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Box EW, Deng L, Morgan DE, Xie R, Kirklin JK, Wang TN, Heslin MJ, Reddy S, Vickers S, Dudeia V, Rose JB. Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy. Am J Surg 2020; 222:133-138. [PMID: 33390246 DOI: 10.1016/j.amjsurg.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulae (POPF) are a major contributing factor to pancreatoduodenectomy-associated morbidity. Established risk calculators mostly rely on subjective or intraoperative assessments. We hypothesized that various objective preoperatively determined computed tomography (CT) measurements could predict POPF as well as validated models and allow for more informed operative consent in high-risk patients. METHODS Patients undergoing elective pancreatoduodenectomies between January 2013 and April 2018 were identified in a prospective database. Comparative statistical analyses and multivariable logistic regression models were generated to predict POPF development. Model performance was tested with receiver operating characteristics (ROC) curves. Pancreatic neck attenuation (Hounsfield units) was measured in triplicate by pancreatic protocol CT (venous phase, coronal plane) anterior to the portal vein. A pancreatic density index (PDI) was created to adjust for differences in contrast timing by dividing the mean of these measurements by the portal vein attenuation. Total areas of subcutaneous fat and skeletal muscle were calculated at the L3 vertebral level on axial CT. Pancreatic duct (PD) diameter was determined by CT. RESULTS In the study period 220 patients had elective pancreatoduodenectomies with 35 (16%) developing a POPF of any grade. Multivariable regression analysis revealed that demographics (age, sex, and race) were not associated with POPF, yet patients resected for pancreatic adenocarcinoma or chronic pancreatitis were less likely to develop a POPF (10 vs. 24%; p = 0.004). ROC curves were created using various combinations of gland texture, body mass index, skeletal muscle index, sarcopenia, PDI, PD diameter, and subcutaneous fat area indexed for height (SFI). A model replacing gland texture with SFI and PDI (AUC 0.844) had similar predictive performance as the established model (p = 0.169). CONCLUSION A combination of preoperative objective CT measurements can adequately predict POPF and is comparable to established models relying on subjective intraoperative variables. Validation in a larger dataset would allow for better preoperative stratification of high-risk patients and improve informed consent among this patient population.
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Affiliation(s)
- E W Box
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - L Deng
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - D E Morgan
- Department of Radiology, University of Alabama at Birmingham, 500 22nd Street South, Birmingham, AL, 35233, USA
| | - R Xie
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - J K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - T N Wang
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - M J Heslin
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - S Reddy
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - S Vickers
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - V Dudeia
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - J B Rose
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA.
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Paluri R, Manne U, Williams G, Rose B, Heslin M, Reddy S, Kyanam Kabir Baig K, Vickers S, Ali A, Gbolahan O, Smith C, Jacob R. Neoadjuvant modified FOLFIRINOX or gemcitabine-nab paclitaxel followed by stereotactic body radiotherapy for patients with locally advanced pancreatic cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jacob R, McDonald A, Manne U, Reddy S, Vickers S, Heslin M, Kyanam Kabir Baig K, Smith C, Williams G, Ali A, Gbolahan O, Rose B, Everett AA, Kasi A, Paluri R. Stereotactic body radiotherapy in locally advanced pancreatic adenocarcinoma: A single institution experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alsaied O, Sangwan V, Banerjee S, Chugh R, Saluja A, Vickers S, Jensen E. Sorafenib and Triptolide as Combination Therapy for Hepatocellular Carcinoma. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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6
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Soltani S, O’Brien T, Loganathan G, Bellin M, Anazawa T, Tiwari M, Papas K, Vickers S, Kumaravel V, Hering B, Sutherland D, Balamurugan A. Severely fibrotic pancreases from young patients with chronic pancreatitis: evidence for a ductal origin of islet neogenesis. Acta Diabetol 2013; 50:807-14. [PMID: 21773756 PMCID: PMC4124082 DOI: 10.1007/s00592-011-0306-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/08/2011] [Indexed: 01/06/2023]
Abstract
While it is known that islet cell mass increases considerably after birth, general uncertainty surrounds the source of new beta cells in humans. Chronic pancreatitis (CP) presents a natural injury model for studying postnatal beta-cell regeneration in the human pancreas. In this report, we present histological evidence from human CP pancreases to support the theory that islet neogenesis can occur from ductal precursor cells after birth. Three young patients (ages 16, 12, and 28 years) underwent total pancreatectomy for the management of CP followed by islet isolation and autologous transplantation to prevent or minimize postsurgical diabetes. In all cases, the pancreases had extensive fibrosis, a rock-like consistency, and calcifications in the ducts. During islet isolations, we observed the unusual release of islets with many ductal fragments. In histopathological evaluation of these pancreases, solid cords of cells sometimes formed islet like structures intraductally or extending from ductal structures. Immunofluorescence staining for chromogranin, insulin, proinsulin, PDX1, glucagon, and cytokeratins confirmed these structures to be composed of chromogranin-positive endocrine cells which included both β-cells and α-cells. Labeling for Ki67 to demonstrate mitotic activity showed frequent labeling of duct epithelial cells and of some periductal cells. Using insulin and wide-spectrum cytokeratin double immunofluorescent labeling, we found insulin-positive cells to be present within the ductal lumens, among the cytokeratin-positive ductal epithelium, and extending from the ductal epithelium into surrounding connective tissues, providing evidence for a ductal origin of islet neogenesis.
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Affiliation(s)
- S.M. Soltani
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - T.D. O’Brien
- Veterinary Population Medicine, University of Minnesota, Minneapolis, MN, USA
| | - G. Loganathan
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - M.D. Bellin
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - T. Anazawa
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - M. Tiwari
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - K.K. Papas
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - S.M. Vickers
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - V. Kumaravel
- Alpha Hospital and Research Center, Institute of Diabetes and Endocrinology, Madurai-9, TamilNadu, India
| | - B.J. Hering
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
| | - D.E.R. Sutherland
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - A.N. Balamurugan
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
- Corresponding author: A.N Balamurugan, PhD, Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA. Phone: 651-253-0656, Fax: 612-626-5855,
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Armstrong L, Davydova J, Brown E, Yamamoto M, Vickers S. A Novel Cancer-Targeting Adenovirus Expressing Interferon Alpha For Pancreatic Cancer Therapy. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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D'Cunha J, Antonoff M, Evenson K, McCauley J, Vickers S, Saluja A, Maddaus M. Triptolide Therapy Inhibits Non-Small Cell Lung Cancer In Vitro and In Vivo. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abraham A, Habermann E, Parsons H, Vickers S, Gupta P, Al-Refaie W. Adjuvant Chemotherapy After Colectomy for Stage III Colon Cancer in the Oldest Old: Trends and Survival Benefits. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Huang Z, Saluja A, Dudeja V, Vickers S, Buchsbaum D. Molecular targeted approaches for treatment of pancreatic cancer. Curr Pharm Des 2011; 17:2221-38. [PMID: 21777178 PMCID: PMC3422746 DOI: 10.2174/138161211796957427] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 06/07/2011] [Accepted: 06/20/2011] [Indexed: 02/07/2023]
Abstract
Human pancreatic cancer remains a highly malignant disease with almost similar incidence and mortality despite extensive research. Many targeted therapies are under development. However, clinical investigation showed that single targeted therapies and most combined therapies were not able to improve the prognosis of this disease, even though some of these therapies had excellent anti-tumor effects in pre-clinical models. Cross-talk between cell proliferation signaling pathways may be an important phenomenon in pancreatic cancer, which may result in cancer cell survival even though some pathways are blocked by targeted therapy. Pancreatic cancer may possess different characteristics and targets in different stages of pathogenesis, maintenance and metastasis. Sensitivity to therapy may also vary for cancer cells at different stages. The unique pancreatic cancer structure with abundant stroma creates a tumor microenvironment with hypoxia and low blood perfusion rate, which prevents drug delivery to cancer cells. In this review, the most commonly investigated targeted therapies in pancreatic cancer treatment are discussed. However, how to combine these targeted therapies and/or combine them with chemotherapy to improve the survival rate of pancreatic cancer is still a challenge. Genomic and proteomic studies using pancreatic cancer samples obtained from either biopsy or surgery are recommended to individualize tumor characters and to perform drug sensitivity study in order to design a tailored therapy with minimal side effects. These studies may help to further investigate tumor pathogenesis, maintenance and metastasis to create cellular expression profiles at different stages. Integration of the information obtained needs to be performed from multiple levels and dimensions in order to develop a successful targeted therapy.
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Affiliation(s)
- Z.Q. Huang
- Department of Radiation Oncology, University of Alabama at Birmingham USA
| | - A.K. Saluja
- Department of Surgery, University of Minnesota, USA
| | - V. Dudeja
- Department of Surgery, University of Minnesota, USA
| | - S.M. Vickers
- Department of Surgery, University of Minnesota, USA
| | - D.J. Buchsbaum
- Department of Radiation Oncology, University of Alabama at Birmingham USA
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11
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Dudeja V, Chugh R, Bezek H, Skube S, Mujumdar N, Yokoyama Y, Borja-Cacho D, Rajinder D, Vickers S, Saluja A. SIRT1 Gene Silencing: A Potential Therapeutic Strategy for Pancreatic Cancer. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Clawson K, Borja-Cacho D, Antonoff M, Saluja A, Vickers S. Triptolide and Trail Combination Enhances Cell Death via Apoptosis in Cholangiocarcinoma Cells. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Dudeja V, Habermann E, Zhong W, Vickers S, Tuttle T, Jensen E, Al-Refaie W. Gastric Cancer Care in the Elderly: Insights into the Generalizability of NCI Cancer Trials. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kinney TP, Li R, Gupta K, Mallery S, Hunter D, Jensen E, Vickers S, Freeman ML. Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access. Endoscopy 2009; 41:898-901. [PMID: 19750454 DOI: 10.1055/s-0029-1215081] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- T P Kinney
- Division of Gastroenterology, Hennepin County Medical Center, Minneapolis, Minnesota 55419, United States of America.
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Antonoff M, Borja-Cacho D, Chugh R, Sorenson B, Saltzman D, Saluja A, Vickers S. 73. Triptolide Therapy for Neuroblastoma Decreases Cell Viability in Vitro and Inhibits Tumor Growth in Vivo. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Al-Refaie W, Habermann E, Jensen E, Tuttle T, Vickers S, Vrinig B. 136. Extremity Soft Tissue Sarcoma Care in the Elderly: A Population-Based Study. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Dudeja V, Skube S, Chugh R, Yokoyama Y, Daniel B, Antonoff M, Dawra R, Vickers S, Saluja A. 172. Silencing of Heat Shock Factor-1 (HSF1): A Novel Therapeutic Modality for Pancreatobiliary Tumors. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Borras C, Martel M, Vickers S, Brateman L, Okuno E, Gueye P. WE-E-342-02: (Part II) 50 Years of Women in Medical Physics - Symposium organized by the AAPM Minority Recruitment Subcommittee. Med Phys 2008. [DOI: 10.1118/1.2962801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fell MJ, Anjum N, Dickinson K, Marshall KM, Peltola LM, Vickers S, Cheetham S, Neill JC. The distinct effects of subchronic antipsychotic drug treatment on macronutrient selection, body weight, adiposity, and metabolism in female rats. Psychopharmacology (Berl) 2007; 194:221-31. [PMID: 17581744 DOI: 10.1007/s00213-007-0833-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [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: 01/22/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment with some antipsychotic drugs may result in excessive body weight gain which can have detrimental effects on patient compliance, morbidity and mortality. The aim of the present study was to investigate the effect of atypical antipsychotic drugs on dietary macronutrient selection, body weight, body composition and biochemical parameters related to obesity in female rats. MATERIALS AND METHODS Forty pair-housed, adult female hooded-Lister rats (250 +/- 5 g) were habituated to three diets containing principally protein, fat, or carbohydrate in a home cage self-selection paradigm. Olanzapine (2 mg/kg), risperidone (0.5 mg/kg), ziprasidone (2.5 mg/kg), or vehicle was injected intraperitoneally once daily for 22 days; food selection, water intake, and body weight were recorded daily, while body composition and plasma hormones (insulin, glucose, nonesterified free fatty acid, total cholesterol, glycerol, triacylglycerol, leptin, and prolactin) were analyzed at the end of the study. RESULTS Only olanzapine significantly increased body weight and food intake. Macronutrient selection was significantly altered after olanzapine and risperidone treatment (increased protein and decreased fat preference). Only olanzapine increased carcass fat content. Locomotor activity was significantly reduced in all treatment groups. Both olanzapine and risperidone significantly increased plasma prolactin. Olanzapine was without effect on any other biochemical parameter measured. Ziprasidone significantly reduced plasma leptin and nonsignificantly reduced NEFA, while risperidone significantly reduced fasting plasma glucose. CONCLUSION This study supports our previous work demonstrating weight gain and increased feeding behavior induced by olanzapine and could have important implications for enhancing our understanding of the mechanisms by which olanzapine and other atypical antipsychotics induce weight gain in the clinic.
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Affiliation(s)
- M J Fell
- Bradford School of Pharmacy, University of Bradford, Bradford BD7 1DP, UK.
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21
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Dudeja V, Phillips P, Dawra R, Vickers S, Saluja A. P86. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rajak SN, Currie ADM, Dubois VJP, Morris M, Vickers S. Tinted contact lenses as an alternative management for photophobia in stationary cone dystrophies in children. J AAPOS 2006; 10:336-9. [PMID: 16935234 DOI: 10.1016/j.jaapos.2006.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 08/29/2005] [Accepted: 12/27/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intense photophobia is a debilitating symptom of the stationary cone dystrophies. The dark-tinted glasses with side-shields and floppy hats used to manage this are very conspicuous and can cause marked psychological morbidity to the children and their families. We assess the use of tinted contact lenses as an alternative management for the photophobia. METHODS Three children, aged 5 to 13, with cone dystrophies, all with markedly reduced visual acuity, color vision, and profound photophobia were fitted with Lunelle ES70 Solaire 70% brown contact lenses. The child's parents completed two Children's Visual Function Questionnaires, the first pertaining to the period when the child wore tinted glasses; the second pertaining to the period of tinted contact lens wear. RESULTS Subjectively, two of the children and their parents described a striking improvement in their quality of life, with improved confidence, interactions with other children, and cessation of name-calling and bullying. The Children's Visual Function Questionnaires gave objective evidence for this improvement in one child and was not significantly different in the other. The third child was reluctant to wear the contact lenses despite her parents' active encouragement. CONCLUSION Tinted contact lenses offer an alternative management of the photophobia associated with stationary cone dystrophies in children. Marked improvements in their quality of life were observed in this case series.
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Affiliation(s)
- S N Rajak
- Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, United Kingdom.
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DeRosier L, Buchsbaum D, Sellers J, Huang Z, Oliver P, Vickers S. Combination of irinotecan and anti-death receptor 5 antibody inhibits pancreatic cancer in an orthotopic tumor model. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Katasani V, Leeth R, Tishler D, Leath T, Roy B, Canon C, Vickers S, Clements R. Water-Soluble Upper GI Based on Clinical Findings is Reliable to Detect Anastomotic Leaks after Laparoscopic Gastric Bypass. Am Surg 2005. [DOI: 10.1177/000313480507101104] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anastomotic leak after laparoscopic Roux- en-Y gastric bypass (LGB) is a major complication that must be recognized and treated early for best results. There is controversy in the literature regarding the reliability of upper GI series (UGI) in diagnosing leaks. LGB was performed in patients meeting NIH criteria for the surgical treatment of morbid obesity. All leaks identified at the time of surgery were repaired with suture and retested. Drains were placed at the surgeon's discretion. Postoperatively, UGI was performed by an experienced radiologist if there was a clinical suspicion of leak. From September 2001 until October 2004, a total of 553 patients (age 40.4 ± 9.2 years, BMI 48.6 ± 7.2) underwent LGB at UAB. Seventy-eight per cent (431 of 553) of patients had no clinical evidence suggesting anastomotic leak and were managed expectantly. Twenty-two per cent (122 of 553) of patients met at least one inclusion criteria for leak and underwent UGI. Four of 122 patients (3.2%) had a leak, two from anastomosis and two from the perforation of the stapled end of the Roux limb. No patient returned to the operating room without a positive UGI. High clinical suspicion and selectively performed UGI based on clinical evidence is reliable in detecting leaks.
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Affiliation(s)
- V.G. Katasani
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - R.R. Leeth
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - D.S. Tishler
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - T.D. Leath
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - B.P. Roy
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - C.L. Canon
- Departments of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - S.M. Vickers
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - R.H. Clements
- Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
AIM Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms. METHODS All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms. RESULTS The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry. CONCLUSION The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.
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Affiliation(s)
- S N Rajak
- Ophthalmology, Sussex Eye Hospital, Brighton, UK.
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Joseph M, Russo S, Plants B, Ledbetter L, Posey J, Vickers S, Saif MW. UAB's experience with concurrent capecitabine (CAP) and radiotherapy (RT) in Pts with resected (RES) or locally advanced (LA) pancreatic cancer (Pan Ca). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Joseph
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - S. Russo
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - B. Plants
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - L. Ledbetter
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - J. Posey
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - S. Vickers
- University of Alabama at Bimingham (UAB), Birmingham, AL
| | - M. W. Saif
- University of Alabama at Bimingham (UAB), Birmingham, AL
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Kabanarou SA, Holder GE, Bird AC, Webster AR, Stanga PE, Vickers S, Harney BA. Isolated foveal retinoschisis as a cause of visual loss in young females. Br J Ophthalmol 2003; 87:801-3. [PMID: 12770998 PMCID: PMC1771730 DOI: 10.1136/bjo.87.6.801] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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29
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Abstract
This article provides a literature review and opinion concerning the need for fetal surveillance in diabetic pregnancy. Low rates of intervention for suspected fetal jeopardy accompany well-controlled diabetic pregnancies in the absence of vascular disease or hypertension. The clinical utility of routine tests of fetal surveillance in uncomplicated type 1 and type 2 diabetic and gestational diabetic pregnancy has not been established. A randomized trial designed to establish whether a benefit exists to fetal testing in this population is not feasible, largely owing to sample size considerations.
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Affiliation(s)
- M B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ohio University College of Medicine and Public Health, Columbus, Ohio 43210-1228, USA
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30
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Chan C, Vilatobá M, Bartolucci A, Vickers S. Improved reduction in pain in chronic pancreatitis with combined intraoperative celiac axis plexus block and lateral pancreaticojejunostomy. Curr Surg 2001; 58:220-222. [PMID: 11275249 DOI: 10.1016/s0149-7944(00)00446-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE:Severe abdominal pain secondary to chronic pancreatitis is often multifactorial in origin. Lateral pancreaticojejunostomy (LPJ) is currently the accepted surgical treatment of choice when the main pancreatic duct is dilated. Chemical ablation of the celiac plexus for the treatment of intractable pain in chronic pancreatitis has been used without clear benefit. The aim of this study is to compare treatment outcomes of 2 groups of patients with the diagnosis of chronic pancreatitis and intractable abdominal pain (LPJ alone versus LPJ with intraoperative alcohol celiac ablation).Between 1994 and 1997, 34 patients underwent LPJ to control intractable pain secondary to chronic pancreatitis. These patients were divided into 2 groups, group 1 was LPJ only (16 patients) and group 2 was LPJ and intraoperative celiac ablation with 50% absolute alcohol (18 patients). Preoperative diagnosis and treatment criteria were similar for both groups. The clinical characteristics and outcome of both groups were retrospectively analyzed. Fisher exact test was used for statistical analysis.Demographic characteristics were similar in both groups. Pain control at short- and long-term follow-up was significantly improved in group 2 compared with group 1 (p < 0.035).Intraoperative celiac ablation in addition to LPJ appears to have a better response than does LPJ alone. Even though the number of patients is small, these results provide a basis for pursuing a prospective, randomized study to definitively answer this question.
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Affiliation(s)
- C Chan
- Department of Surgery, Instituto Nacional de la Nutricion SZ, Mexico City, Mexico
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31
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Abstract
The metabolism of nitrogen heterocyclics may lead to lactam formation. In early studies on xenobiotic metabolism lactams were identified as metabolites of nicotine, cyproheptadine, tremorine and prolintane. Now, because of the increasing availability of powerful analytical techniques, there are many instances of lactams being identified as metabolites. Lactam metabolites are formed from either iminium ions or carbinolamines. These two intermediates may have distinct mechanisms of formation but they can interconvert. There is evidence that the iminium ions are oxidized to lactams by aldehyde oxidases (cytosolic molybdenum hydroxylases). The tissue distribution and enzyme activities of aldehyde oxidase have been studied in several animal species. However, it is also known that iminium ions can undergo spontaneous hydrolysis to the corresponding carbinolamine. If the latter is stable it may undergo oxidation by cytochrome P-450 to form the lactam. Thus, species differences in lactam formation might be caused by differences in the concentrations of either cytochrome P450 isozymes or aldehyde oxidases. It appears that lactam formation is an end stage in the metabolism of N-heterocycles in that it is unlikely that the lactam will undergo hydrolysis to the corresponding amino acid. Such amino acids probably arise from the amino aldehydes that may be produced from ring opening of unstable carbinolamine intermediates. When microsomal preparations are incubated with the appropriate substrate in the presence of sodium cyanide the iminium ion may be trapped to produce a cyano compound. Such reactions have led to the proposal that iminium ions might react with nucleophilic sites of cellular macromolecules and so contribute to both the pharmacology and toxicology of N-heterocyclic compounds. Other pathways for the formation of lactam metabolites involve the internal cyclization of precursor metabolites, e.g. the self-condensation of an aldehyde group (formed during metabolism) with a neighboring amide group. However, spontaneous ring closures of amino acids to form lactams seem unlikely since it would be anticipated that the amino acid residue would exist as a stable zwitterion under physiological conditions. Thus, it is unlikely that lactams will undergo futile metabolism via hydrolytic ring opening followed by ring closure. Under extreme conditions such unanticipated ring closures may occur and the conditions of metabolite isolation may contribute to the occurrence of artifacts.
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Affiliation(s)
- S Vickers
- Merck Research Laboratories, West Point, PA 19486, USA.
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32
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Chan C, Medina-Franco H, Bell W, Lazenby A, Vickers S. Carcinoid tumor of the hepatic duct presenting as a Klatskin tumor in an adolescent and review of world literature. Hepatogastroenterology 2000; 47:519-21. [PMID: 10791227] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This is a case presentation of a 14-year-old boy with the radiological diagnosis of cholangiocarcinoma occluding the hepatic duct bifurcation. His only symptom at presentation was jaundice and further workup confirmed a mass at the porta hepatis. Surgical treatment resulted in a resection of the hepatic bifurcation tumor with a final pathological diagnosis of a carcinoid tumor of the hepatic duct bifurcation. To our knowledge, this is only the second case presented of a resected carcinoid tumor in adolescence. In this communiqué we present the above case and review of the world literature of biliary neuroendocrine tumors.
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Affiliation(s)
- C Chan
- Department of General Surgery, University of Alabama, School of Medicine, Birmingham 35294-0007, USA
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33
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Vickers S, Theoharides AD, Arison B, Balani SK, Cui D, Duncan CA, Ellis JD, Gorham LM, Polsky SL, Prueksaritanont T, Ramjit HG, Slaughter DE, Vyas KP. In vitro and in vivo studies on the metabolism of tirofiban. Drug Metab Dispos 1999; 27:1360-6. [PMID: 10534322] [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: 02/14/2023] Open
Abstract
Tirofiban hydrochloride [L-tyrosine-N-(butylsulfonyl)-O-[4-(4-piperidinebutyl)] monohydrochloride, is a potent and specific fibrinogen receptor antagonist. Radiolabeled tirofiban was synthesized with either (3)H-label incorporated into the phenyl ring of the tyrosinyl residue or (14)C-label in the butane sulfonyl moiety. Neither human liver microsomes nor liver slices metabolized [(14)C]tirofiban. However, male rat liver microsomes converted a limited amount of the substrate to a more polar metabolite (I) and a relatively less polar metabolite (II). The formation of I was sex dependent and resulted from an O-dealkylation reaction catalyzed by CYP3A2. Metabolite II was identified as a 2-piperidone analog of tirofiban. There was no evidence for Phase II biotransformation of tirofiban by microsomes fortified with uridine-5'-diphospho-alpha-D-glucuronic acid. After a 1 mg/kg i.v. dose of [(14)C]tirofiban, recoveries of radioactivity in rat urine and bile were 23 and 73%, respectively. Metabolite I and unchanged tirofiban represented 70 and 30% of the urinary radioactivity, respectively. Tirofiban represented >90% of the biliary radioactivity. At least three minor biliary metabolites represented the remainder of the radioactivity. One of them was identified as I. Another was identified as II. When dogs received 1 mg/kg i.v. of [(3)H]tirofiban, most of the radioactivity was recovered in the feces as unchanged tirofiban. The plasma half-life of tirofiban was short in both rats and dogs, and tirofiban was not concentrated in tissues other than those of the vasculature and excretory organs.
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Affiliation(s)
- S Vickers
- Merck Research Laboratories, West Point, Pennsylvania 19486-0004, USA.
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34
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Abstract
PURPOSE To report anterior ischemic optic neuropathy associated with systemic hypotension in a patient undergoing continuous ambulatory peritoneal dialysis. METHODS Case report. A 58-year-old man undergoing continuous ambulatory peritoneal dialysis developed painless blurred vision in both eyes and bilateral optic disk swelling with an altitudinal field defect in the left eye. Twenty-four-hour ambulatory blood pressure monitoring was requested in addition to other routine investigations. RESULTS Routine blood pressure measurement in the clinic was 130/86 mm Hg, but ambulatory blood pressure monitoring demonstrated pronounced early morning hypotension with individual readings as low as 91/41 mm Hg. CONCLUSIONS Renal dialysis can render patients hypotensive, and this may be associated with anterior ischemic optic neuropathy. The overnight drop in blood pressure may not be appreciated with routine blood pressure measurement. Therefore, 24-hour ambulatory blood pressure monitoring should be considered when investigating patients with suspected anterior ischemic optic neuropathy who are undergoing renal replacement.
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Affiliation(s)
- T L Jackson
- The Sussex Eye Hospital, Brighton, United Kingdom.
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35
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Vickers S, Schiller HJ, Hildreth JE, Bulkley GB. Immunoaffinity localization of the enzyme xanthine oxidase on the outside surface of the endothelial cell plasma membrane. Surgery 1998; 124:551-60. [PMID: 9736909] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Reactive oxygen metabolites generated from endothelial xanthine oxidase (XO) trigger reperfusion injury in many organs. We evaluated the possibility that endothelial XO was localized on the endothelial cell surface, as well as within the cytoplasm. METHODS Primary cultures of bovine (BAECs) and porcine (PAECs) aortic endothelial cells were grown in media documented to be free of XO. Polyclonal and monoclonal antibodies were developed against XO. These antibodies were used to evaluate BAEC and PAEC for cell surface XO through immunofluorescence staining, hybridoma cell surface labeling, and endothelial cell surface binding. RESULTS These antibodies bound specifically to the surface of these cells when the membrane was shown to be intact and impermeable (and the cytoplasm inaccessible) to immunoglobulins Moreover, hybridoma cells expressing monoclonal antibody to XO bound specifically to the endothelial cell surface. Finally, intact endothelial cells bound specifically to the anti-XO polyclonal antibodies immobilized to the surface of a Petri dish. The integrity of these endothelial cell plasma membranes was demonstrated by the subsequent growth and replication of these cells in culture. CONCLUSIONS These findings indicate that XO is present on the outside surface of the endothelial cell plasma membrane. This would not only explain the known in vivo efficacy of intravascularly administered large molecular weight antioxidants (such as superoxide dismutase) but could have important implications for inflammatory signaling.
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Affiliation(s)
- S Vickers
- Department of Surgery, University of Alabama at Birmingham 35294-0007, USA
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36
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Bell IM, Erb JM, Freidinger RM, Gallicchio SN, Guare JP, Guidotti MT, Halpin RA, Hobbs DW, Homnick CF, Kuo MS, Lis EV, Mathre DJ, Michelson SR, Pawluczyk JM, Pettibone DJ, Reiss DR, Vickers S, Williams PD, Woyden CJ. Development of orally active oxytocin antagonists: studies on 1-(1-[4-[1-(2-methyl-1-oxidopyridin-3-ylmethyl)piperidin-4-yloxy]-2- methoxybenzoyl]piperidin-4-yl)-1,4-dihydrobenz[d][1,3]oxazin-2-one (L-372,662) and related pyridines. J Med Chem 1998; 41:2146-63. [PMID: 9622556 DOI: 10.1021/jm9800797] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [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: 02/07/2023]
Abstract
The previously reported oxytocin antagonist L-371,257 (2) has been modified at its acetylpiperidine terminus to incorporate various pyridine N-oxide groups. This modification has led to the identification of compounds with improved pharmacokinetics and excellent oral bioavailability. The pyridine N-oxide series is exemplified by L-372,662 (30), which possessed good potency in vitro (Ki = 4.1 nM, cloned human oxytocin receptor) and in vivo (intravenous AD50 = 0.71 mg/kg in the rat), excellent oral bioavailability (90% in the rat, 96% in the dog), good aqueous solubility (>8.5 mg/mL at pH 5.2) which should facilitate formulation for iv administration, and excellent selectivity against the human arginine vasopressin receptors. Incorporation of a 5-fluoro substituent on the central benzoyl ring of this class of oxytocin antagonists enhanced in vitro and in vivo potency but was detrimental to the pharmacokinetic profiles of these compounds. Although lipophilic substitution around the pyridine ring of compound 30 gave higher affinity in vitro, such substituents were a metabolic liability and caused shortfalls in vivo. Two approaches to prevent this metabolism, addition of a cyclic constraint and incorporation of trifluoromethyl groups, were examined. The former approach was ineffective because of metabolic hydroxylation on the constrained ring system, whereas the latter showed improvement in plasma pharmacokinetics in some cases.
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Affiliation(s)
- I M Bell
- Department of Drug Metabolism, Merck Research Laboratories, West Point, Pennsylvania 19486, USA
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37
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Vickers S, Duncan CA, Slaughter DE, Arison BH, Greber T, Olah TV, Vyas KP. Metabolism of MK-499, a class III antiarrhythmic agent, in rats and dogs. Drug Metab Dispos 1998; 26:388-95. [PMID: 9571219] [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: 02/07/2023] Open
Abstract
MK-499 [(+)-N-[1'-(6-cyano-1, 2, 3, 4-tetrahydro-2(R)-naphthalenyl)-3, 4-dihydro-4(R)-hydroxyspiro(2H-1-benzopyran-2, 4'-piperidin)-6-yl]methanesulfonamide] monohydrochloride is an investigational class III antiarrhythmic agent for treatment of malignant ventricular tachyarrhythmias. The disposition of [3H]MK-499 and [14C]MK-499 was studied in rats and dogs after oral and iv administration. MK-499 was concentrated in organs of excretion and the heart. In the rat, urinary radioactivity elimination values after iv (0.5 mg/kg) and oral (6.25 mg/kg) doses were 21 +/- 3% and 10 +/- 2%, respectively. Corresponding fecal recoveries were 68 +/- 6% and 78 +/- 7%. Similar results were found after corresponding doses of [14C]MK-499. In dogs, urine and feces accounted for 16 +/- 3% and 75 +/- 4% of recovered radioactivity after a [3H]MK-499 iv dose (0.1 mg/kg). Corresponding recoveries after an oral dose (1 mg/kg) were 12 +/- 2% and 76 +/- 3%. Biliary (0-24 hr) excretion accounted for 39 +/- 5% and 41 +/- 18% of [3H] and [14C] oral doses in rats, respectively. Dogs excreted 34% of [3H] oral dose in (0-24 hr) bile. The data indicated that a substantial amount of MK-499 was absorbed by rats and dogs. MK-499, metabolite I (formed by loss of N-substitution), and metabolite II (an acid formed by metabolic scission across the benzopyran ring) each represented 30% of rat urinary label. Rat bile contained MK-499 (10%), II (20%), and IV (10%), which was formed by carbon-4 hydroxylation of the tetralin ring. Additionally, rat bile included glutathione (V) and N-acetyl-1-cysteine (VI) conjugates of a ring-opened metabolite. Metabolite III, a positional isomer of IV, was excreted in rat urine. The major labeled species excreted in dog bile were unchanged MK-499 and its glucuronide (VII), which, respectively, represented 50% and 30% of the biliary radioactivity. MK-499 and a small amount of I represented dog urinary radioactivity. The bioavailability of MK-499 was high in dogs (100%) but low in rats (17%). This difference was probably due to the more extensive presystemic metabolism of MK-499 in rats.
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Affiliation(s)
- S Vickers
- Drug Metabolism, Merck Research Laboratories, West Point, PA 19486, USA
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38
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Vickers S. Use of gender and oxygenation as synonyms for sex and oxidation. Drug Metab Dispos 1995; 23:1007. [PMID: 8654186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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39
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Abstract
Various developmental abnormalities can give rise to the clinical syndrome of autism, and some are due to chromosomal anomalies. One syndrome has been identified in which behavioural disorder is associated with the clinical features of epilepsy and ataxia, and with the chromosomal anomaly of an extra marker chromosome containing a duplication of 15q11-13. The authors report a boy with autism, epilepsy, ataxia and an interstitial duplication of 15q, in whom molecular analysis reveals duplication of the GABRA5 and GABRB3 genes on the maternally derived chromosome.
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Affiliation(s)
- S Bundey
- Clinical Genetics Unit, Birmingham Maternity Hospital, UK
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40
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Vickers S, Duncan CA, Yuan AS, Vyas KP. Disposition of MK-852, a fibrinogen receptor antagonist, in rats and dogs. Drug Metab Dispos 1994; 22:631-6. [PMID: 7956740] [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: 01/28/2023] Open
Abstract
MK-852, an antagonist of the platelet fibrinogen receptor GPIIb/IIIa, is the cyclic disulfide N-acetyl-cys-asn-(5,5-dimethyl-4-thiazolidine-carbonyl)- (4-aminomethyl-phe)-gly-asp-cys, monoacetate (all L-amino acids). Radiolabeled MK-852 was synthesized with either a 3H label in the N-acetyl group of the cystine residue or a 14C label in the aminomethyl group. Plasma concentrations of unchanged MK-852 in five rats declined with a mean terminal half-life of 0.92 hr after a 2.5 mg/kg i.v. dose of MK-852; plasma clearance and Vd were 23.1 ml/min/kg and 1.81 liters/kg, respectively. More label was excreted in urine (74-76%) than in feces (7-15%) when either [3H]MK-852 or [14C]MK-852 was given intravenously to groups of four rats (2.5 mg/kg). High concentrations of 3H in rat kidney were consistent with high renal clearance of MK-852, and MK-852 accounted for virtually all of the urinary 3H (and 14C) label. Following a 0.6 mg/kg i.v. dose, the half-life, plasma clearance, and Vd of MK-852 in four dogs were 0.84 hr, 3.93 ml/min/kg, and 0.28 liters/kg, respectively. In dogs, the excretion patterns of radioactivity were similar to those of rats, except that 14C urinary recoveries (79%) were higher than 3H (63%). Unchanged MK-852 represented essentially all of the urinary 3H label. Fractionation of dog 14C urinary radioactivity yielded one major and several minor polar labeled species. The major species was unchanged [14C]MK-852 (quantitated by radioimmunoassay as approximately 80% of the label).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Vickers
- Department of Drug Metabolism, Merck Research Laboratories, West Point, PA 19486
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41
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Vickers S, Dahlitz M, Hardy C, Kilpatrick M, Webb T. A male with a de novo translocation involving loss of 15q11q13 material and Prader-Willi syndrome. J Med Genet 1994; 31:478-81. [PMID: 8071975 PMCID: PMC1049927 DOI: 10.1136/jmg.31.6.478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A male proband is described who carries a de novo translocation between chromosomes Y and 15 associated with Prader-Willi syndrome. In situ hybridisation and molecular studies were used to show loss of the paternally derived 15q11q13 region in the translocated chromosome. Lack of further symptoms indicate that this region was lost with no apparent deletion of the Y chromosome.
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Affiliation(s)
- S Vickers
- Clinical Genetics Unit, Birmingham Maternity Hospital, Edgbaston, UK
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42
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Cheng H, Schwartz MS, Vickers S, Gilbert JD, Amin RD, Depuy B, Liu L, Rogers JD, Pond SM, Duncan CA. Metabolic disposition of simvastatin in patients with T-tube drainage. Drug Metab Dispos 1994; 22:139-42. [PMID: 8149872] [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: 01/29/2023] Open
Abstract
A study to investigate the disposition and biliary excretion of simvastatin (SV) was conducted in four cholecystectomy patients with T-tube drainage. Each patient received a single oral dose of 100 mg of [14C]SV (20 microCi). Of the 14C-labeled dose, approximately 35% was excreted in urine, 25% in bile, and 20% in feces. Thus, at least 60% of the oral dose was absorbed from the gastrointestinal tract. Of the AUC for radioactivity in plasma, 13% was contributed by the HMG-CoA reductase inhibitors. In addition, only 2% of the 14C-dose was eliminated in urine as HMG-CoA reductase inhibitors. Thus, most of the SV-related compounds in plasma and urine have little or no HMG-CoA reductase inhibitory activity. The same is probably true for these compounds in bile. Two major active metabolites were present in the bile. Based on HPLC and MS/MS data, they were identified as 6' beta-COOH-SVA and 6'-OH-SVA. In general, the majority of the radioactivity in the bile and urine was excreted within 24 hr postdose. Of the radioactivity excreted in the 0- to 24-hr bile, on average, approximately 30% was contributed by 6' beta-COOH-SVA and 6'-OH-SVA. These two metabolites accounted for the majority of HMG-CoA reductase inhibitory activity in the bile. Little or SV or no SVA was present in the bile.
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Affiliation(s)
- H Cheng
- Department of Drug Metabolism, Merck Research Laboratories, West Point, PA 19486
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43
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Vickers P, Vickers S. Developing software in the Third World: Papua New Guinea provincial health information system. J Trop Pediatr 1993; 39:322-4. [PMID: 8271351 DOI: 10.1093/tropej/39.5.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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44
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Vickers S, Duncan CA, Kari PH, Homnick CF, Elliott JM, Pitzenberger SM, Hichens M, Vyas KP. In vivo and in vitro metabolism studies on a class III antiarrhythmic agent. Drug Metab Dispos 1993; 21:467-73. [PMID: 8100503] [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: 01/28/2023] Open
Abstract
The metabolism of L-691,121 (I), a class III antiarrhythmic agent, was studied in vivo in rats and dogs and in vitro by using liver S9 or slices from these species and humans. After oral doses of [14C]I to rats (5 mg/kg) and dogs (1 mg/kg), urinary recoveries of label were, respectively, 6% and 28%. Biliary excretion (0-24 hr) accounted for 68% of a 5 mg/kg, po dose in rats and 19% of a 10 mg/kg dose, po in dogs. Metabolites were identified by application of FAB/MS, NMR, and diode-array UV spectroscopy. The major dog metabolites were the secondary alcohol (II) produced by carbonyl reduction and its glucuronide conjugate (III). It was estimated that II and III represented 24 and 36%, respectively, of the dog biliary radioactivity. After a 50 mg/kg dose of I, II represented approximately 50% of the dog urinary label. A minor metabolite (IV) in dog urine was produced by reduction and loss of N-substitution. There were species differences in that, relative to dogs, II represented a much smaller fraction of the excreted dose in rats and there was no evidence for excretion of III in rats. N-Dealkylated I (V) was excreted, along with IV in rat bile. Dog liver slices and S9 fractions were most efficient (relative to human and rat liver tissues) at reducing I to II. Metabolic reduction of I to II was highly stereoselective and yielded the (-)-antipode as determined by chiral chromatography.
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Affiliation(s)
- S Vickers
- Department of Drug Metabolism, Mercke Research Laboratories West Point, PA 19486
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45
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Abstract
The quantitative impact of mesenteric vasoconstriction on the systemic hemodynamic response to cardiogenic shock induced by pericardial tamponade was evaluated. Graded increases in pericardial pressure produced corresponding decreases in cardiac output to 44% +/- 2% and arterial pressure to 64% +/- 3% of baseline and increases in total peripheral vascular resistance to 131% +/- 4% of baseline. Total mesenteric blood flow decreased disproportionately, to 28% +/- 3% of baseline, because of a disproportionate increase in mesenteric vascular resistance to 223% +/- 6% of baseline. Nonmesenteric vascular resistance increased only to 119% +/- 4% of baseline. Thus mesenteric vasoconstriction accounted for 42% of the increase in total peripheral resistance. Prior blockade of the renin-angiotensin axis ablated this response and eliminated the mesenteric contribution to systemic vascular resistance, while confirmed blockade of the alpha-adrenergic system or vasopressin system had no effect. Without shock, central intravenous infusions of angiotensin II (but not norepinephrine or vasopressin) closely mimicked this selective vasoconstriction. Angiotensin-mediated selective mesenteric vasoconstriction accounts for more than 40% of the overall increase in systemic vascular resistance in cardiogenic shock.
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Affiliation(s)
- P M Reilly
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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46
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Abstract
In two simvastatin (SV) metabolites the 6' alpha-methyl of SV is oxidized to either 6' beta-CH2OH (I) or 6' beta-COOH (II). A possible intermediate is 6' exomethylene SV (III). When Sprague Dawley rats received an i.v. dose of [14C] III (1 mg/kg) metabolite II was excreted in bile. When dogs received an i.v. dose of [14C] III together with either [3H] SV (1 mg/kg) or its hydroxy acid form, [( 3H] SVA) (10 mg/kg), both 3H and 14C I and II were excreted in bile. These results strongly indicate that I and II are secondary metabolites of SV formed from III perhaps via a common aldehyde intermediate.
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Affiliation(s)
- S Vickers
- Merck Sharp & Dohme Research Laboratories West Point, Pennsylvania 19486
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47
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Quérin S, Lambert R, Cusson JR, Grégoire S, Vickers S, Stubbs RJ, Sweany AE, Larochelle P. Single-dose pharmacokinetics of 14C-lovastatin in chronic renal failure. Clin Pharmacol Ther 1991; 50:437-41. [PMID: 1914380 DOI: 10.1038/clpt.1991.161] [Citation(s) in RCA: 20] [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: 12/29/2022]
Abstract
An open study on the pharmacokinetics of lovastatin was conducted in six patients with chronic renal failure (mean creatinine clearance, 0.40 ml/sec; range, 0.20 to 0.65 ml/sec) and seven healthy subjects. Plasma levels of 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitory activity (total and active) and total radioactivity were determined over 168 hours after a single dose of 80 mg 14C-lovastatin. The mean area under the plasma concentration-time curve for active inhibitors were 606 +/- 346 and 282 +/- 138 ngEq.hr/ml (p = 0.04) in patients and control subjects, respectively. Total inhibitors in plasma and total radioactivity were similarly elevated in patients with chronic renal failure. Results indicate that patients with severe renal dysfunction have altered elimination kinetics of lovastatin. Current ongoing clinical studies in patients with renal dysfunction will allow better assessment of the pharmacodynamic meaning of our observations.
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Affiliation(s)
- S Quérin
- Department of Medicine, Hôtel-Dieu de Montréal Hospital, Québec, Canada
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Buchman TG, Cabin DE, Vickers S, Deutschman CS, Delgado E, Sussman MM, Bulkley GB. Molecular biology of circulatory shock. Part II. Expression of four groups of hepatic genes is enhanced after resuscitation from cardiogenic shock. Surgery 1990; 108:559-66. [PMID: 1697703] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite an initially successful resuscitation from circulatory shock, multiple organ failure (MOF) develops in some patients. The marked biochemical alterations associated with shock and MOF include clinically important changes in gene expression, such as altered rates of albumin and procoagulant synthesis. To characterize the MOF-associated changes at the cellular level, sequential liver biopsies were obtained from a swine model of cardiogenic shock associated with MOF. Preshock and postresuscitation biopsies were used not only to create a complementary DNA (cDNA) library but also to screen, to confirm, and, in nine out of 12 cases, to specifically identify genes whose expression is enhanced at least fivefold after resuscitation. The twelve genes thus characterized can be separated according to function into distinct groups, including the acute-phase genes and the heat-shock genes. Expression of acute-phase genes is liver specific and is essential for systemic homeostasis; heat-shock gene expression is generic to all cells and important for intracellular homeostasis.
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Affiliation(s)
- T G Buchman
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
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Vickers S, Duncan CA, Vyas KP, Kari PH, Arison B, Prakash SR, Ramjit HG, Pitzenberger SM, Stokker G, Duggan DE. In vitro and in vivo biotransformation of simvastatin, an inhibitor of HMG CoA reductase. Drug Metab Dispos 1990; 18:476-83. [PMID: 1976071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Simvastatin (SV), an analog of lovastatin, is the lactone form of 1', 2', 6', 7', 8', 8a'-hexahydro-3,5-dihydroxy-2', 6'-dimethyl-8' (2", 2"-dimethyl-1"-oxobutoxy)-1'-naphthalene-heptanoic acid (SVA) which lowers plasma cholesterol by inhibiting 3-hydroxy-3-methylglutaryl-CoA reductase. SV but not its corresponding hydroxy acid form SVA underwent microsomal metabolism. Major in vitro metabolites were 6'-OH-SV (I) and 3"-OH-SV (III) formed by allylic and aliphatic hydroxylation, respectively, and 6'-exomethylene-SV (IV) formed by dehydrogenation. In rats, dogs, and humans, biliary excretion is the major route of elimination. Biliary metabolites (as both hydroxy acids and lactones) also included 6'-CH2OH-SV (V) and 6'-COOH-SV (VI) in both of which the 6'-chiral center had been inverted. High levels of esterase in rodent plasma favored the formation of SVA from SV. The formation of 1', 2', 6', 7', 8', 8a'-hexahydro-2', 6'-dimethyl-8'-(2",2"-dimethyl-1-oxobutoxy)-1'-naphthalene-pentano ic acid (VII) only in rodents represented a species difference in the metabolism of SV. It is proposed that VII is formed by beta-oxidation pathways of fatty acid intermediary metabolism. Several metabolites resulting from microsomal oxidation (after subsequent conversion from lactones to hydroxy acids) are effective inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase and may contribute to the cholesterol lowering effect of SV. Qualitatively, the metabolism of SV closely resembles that of lovastatin.
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Affiliation(s)
- S Vickers
- Merck Sharp & Dohme Research Laboratories, West Point, PA 19486
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Vickers S, Duncan CA, Chen IW, Rosegay A, Duggan DE. Metabolic disposition studies on simvastatin, a cholesterol-lowering prodrug. Drug Metab Dispos 1990; 18:138-45. [PMID: 1971563] [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: 12/29/2022] Open
Abstract
The biosynthesis of cholesterol is mainly regulated by 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Because the liver is the major site of cholesterol synthesis, it is the primary target of the class of drugs known as HMG-CoA reductase inhibitors. Simvastatin (SV) is a lactone prodrug which undergoes reversible metabolism. In the hydroxy acid form (SVA) it is a potent inhibitor of HMG-CoA reductase. SV is well absorbed by rats, dogs, and humans. After an oral dose of SV, tissue distribution studies were consistent with high hepatic extraction of SV and relatively poor tissue penetration of SVA. The majority of a radioactive dose of SV is eliminated in bile. A high portal/systemic gradient for 6'-OH-SVA, an active biliary metabolite, suggests its probable reentry and indicates potential for prolongation of HMG-CoA reductase inhibition. AUC comparisons in dogs after simultaneous iv (3H) and intraportal (14C) infusions indicate that hepatic extraction is high with only 8% of SV reaching the systemic circulation unchanged. Approximately 98% and 96% of SV was bound to human and dog plasma protein, respectively. The physiological disposition of SV in dog appears to be a suitable paradigm for man. Because of its high hepatic extraction SV should be both specific and selective with respect to the inhibition of HMG-CoA reductase.
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Affiliation(s)
- S Vickers
- Merck Sharp & Dohme Research Laboratories, West Point, PA 19486
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