Origins, Admixture Dynamics, and Homogenization of the African Gene Pool in the Americas

The Transatlantic Slave Trade transported more than 9 million Africans to the Americas between the early 16th and the mid-19th centuries. We performed a genome-wide analysis using 6,267 individuals from 25 populations to infer how different African groups contributed to North-, South-American, and Caribbean populations, in the context of geographic and geopolitical factors, and compared genetic data with demographic history records of the Transatlantic Slave Trade. We observed that West-Central Africa and Western Africa-associated ancestry clusters are more prevalent in northern latitudes of the Americas, whereas the South/East Africa-associated ancestry cluster is more prevalent in southern latitudes of the Americas. This pattern results from geographic and geopolitical factors leading to population differentiation. However, there is a substantial decrease in the between-population differentiation of the African gene pool within the Americas, when compared with the regions of origin from Africa, underscoring the importance of historical factors favoring admixture between individuals with different African origins in the New World. This between-population homogenization in the Americas is consistent with the excess of West-Central Africa ancestry (the most prevalent in the Americas) in the United States and Southeast-Brazil, with respect to historical-demography expectations. We also inferred that in most of the Americas, intercontinental admixture intensification occurred between 1750 and 1850, which correlates strongly with the peak of arrivals from Africa. This study contributes with a population genetics perspective to the ongoing social, cultural, and political debate regarding ancestry, admixture, and the mestizaje process in the Americas.

Comparison of demographic features and prognosis between cardiogenic shock in patients with Chagas heart disease and other etiologies – Registry Of Acute Medical Emergencies in Brazil (ROAD)

Background

Chagas disease is a chronic, systemic, parasitic infection caused by Trypanosoma cruzi, and a common cause of heart failure (HF) in Latin America. The incidence can be as high as 14% in endemic areas. The prognosis seems to be worse than other causes of HF, with mortality of up to 20%/year. Mortality and prognosis during the acute decompensation, however, are less studied.

Purpose

Compare differences between cardiogenic shock (CS) in patients with HF caused by chronic Chagas heart disease (ChHD) and those caused by other etiologies (non-ChHD).

Methods

We performed a multicentric, prospective, observational study of patients admitted with CS at 3 emergency departments in Brazil between January 2015 and December 2019. Baseline characteristics and intrahospital outcomes were obtained. Statistical analysis: The primary outcome was combined intra-hospital events (death, stroke, acute renal failure and bleeding). Comparison between groups was performed through Chi-squared and Student's T-test and the multivariate analysis by logistic regression, being p<0.05 considered significant.

Results

856 patients with CS were included, 158 (18,5%) ChHD and 698 (81,5%) non-ChHD. Those with ChHD were younger (60.5±11.7 vs. 64.9±4.8 years old, p<0.0001), less often male (50.0 vs. 64.3%, p=0.001) and had lower prevalence of diabetes (20.9 vs. 36.2%, p<0.0001), hypertension (36.07 vs. 64.1%, p<0.0001), chronic obstructive pulmonary disease (1.9 vs. 7.8%, p=0.007) and dyslipidemia (14.6 vs. 36%, p<0.0001). The ejection fraction was lower in ChHD (26 + 7.3 vs. 30.4% + 11.4, p<0.0001) and they had more definitive pacemaker (17.3 vs. 6.8%, p<0.0001). At the admission, patients with ChHD had lower systolic blood pressure (91.3±20.6 vs. 98.8±25.9 mmHg, p=0.001) and were more symptomatic, with orthopnea (41.3 vs. 28.3%, p=0.004), dyspnea (75.3 vs. 57.3%, p<0.0001). Treatment in the first 24 hours was different, with less withdrawal of beta-blockers (51.2 vs. 63.9%, p=0.006) and more use dobutamine (80.4 vs. 66.2%, p<0.0001). Main cause of decompensation was progression of disease in 39.1% of ChHD versus 22.9% of non-ChHD (p<0.001). Decompensation seemed more severe with greater necessity of orotracheal intubation (30 vs. 14.5%, p<0.0001), intra-aortic balloon pump (27.9 vs. 7.5%, p<0.0001), bleeding (9.2 vs. 3.8%, p=0.012) and acute renal failure (46.7 vs. 35.8%, p=0.024). The primary outcome was observed in 57% of the non-ChHD and 71.5% of the ChHD (OR 0.578, 95% CI: 0.314–1.064, p=0.079). Also, there were no differences between intra-hospital mortality in patients with ChHD versus non-ChHD (37.3 vs. 32.7%, p=0.261).

Conclusion

To the best of our knowledge, this is the biggest registry with Chagasic patients in cardiogenic shock. They were younger and had less comorbidities, but were admitted with lower blood pressure, more symptoms and needed more inotropes in the first 24 hours. No difference in mortality or combined outcome was observed.

Funding Acknowledgement

Type of funding source: None

Long-term outcome of liver transplantation in childhood: A study of 20-year survivors

We report the results of a study of survival, liver and kidney functions, and growth with a median follow-up of 24 years following liver transplantation in childhood. From 1988 to 1993, 128 children underwent deceased donor liver transplantation (median age: 2.5 years). Twenty-year patient and graft survival rates were 79% and 64%, respectively. Raised serum aminotransferase and/or γ-glutamyl transferase activities were present in 42% of survivors after a single transplantation. Graft histology (35 patients) showed signs of chronic rejection in 11 and biliary obstruction in 5. Mean total fibrosis scores were 4.5/9 and 3/9 in patients with abnormal and normal serum liver tests, respectively. Glomerular filtration rate was <90 mL·min^-1 in 35 survivors, including 4 in end-stage renal disease who were undergoing dialysis or had undergone renal transplantation. Median final heights were 159 cm for women and 172 cm for men; final height was below the target height in 37 patients. Twenty-year survival after childhood liver transplantation may be close to 80%, and final height is within the normal range for most patients. However, chronic kidney disease or altered liver biochemistries are present in over one third of patients, which is a matter of concern for the future.

Psicologia e a Política de Direitos: Percursos de uma Relação

Resumo: Este é um ensaio que visou recuperar os percursos da relação da Psicologia com a Política de Direitos no período da ditadura civil-militar e da atualidade. Para tanto, recorremos à pesquisa bibliográfica e à pesquisa documental. A primeira busca recuperar os processos históricos desta relação, fazendo um resgate das práticas da Psicologia durante o período da ditadura até o atual momento. A segunda objetiva encontrar elementos deste percurso e que revelam como tem se dado a relação da Psicologia com a Política de Direitos em nosso tempo. A partir das investigações, observa-se que a Psicologia serviu e andou de mãos dadas com a ditadura militar, contribuindo com a aplicação de testes e práticas de tortura aos presos políticos. Apesar de esta prática ter sido hegemônica nesse período, a Psicologia conformava-se enquanto um campo conflituoso de saberes, fazeres e posicionamentos político-ideológicos e, com os processos de democratização do país, ela também se reorientou e se reinventou, assumindo como norte um compromisso ético e político com a construção de uma sociedade mais justa e igualitária e com a Política de Direitos. Não obstante este compromisso ter tomado conta da Psicologia, a partir de articulações da atuação da Psicologia durante a ditadura e em nosso tempo, identificam-se heranças em seu seio que foram deixadas pela ditadura, como as violações de direitos em instituições e entidades em que o profissional da Psicologia atua e contribui para tais violações, bem como quando apoiam projetos que estão na contramão da Política de Direitos, como do suposto projeto da “cura gay”.

Effect of exercise training on ventilatory efficiency in patients with heart disease: a review

The analysis of ventilatory efficiency in cardiopulmonary exercise testing has proven useful for assessing the presence and severity of cardiorespiratory diseases. During exercise, efficient pulmonary gas exchange is characterized by uniform matching of lung ventilation with perfusion. By contrast, mismatching is marked by inefficient pulmonary gas exchange, requiring increased ventilation for a given CO2 production. The etiology of increased and inefficient ventilatory response to exercise in heart disease is multifactorial, involving both peripheral and central mechanisms. Exercise training has been recommended as non-pharmacological treatment for patients with different chronic cardiopulmonary diseases. In this respect, previous studies have reported improvements in ventilatory efficiency after aerobic exercise training in patients with heart disease. Against this background, the primary objective of the present review was to discuss the pathophysiological mechanisms involved in abnormal ventilatory response to exercise, with an emphasis on both patients with heart failure syndrome and coronary artery disease. Secondly, special focus was dedicated to the role of aerobic exercise training in improving indices of ventilatory efficiency among these patients, as well as to the underlying mechanisms involved.

Effects of continuous vs interval exercise training on oxygen uptake efficiency slope in patients with coronary artery disease

The oxygen uptake efficiency slope (OUES) is a submaximal index incorporating cardiovascular, peripheral, and pulmonary factors that determine the ventilatory response to exercise. The purpose of this study was to evaluate the effects of continuous exercise training and interval exercise training on the OUES in patients with coronary artery disease. Thirty-five patients (59.3±1.8 years old; 28 men, 7 women) with coronary artery disease were randomly divided into two groups: continuous exercise training (n=18) and interval exercise training (n=17). All patients performed graded exercise tests with respiratory gas analysis before and 3 months after the exercise-training program to determine ventilatory anaerobic threshold (VAT), respiratory compensation point, and peak oxygen consumption (peak VO₂). The OUES was assessed based on data from the second minute of exercise until exhaustion by calculating the slope of the linear relation between oxygen uptake and the logarithm of total ventilation. After the interventions, both groups showed increased aerobic fitness (P<0.05). In addition, both the continuous exercise and interval exercise training groups demonstrated an increase in OUES (P<0.05). Significant associations were observed in both groups: 1) continuous exercise training (OUES and peak VO₂ r=0.57; OUES and VO₂ VAT r=0.57); 2) interval exercise training (OUES and peak VO₂ r=0.80; OUES and VO₂ VAT r=0.67). Continuous and interval exercise training resulted in a similar increase in OUES among patients with coronary artery disease. These findings suggest that improvements in OUES among CAD patients after aerobic exercise training may be dependent on peripheral and central mechanisms.

In vitro effects of tacrolimus on human cytochrome P450

Tacrolimus, a potent immunosuppressive drug, is known to be metabolized predominantly in the liver by cytochrome P450 3A (CYP3A). In order to determine the potential of tacrolimus to inhibit the metabolism of other drugs, we have investigated its inhibitory effects on specific cytochrome reactions. Specific substrates for the seven cytochromes (CYPs) 1A2, 2A6, 2C9, 2C19, 2D6, 2E1 and 3A4/5 were incubated with human hepatic microsome preparations with or without specific inhibitors or tacrolimus and the metabolites were detected by high-pressure liquid chromatography (HPLC) or fluorimetric methods. All the specific inhibitors reduced or abolished the specific CYP activity. Tacrolimus had no effect on any CYP at concentrations below 1 microM, while at higher concentrations it had a mild inhibitory effect on CYP3A4 and 3A5. These observations suggest that tacrolimus is unlikely to potentiate the effect of coadministered drugs through inhibition of their metabolism in the liver.

Slow metabolism and long half life of methadone in a patient with lung cancer and cirrhosis

In a patient on methadone maintenance treatment, admitted for lung cancer suspicion, a slight decrease in pain dose response to morphine have necessitated adjustments of methadone treatment founded on clinical check-up and methadone assay. Plasma methadone concentrations were 4 fold higher than mean plasma concentration for control population at the same dose. Half-life was above 70 hours and clearance and metabolic index were strongly decreased. In this patient, daily dose methadone occurred in progressive accumulation and neuro-physiological tolerance without clinical incidence, except decrease in morphine effectiveness compared to our knowledge. Cancer, cirrhosis and adjuvant therapy contributions (fluconazole, omeprazole) to this original methadone kinetic are discussed. Methadone and morphine dose clinical adjustments are described. However, the main objective of this case report is focused on plasma methadone assay contribution to therapeutic adjustment of the interval dose in a single patient with a complex clinical situation.

Response of onion plants to arbuscular mycorrhizae : 2. Effects of nitrogen fertilization on biomass and bulb firmness

The effects of N fertilization on growth and root colonization of preinoculated onion (Allium cepa L. cv. Improved Autumn Spice) were studied. Onion transplants, inoculated with either Glomus intraradices, G. versiforme or nothing at sowing, were grown under three levels of N in soils which had either been irradiated, irradiated and amended with nonmycorrhizal microflora, or not irradiated. Interactions between inoculation and soil treatment had a significant effect on dry biomass and final bulb diameter. Control plants cultivated in non-irradiated natural soil grew normally because of the presence of indigenous arbuscular mycorrhizae, but control plants in irradiated soils were stunted. There was no such difference among inoculated plants. In non-irradiated natural soil, bulbs of onions inoculated with G. intraradices or G. versiforme were significantly firmer than bulbs of control plants. Bulb firmness decreased as N fertilization level increased. In non-irradiated natural soil, tissue P concentration of onion plants preinoculated with either fungus was significantly higher than that of control plants. In all soil types, N, P, and Zn concentrations were higher in onion plants colonized by G. versiforme than in those colonized by G. intraradices. The opposite was true of Mn tissue concentration.

Response of onion plants to arbuscular mycorrhizae : 2. Effects of nitrogen fertilization on biomass and bulb firmness

The effects of N fertilization on growth and root colonization of preinoculated onion (Allium cepa L. cv. Improved Autumn Spice) were studied. Onion transplants, inoculated with either Glomus intraradices, G. versiforme or nothing at sowing, were grown under three levels of N in soils which had either been irradiated, irradiated and amended with nonmycorrhizal microflora, or not irradiated. Interactions between inoculation and soil treatment had a significant effect on dry biomass and final bulb diameter. Control plants cultivated in non-irradiated natural soil grew normally because of the presence of indigenous arbuscular mycorrhizae, but control plants in irradiated soils were stunted. There was no such difference among inoculated plants. In non-irradiated natural soil, bulbs of onions inoculated with G. intraradices or G. versiforme were significantly firmer than bulbs of control plants. Bulb firmness decreased as N fertilization level increased. In non-irradiated natural soil, tissue P concentration of onion plants preinoculated with either fungus was significantly higher than that of control plants. In all soil types, N, P, and Zn concentrations were higher in onion plants colonized by G. versiforme than in those colonized by G. intraradices. The opposite was true of Mn tissue concentration.

[Drug interactions with antiretroviral agents]

Concomitant administration of three or more antiretroviral drugs is the standard treatment for HIV-infected patients. I.p. and NNRT are metabolized by cytochrome P450 and are inhibitors or inducers of CYP3A4. Therefore a number of drug-drug interactions are likely to occur. Ritonavir, a potent CYP3A4 inhibitor, is coadministered with saquinavir, indinavir and amprenavir to enhance their plasma concentrations and their virological efficacy. In contrast, nevirapine and efavirenz are CYP3A4 inducers, which warrant an increase in i.p. dosing. These properties lead to interactions with other drugs metabolized by CYP3A4 and a knowledge or the route of biotransformation is useful to avoid side-effects or decrease efficacy (as in the case of statine coadministration). Some important interactions can lead to contraindications such as coadministration of rifampicine, astemizole, ergot derivates or cizapride, as a large decrease or increase in concentration can lead to inefficacy or to major side-effects. Clinical trials and notification of side-effects are important to detect unpredictable interactions and to propose guidelines; such an example is therapeutic drug monitoring of methadone to avoid withdrawal syndrome when coadministered with ritonavir or nelfinavir.

Defective interleukin-1 receptor antagonist production is associated with resistance of acute liver graft rejection to steroid therapy

Thirty percent of acute liver graft rejection episodes are resistant to steroids. As interleukin-1 (IL-1) is an important target of steroid therapy, we examined the possible involvement of reduced sensitivity of IL-1 production to steroids or defective production of its antagonist, IL-1Ra. Patients were assessed during steroid-sensitive or -resistant rejection and 2 years later. In situ IL-1beta and IL-1Ra expression was evaluated by immunohistochemistry; their production was assayed by enzyme-linked immunosorbent assay and the gene polymorphisms by reverse transcriptase-polymerase chain reaction on blood cells. Hepatic IL-1beta and IL-1Ra expression were enhanced during rejection. IL-1 production and its inhibition by steroids were similar in steroid-responsive and steroid-resistant rejection. However, IL-1Ra production was lower in steroid-resistant than in steroid-responsive rejection, and this difference was still observed 2 years after rejection. IL-1beta and IL-1Ra gene polymorphisms did not differ between patients with and without steroid resistance. Low IL-1Ra production is associated with steroid resistance of acute rejection and is due to a constitutional defect. The early identification of such patients might qualify them for stronger anti-rejection therapy, including IL-1Ra.

Conversion from cyclosporin A to tacrolimus in pediatric liver transplantation

The dosing regimen for conversion from cyclosporin A (CsA) to tacrolimus immunosuppression was studied in 12 pediatric liver allograft recipients. Patients were stratified according to their age. Tacrolimus was started orally at a dosage of 0.05 mg/kg b.i.d., 12 h after stopping CsA administration and increased thereafter if needed. Tacrolimus and CsA concentrations were assayed by immunoassay using, respectively, an IMx and a TDx autoanalyzer (Abbott-France). Mean CsA concentration was in the therapeutic range 12 h prior to and at the time of introduction of tacrolimus. After 72 h of tacrolimus therapy, CsA concentrations were undetectable whereas mean tacrolimus concentration was 10.4 ng/mL with a mean dose of 0.09 mg/ kg b.i.d. The decline of CsA concentration was clearly biphasic. A slower decline in CsA concentration was detected after initiation of tacrolimus therapy, suggesting an inhibition of CsA metabolism by tacrolimus. No nephrotoxicity was observed. This dosage regimen allowed effective immunosuppression while avoiding additive nephrotoxicity.

Cytomegalovirus retinitis in advanced HIV-infected patients treated with protease inhibitors: incidence and outcome over 2 years

We prospectively studied the incidence of cytomegalovirus (CMV) retinitis in 93 patients treated with highly active antiretroviral therapy (HAART) containing a protease inhibitor (PI), during a median follow-up period of 24 months. The median initial CD4+ count was 22 cells/microl (range, 1-311 cells/microl), and the median plasma HIV viral load was 5.1 log10 copies/ml (range, 2.4-6.4 log10 copies/ml). The fundus was examined monthly in patients with a history of CMV retinitis or an initial CD4+ count <50 cells/microl and every 3 months in the other patients. Of patients with previously controlled CMV retinitis, 1 of 7 relapsed. In addition, 6 of 59 patients with a CD4+ count <50 cells/microl and no history of CMV retinitis before starting PI therapy developed CMV retinitis. Of them, 3 had at least one relapse during follow-up. CD4+ counts were <40 cells/microl at the time of primary or recurrent CMV retinitis, except in two cases (147 cells/microl and 203 cells/microl). In conclusion, the incidence of CMV retinitis was 0.091 per patient-year among study subjects with advanced HIV infection who were receiving HAART (95% confidence interval [CI], 0.037-0.145). The time to progression of CMV retinitis (mean, 215 days; 95% CI, 113-317 days) was longer than reported before widespread use of PIs.

In vitro effects of racemates, separate enantiomers and major metabolites of mefloquine and halofantrine on metoprolol biotransformation by rat liver microsomes

1. The effects of the anti-malarial drugs mefloquine and halofantrine and of their major metabolites on metoprolol metabolism by rat liver microsomes have been investigated. 2. The observed Km and Vmax, and the formation kinetics of alpha-hydroxymetoprolol and O-demethylmetoprolol, two major metoprolol metabolites, were in keeping with published data. 3. In vitro, mefloquine competitively inhibited metoprolol biotransformation, whereas halofantrine did so in a mixed fashion. The mefloquine Ki of metoprolol alpha-hydroxylation and O-demethylation were 3.4 and 5.8 microM respectively, whereas those of halofantrine were 0.15 and 0.32 microM respectively. 4. The main metabolites, N-debutylhalofantrine and carboxymefloquine, were 4-10-fold less inhibitory than the parent drugs. The difference in inhibitory potency of parent drugs and metabolites was higher for halofantrine than for mefloquine. The potency order for metoprolol metabolism inhibition was halofantrine >> mefloquine = N-debutylhalofantrine > carboxymefloquine. 5. A preliminary study with anti-malarial enantiomers showed a weak difference, in metoprolol metabolism inhibition between the enantiomers of halofantrine or mefloquine. 6. It is concluded that halofantrine is a potent inhibitor of metoprolol metabolism and that halofantrine metabolites or its enantiomers may have a different inhibitor potency than the parent drug: (1) the inhibition potency of these compounds should be studied in vitro and (2) their in vivo elimination half-life and plasma concentrations should be taken into be account to extrapolate this experimental results to in vivo.

Effect of selected antimalarial drugs and inhibitors of cytochrome P-450 3A4 on halofantrine metabolism by human liver microsomes

Halofantrine (HF) is used in the treatment of uncomplicated multidrug-resistant Plasmodium falciparum malaria. Severe cardiotoxicity has been reported to be correlated with high plasma concentrations of HF but not with that of its metabolite N-debutylhalofantrine. The aim of this study was to investigate the effects of other antimalarial drugs and of ketoconazole, a typical cytochrome P-450 3A4 inhibitor, on HF metabolism by human liver microsomes. Antimalarial drug inhibitory effects were ranked as follows: primaquine > proguanil > mefloquine > quinine > quinidine > artemether > amodiaquine. Artemisine, doxycycline, sulfadoxine, and pyrimethamine showed little or no inhibition of HF metabolism. Mefloquine, quinine, quinidine, and ketoconazole used at maximal plasma concentrations inhibited N-debutylhalofantrine formation noncompetitively with Ki values of 70 microM, 49 microM, 62 microM, and 0.05 microM resulting in 7%, 49%, 26%, and 99% inhibition, respectively, in HF metabolism. In conclusion, we showed that quinine and quinidine coadministered with HF might inhibit its metabolism resulting in the potentiation of HF-induced cardiotoxicity in patients. This requires a close monitoring of ECG. For the same reasons, the concomitant administration of HF and ketoconazole must be avoided. By contrast, none of the other antimalarials studied inhibited HF metabolism and, by extrapolation, cytochrome P-450 3A4 activity.

Glucuronidation of drugs by hepatic microsomes derived from healthy and cirrhotic human livers

Pharmacokinetic studies demonstrated that the decrease in drug biotransformation in hepatic failure depends on the metabolic pathways involved. To test whether glucuronidation reactions supported by UDP-glucuronosyltransferases are differentially affected in such conditions, we investigated the in vitro glucuronidation of four selected drugs and xenobiotics (zidovudine, oxazepam, lamotrigine, and umbelliferone) by using microsomes from human healthy and unhealthy (cirrhosis, hepatitis) livers as enzyme sources. Theses substances are glucuronidated by several UDP-glucuronosyltransferase isoforms. Lidocaine N-deethylation activity measured concomitantly was used as a positive control, because the inhibition of this reaction in patients with hepatic diseases is well documented. The metabolic clearances of zidovudine and lidocaine were decreased significantly in liver cirrhosis (0.17 versus 0.37 microliter/min/mg protein and 0.40 versus 2.73 microliter/min/mg protein, respectively) as a consequence of a decrease of their corresponding Vmax of metabolism. By contrast, the metabolic clearances of oxazepam, umbelliferone, and lamotrigine glucuronidation remained unchanged. Previous studies reported that the in vivo oral clearances of zidovudine and lidocaine were decreased by 70% and 60%, respectively, in cirrhotic livers, whereas those of lamotrigine and oxazepam were not affected. Consequently, it is likely that the in vitro metabolic data, which support the in vivo results, therefore could contribute to reasonably predict the level of impairment of hepatic clearance in patients with liver cirrhosis.

Halofantrine metabolism in microsomes in man: major role of CYP 3A4 and CYP 3A5

We have clarified the contribution of the different enzymes involved in the N-debutylation of halofantrine in liver microsomes in man. The effect of ketoconazole and cytochrome P450 (CYP) 3A substrates on halofantrine metabolism has also been studied. The antimalarial drug halofantrine is metabolized into one major metabolite, N-debutylhalofantrine. In microsomes from nine livers from man, N-debutylation of halofantrine was highly variable with apparent Michaelis-Menten constant V(max) and K(m) values of 215+/-172 pmol min(-1) mg(-1) and 48+/-26 micromol L(-1), respectively, (mean+/-standard deviation). Formation of N-debutylhalofantrine was cytochrome P450 (CYP)-mediated. Studies using selective inhibitors of individual CYPs revealed the role of CYP 3As in the formation of N-debutylhalofantrine. alpha-Naphthoflavone, a CYP 3A activator, increased metabolite formation. In microsomes from 12 livers from man the rate of N-debutylation of halofantrine correlated strongly with CYP 3A4 relative levels (P = 0.002) and less strongly, but significantly, with CYP 2C8 levels (P = 0.025). To characterize CYP-mediated metabolism of halofantrine further, incubations were performed with yeast microsomes expressing specific CYP 3A4, CYP 3A5, CYP 2D6, CYP 2C8 and CYP 2C19 from man. The rate of formation of N-debutylhalofantrine was six- and twelvefold with CYP 3A4 than with CYP 3A5 and CYP 2C8, respectively. CYP 2D6 and CYP 2C19 did not mediate the N-debutylation of halofantrine, but, because in-vivo CYP 2C8 is present at lower concentrations than CYP 3A in the liver in man, the involvement of CYP 3As would be predominant. Diltiazem, erythromycin, nifedipine and cyclosporin (CYP 3A substrates) inhibited halofantrine metabolism. Similarly, ketoconazole inhibited, non-competitively, formation of N-debutylhalofantrine with an inhibition constant, K(i), of 0.05 microM. The theoretical percentage inhibition of halofantrine metabolism in-vivo by ketoconazole was estimated to be 99%. These results indicate that both CYP 3A4 and CYP 3A5 metabolize halofantrine, with major involvement of CYP 3A4. In-vivo, the other CYPs have a minor role only. Moreover, strong inhibition, and consequently increased halofantrine cardiotoxicity, might occur with the association of ketoconazole or other CYP 3A4 substrates.

[Incidence and evaluation of viral retinitis in patients infected with the HIV virus and treated with HIV protease inhibitors]

BACKGROUND

Since the beginning of the use of HIV-Protease Inhibitors (PI) to treat HIV-infected patients, a decrease of the incidence of extraocular opportunistic infections has been observed. We studied the incidence of CMV-retinitis in patients treated with a highly active antitetroviral therapy (HAART) containing PI over a mean follow-up of 12 months.

METHODS

Ninety-three HIV-infected patients treated with HAART containing PI were included. The mean initial CD4+ cell-count was 54/microliter (median: 22/microliter), and the mean plasma HIV-load was 5.46 log 10 RNA-copies/ml. Fundus examination was performed each month in case of a previously treated and controlled CMV-retinitis or if initial CD4 cells were below 50/microliter. In other patients, fundus examination was performed every 3 months. The mean follow-up was 362 days.

RESULTS

Among the 7 patients with a previously treated and controlled CMV-retinitis, one experienced a progression during the study (after 163 days of PI). Among the 59 patients with CD4 cells below 50/microliter and without previous CMV-retinitis before the beginning of PI, 5 experienced a CMV-retinitis (mean delay after the onset of HAART: 141 days), including 2 with relapse. When retinitis occurred, CD4 cells were below 32/microliter except in one case (147/microliter).

CONCLUSIONS

Compared to previously published reports, this study showed an increase of the time to progression of previously treated and controlled CMV-retinitis in patients treated with PI. Considering deeply immunocompromised patients (less than 50 CD4-cells/microliter), the risk of suffering from CMV-retinitis was 8.5% after 12 months of PI treatment. Longer follow-up remains necessary to confirm these results.

Pharmacokinetics of tacrolimus (FK506) in paediatric liver transplant recipients

The pharmacokinetics of intravenous and oral tacrolimus was assessed in paediatric liver transplant patients at two centers in Europe. Sixteen patients, age 0.7 to 13 years, participated in the study; 12 patients were evaluable for intravenous pharmacokinetics, and 16 for oral. Intravenous tacrolimus was given as a continuous 24 h infusion (mean 0.037+/-0.013 mg/kg/day), and oral tacrolimus was given in 2 doses per day (mean 0.152+/-0.015 mg/kg). Whole blood samples for the intravenous pharmacokinetic profile were taken before initiation of the first infusion, 4, 8, 12 and 24 h post-infusion, and every 24 h thereafter until intravenous administration was discontinued. During the 12 h wash-out period between intravenous and oral administration, samples were taken every 3 h. Samples for the oral pharmacokinetic profile were taken immediately before the first oral dose and 0.5, 0.75, 1, 2, 2.5, 3, 4, 6, 8, 10 and 12 h post-administration. Non-compartmental procedures were used to characterise the pharmacokinetic parameters. Mean estimates for clearance and terminal half-life were 2.3+/-1.2 ml/min/kg and 11.5+/-3.8 h, respectively, following intravenous tacrolimus. The mean bioavailability of oral tacrolimus was 25+/-20%. A strong correlation was observed between AUC and trough whole blood levels of tacrolimus (r=0.90). The clearance was approximately 2-fold higher than that previously observed in adults; this could explain the higher dosage requirements in children.

FK 506 renal toxicity and lack of detectable cytochrome P-450 3A in the liver graft of a patient undergoing liver transplantation

Many commonly used drugs are substrates for hepatic cytochrome P-450 3A in human beings, and its role in the metabolism of potentially toxic immunosuppressants has been highlighted (cyclosporine, FK 506). One hundred fifty human liver grafts were biopsied before and after liver transplantation, and levels of cytochromes P-450 3A, 1A2, 2D6 and 2C were estimated by means of the Western-blot technique and correlated with histological appearance, glycogen content and clinical course. In 15 of the grafts, cyclosporine oxidase was also measured, and in 12 of 15 recipients, urinary 6 beta-hydroxycortisol excretion was assayed. A wide range of cytochrome P-450 3A values were observed (25 to 366 arbitrary units/mg; mean, 105 +/- 63 arbitrary units/mg). In one graft (no. 730) no cytochrome P-450 3A was detectable on immunoblotting, despite increasing homogenate concentrations. In this sample, cytochromes P-450 1A2, 2D6, and 2C were present in normal ranges. Levels of cyclosporine oxidase and 6 beta-hydroxycortisol in the urine specimens of the recipient were found to be low. The recipient of graft 730 experienced reversible complications of FK 506 therapy despite adherence to the administration protocol and drug plasma level in the normal range. The subsequent appearance of the cytochrome P-450 3A was associated with the consequent tolerance of oral FK 506. The absence of detectable amounts of P-450 3A in one biopsy from a donated human liver graft dramatically emphasizes the extreme range of this enzyme levels and has important clinical implications.

Penile prosthesis surgery with the patient under local regional anesthesia

A total of 20 patients underwent penile prosthesis implantation while under local regional anesthesia with a pudendal nerve blockade at the perineum. The method is safe, performed as an outpatient procedure and showed no complication. It avoids the need to inject a local anesthetic intracorporeally, which is risky in elderly patients.

Long-term culture of adult rat hepatocyte spheroids

Hepatocytes from adult rats were cultured on poly-HEMA-coated surface to form spheroids in hormonally defined media as previously shown with newborn rat hepatocytes. Spheroidal aggregates of adult rat hepatocytes were morphologically similar to those of newborn rat hepatocytes and could also form a monolayer of uniform liver parenchyma-like cells when transferred on collagen-coated surfaces even after 2 months of culture. Under these culture conditions, albumin and transferrin secreted in vitro by adult rat hepatocyte spheroids were detectable by immunoprecipitation method at least until 2 months of culture. The production of proteins by hepatocyte spheroids could be regulated in vitro by IL-6: the secretion of alpha 2-macroglobulin was increased and the secretion of albumin was decreased in the presence of this cytokine. In addition, cytochrome P450 IA1 was strongly induced by methylcholanthrene in adult rat hepatocyte spheroids, and the induction remained relatively constant up to 22 days of culture. These cells were also able to metabolize lidocaine to monoethylglycinexylidine when measured up to 14 days of culture, showing the presence of a relatively high level of P450 IIIA2. The UDP-glucuronyltransferase activity, specific for bilirubin conjugation, decreased to 18% of the initial value after 2 weeks of culture. This work showed that adult rat hepatocytes in long-term spheroid culture kept differentiated functions, providing a new model for the in vitro study of hepatocyte functions and complementing that of newborn rat hepatocytes using the same system.

Abondance relative et diversité des Endogonacées dans un sol de verger du Québec

Studies of soil samples from an apple orchard in Frelighsburg revealed the presence of seven species of Endogonaceae, six of which generated vesicular and arbuscular mycorrhizae on Tagetes erecta L. While Glomus constrictum Trappe, Glomus mosseae (Nicol. & Gerd.) Gerd. & Trappe, and Sclerocystis rubiformis Gerd. & Trappe made up more than 90% of the organisms observed, Gigaspora calospora (Nicol. & Gerd.) Gerd. & Trappe, Glomus aggregatum Schenck & Smith, and Glomus etunicatum were seen in approximately half of the samples. An enumeration of the Endogonaceae observed is followed herein by a discussion dealing with the frequency and the relative abundance of these species in the soil and with the practical interest which arises from this type of survey.