1
|
Melsom T, Viljar NJ, Enoksen IT, Stefansson V, Mathisen UD, Fuskevåg OM, Jenssen TG, Solbu MD, Eriksen BO. Correction: Sex Differences in Age-Related Loss of Kidney Function. J Am Soc Nephrol 2024:00001751-990000000-00295. [PMID: 38652688 DOI: 10.1681/asn.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Toralf Melsom
- University Hospital of North Norway: Universitetssykehuset Nord-Norge HF
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Staubo SC, Fuskevåg OM, Toft M, Lie IH, Alvik KMJ, Jostad P, Tingvoll SH, Lilleng H, Rosqvist K, Størset E, Odin P, Dietrichs E, Dietrichs ES. Dopamine agonist serum concentrations and impulse control disorders in Parkinson's disease. Eur J Neurol 2024; 31:e16144. [PMID: 37955562 DOI: 10.1111/ene.16144] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND PURPOSE Impulse control disorders (ICDs) are common among Parkinson's disease patients using dopamine agonists. We wanted to determine whether ICD patients have higher dopamine agonist serum concentrations than those without any sign of ICD. METHODS Patients who used either pramipexole or ropinirole depot once daily were screened for ICDs using the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale. Those who scored above the cut-off for one or more of the four defined ICDs (gambling, compulsive sexual behavior, compulsive shopping, and binge-eating) were compared in a case-control study to patients who scored zero points (no evidence of ICD) on the same items. They were examined clinically and evaluated using relevant scales. Three blood samples were taken on the same day: before daily dose, and then 6 and 12 h later. RESULTS Forty-six patients were included: 19 ICD-positive and 27 controls. Ropinirole serum concentrations 6 h after daily intake (Cmax ) were higher in the case group compared to the control group, as was the daily ropinirole dosage. No differences were observed in serum concentrations, dosage or total drug exposure for pramipexole. Disease duration and length of dopamine agonist treatment was significantly longer among ICD patients for ropinirole, but not for pramipexole. CONCLUSIONS The use of pramipexole may in itself confer high ICD risk, whereas ICDs among ropinirole users depend more on serum concentration and drug exposure. The pharmacokinetic properties of ropinirole make it challenging to predict its effects on patients, which supports the need for therapeutic drug monitoring to reduce risk of ICD.
Collapse
Affiliation(s)
- Sara C Staubo
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
| | - Ole Martin Fuskevåg
- Experimental and Clinical Pharmacology, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of Northern Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg H Lie
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Pål Jostad
- Ringen Rehabilitation Centre, Moelv, Norway
| | | | - Hallvard Lilleng
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of Northern Norway, Tromsø, Norway
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Elisabet Størset
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of Northern Norway, Tromsø, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Oral Biology, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Lynghaug T, Bakke HK, Fuskevåg OM, Nielsen EW, Dietrichs ES. HOW SHOULD TRANEXAMIC ACID BE ADMINISTERED IN HEMORRHAGIC SHOCK? CONTINUOUS SERUM CONCENTRATION MEASUREMENTS IN A SWINE MODEL. Shock 2023; 60:707-712. [PMID: 37695638 PMCID: PMC10662641 DOI: 10.1097/shk.0000000000002222] [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: 06/09/2023] [Revised: 07/02/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
ABSTRACT Background : Tranexamic acid (TXA) reduces mortality in trauma patients. Intramuscular (IM) administration could be advantageous in low-resource and military settings. Achieving the same serum concentration as intravenous (IV) administration is important to achieve equal mortality reduction. Therefore, we aimed to investigate whether dividing an IM dose of TXA between two injection sites and whether an increase in dose would lead to serum concentrations comparable to those achieved by IV administration. Methods : Norwegian landrace pigs (n = 29) from a course in hemostatic emergency surgery were given TXA 1 h after start of surgery. Blood samples were drawn at 0, 5, 10, 15, 20, 25, 35, 45, 60, and 85 min. The samples were centrifuged and serum TXA concentrations quantified with liquid chromatography-tandem mass spectrometry. The use of two injection sites was compared with distributing the dose on one injection site, and a dose of 15 mg/kg was compared with a dose of 30 mg/kg. All IM groups were compared with IV administration. Results : The groups were in a similar degree of shock. Increasing the IM dose from the standard of 15 mg/kg to 30 mg/kg resulted in significantly higher serum concentrations of TXA, comparable to those achieved by IV administration. Distributing the IM dose on two injection sites did not affect drug uptake, as shown by equal serum concentrations. Conclusions : For IM administration of TXA, 30 mg/kg should be the standard dose. With a short delay, IM administration will provide equal serum concentrations as IV administration, above what is considered necessary to inhibit fibrinolysis.
Collapse
Affiliation(s)
- Trine Lynghaug
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences, IKM, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Science, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Håkon Kvåle Bakke
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences, IKM, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Science, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Anaesthesia and Critical Care, University Hospital of North Norway, Tromsø, Norway
| | - Ole Martin Fuskevåg
- Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT, The arctic University of Norway, Tromsø, Norway
| | - Erik Waage Nielsen
- Department of Anaesthesia and Critical Care, Nordland Hospital, Bodø, Norway
- University Nord, Bodø, Norway
- Department of Immunology, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, UiT, The Arctic University of Norway, Norway, Norway
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Oral Biology, University of Oslo, Oslo, Norway
- Centre for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
4
|
Melsom T, Norvik JV, Enoksen IT, Stefansson V, Mathisen UD, Fuskevåg OM, Jenssen TG, Solbu MD, Eriksen BO. Sex Differences in Age-Related Loss of Kidney Function. J Am Soc Nephrol 2022; 33:1891-1902. [PMID: 35977806 PMCID: PMC9528336 DOI: 10.1681/asn.2022030323] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND CKD is more prevalent in women, but more men receive kidney replacement therapy for kidney failure. This apparent contradiction is not well understood. METHODS We investigated sex differences in the loss of kidney function and whether any sex disparities could be explained by comorbidity or CKD risk factors. In the Renal Iohexol Clearance Survey (RENIS) in northern Europe, we recruited 1837 persons (53% women, aged 50-62 years) representative of the general population and without self-reported diabetes, CKD, or cardiovascular disease. Participants' GFR was measured by plasma iohexol clearance in 2007-2009 (n=1627), 2013-2015 (n=1324), and 2018-2020 (n=1384). At each study visit, healthy persons were defined as having no major chronic diseases or risk factors for CKD. We used generalized additive mixed models to assess age- and sex-specific GFR decline rates. RESULTS Women had a lower GFR than men at baseline (mean [SD], 90.0 [14.0] versus 98.0 [13.7] ml/min per 1.73 m2; P<0.001). The mean GFR change rate was -0.96 (95% confidence interval [CI], -0.88 to -1.04) ml/min per 1.73 m2 per year in women and -1.20 (95% confidence interval [CI], -1.12 to -1.28) in men. Although the relationship between age and GFR was very close to linear in women, it was curvilinear in men, with steeper GFR slopes at older ages (nonlinear effect; P<0.001). Healthy persons had a slower GFR decline, but health status did not explain the sex difference in the GFR decline. CONCLUSION Among middle-aged and elderly individuals in the general population, decline in the mean GFR in women was slower than in men, independent of health status.
Collapse
Affiliation(s)
- Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Jon Viljar Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Vidar Stefansson
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Trond G. Jenssen
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marit D. Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
Bakke HK, Fuskevåg OM, Nielsen EW, Dietrichs ES. Intramuscular uptake of tranexamic acid during haemorrhagic shock in a swine model. Scand J Trauma Resusc Emerg Med 2021; 29:171. [PMID: 34922577 PMCID: PMC8684106 DOI: 10.1186/s13049-021-00983-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tranexamic acid (TXA) reduce mortality in bleeding trauma patients, with greater effect if administered early. Serum concentrations above 10 µg/mL are considered sufficient to inhibit fibrinolysis. Normally administered intravenously (i.v.), TXA can also be administered intramuscularly (i.m.). This could be advantageous in low resource and military settings, if sufficient serum concentrations can be reached in shocked patients with reduced muscular blood perfusion. Accordingly, we aimed to: (1) Determine the impact of shock on the pharmacokinetics of i.m. TXA, and (2) Compare the pharmacokinetics of i.v. versus i.m. TXA in ongoing shock. Materials and methods In a prospective experimental study, N = 18 Norwegian landrace pigs (40–50 kg), utilised in a surgical course in haemostatic emergency surgery, were subjected to various abdominal and thoracic trauma. After 1 h of surgery the animals were given 15 mg/kg TXA either i.v. or i.m. A control group without injury, or surgery, received intramuscular TXA. Blood samples were drawn at 0, 5, 15, 25, 35, 45, 60 and 85 min. The samples were centrifuged and analysed with liquid chromatography–tandem mass spectrometry (LC–MS/MS) for TXA serum-concentrations. Results In shocked pigs, i.m. administration resulted in a mean maximum serum concentration (Cmax) of 20.9 µg/mL, and i.v. administration a Cmax of 48.1 µg/mL. Cmax occurred 15 min after i.m. administration and 5 min after i.v. administration. In non-shocked swine, i.m. administration resulted in a Cmax of 36.9 µg/mL after 15 min. In all groups, mean TXA serum concentrations stayed above 10 µg/mL from administration to end of experiments. Conclusions I.m. administration of TXA in shocked pigs provides serum concentrations associated with inhibition of fibrinolysis. It may be an alternative to i.v. and intraosseous administration during stabilisation and transport of trauma patients to advanced medical care.
Collapse
Affiliation(s)
- Håkon Kvåle Bakke
- Department of Anaesthesia and Critical Care, University Hospital of North Norway, 9038, Tromsø, Norway. .,Department of Traumatology, University Hospital of North Norway, Tromsø, Norway. .,Department of Health and Care Sciences, Faculty of Health Science, UiT, The Arctic University of Norway, Tromsø, Norway.
| | - Ole Martin Fuskevåg
- Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Erik Waage Nielsen
- Department of Anaesthesia and Critical Care, Nordland Hospital, Bodø, Bodø, Norway.,University Nord, Bodø, Norway.,Department of Immunology, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
6
|
Miroslawska AK, Gjessing PF, Solbu MD, Norvik JV, Fuskevåg OM, Hanssen TA, Steigen TK. Metabolic effects two years after renal denervation in insulin resistant hypertensive patients. The Re-Shape CV-risk study. Clin Nutr 2021; 40:1503-1509. [PMID: 33743285 DOI: 10.1016/j.clnu.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Denervation of renal sympathetic nerves (RDN) is an invasive endovascular procedure introduced as an antihypertensive treatment with a potential beneficial effect on insulin resistance (IR). We have previously demonstrated a reduction in blood pressure (BP) six months after RDN, but severe hepatic and peripheral IR, assessed by glucose tracer and two step hyperinsulinemic-euglycemic clamp (HEC), did not improve. The aim of the current study was to evaluate IR and adipokines profiles in relation to BP and arterial stiffness changes two years after RDN. METHODS In 20 non-diabetic patients with true treatment-resistant hypertension, ambulatory and office BP were measured after witnessed intake of medications prior to, six and 24 months after RDN. Arterial stiffness index (AASI) was calculated from ambulatory BP. Insulin sensitivity (IS) was assessed using an oral glucose tolerance test (OGTT), the Homeostasis Model Assessment (HOMA-IR), HOMA-Adiponectin Model Assessment (HOMA-AD), the Quantitative Insulin Sensitivity Check Index (QUICKI), the Triglyceride and Glucose Index (TyG) and the Leptin-to-Adiponectin Ratio (LAR). These surrogate indices of IS were compared with tracer/HEC measurements to identify which best correlated in this group of patients. RESULTS All measured metabolic variables and IS surrogate indices remained essentially unchanged two years after RDN apart from a significant increase in HOMA-AD. OGTT peak at 30 min correlated best with reduction in endogenous glucose release (EGR) during low insulin HEC (r = -0.6, p = 0.01), whereas HOMA-IR correlated best with whole-body glucose disposal (WGD) (r = -0.6, p = 0.01) and glucose infusion rate (r = -0.6, p = 0.01) during high insulin HEC. BP response was unrelated to IS prior to RDN. Nocturnal systolic BP and arterial stiffness before RDN correlated positively with a progression in hepatic IR at six-month follow-up. CONCLUSION IR, adiponectin and leptin did not improve two years after RDN. There was no correlation between baseline IS and BP response. Our study does not support the notion of a beneficial metabolic effect of RDN in patients with treatment resistant hypertension.
Collapse
Affiliation(s)
- A K Miroslawska
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - P F Gjessing
- Gastrosurgery Research Group, UiT, The Arctic University of Norway, Norway
| | - M D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - J V Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - O M Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - T A Hanssen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - T K Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| |
Collapse
|
7
|
Hagve M, Gjessing PF, Hole MJ, Jansen KM, Fuskevåg OM, Mollnes TE, Larsen TS, Irtun Ø. Perioperative Infusion of Glucagon-Like Peptide-1 Prevents Insulin Resistance After Surgical Trauma in Female Pigs. Endocrinology 2019; 160:2892-2902. [PMID: 31589305 DOI: 10.1210/en.2019-00374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
Insulin resistance is an independent negative predictor of outcome after elective surgery and increases mortality among surgical patients in intensive care. The incretin hormone glucagon-like peptide-1 (GLP-1) potentiates glucose-induced insulin release from the pancreas but may also increase insulin sensitivity in skeletal muscle and directly suppress hepatic glucose release. Here, we investigated whether a perioperative infusion of GLP-1 could counteract the development of insulin resistance after surgery. Pigs were randomly assigned to three groups; surgery/control, surgery/GLP-1, and sham/GLP-1. Both surgery groups underwent major abdominal surgery. Whole-body glucose disposal (WGD) and endogenous glucose release (EGR) were assessed preoperatively and postoperatively using D-[6,6-2H2]-glucose infusion in combination with hyperinsulinemic euglycemic step-clamping. In the surgery/control group, peripheral insulin sensitivity (i.e., WGD) was reduced by 44% relative to preoperative conditions, whereas the corresponding decline was only 9% for surgery/GLP-1 (P < 0.05). Hepatic insulin sensitivity (i.e., EGR) remained unchanged in the surgery/control group but was enhanced after GLP-1 infusion in both surgery and sham animals (40% and 104%, respectively, both P < 0.05). Intraoperative plasma glucose increased in surgery/control (∼20%) but remained unchanged in both groups receiving GLP-1 (P < 0.05). GLP-1 diminished an increase in postoperative glucagon levels but did not affect skeletal muscle glycogen or insulin signaling proteins after surgery. We show that GLP-1 improves intraoperative glycemic control, diminishes peripheral insulin resistance after surgery, and suppresses EGR. This study supports the use of GLP-1 to prevent development of postoperative insulin resistance.
Collapse
Affiliation(s)
- Martin Hagve
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Cardiovascular Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Petter F Gjessing
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Mikal J Hole
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kirsten M Jansen
- Cardiovascular Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Tom Eirik Mollnes
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K. G. Jebsen TREC, UiT The Arctic University of Norway, Tromsø, Norway
- Center of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Immunology, Oslo University Hospital, and K. G. Jebsen IRC, University of Oslo, Oslo, Norway
| | - Terje S Larsen
- Cardiovascular Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Øivind Irtun
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
8
|
Sollid ST, Hutchinson MYS, Fuskevåg OM, Joakimsen RM, Jorde R. Large Individual Differences in Serum 25-Hydroxyvitamin D Response to Vitamin D Supplementation: Effects of Genetic Factors, Body Mass Index, and Baseline Concentration. Results from a Randomized Controlled Trial. Horm Metab Res 2016; 48:27-34. [PMID: 25702786 DOI: 10.1055/s-0034-1398617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The main aim of the study was to determine the influence of genetic factors on the serum 25-hydroxyvitamin D response to vitamin D supplementation. The main outcome measure was an increase in serum 25-hydroxyvitamin D after vitamin D supplementation. The patients are part of a randomized controlled trial in individuals with prediabetes assigned to 20 000 IU of vitamin D3 per week or placebo for 12 months. A total of 484 subjects were included in the analyses and genotyped for single nucleotide polymorphisms in the DBP, DHCR7, CYP2R1, and CYP24A1 genes. Single nucleotide polymorphisms from all 4 selected genes were significantly related to baseline serum 25-hydroxyvitamin D concentrations with differences between major and minor homozygote genotypes ranging from 4.4 to 19.2 nmol/l. In the subjects given vitamin D, those with genotypes with the highest baseline 25-hydroxyvitamin D concentration also had the highest 25-hydroxyvitamin D concentration after 12 months, and the increase (delta) in 25-hydroxyvitamin D was significantly related to 3 of the single nucleotide polymorphisms. The increase in serum 25-hydroxyvitamin D was also higher in lean vs. obese subjects, and higher in those with low baseline 25-hydroxyvitamin D concentrations. When combining these 3 factors in a linear regression model, the predicted (and observed) difference in 25-hydroxyvitamin D increase between high and low responders to the supplementation was approximately 60 nmol/l. In conclusion, due to genetic, body mass, and baseline 25-hydroxyvitamin D differences, there are huge individual variations in the serum 25-hydroxyvitamin D response to vitamin D supplementation that could be of clinical importance.
Collapse
Affiliation(s)
- S T Sollid
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - M Y S Hutchinson
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - O M Fuskevåg
- Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - R M Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - R Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
9
|
Hagve M, Gjessing PF, Fuskevåg OM, Larsen TS, Irtun Ø. Skeletal muscle mitochondria exhibit decreased pyruvate oxidation capacity and increased ROS emission during surgery-induced acute insulin resistance. Am J Physiol Endocrinol Metab 2015; 308:E613-20. [PMID: 25670828 DOI: 10.1152/ajpendo.00459.2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/04/2015] [Indexed: 01/01/2023]
Abstract
Development of acute insulin resistance represents a negative factor after surgery, but the underlying mechanisms are not fully understood. We investigated the postoperative changes in insulin sensitivity, mitochondrial function, enzyme activities, and release of reactive oxygen species (ROS) in skeletal muscle and liver in pigs on the 2nd postoperative day after major abdominal surgery. Peripheral and hepatic insulin sensitivity were assessed by D-[6,6-²H₂]glucose infusion and hyperinsulinemic euglycemic step clamping. Surgical trauma elicited a decline in peripheral insulin sensitivity (∼34%, P<0.01), whereas hepatic insulin sensitivity remained unchanged. Intramyofibrillar (IFM) and subsarcolemma mitochondria (SSM) isolated from skeletal muscle showed a postoperative decline in ADP-stimulated respiration (V(ADP)) for pyruvate (∼61%, P<0.05, and ∼40%, P<0.001, respectively), whereas V(ADP) for glutamate and palmitoyl-L-carnitine (PC) was unchanged. Mitochondrial leak respiration with PC was increased in SSM (1.9-fold, P<0.05) and IFM (2.5-fold, P<0.05), indicating FFA-induced uncoupling. The activity of the pyruvate dehydrogenase complex (PDC) was reduced (∼32%, P<0.01) and positively correlated to the decline in peripheral insulin sensitivity (r=0.748, P<0.05). All other mitochondrial enzyme activities were unchanged. No changes in mitochondrial function in liver were observed. Mitochondrial H₂O₂ and O₂·⁻ emission was measured spectrofluorometrically, and H₂O₂ was increased in SSM, IFM, and liver mitochondria (∼2.3-, ∼2.5-, and ∼2.3-fold, respectively, all P<0.05). We conclude that an impairment in skeletal muscle mitochondrial PDC activity and pyruvate oxidation capacity arises in the postoperative phase along with increased ROS emission, suggesting a link between mitochondrial function and development of acute postoperative insulin resistance.
Collapse
Affiliation(s)
- Martin Hagve
- Laboratory of Surgical Research, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Cardiovascular Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway;
| | - Petter Fosse Gjessing
- Laboratory of Surgical Research, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway; and
| | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Terje S Larsen
- Cardiovascular Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Øivind Irtun
- Laboratory of Surgical Research, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway; and
| |
Collapse
|
10
|
Abstract
OBJECTIVE The objective was to assess the amount of vitamin D3 stored in adipose tissue after long-term supplementation with high dose vitamin D3. DESIGN A cross-sectional study on 29 subjects with impaired glucose tolerance who had participated in a randomized controlled trial with vitamin D3 20 000 IU (500 μg) per week vs placebo for 3-5 years. METHODS Abdominal subcutaneous fat tissue was obtained by needle biopsy for the measurements of vitamin D3 and 25-hydroxyvitamin D3 (25(OH)D3). Body fat was measured with dual-energy X-ray absorptiometry, and serum 25(OH)D3 level was quantified. RESULTS In the subjects given vitamin D3, the median concentrations of serum 25(OH)D3, fat vitamin D3, and fat 25(OH)D3 were 99 nmol/l, 209 ng/g, and 3.8 ng/g, respectively; and correspondingly in the placebo group 62 nmol/l, 32 ng/g, and 2.5 ng/g. If assuming an equal amount of vitamin D3 stored in all adipose tissue in the body, the median body store was 6.6 mg vitamin D3 and 0.12 mg 25(OH)D3 in those given vitamin D3. CONCLUSIONS Subcutaneous adipose tissue may store large amounts of vitamin D3. The clinical importance of this storage needs to be determined.
Collapse
Affiliation(s)
- Allan Didriksen
- Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway
| | - Anders Burild
- Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway
| | - Jette Jakobsen
- Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway
| | - Ole Martin Fuskevåg
- Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway Tromsø Endocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, 9037 Tromsø, NorwayNational Food InstituteTechnical University of Denmark, Søborg, DenmarkDivision of Diagnostic ServicesDivision of Internal MedicineUniversity Hospital of North Norway, 9038 Tromsø, Norway
| |
Collapse
|
11
|
Melsom T, Fuskevåg OM, Mathisen UD, Strand H, Schei J, Jenssen T, Solbu M, Eriksen BO. Estimated GFR is biased by non-traditional cardiovascular risk factors. Am J Nephrol 2015; 41:7-15. [PMID: 25612475 DOI: 10.1159/000371557] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) based on either cystatin C or creatinine performs similarly in estimating measured GFR, but associate differently with cardiovascular disease (CVD) and mortality. This could be due to confounding by non-GFR-related traits associated with cystatin C and creatinine levels. We investigated non-GFR-related associations between eGFR and two types of nontraditional risk factors for CVD and death: L-arginine/dimethylarginine metabolism and insulin resistance. METHODS GFR was measured via iohexol clearance in a cross-sectional study of 1,624 middle-aged persons from the general population without CVD, diabetes or chronic kidney disease. The dimethylarginines were measured using liquid chromatography tandem mass spectrometry (LC-MSMS). Insulin resistance was determined by the homeostasis model assessment (HOMA-IR). RESULTS Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), the L-arginine/ADMA ratio and insulin resistance were associated with creatinine-based eGFR after accounting for measured GFR in multivariable adjusted analyses. The cystatin C-based eGFR showed a similar residual association with SDMA; an oppositely directed, borderline significant association with ADMA; and a stronger residual association with insulin resistance compared with eGFR based on creatinine. CONCLUSION Both creatinine- and cystatin C-based eGFR are influenced by nontraditional risk factors, which may bias risk prediction by eGFR in longitudinal studies.
Collapse
Affiliation(s)
- Toralf Melsom
- Department of Nephrology, University Hospital of North Norway, UNN, Tromsø Norway
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Berg V, Nøst TH, Huber S, Rylander C, Hansen S, Veyhe AS, Fuskevåg OM, Odland JØ, Sandanger TM. Maternal serum concentrations of per- and polyfluoroalkyl substances and their predictors in years with reduced production and use. Environ Int 2014; 69:58-66. [PMID: 24815340 DOI: 10.1016/j.envint.2014.04.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 05/20/2023]
Abstract
Determining maternal concentrations of per- and polyfluoroalkyl substances (PFASs) and the relative impact of various demographic and dietary predictors is important for assessing fetal exposure and for developing proper lifestyle advisories for pregnant women. This study was conducted to investigate maternal PFAS concentrations and their predictors in years when the production and use of several PFASs declined, and to assess the relative importance of significant predictors. Blood from 391 pregnant women participating in The Northern Norway Mother-and-Child Contaminant Cohort Study (MISA) was collected in the period 2007-2009 and serum analyses of 26 PFASs were conducted. Associations between PFAS concentrations, sampling date, and demographic and dietary variables were evaluated by multivariate analyses and linear models including relevant covariates. Parity was the strongest significant predictor for all the investigated PFASs, and nulliparous women had higher concentrations compared to multiparous women (10 ng/mL versus 4.5 ng/mL in median PFOS, respectively). Serum concentrations of PFOS and PFOA of women recruited day 1-100 were 25% and 26% higher, respectively, compared to those women recruited in the last 167 days of the study (day 601-867), and the concentrations of PFNA, PFDA and PFUnDA increased with age. Dietary predictors explained 0-17% of the variation in concentrations for the different PFASs. Significantly elevated concentrations of PFOS, PFNA, PFDA and PFUnDA were found among high consumers of marine food. The concentrations of PFHxS, PFHpS and PFNA were also increased in high consumers of game and elevated concentrations of PFHpS and PFOS were detected in high consumers of white meat. Study subjects with a high intake of salty snacks and beef had significantly higher concentrations of PFOA. The present study demonstrates that parity, sampling date and birth year are the most important predictors for maternal PFAS concentrations in years following a decrease in production and use of several PFASs. Further, dietary predictors of PFAS concentrations were identified and varied in importance according to compound.
Collapse
Affiliation(s)
- Vivian Berg
- Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of Northern Norway, Sykehusveien 38, NO-9038 Tromsø, Norway; Department of Environmental Chemistry, Norwegian Institute of Air Research, Fram Centre, Hjalmar Johansens Gate 14, NO-9296 Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway.
| | - Therese Haugdahl Nøst
- Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of Northern Norway, Sykehusveien 38, NO-9038 Tromsø, Norway; Department of Environmental Chemistry, Norwegian Institute of Air Research, Fram Centre, Hjalmar Johansens Gate 14, NO-9296 Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| | - Sandra Huber
- Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of Northern Norway, Sykehusveien 38, NO-9038 Tromsø, Norway; Department of Environmental Chemistry, Norwegian Institute of Air Research, Fram Centre, Hjalmar Johansens Gate 14, NO-9296 Tromsø, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| | - Solrunn Hansen
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| | - Anna Sofía Veyhe
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of Northern Norway, Sykehusveien 38, NO-9038 Tromsø, Norway
| | - Jon Øyvind Odland
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| | - Torkjel Manning Sandanger
- Department of Environmental Chemistry, Norwegian Institute of Air Research, Fram Centre, Hjalmar Johansens Gate 14, NO-9296 Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Hansine Hansens veg 18, NO-9019 Tromsø, Norway
| |
Collapse
|
13
|
Westin AA, Mjønes G, Burchardt O, Fuskevåg OM, Slørdal L. Can physical exercise or food deprivation cause release of fat-stored cannabinoids? Basic Clin Pharmacol Toxicol 2014; 115:467-71. [PMID: 24674455 PMCID: PMC4270258 DOI: 10.1111/bcpt.12235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate whether physical exercise or food deprivation may increase cannabinoid levels in serum or urine in abstinent chronic cannabis users. The study took place in a drug detoxification ward parallel to study participants receiving treatment. Six chronic, daily cannabis users (one female, five males, average age 30.0 years; BMI 20.8) were exposed to a 45-min. moderate-intensity workout and a 24-hr period of food deprivation. Serum samples were drawn prior to and after interventions and analysed for Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) by liquid chromatography–tandem mass spectrometry (LCMSMS), and all voided urine was tested for THCCOOH by LCMSMS and normalized to the creatinine levels, yielding ng/mg ratios. There were no major differences in the measured cannabinoid levels in serum or urine before and after physical exercise or food deprivation. We conclude that exercise and/or food deprivation are unlikely to cause sufficient cannabinoid concentration changes to hamper correct interpretations in drug testing programmes.
Collapse
|
14
|
Abstract
Endogenous production complicates the interpretation when gamma-hydroxybutyric acid (GHB) is measured in urine for forensic purposes. We performed a cross-sectional study to test the hypothesis that pregnant women have higher levels of urinary GHB than non-pregnant controls, and thus increased risk of false-positive GHB tests. GHB, gamma-butyrolactone (GBL) and beta-hydroxybutyric acid (BHB) concentrations in urine from 66 pregnant women and 69 non-pregnant controls were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The mean GHB, GBL, and BHB concentrations were 0.36, 0.34 and 1.92 mg/L in the pregnant women, and 0.24, 0.08 and 0.40 mg/L in the control group. The pregnant women had significantly higher levels of GHB (1.5-fold), GBL (4.3-fold), and BHB (4.8-fold). Creatinine-adjusted GHB concentrations were similar in both groups. Pregnant women have higher urinary levels of GHB, GBL, and BHB. In LC-MS-MS assays not distinguishing between GHB and BHB, there is a significantly increased risk of false-positive GHB tests in pregnant women. This false-positive rate can be reduced by correcting for creatinine concentration, by using GHB-specific assays or by introducing higher interpretative cut-off levels for pregnant women in assays that do not discriminate between GHB and GBL or BHB.
Collapse
Affiliation(s)
- Guttorm Raknes
- Department of Clinical Pharmacology, University Hospital of North Norway Trust, NO-903B Tromsø, Norway
| | | | | |
Collapse
|
15
|
|
16
|
Ytrebø LM, Kristiansen RG, Maehre H, Fuskevåg OM, Kalstad T, Revhaug A, Cobos MJ, Jalan R, Rose CF, Deutz NEP, Jalan R, Revhaug A. L-ornithine phenylacetate attenuates increased arterial and extracellular brain ammonia and prevents intracranial hypertension in pigs with acute liver failure. Hepatology 2009; 50:165-74. [PMID: 19554542 DOI: 10.1002/hep.22917] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED Hyperammonemia is a feature of acute liver failure (ALF), which is associated with increased intracranial pressure (ICP) and brain herniation. We hypothesized that a combination of L-ornithine and phenylacetate (OP) would synergistically reduce toxic levels of ammonia by (1) L-ornithine increasing glutamine production (ammonia removal) through muscle glutamine synthetase and (2) phenylacetate conjugating with the ornithine-derived glutamine to form phenylacetylglutamine, which is excreted into the urine. The aims of this study were to determine the effect of OP on arterial and extracellular brain ammonia concentrations as well as ICP in pigs with ALF (induced by liver devascularization). ALF pigs were treated with OP (L-ornithine 0.07 g/kg/hour intravenously; phenylbutyrate, prodrug for phenylacetate; 0.05 g/kg/hour intraduodenally) for 8 hours following ALF induction. ICP was monitored throughout, and arterial and extracellular brain ammonia were measured along with phenylacetylglutamine in the urine. Compared with ALF + saline pigs, treatment with OP significantly attenuated concentrations of arterial ammonia (589.6 +/- 56.7 versus 365.2 +/- 60.4 mumol/L [mean +/- SEM], P= 0.002) and extracellular brain ammonia (P= 0.01). The ALF-induced increase in ICP was prevented in ALF + OP-treated pigs (18.3 +/- 1.3 mmHg in ALF + saline versus 10.3 +/- 1.1 mmHg in ALF + OP-treated pigs;P= 0.001). The value of ICP significantly correlated with the concentration of extracellular brain ammonia (r(2) = 0.36,P< 0.001). Urine phenylacetylglutamine levels increased to 4.9 +/- 0.6 micromol/L in ALF + OP-treated pigs versus 0.5 +/- 0.04 micromol/L in ALF + saline-treated pigs (P< 0.001). CONCLUSION L-Ornithine and phenylacetate act synergistically to successfully attenuate increases in arterial ammonia, which is accompanied by a significant decrease in extracellular brain ammonia and prevention of intracranial hypertension in pigs with ALF.
Collapse
Affiliation(s)
- Lars Marius Ytrebø
- Department of Anesthesiology, University Hospital of North Norway and University of Tromsø, Norway.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
High-dose methotrexate (HD-MTX) is widely used in combination chemotherapy and can be handled without life-threatening toxicity in combination with leucovorin (LV) rescue. However, in an experimental animal model for testing of short-term HD-MTX effects in anesthetized rats, the authors previously demonstrated intolerable toxicity and death within a few hours in some animals. Serum levels were below levels routinely found in patients on HD-MTX treatment. This study was aimed at disclosure of possible mechanisms for acute toxicity of MTX in rats. The previously determined maximum tolerated dose of 5 g/kg MTX was used as the test dose. The animals that died showed sudden reduction in heart rate and blood pressure. LV, 1 g/kg infused immediately prior to MTX, changed MTX elimination kinetics, but did not change the acute toxicity. The data of this study together with additional evidence obtained in the experimental model, suggest that MTX acute toxicity may not be related to its antiproliferative effect, but rather to perturbation of endothelial cell and platelet function.
Collapse
Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Tromsø, Norway
| | | | | | | |
Collapse
|
18
|
Fuskevåg OM, Kristiansen C, Olsen R, Aarbakke J, Lindal S. Microvascular perturbations in rats receiving the maximum tolerated dose of methotrexate or its major metabolite 7-hydroxymethotrexate. Ultrastruct Pathol 2000; 24:325-32. [PMID: 11071571 DOI: 10.1080/019131200750035058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Methotrexate (MTX) is a clinically important cytostatic antifolate. The study describes the acute effects of maximum tolerated doses of MTX or its major metabolite 7-hydroxymethotrexate (7-OH-MTX) on the ultrastructure of rat liver and kidneys. The ultrastructural changes in rats receiving MTX or 7-OH-MTX were, in principle, indistinguishable and their severity and extension increased with time of survival or doses of medication. All lesions were focal, microvascular, or parenchymal. Microvascular changes were more severe in nature when blood cells were present. The endothelial cells were swollen with loss of pinocytotic vesicles, their luminal plasma membrane formed blebs or were disrupted. Partly detached endothelial cells or deendothelialized areas, various types of white blood cells, in particular, neutrophil granulocytes, were observed in the microcirculation. Single platelets or small platelet aggregates were found either in the lumen or adhering to deendothelialized areas of injured endothelial cells. Hepatocytes exhibited steatosis, edema, and manifest single cell necrosis. There were also nuclear changes, marked proliferation of smooth endoplasmatic reticulum, increased amounts of intracellular lipid vacuoles, and a decrease in glycogen particles in hepatocytes. The kidney presented the major changes in the tubules and in the interstitial part. MTX and 7-OH-MTX acute toxicity may primarily be related to microvascular perturbation.
Collapse
Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Norway
| | | | | | | | | |
Collapse
|
19
|
Fuskevåg OM, Kristiansen C, Lindal S, Aarbakke J. Maximum tolerated doses of methotrexate and 7-hydroxy-methotrexate in a model of acute toxicity in rats. Cancer Chemother Pharmacol 2000; 46:69-73. [PMID: 10912581 DOI: 10.1007/s002800000111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE After more than 50 years of methotrexate (MTX) treatment of acute lymphoblastic leukaemia (ALL), it is currently believed that as long as dose escalations are followed by adequate leucovorin rescue guided by monitoring MTX serum concentrations, hydration and urinary alkalinization, high-dose MTX (HD-MTX) can be tolerated without life-threatening toxicity. However, our recent experimental animal studies of the major metabolite of MTX, 7-OH-MTX, indicate that this concept may have some limitations. Animals with levels of 7-OH-MTX of 1 mM, which is below the levels routinely found in patients on HD-MTX, demonstrate intolerable toxicity and some animals die within 8 h. Electron microscopy indicates that endothelial cell and platelet functions are perturbed. Since animal data are lacking, and interspecies differences not known, we wanted to investigate the maximum tolerated doses of MTX and 7-OH-MTX in a rat model of short-term effects. The maximum tolerated dose was chosen instead of LD(50) for reasons of animal welfare. METHODS We infused MTX and 7-OH-MTX into anaesthetized male Wistar rats and monitored the animals for 8 h. The drugs were given as a bolus plus continuous infusion. The dose-finding ranges were 1.8 11.3 g/kg MTX and 0.1-1.2 g/kg 7-OH-MTX. RESULTS The maximum tolerated dose was between 3 and 5 g/kg for MTX and lower than 0.1 g/kg for 7-OH-MTX. The mean serum concentrations of MTX and 7-OH-MTX in animals that did not survive the 8-h period were 21.9 and 1.6 mM, respectively. The animals that received the highest MTX or 7-OH-MTX doses and concentrations died after sudden reductions in heart rate and blood pressure. CONCLUSIONS We demonstrated a lower maximum tolerated dose of 7-OH-MTX than of MTX in rats after 8 h. The 7-OH-MTX concentrations were in the therapeutic range after HD-MTX. If the rat/human interspecies differences are not large, our data may indicate that HD-MTX regimens should not be further dose intensified, due not so much to the effects of MTX as to those of 7-OH-MTX.
Collapse
Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Norway
| | | | | | | |
Collapse
|
20
|
Figenschau Y, Sundsfjord JA, Yousef MI, Fuskevåg OM, Sveinbjörnsson B, Bertheussen K. A simplified serum-free method for preparation and cultivation of human granulosa-luteal cells. Hum Reprod 1997; 12:523-31. [PMID: 9130754 DOI: 10.1093/humrep/12.3.523] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A simplified method for the preparation and long-term cultivation of granulosa-luteal cells in serum-free medium is described. The cells were harvested from women undergoing in-vitro fertilization, enriched by sedimentation and dissociated by enzymatic treatment. We demonstrated, by introducing a synthetic serum replacement (SSR2), that these primary cell cultures cultivated in monolayers on an extracellular matrix may be used in experiments exceeding 7 days with low cell loss and cell death. No adverse effect on progesterone production was found. There was a high diversity in progesterone production between cells from individual patients. After several days in culture, the cells were challenged with human chorionic gonadotrophin which revived the rapidly decreasing progesterone production. We were unable to demonstrate an increase in cell number after 7 days of cultivation when the cells were grown in medium supplemented with either serum or SSR2. The mitogens epidermal growth factor and basic fibroblast growth factor had no influence on proliferation. We also found that the present method prevents leukocyte contamination in the granulosa-luteal cell cultures. Compared with the common method based on the enrichment of granulosa-luteal cells on a density gradient (Ficoll/Percoll), this method saves time, labour and expense, in addition to augmenting purity.
Collapse
Affiliation(s)
- Y Figenschau
- Department of Obstetrics and Gynaecology, University Hospital of Tromsö, Norway
| | | | | | | | | | | |
Collapse
|
21
|
Smeland E, Fuskevåg OM, Nymann K, Svendesn JS, Olsen R, Lindal S, Bremnes RM, Aarbakke J. High-dose 7-hydromethotrexate: acute toxicity and lethality in a rat model. Cancer Chemother Pharmacol 1996; 37:415-22. [PMID: 8599863 DOI: 10.1007/s002800050406] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To elucidate mechanisms for methotrexate (MTX)-induced renal and hepatic toxicity, we investigated the acute effects of bolus plus continuous infusion of up to 0.4 g/kg 7-hydroxymethotrexate (7-OH-MTX) in the rat. We demonstrate for the first time in any species the occurrence of acute lethal toxicity within a few hours after 7-OH-MTX administration. Serum concentrations of 7-OH-MTX measured at the time of death were 1.4 mM (mean), about one-half of those achieved in some patients after infusion of high-dose MTX (HD-MTX) in the clinic. The data suggest an approximate LD50 (the dose lethal to 50% of the study population) of 0.3 g/kg and a steep dose/lethality curve for 7-OH-MTX. Moreover, acute renal and hepatic toxicity occurred as evidenced by severe morphological findings and increased serum levels of creatinine and liver transaminases. In all rats subjected to continuous infusion of 7-OH-MTX, yellow microscopic precipitations were apparent in the kidney tubules. Crystallization was also seen in bile ducts of the liver in some of the rats. These results further support that the formation of 7-OH-MTX is disadvantageous and that reported attempts to prevent its formation during MTX treatment are warranted.
Collapse
Affiliation(s)
- E Smeland
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Norway
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Smeland E, Bremnes RM, Fuskevåg OM, Aarbakke J. Perturbation of methotrexate transport by verapamil, vinblastine, taurocholate and bromosulfophthalein in rat hepatocytes. Anticancer Res 1995; 15:45-50. [PMID: 7733639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Methotrexate (MTX) is extensively used in different combination chemotherapy regimens. More knowledge about interactions and their mechanisms in target cancer cells and normal cells is needed to improve therapeutic efficacy and reduce toxicity. MATERIALS AND METHODS The effect of verapamil (VRP), vinblastine (VBL), taurocholate (TAURO) and bromosulfophthalein (BSP) on MTX transport were studied in freshly isolated rat hepatocytes. RESULTS During 60 min, 50 microM VRP decreased the hepatocellular MTX accumulation with 29%; whereas 100 microM BSP reduced MTX entrance with 15%. 100 microM VBL and 100 microM TAURO reduced the intracellular accumulation of MTX with 36% and 23%, respectively. VRP and BSP appeared to be selective MTX influx blockers, whereas VBL and TAURO inhibited both MTX influx and efflux, however, with major inhibition on MTX influx. Dixon plot analyses for TAURO and BSP were suggestive of competitive inhibition, giving inhibition constants (Ki) values of 105 microM for TAURO, and 800 microM for BSP. CONCLUSION The data demonstrate for the first time a selective inhibitory effect of VRP upon MTX influx in isolated rat hepatocytes, whereas BSP, a potent MTX efflux inhibitor in malignant cells fails to achieve this effect in the normal cell type here investigated.
Collapse
Affiliation(s)
- E Smeland
- Department of Pharmacology, University of Tromsø, Norway
| | | | | | | |
Collapse
|