Pilot Study of Real-World Monitoring of the Heart Rate Variability in Amyotrophic Lateral Sclerosis

Aims

Cardiovascular dysautonomia may impact the quality of life and survival in amyotrophic lateral sclerosis (ALS). Such dysfunction is not systematically assessed in these patients. Wearable devices could help. The feasibility of a wearable biosensor to detect heart rate variability (HRV), a physiological marker of sympathovagal balance, was studied for the first time in real-world settings in ALS.

Methods

Five ALS patients (two early/three late; one bulbar-onset; mildly-to-moderately disabled) and five age/sex/BMI/comorbidities-matched controls underwent assessment of 3-day HRV via VitalConnect biosensor (worn on the left thorax). De-identified data captured by the biosensor were transferred to a secure cloud server via a relay Bluetooth device. Baseline ALS severity/anxiety and physical activity during testing were documented/quantified. Time-domain HRV measures (i.e., pNN50) were analyzed.

Results

An overall 3-day abnormal HRV (pNN50 < 3%), was found in three out of five patients (mean ± SD for the group, 2.49 ± 1.51). Similar changes were reported in controls (12.32 ± 21.14%). There were no statistically significant relationships between pNN50 values and baseline anxiety or physical activity during the tested days (p > 0.05 for both groups). A negative correlation was found between pNN50 values and age in patients (p = 0.01) and controls (p = 0.09), which is similar with what is found in the general population. In line with prior studies, pNN50 values were independent of disease stage (p = 0.6) and disability (p = 0.4).

Conclusions

These preliminary results suggest that remote HRV measures using the VitalConnect is feasible and may constitute an improved strategy to provide insights into sympathovagal balance in ALS. Further work with larger sample sizes is warranted.

Hemodynamic force is required for vascular smooth muscle cell recruitment to blood vessels during mouse embryonic development

Blood vessel maturation, which is characterized by the investment of vascular smooth muscle cells (vSMCs) around developing blood vessels, begins when vessels remodel into a hierarchy of proximal arteries and proximal veins that branch into smaller distal capillaries. The ultimate result of maturation is formation of the tunica media-the middlemost layer of a vessel that is composed of vSMCs and acts to control vessel integrity and vascular tone. Though many studies have implicated the role of various signaling molecules in regulating maturation, no studies have determined a role for hemodynamic force in the regulation of maturation in the mouse. In the current study, we provide evidence that a hemodynamic force-dependent mechanism occurs in the mouse because reduced blood flow mouse embryos exhibited a diminished or absent coverage of vSMCs around vessels, and in normal-flow embryos, extent of coverage correlated to the amount of blood flow that vessels were exposed to. We also determine that the cellular mechanism of force-induced maturation was not by promoting vSMC differentiation/proliferation, but instead involved the recruitment of vSMCs away from neighboring low-flow distal capillaries towards high-flow vessels. Finally, we hypothesize that hemodynamic force may regulate expression of specific signaling molecules to control vSMC recruitment to high-flow vessels, as reduction of flow results in the misexpression of Semaphorin 3A, 3F, 3G, and the Notch target gene Hey1, all of which are implicated in controlling vessel maturation. This study reveals another role for hemodynamic force in regulating blood vessel development of the mouse, and opens up a new model to begin elucidating mechanotransduction pathways regulating vascular maturation.

Nonsteroidal selective glucocorticoid modulators: the effect of C-5 alkyl substitution on the transcriptional activation/repression profile of 2,5-dihydro-10-methoxy-2,2,4-trimethyl-1H-[1]benzopyrano[3,4-f]quinolines

The preparation and characterization of a series of selective glucocorticoid receptor modulators are described. The preliminary structure-activity relationship of nonaromatic C-5 substitution on the tetracyclic quinoline core showed a preference for small lipophilic side chains. Proper substitution at this position maintained the transcriptional repression of proinflammatory transcription factors while diminishing the transcriptional activation activity of the ligand/glucocorticoid receptor complex. The optimal compounds described in this study were the allyl analogue 18 and cyclopentyl analogue 32. These candidates showed slightly less potent, highly efficacious E-selectin repression with significantly reduced levels of glucocorticoid response element activation in reporter gene assays vs prednisolone. Allyl analogue 18 was evaluated in vivo. An oral dose of 18 showed an ED(50) = 1.7 mg/kg as compared to 1.2 mg/kg for prednisolone in the Sephadex-induced pulmonary eosinophilia model and an ED(50) = 15 mg/kg vs 4 mg/kg for prednisolone in the carrageenan-induced paw edema model.

Marijuana use and depression

The primary goal of this study is to examine the association between marijuana use and adult depressive symptomatology. The key independent variables examined are age of marijuana initiation, frequency of current marijuana use, the use of other licit and illicit drugs, and whether marijuana was used to cope with problems. The relationships among these variables are assessed using data from the Young Men and Drugs Survey (n = 1,941), a nationally representative sample of men from the 1944-1954 birth cohort. Results show that early marijuana initiation appears to be weakly associated with increased depression in adulthood. This effect, however, is mediated by educational attainment, employment status, marital status, and other drug use, notably alcohol and tobacco use. Adult frequency of marijuana use is not significantly associated with increased depression in adulthood. Finally, marijuana users who use the drug to cope with problems are more depressed than those who do not use to cope with problems.

Potent piperazine hydroxyethylamine HIV protease inhibitors containing novel P3 ligands

The 2-isopropyl thiazolyl group is a highly optimized P3 ligand for C2 symmetry-based HIV protease inhibitors, as exemplified in the drug ritonavir. Here we report that incorporation of this P3 ligand into a piperazine hydroxyethylamine series also yielded novel, highly potent inhibitors. In tissue culture assays, the presence of human serum was less deleterious to the activity of these inhibitors than to that of ritonavir. Furthermore, potent activity against ritonavir resistant HIV was observed.

Discovery of ritonavir, a potent inhibitor of HIV protease with high oral bioavailability and clinical efficacy

The structure-activity studies leading to the potent and clinically efficacious HIV protease inhibitor ritonavir are described. Beginning with the moderately potent and orally bioavailable inhibitor A-80987, systematic investigation of peripheral (P3 and P2') heterocyclic groups designed to decrease the rate of hepatic metabolism provided analogues with improved pharmacokinetic properties after oral dosing in rats. Replacement of pyridyl groups with thiazoles provided increased chemical stability toward oxidation while maintaining sufficient aqueous solubility for oral absorption. Optimization of hydrophobic interactions with the HIV protease active site produced ritonavir, with excellent in vitro potency (EC50 = 0.02 microM) and high and sustained plasma concentrations after oral administration in four species. Details of the discovery and preclinical development of ritonavir are described.

Discovery of ritonavir, a potent inhibitor of HIV protease with high oral bioavailability and clinical efficacy

The structure-activity studies leading to the potent and clinically efficacious HIV protease inhibitor ritonavir are described. Beginning with the moderately potent and orally bioavailable inhibitor A-80987, systematic investigation of peripheral (P3 and P2') heterocyclic groups designed to decrease the rate of hepatic metabolism provided analogues with improved pharmacokinetic properties after oral dosing in rats. Replacement of pyridyl groups with thiazoles provided increased chemical stability toward oxidation while maintaining sufficient aqueous solubility for oral absorption. Optimization of hydrophobic interactions with the HIV protease active site produced ritonavir, with excellent in vitro potency (EC50 = 0.02 microM) and high and sustained plasma concentrations after oral administration in four species. Details of the discovery and preclinical development of ritonavir are described.

Stability of equine infectious anemia virus in Aedes aegypti (Diptera: Culicidae), Stomoxys calcitrans (Diptera:Muscidae), and Tabanus fuscicostatus (Diptera:Tabanidae) stored at -70 degrees C

Equine infectious anemia virus (EIAV) was injected intrathoracically into Aedes aegypti, Stomoxys calcitrans, and Tabanus fuscicostatus, and fed to Ae. aegypti in suspensions of either artificial blood of Eagle's Minimum Essential Medium. Insects were stored at -70 degrees C for up to 9 months before testing for the presence of EIAV. The viral tissue culture titers detected from stored insects were similar to those from insects tested at time 0.

ABT-538 is a potent inhibitor of human immunodeficiency virus protease and has high oral bioavailability in humans

Examination of the structural basis for antiviral activity, oral pharmacokinetics, and hepatic metabolism among a series of symmetry-based inhibitors of the human immunodeficiency virus (HIV) protease led to the discovery of ABT-538, a promising experimental drug for the therapeutic intervention in acquired immunodeficiency syndrome (AIDS). ABT-538 exhibited potent in vitro activity against laboratory and clinical strains of HIV-1 [50% effective concentration (EC50) = 0.022-0.13 microM] and HIV-2 (EC50 = 0.16 microM). Following a single 10-mg/kg oral dose, plasma concentrations in rat, dog, and monkey exceeded the in vitro antiviral EC50 for > 12 h. In human trials, a single 400-mg dose of ABT-538 displayed a prolonged absorption profile and achieved a peak plasma concentration in excess of 5 micrograms/ml. These findings demonstrate that high oral bioavailability can be achieved in humans with peptidomimetic inhibitors of HIV protease.

The stereochemistry of Bis(α,α'-diimine)copper(I) complexes: the crystal and molecular structures of Bis(2,9-dimethyl-1,10-phenanthroline)copper(I) bromide hydrate, Bis(4,4',6,6'-tetramethyl-2,2'-bipyridine)copper(I) chloride dihydrate, and Bis(2,9-dimethyl-1,10-phenanthroline)copper(I) nitrate dihydrate (a redetermination)

The crystal structures of the title compounds have been determined by single-crystal X-ray diffraction methods at 295 K, and refined by least-squares methods. Crystal data for [Cu(Cl4H12N2)2] Br.H2O (1) are: monoclinic, P21/c, a 14.067(4), b 17.687(6), c 10.337(5) �, β 91.04(3)�, with R 0.038, R' 0.040 for 1855 'observed' reflections. Crystal data for [Cu(Cu14H12N2)2] C1.2H2O (2) are: triclinic, P1, a 15.305(2), b 13.164(2), c 7.344(3) �, α 83.03(3), β 93.83(3), γ 108. 11260(3)�, with R 0.051, R' 0.053 for 1293 'observed' reflections. Crystal data for [Cu(Cl4H12N2)2] Br.H2O (3) are: triclinic, P1, a 7.619(2), b 11.967(3), c 15.534(3) �, α 71.26(1), β 82.13(1), γ 86.86(2)�, with R 0.043, R' 0.052 for 2335 'observed' reflections. The anionic and solvent species are uncoordinated in all three compounds. Cu-N bond lengths range from 2.027(5) to 2.053(5) �. The copper(1) environment (CuN4) in each complex shows considerable distortion from tetrahedral geometry. N-Cu-N intraligand angles range from 81.0(2) to 83.0(2)�, while N-Cu-N interligand angles range from 114.7(2) to 135.2(2)�. The variation in interligand angles can be described in terms of three independent rotations of ligand 2 about an orthogonal axial system defined by ligand 1.