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Sunzel EM, Rabinovich-Guilatt L, Iyengar M, Ruffo D, Birajdar NG, Loupe P, Gutierrez M, Gordon MF, Ghibellini G. A Bioequivalence Comparison Between the Once-Daily Extended-Release Tablet and the Twice-Daily Tablet Formulations of Deutetrabenazine at Steady State. Clin Pharmacol Drug Dev 2024; 13:224-232. [PMID: 38214040 DOI: 10.1002/cpdd.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Deutetrabenazine is approved for the treatment of tardive dyskinesia and chorea associated with Huntington's disease. This study compared the exposure between the once-daily (test) and twice-daily (reference) formulations of deutetrabenazine under fed conditions. Using a randomized crossover design, healthy adults (n = 262) received the 24 mg of the test formulation once daily and 12 mg of the reference formulation twice daily, each for 7 days. Plasma concentrations were collected on Days 4-6 before dose intake, and frequently for pharmacokinetic evaluation on Days 6 and 7 for determination of deutetrabenazine and active metabolites, deuterated α-dihydrotetrabenazine (α-HTBZ) and β-dihydrotetrabenazine (β-HTBZ). Geometric mean ratios (GMRs, test/reference) were computed for all analytes, and bioequivalence was tested for area under the plasma concentration-time curve over 24 hours at steady state (AUC0-24 h,ss ) and for maximum plasma concentrations at steady state (Cmax,ss ). The GMRs for AUC0-24 h,ss were 115% for deutetrabenazine and 95% for deuterated total (α+β)-HTBZ; and the GMR for Cmax,ss for deutetrabenazine was 95%. Relative bioavailability was assessed for Cmax,ss of the active metabolites; the GMR was 78% for total (α+β)-HTBZ. At steady state, deutetrabenazine administered as the once-daily formulation was bioequivalent to the twice-daily formulation for both AUC and Cmax, and the active metabolites were bioequivalent with regard to AUC0-24 h,ss .
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Affiliation(s)
- Eva-Maria Sunzel
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
| | | | - Malini Iyengar
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
| | - Debra Ruffo
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
| | | | - Pippa Loupe
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
| | | | - Mark Forrest Gordon
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
| | - Giulia Ghibellini
- Innovative Medicines R&D Global Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA
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Celletti C, Mari G, Ghibellini G, Celli M, Castori M, Camerota F. Phenotypic variability in developmental coordination disorder: Clustering of generalized joint hypermobility with attention deficit/hyperactivity disorder, atypical swallowing and narrative difficulties. Am J Med Genet C Semin Med Genet 2015; 169C:117-22. [PMID: 25821095 DOI: 10.1002/ajmg.c.31427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Developmental coordination disorder (DCD) is a recognized childhood disorder mostly characterized by motor coordination difficulties. Joint hypermobility syndrome, alternatively termed Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly featuring generalized joint hypermobility (gJHM), musculoskeletal pain, and minor skin features. Although these two conditions seem apparently unrelated, recent evidence highlights a high rate of motor and coordination findings in children with gJHM or JHS/EDS-HT. Here, we investigated the prevalence of gJHM in 41 Italian children with DCD in order to check for the existence of recognizable phenotypic subgroups of DCD in relation to the presence/absence of gJHM. All patients were screened for Beighton score and a set of neuropsychological tests for motor competences (Movement Assessment Battery for Children and Visual-Motor Integration tests), and language and learning difficulties (Linguistic Comprehension Test, Peabody Picture Vocabulary Test, Boston Naming Test, Bus Story Test, and Memoria-Training tests). All patients were also screening for selected JHS/EDS-HT-associated features and swallowing problems. Nineteen (46%) children showed gJHM and 22 (54%) did not. Children with DCD and gJHM showed a significant excess of frequent falls (95 vs. 18%), easy bruising (74 vs. 0%), motor impersistence (89 vs. 23%), sore hands for writing (53 vs. 9%), attention deficit/hyperactivity disorder (89 vs. 36%), constipation (53 vs. 0%), arthralgias/myalgias (58 vs. 4%), narrative difficulties (74 vs. 32%), and atypical swallowing (74 vs. 18%). This study confirms the non-causal association between DCD and gJHM, which, in turn, seems to increase the risk for non-random additional features. The excess of language, learning, and swallowing difficulties in patients with DCD and gJHM suggests a wider effect of lax tissues in the development of the nervous system.
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Castori M, Morlino S, Ghibellini G, Celletti C, Camerota F, Grammatico P. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. Am J Med Genet 2015; 169C:84-96. [DOI: 10.1002/ajmg.c.31426] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ghibellini G, Brancati F, Castori M. Neurodevelopmental attributes of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: Update and perspectives. Am J Med Genet 2015; 169C:107-16. [DOI: 10.1002/ajmg.c.31424] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Castori M, Morlino S, Celletti C, Ghibellini G, Bruschini M, Grammatico P, Blundo C, Camerota F. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet A 2013; 161A:2989-3004. [DOI: 10.1002/ajmg.a.36315] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 09/29/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Silvia Morlino
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Claudia Celletti
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
| | - Giulia Ghibellini
- Division of Pharmacotherapy and Experimental Therapeutics; School of Pharmacy, University of North Carolina at Chapel Hill; North Carolina
| | - Michela Bruschini
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine; Sapienza University, San Camillo-Forlanini Hospital; Rome Italy
| | - Carlo Blundo
- Unit of Cognitive and Behavioral Neurology, Division of Neurology and Neurophysiopathology; San Camillo-Forlanini Hospital; Rome Italy
| | - Filippo Camerota
- Division of Physical Therapy and Rehabilitation, Department of Orthopedic Sciences; Sapienza University, Umberto I University Hospital; Rome Italy
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Ghibellini G, Park J, Brittain CF, Iavarone L, Andorn AC, Levy N, Muir KT. Bupropion Has No Effect on Intraocular Pressure or Other Ophthalmologic Parameters After Single or Repeat Doses in Healthy Volunteers. J Clin Pharmacol 2013; 49:489-95. [DOI: 10.1177/0091270008330981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Searle GE, Beaver JD, Tziortzi A, Comley RA, Bani M, Ghibellini G, Merlo-Pich E, Rabiner EA, Laruelle M, Gunn RN. Mathematical modelling of [¹¹C]-(+)-PHNO human competition studies. Neuroimage 2012. [PMID: 23207573 DOI: 10.1016/j.neuroimage.2012.11.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The D(2)/D(3) agonist radioligand [(11)C]-(+)-PHNO is currently the most suitable D(3) imaging agent available, despite its limited selectivity for the D(3) over the D(2). Given the collocation of D(2) and D(3) receptors, and generally higher densities of D(2), the separation of D(2) and D(3) information from [(11)C]-(+)-PHNO PET data are somewhat complex. This complexity is compounded by recent data suggesting that [(11)C]-(+)-PHNO PET scans might be routinely performed in non-tracer conditions (with respect to D(3) receptors), and that the cerebellum (used as a reference region) might manifest some displaceable binding signal. Here we present the modelling and analysis of data from two human studies which employed an adequate dose range of selective D(3) antagonists (GSK598809 and GSK618334) to interrogate the [(11)C]-(+)-PHNO PET signal. Models describing the changes observed in the PET volume of distribution (V(T)) and binding potential (BP(ND)) were used to identify and quantify a [(11)C]-(+)-PHNO mass dose effect at the D(3), and displaceable signal in the cerebellum, as well as providing refined estimates of regional D(3) fractions of [(11)C]-(+)-PHNO BP(ND). The dose of (+)-PHNO required to occupy half of the available D(3) receptors (ED(50)(PHNO,D3)) was estimated as 40ng/kg, and the cerebellum BP(ND) was estimated as 0.40. These findings confirm that [(11)C]-(+)-PHNO human PET studies are in fact routinely performed under non-tracer conditions. This suggests that (+)-PHNO injection masses should be minimised and tightly controlled in order to mitigate the mass dose effect. The specific binding detected in the cerebellum was modest but could have a significant effect, for example on estimates of D(3) potency in drug occupancy studies. A range of methods for the analysis of future [(11)C]-(+)-PHNO data, incorporating models for the effects quantified here, were developed and evaluated. The comparisons and conclusions drawn from these can inform the design and analysis of future PET studies with [(11)C]-(+)-PHNO.
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Affiliation(s)
- Graham E Searle
- GlaxoSmithKline Clinical Imaging Centre, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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Leslie EM, Ghibellini G, Nezasa KI, Brouwer KLR. Biotransformation and transport of the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in bile duct-cannulated wild-type and Mrp2/Abcc2-deficient (TR ) Wistar rats. Carcinogenesis 2007; 28:2650-6. [PMID: 17724374 DOI: 10.1093/carcin/bgm187] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The role of uptake and efflux transport proteins in the tissue distribution of the tobacco carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and its metabolites is largely unknown. Carbonyl reduction of NNK results in formation of the carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), which in rats is glucuronidated to the non-toxic NNAL-O-glucuronide. Previous in vitro studies showed that NNAL-O-glucuronide is a substrate for the human ATP-binding cassette transport proteins multidrug resistance protein (MRP)1 (ABCC1) and MRP2 (ABCC2). To investigate the influence of Mrp2 deficiency on NNK biotransformation and biliary excretion, [(3)H]NNK was administered intravenously to bile duct-cannulated wild-type (WT) and Mrp2-deficient (TR(-)) Wistar rats; plasma, bile and urine samples were collected for 5 h and analyzed by high-pressure liquid chromatography with radiochemical detection. The total radioactivity recovered in WT and TR(-) bile was 12 and 7% of the dose, respectively. NNAL-O-glucuronide accounted for 87% of the radioactivity in WT bile but was not detected in TR(-) bile. Urinary recovery of 1-(3-pyridyl)-1-butanol-4-carboxylic acid (hydroxy acid), NNAL-O-glucuronide and NNAL-N-oxide from 2-5 h was greater in TR(-) compared with WT rats. NNK plasma clearance was significantly higher in TR(-) (115 +/- 23 ml/min/kg) compared with WT (48 +/- 13 ml/min/kg) rats. A higher concentration and/or earlier appearance of hydroxy and 1-(3-pyridyl)-1-butanone-4-carboxylic acids, NNAL-N-oxide and NNK-N-oxide, and decreased NNK and NNAL concentrations in TR(-) plasma suggested increased cytochrome P450 biotransformation in TR(-) rats. The total recovery of hydroxy acid in bile and urine was significantly higher in TR(-) compared with WT rats. Thus, Mrp2 is responsible for the biliary excretion of NNAL-O-glucuronide and Mrp2 deficiency results in increased formation of carcinogenic NNK metabolites.
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Affiliation(s)
- Elaine M Leslie
- School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
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Ghibellini G, Vasist LS, Leslie EM, Heizer WD, Kowalsky RJ, Calvo BF, Brouwer KLR. In vitro-in vivo correlation of hepatobiliary drug clearance in humans. Clin Pharmacol Ther 2007; 81:406-13. [PMID: 17235333 DOI: 10.1038/sj.clpt.6100059] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The biliary clearance (Cl(biliary)) of three compounds was estimated using sandwich-cultured human hepatocytes (SCHH) and compared with Cl(biliary) values measured in vivo. Tc-99m sestamibi (MIBI) Cl(biliary) was determined in seven healthy volunteers using an oroenteric catheter to aspirate duodenal secretions, and gamma scintigraphy to determine gallbladder contraction; this technique was used previously to determine Tc-99m mebrofenin (MEB) and piperacillin (PIP) in vivo Cl(biliary). In vitro Cl(biliary) of MEB, MIBI, and PIP was quantified in SCHH as the ratio of mass excreted into bile canaliculi and area under the blood concentration-time curve (AUC) in medium. MIBI Cl(biliary) in vivo was 5.5+/-1.2 mL/min/kg (mean+/-SD). The rank order of Cl(biliary) predicted from SCHH corresponded well with the in vivo Cl(biliary) values in mL/min/kg for MEB (7.44 vs 16.1), MIBI (1.20 vs 5.51), and PIP (0.028 vs 0.032). In conclusion, the methods developed allowed for reproducible quantification of Cl(biliary) of drugs in healthy humans and prediction of Cl(biliary) from in vitro data.
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Affiliation(s)
- G Ghibellini
- School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
Piperacillin metabolism and biliary excretion are different between humans and preclinical species. In the present study, piperacillin metabolites were characterized in bile and urine of healthy humans and compared with metabolites formed in vitro. Volunteers were administered 2 g of piperacillin IV; blood, urine, and duodenal aspirates (obtained via a custom-made oroenteric catheter) were collected. The metabolism of piperacillin in humans also was investigated in vitro using pooled human liver microsomes and sandwich-cultured human hepatocytes. Piperacillin and metabolites were estimated by high-performance liquid chromatography with tandem mass spectrometry detection. Piperacillin, desethylpiperacillin, and desethylpiperacillin glucuronide were detected in bile, urine, and human liver microsomal incubates. Similar to the in vivo results, desethylpiperacillin was formed and excreted into bile canaliculi of sandwich-cultured human hepatocytes. This is the first report of glucuronidation of desethylpiperacillin in vitro or in vivo. The clinical method employed in this study to determine biliary clearance of drugs also facilitates bile collection as soon as bile is excreted from the gallbladder, thereby minimizing the exposure of labile metabolites to the intestinal environment. This study exemplifies how a combination of in vitro and in vivo tools can aid in the identification of metabolites unique to the human species.
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Affiliation(s)
- Giulia Ghibellini
- Division of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA.
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Ghibellini G, Vasist LS, Hill TE, Heizer WD, Kowalsky RJ, Brouwer KLR. Determination of the biliary excretion of piperacillin in humans using a novel method. Br J Clin Pharmacol 2006; 62:304-8. [PMID: 16934046 PMCID: PMC1885142 DOI: 10.1111/j.1365-2125.2006.02662.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 02/28/2006] [Indexed: 11/30/2022] Open
Abstract
AIM To evaluate the applicability of a novel method to determine the biliary excretion of piperacillin. METHODS Healthy volunteers were administered piperacillin i.v. Duodenal aspirates were collected via a custom-made oroenteric catheter; blood and urine also were collected. Gallbladder ejection fraction (EF) was determined by gamma scintigraphy and pharmacokinetic parameters were calculated using noncompartmental analysis. RESULTS The fraction of the piperacillin dose excreted unchanged into bile was 1.1 +/- 0.3% (biliary clearance corrected for EF was 0.032 +/- 0.008 ml min(-1) kg(-1)). CONCLUSIONS This methodology can be used to determine reliably the biliary clearance of drugs that are excreted only marginally into bile. Normalization of biliary clearance for EF significantly reduces intersubject variability of this parameter.
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Affiliation(s)
- Giulia Ghibellini
- School of Pharmacy, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
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Abstract
Determining the biliary clearance of drugs in humans is very challenging because bile is not readily accessible due to the anatomy of the hepatobiliary tract. The collection of bile usually is limited to postsurgical patients with underlying hepatobiliary disease. In healthy subjects, feces typically are used as a surrogate to quantify the amount of drug excreted via nonurinary pathways. Nevertheless, it is very important to characterize hepatobiliary elimination because this is a potential site of drug interactions that might result in significant alterations in systemic or hepatic exposure. In addition to the determination of in vivo biliary clearance values of drugs, the availability of in vitro models that can predict the extent of biliary excretion of drugs in humans may be a powerful tool in the preclinical stages of drug development. In this review, recent advances in the most commonly used in vivo methods to estimate biliary excretion of drugs in humans are outlined. Additionally, in vitro models that can be employed to investigate the molecular processes involved in biliary excretion are discussed to present an updated picture of the new tools and techniques that are available to study the complex processes involved in hepatic drug transport.
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Affiliation(s)
| | | | - Kim L.R. Brouwer
- School of Pharmacy, University of North Carolina at Chapel Hill
- Corresponding Author: Kim L.R. Brouwer, Division of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599 Telephone: 919-962-7030 Fax: 919-962-0644
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Abstract
Biliary excretion is an important route of elimination and the biliary tract is a potential site of toxicity for many drugs and xenobiotics. Quantification of biliary excretion in healthy human volunteers is logistically challenging and is rarely defined during drug development. The current study uses a novel oroenteric tube coupled with a specialized clinical protocol to examine the pharmacokinetics of 99mTechnetium (Tc-99m) mebrofenin, a compound that undergoes rapid hepatic uptake and extensive biliary excretion. A custom-made multilumen oroenteric tube was positioned in the duodenum of healthy human volunteers. Subjects were positioned under a gamma camera and 2.5 mCi of Tc-99m mebrofenin was administered intravenously. Duodenal aspirates, blood samples, and urine were collected periodically for 3 hours. Two hours after Tc-99m mebrofenin administration, the gallbladder was contracted with an intravenous infusion of cholecystokinin-8. Gamma scintigraphy was used to determine the gallbladder ejection fraction in each subject. Total systemic clearance of Tc-99m mebrofenin approximated liver blood flow (Cl(total) 17.3 degrees 1.7 mL/min/kg), and 35% to 84% of the Tc-99m mebrofenin dose was recovered in bile. However, when the data were corrected for the gallbladder ejection fraction, 71% to 92% of the excreted Tc-99m mebrofenin dose was recovered. This novel oroenteric tube and clinical protocol provide a useful method to quantify biliary excretion of xenobiotics in healthy human volunteers.
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Affiliation(s)
- Giulia Ghibellini
- />School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7360, 27599 Chapel Hill, NC
| | - Brendan M. Johnson
- />School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7360, 27599 Chapel Hill, NC
| | - Richard J. Kowalsky
- />School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7360, 27599 Chapel Hill, NC
- />School of Medicine, University of North Carolina at Chapel Hill, 27599 Chapel Hill, NC
| | - William D. Heizer
- />School of Medicine, University of North Carolina at Chapel Hill, 27599 Chapel Hill, NC
| | - Kim L. R. Brouwer
- />School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7360, 27599 Chapel Hill, NC
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