Molecular structures of cdc2-like kinases in complex with a new inhibitor chemotype

Cdc2-like kinases (CLKs) represent a family of serine-threonine kinases involved in the regulation of splicing by phosphorylation of SR-proteins and other splicing factors. Although compounds acting against CLKs have been described, only a few show selectivity against dual-specificity tyrosine phosphorylation regulated-kinases (DYRKs). We here report a novel CLK inhibitor family based on a 6,7-dihydropyrrolo[3,4-g]indol-8(1H)-one core scaffold. Within the series, 3-(3-chlorophenyl)-6,7-dihydropyrrolo[3,4-g]indol-8(1H)-one (KuWal151) was identified as inhibitor of CLK1, CLK2 and CLK4 with a high selectivity margin towards DYRK kinases. The compound displayed a potent antiproliferative activity in an array of cultured cancer cell lines. The X-ray structure analyses of three members of the new compound class co-crystallized with CLK proteins corroborated a molecular binding mode predicted by docking studies.

TDM in psychiatry and neurology: A comprehensive summary of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology, update 2017; a tool for clinicians<sup/>

OBJECTIVES

Therapeutic drug monitoring (TDM) combines the quantification of drug concentrations in blood, pharmacological interpretation and treatment guidance. TDM introduces a precision medicine tool in times of increasing awareness of the need for personalized treatment. In neurology and psychiatry, TDM can guide pharmacotherapy for patient subgroups such as children, adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance use disorders, individuals with pharmacokinetic peculiarities and forensic patients. Clear indications for TDM include lack of clinical response in the therapeutic dose range, assessment of drug adherence, tolerability issues and drug-drug interactions.

METHODS

Based upon existing literature, recommended therapeutic reference ranges, laboratory alert levels, and levels of recommendation to use TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dose-related drug concentrations and metabolite-to-parent ratios were calculated.

RESULTS

This summary of the updated consensus guidelines by the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie offers the practical and theoretical knowledge for the integration of TDM as part of pharmacotherapy with neuropsychiatric agents into clinical routine.

CONCLUSIONS

The present guidelines for TDM application for neuropsychiatric agents aim to assist clinicians in enhancing safety and efficacy of treatment.

Assessment of the correlations of lacosamide concentrations in saliva and serum in patients with epilepsy

Therapeutic drug monitoring of antiepileptic drugs is based on patient serum samples. In this study, we evaluated the correlation between lacosamide (LCM) steady state concentrations in serum and saliva samples. Additionally, we investigated the relation with daily dose, and assessed the feasibility of saliva collection. This was an open-label, single center study including data from 25 patients at the Bethel Epilepsy Center treated with LCM (50-650 mg/d). Samples were collected in the morning (fasting values) and in selected cases at 50 minutes to 5 hours after the morning dose. Nonsignificant differences in the mean LCM morning (trough) concentration in serum and saliva were observed. Serum and saliva concentrations across all samples were highly correlated, (r = .874), with a slightly lower correlation when only fasting values were analyzed (r = .860). Higher correlation with daily dosages was observed in serum samples (r = .773) than in saliva samples (r = .604). Serum and saliva concentrations increased significantly after intake of the LCM morning dose (P < .001). The median absolute and percentage increase of LCM in serum were moderately lower than in saliva samples, with a few outliers in saliva samples. Consequently, saliva could offer great clinical potential to monitor drug concentrations and guide LCM treatment in epileptic patients.

Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017

Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.

Comparison of lacosamide concentrations in cerebrospinal fluid and serum in patients with epilepsy

OBJECTIVE

This study was carried out to estimate the exposure of the central nervous system (CNS) to the antiepileptic drug (AED) lacosamide, under steady state conditions, in patients with epilepsy who take oral lacosamide alongside up to three other AEDs.

METHODS

Twenty-seven serum and cerebral spinal fluid (CSF) samples were collected from 21 patients receiving lacosamide for the treatment of epilepsy (50-600 mg/day over two or three doses). This included 23 time-matched pairs of serum and CSF samples from 19 patients. The concentration of lacosamide in each sample was determined using high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Linear regression was used to characterize the relationship between the CSF-to-serum ratio of lacosamide concentration and the time since dosing, the daily lacosamide dose, or the daily dose normalized by volume of distribution (Vd , approximated to total body water), and between the drug concentrations in each compartment (CSF vs. serum).

RESULTS

Concentrations of lacosamide in CSF (mean ± standard deviation [SD] 7.37 ± 3.73 μg/ml, range 1.24-14.95, n = 27) and serum (mean ± SD 8.16 ± 3.82 μg/ml, range 2.29-15.45, n = 27) samples showed a good correlation over the dose range investigated. The mean CSF-to-serum ratio of lacosamide concentrations was 0.897 ± 0.193 (range 0.492-1.254, n = 23 time-matched pairs) and was independent of lacosamide dose.

SIGNIFICANCE

Drug concentrations in the CSF are often used to indicate those in the brain interstitial fluid. In patients with epilepsy who follow a stable oral AED dosing regimen, lacosamide concentration in CSF is approximately 85% of that found in serum, suggesting that serum may be a valuable indicator of lacosamide concentration in the CNS.

Parity violation in proton-proton scattering at 221 MeV

The parity-violating longitudinal analyzing power, A(z), has been measured in pvectorp elastic scattering at an incident proton energy of 221 MeV. The result obtained is A(z) = [0.84+/-0.29(stat)+/-0.17(syst)]x10(-7). This experiment is unique in that it selects a single parity violating transition amplitude (3P2 - 1D2) and consequently directly constrains the weak meson-nucleon coupling constant h(pp)(rho). When this result is taken together with the existing pvectorp parity violation data, the weak meson-nucleon coupling constants h(pp)(rho) and h(pp)(omega) can, for the first time, both be determined.

[Plastic face reconstruction as a possibility for identifying unknown skulls (II). An evaluation of the reliability of the reconstruction technic by a double-blind trial]

In a double blind-trial two examiners reconstructed the soft tissue on lifelike casts of 12 skulls. They worked independently after having been given information about age, sex and constitution of the person in question and following a reconstruction plan based on the morphology of the skull. The comparison of the completed reconstruction with each other chiefly showed approximate to far-reaching degrees of resemblance and conformity. The comparison of reconstructions and photographs of the individuals also showed predominantly approximate to far-reaching likeness of the general impression, and, with one exception, at least little likeness was achieved. The reconstruction of soft tissue on the skull proved to be a relatively useful method of identifying unknown skulls, provided information on the colour and length of the hair, and possibly on the hairstyle as well, is at the examiner's disposal.

[Value of skull identification as evidence using a superimposed video image technic with reference to individual craniometric differences in the human skull]

The possibility of using the video superimposition technique for the identification of a skull by comparing it with photographs of missing persons is based on the fact that the human skull, unlike any other part of the human skeleton, shows unmistakable individual characteristics. In order to obtain a quantification, the individuality of human skulls is defined in terms of craniometric data and their probability distribution. First calculations based on the coordinates of some important encephalometric points of 52 European skulls suggest that there are individual aspects comparable to those of fingerprints. Under certain conditions, the video superimposition technique can establish very strong evidence for the identity of an unknown skull, provided that it is applied correctly and carefully.

[Measuring the thickness of facial soft tissues using nuclear magnetic resonance tomography for the purpose of identification]

Nuclear spin tomography since its beginnings in the seventies has steadily gained in importance as a method of examination in medical diagnostics as it produces a picture. In the field of forensic medicine the NMR technique as used for anatomic-anthropologic issues attempting to identify skulls this is a valuable supplement to an extension of the existing methods of investigation. The results of a measurement of the thickness of soft facial tissue in a live test person is shown as compared to measures obtained by sonography.

[Identification of the cadaveric remains of Josef Mengele]

In 1985 at the cemetery in Embu near Sao Paulo, Brazil, parts of a skeleton were exhumed, and now these parts have been examined in order to determine whether they are the remains of the corpse of Dr. Josef Mengele, the camp doctor of the Auschwitz Concentration Camp. The osteometrical and osteological findings ascertained correspond completely and consistently without contradiction with all the available personal data of Josef Mengele. Through a method of electronic visual mixing for the identification of the skull, it was determined that all the authentic pictures available used for comparison correspond definitely and consistently in all details to the exhumed skull.

[Skull identification by means of superprojection using the electronic photo-composition technique, modified to the animated picture-difference procedure (author's transl)]

Skull identification by electronic photo-composition can, with the help of a video-animation compositor, be further developed beyond the pure superprojection technique into an animated picture difference image. The employment of this combined technique to be recommended on account of the improved possibilities of control to be realized in the congruity of the superprojection composite picture.

[Improved skull identification using the superprojection technique with the help of a video-tape system (author's transl)]

The photographic identification of a skull through the well-known superprojection technique can be modified and decisively improved by the use of a video-tape system. The identification method based on electronic photo composition is methodically simple to use. It offers the examiner the possibility to recognize the relationship between bone and soft part proportions, and the structure of the bone surface and the details of the soft part shape, as a concrete, tangible characteristic of identity to a substantially greater extent. The large number of controllable characteristics inherent in the ihgh degree of individuality of the skull offers not just an either/or "The skull fits"/ "It does not fit" into a photograph, but achieves proof of disproof of identity.