmacologic inhibitor mifepristone or by genetic deletion of the progesterone receptor (PR) effectively suppressed HGSC development and its peritoneal metastases. Strikingly, mifepristone treatment profoundly improved mouse survival (∼18 human years). Hence, targeting progesterone/PR signaling could offer an effective chemopreventive strategy, particularly in high-risk populations of women carrying a deleterious mutation in the BRCA gene.
Collapse
MESH Headings
- Adult
- Animals
- BRCA1 Protein/genetics
- Breast/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/prevention & control
- Cystadenocarcinoma, Serous/chemistry
- Cystadenocarcinoma, Serous/genetics
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/prevention & control
- Disease Models, Animal
- Estradiol/administration & dosage
- Female
- Humans
- Mice
- Middle Aged
- Mifepristone/pharmacology
- Mifepristone/therapeutic use
- Mutation
- Neoplasms, Experimental/chemically induced
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/pathology
- Neoplasms, Experimental/prevention & control
- Ovarian Neoplasms/chemically induced
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/prevention & control
- Ovary/pathology
- Ovary/surgery
- Progesterone/administration & dosage
- Progesterone/antagonists & inhibitors
- Progesterone/metabolism
- Receptors, Progesterone/genetics
- Receptors, Progesterone/metabolism
- Salpingo-oophorectomy
- Signal Transduction/drug effects
- Signal Transduction/genetics
Collapse
Affiliation(s)
- Olga Kim
- Department of Biochemistry and Molecular Biology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Eun Young Park
- Department of Biochemistry and Molecular Biology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Sun Young Kwon
- Department of Pathology, School of Medicine, Keimyung University, 41931 Daegu, Republic of Korea
| | - Sojin Shin
- Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, 41931 Daegu, Republic of Korea
| | - Robert E Emerson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Yong-Hyun Shin
- Department of Biochemistry and Molecular Biology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Francesco J DeMayo
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709
| | - John P Lydon
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030
| | - Donna M Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist and Weill Cornell Medical College, Houston, TX 77030
| | - Shannon M Hawkins
- Department of Obstetrics and Gynecology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Lawrence A Quilliam
- Department of Biochemistry and Molecular Biology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Dong-Joo Cheon
- Department of Regenerative and Cancer Cell Biology, Albany Medical College, Albany, NY 12208
| | - Facundo M Fernández
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA 30332
| | - Kenneth P Nephew
- Medical Sciences Program, Indiana University School of Medicine, Bloomington, IN 47405
| | - Adam R Karpf
- Eppley Institute for Cancer Research, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, WC1E 6AU London, United Kingdom
- Research Institute for Biomedical Aging Research, Universität Innsbruck, 6020 Innsbruck, Austria
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, 6060 Hall in Tirol, Austria
| | - Anil K Sood
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
- Department of Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160
| | - Kathy D Miller
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, 41931 Daegu, Republic of Korea;
| | - Jaeyeon Kim
- Department of Biochemistry and Molecular Biology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202;
| |
Collapse
|
8
|
Langer B, Grimm S, Lungfiel G, Mandlmeier F, Wenig V. The Quality of Counselling for Oral Emergency Contraceptive Pills-A Simulated Patient Study in German Community Pharmacies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186720. [PMID: 32942744 PMCID: PMC7559115 DOI: 10.3390/ijerph17186720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.
Collapse
|
9
|
Li HWR, Resche-Rigon M, Bagchi IC, Gemzell-Danielsson K, Glasier A. Does ulipristal acetate emergency contraception (ella®) interfere with implantation? Contraception 2019; 100:386-390. [DOI: 10.1016/j.contraception.2019.07.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
|
10
|
Gómez-Elías MD, May M, Munuce MJ, Bahamondes L, Cuasnicú PS, Cohen DJ. A single post-ovulatory dose of ulipristal acetate impairs post-fertilization events in mice. Mol Hum Reprod 2019; 25:257-264. [PMID: 30824928 DOI: 10.1093/molehr/gaz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023] Open
Abstract
Ulipristal acetate (UPA) is a selective progesterone receptor modulator used for emergency contraception that has proven to be highly effective in preventing pregnancy when taken up to 120 h after unprotected sexual intercourse. Even though it may act mainly by delaying or inhibiting ovulation, additional effects of UPA on post-fertilization events cannot be excluded. Therefore, the aim of this study was to determine whether a single post-ovulatory dose of UPA could prevent pregnancy using the mouse as a pre-clinical model. Mated females received a single dose of UPA (40 mg/kg) on Day E1.5 or E2.5 (E0.5: copulatory plug detection) and post-fertilization events were evaluated. Our studies revealed that UPA administration produced a significant decrease in the number of conceptuses compared to control. Moreover, UPA-treated females exhibited a lower number of early implantation sites on Day E5.5, despite normal in vivo embryo development and transport to the uterus at E3.5. Administration of UPA produced histological and functional alterations in the uterine horns, i.e., a dyssynchronous growth between endometrial glands and stroma, with non-physiological combination of both fractions compared to controls, and a completely impaired ability to respond to an artificial decidualization stimulus. Altogether, our results show that the administration of a single post-ovulatory dose of UPA impairs mouse pregnancy probably due to an effect on embryo-uterine interaction, supporting additional effects of the drug on post-fertilization events. Although these studies cannot be performed with human samples, our results with the mouse model provide new insights into the mechanism of action of UPA as an emergency contraception method.
Collapse
Affiliation(s)
- Matías D Gómez-Elías
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María May
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María José Munuce
- Laboratory of Reproductive Medicine, Biochemical Chemistry Area, School of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patricia S Cuasnicú
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Débora J Cohen
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| |
Collapse
|
11
|
Mozzanega B, Nardelli GB. UPA and LNG in emergency contraception: the information by EMA and the scientific evidences indicate a prevalent anti-implantation effect. EUR J CONTRACEP REPR 2019; 24:4-10. [DOI: 10.1080/13625187.2018.1555662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Bruno Mozzanega
- Department SDB Woman’s and Child’s Health, University of Padua, Padova, Italy
| | | |
Collapse
|
12
|
Xu P, Luan H, Yu B, Tu Y, Sun Y, Chen W, Xu X, Ge R, Wang J, Li Z, Bian J. Synthesis and characterization of potential stereoisomeric and degradation impurities of ulipristal acetate. Org Chem Front 2019. [DOI: 10.1039/c9qo00144a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Potential stereoisomeric and degradation impurities of UPA has been synthesized through practical approaches which would be valuable for the quality control of UPA.
Collapse
|
13
|
Shortrede JE, Montt-Guevara MM, Pennacchio G, Finiguerra M, Giannini A, Genazzani AD, Simoncini T. Ulipristal Acetate Interferes With Actin Remodeling Induced by 17β-Estradiol and Progesterone in Human Endometrial Stromal Cells. Front Endocrinol (Lausanne) 2018; 9:350. [PMID: 30013514 PMCID: PMC6036300 DOI: 10.3389/fendo.2018.00350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022] Open
Abstract
Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) used for emergency contraception and for the medical management of symptomatic uterine fibroids (UF). Treatment with UPA turns in amenorrhea and UF volume reduction. Treatment with UPA is associated with the frequent development of benign, transitory endometrial changes known as SPRM-associated endometrial changes (PAECs). Why PAECs develop and their biological or cellular basis is unknown. Sex steroids, including estrogen and progesterone, are established modulators of the actin cytoskeleton in various cells, including endometrial cells. This explains several morphological and functional changes in endometrial cells. We thus hypothesized that UPA may alter the appearance of the endometrium by interfering with the actions of 17β-estradiol (E2) or progesterone (P4) on actin dynamics. We isolated and cultured human endometrial stromal cells (ESC) from endometrial biopsies from healthy fertile women. Treatment with E2 or P4 stimulated visible actin rearrangements with actin remodeling toward the membrane. Activation through phosphorylation of the actin regulatory proteins, Moesin, and focal adhesion kinase (FAK), hacked actin remodeling induced by E2 and P4. Membrane re-localization of Paxillin and Vinculin were also induced by E2 and P4, showing the formation of focal adhesion complexes. All these E2 and P4 actions were inhibited by co-treatment with UPA, which was otherwise inactive if given alone. The cytoskeletal changes induced by E2 and P4 turned into increased motility of ESC, and UPA again blocked the actions E2 and P4. In conclusion, we find that UPA interferes with the cytoskeletal actions of E2 and P4 in ESC. This finding helps understanding the mode of actions of SPRMs in the endometrium and may be relevant for other potential clinical applications of UPA.
Collapse
Affiliation(s)
- Jorge E. Shortrede
- Molecular and Cellular Gynecological Endocrinology Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria M. Montt-Guevara
- Molecular and Cellular Gynecological Endocrinology Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gisela Pennacchio
- Institute of Experimental Medicine and Biology of Cuyo, Technology and Scientific Center (CCT)-National Research Council of Argentina, Mendoza, Argentina
| | - Michele Finiguerra
- Molecular and Cellular Gynecological Endocrinology Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Molecular and Cellular Gynecological Endocrinology Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro D. Genazzani
- Department of Obstetrics and Gynecology, Center for Gynecological Endocrinology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Simoncini
- Molecular and Cellular Gynecological Endocrinology Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Tommaso Simoncini
| |
Collapse
|
14
|
Cox J, Malik M, Britten J, Lewis T, Catherino WH. Ulipristal Acetate and Extracellular Matrix Production in Human Leiomyomas In Vivo: A Laboratory Analysis of a Randomized Placebo Controlled Trial. Reprod Sci 2017; 25:198-206. [PMID: 28929861 DOI: 10.1177/1933719117728802] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a prior randomized controlled study, patients treated with ulipristal acetate (UPA) or placebo for 3 months had a decrease in leiomyoma size. A total of 10 patients' tissue samples (5 placebo and 5 treated with 10 mg/d UPA) that underwent hysterectomy and tissue preservation were identified from this study. Quantitative real-time reverse transcriptase polymerase chain reaction and Western blotting were used to assess fold gene and protein expression of extracellular membrane (ECM) proteins: collagen 1A (COL1A), fibronectin (FN1), and versican (VCAN) of the samples. Confirmatory immunohistochemical analysis was performed. Changes in total matrix collagen were examined using Masson trichrome staining. Multiplex measurement of the matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases was performed. Compared to placebo-treated surgical specimens, 80% of the treated specimens showed decrease in VCAN protein, 60% showed decrease in FN1, but no consistent alteration in COL1A. This effect was also supported by immunohistochemistry where leiomyoma surgical specimens demonstrated decreased amount of FN1 and VCAN on UPA treatment. Increased MMP2 and decreased MMP9 in treated patient leiomyomas indicate both degradation of the matrix and inhibition of the pathway involved in matrix production. Treatment with UPA decreased fibroid volume in placebo-controlled, randomized trials. Treatment with UPA decreased gene expression and protein production in leiomyoma tissue, suggesting both an impact on water content and ECM protein concentration as a mechanism of ulipristal-mediated decrease in leiomyoma size.
Collapse
Affiliation(s)
- Jeris Cox
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Minnie Malik
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joy Britten
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Terrence Lewis
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,3 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - William H Catherino
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,3 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| |
Collapse
|
15
|
Bastianelli C, Rosato E, Farris M, Benagiano G. Emergency contraception: a survey of 1773 women. EUR J CONTRACEP REPR 2016; 21:455-461. [DOI: 10.1080/13625187.2016.1237630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Carlo Bastianelli
- Department of Gynaecology–Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | - Elena Rosato
- Department of Gynaecology–Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | - Manuela Farris
- Department of Gynaecology–Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
- AIED Italian Association for Demographic Education, Rome, Italy
| | - Giuseppe Benagiano
- Department of Gynaecology–Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|