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Opazo-Toro V, Fortuna V, Jiménez W, Pazos López M, Royo MJM, Ventura-Abreu N, Brunet M, Milla E. Genotype and Phenotype Influence the Personal Response to Prostaglandin Analogues and Beta-Blockers in Spanish Glaucoma and Ocular Hypertension Patients. Int J Mol Sci 2023; 24:ijms24032093. [PMID: 36768422 PMCID: PMC9916755 DOI: 10.3390/ijms24032093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
Analysis of the genotype that predicts the phenotypic characteristics of a cohort of glaucoma and ocular hypertension patients, and the correlation with their personal pharmacological response to beta-blockers (BB) and prostaglandin analogues (PGA). Prospective study that included 139 eyes from 72 patients under BB and/or PGA treatment, and in some cases other types of ocular hypotensive treatments. Five single-nucleotide polymorphisms were genotyped by real-time PCR assays: prostaglandin-F2α receptor (rs3766355, rs3753380); cytochrome-P450 2D6 (rs16947, rs769258); and beta-2-adrenergic receptor (rs1042714). Other studied variables were mean deviation (MD) of visual field, previous ocular interventions, medical treatment, baseline (bIOP), and treated intraocular pressure (tIOP). From a total of 139 eyes, 71 (51.1%) were left eyes. The main diagnosis was primary open angle glaucoma (66.2%). A total of 57 (41%) eyes were under three or more medications (PGA + BB + other) and, additionally, 57 eyes (41%) had had some kind of glaucoma surgery. The mean bIOP and tIOP were 26.55 ± 8.19 and 21.01 ± 5.54 mmHg, respectively. Significant differences in tIOP were found between heterozygous (HT) (21.07 ± 0.607 mmHg) and homozygous (HM) (20.98 ± 0.639 mmHg) rs3766355 with respect to wildtype individuals (16 ± 1.08 mmHg) (p = 0.031). The MD values presented significant differences between wildtype rs3766355 (-2 ± 2.2 dB), HT (-3.87 ± 4 dB), and HM carriers (-9.37 ± 9.51 dB) (p = 0.009). Significant differences were also observed between the MD in wildtype rs3753380 (-6.1 ± 8.67 dB), HT (-9.02 ± 8.63 dB), and HM carriers (-9.51 ± 7.44 dB) (p = 0.017). Patients carrying the variant rs3766355 in HM or HT presented clinically-significantly higher tIOP than wildtype patients. Additionally, some differences in MD were found in rs3766355 and rs3753380 carriers, and the more alleles that were affected, the worse the MD value, meaning greater severity of the glaucoma. Poor response to treatment and more visual field damage may be associated with being a carrier of these mutated alleles.
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Affiliation(s)
- Valeria Opazo-Toro
- Glaucoma Unit, Instituto Oftalmologico Integral, C/María Auxiliadora 25, 08017 Barcelona, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center, Hospital Clinic Barcelona, University of Barcelona, 08007 Barcelona, Spain
| | - Wladimiro Jiménez
- Biochemistry and Molecular Genetics Service, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, 08036 Barcelona, Spain
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Correspondence:
| | - Marta Pazos López
- Glaucoma Unit, Institut Clínic d’Oftalmologia, Hospital Clínic, 08036 Barcelona, Spain
| | | | | | - Mercè Brunet
- Biochemistry and Molecular Genetics Service, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, 08036 Barcelona, Spain
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Elena Milla
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Glaucoma Unit, Institut Clínic d’Oftalmologia, Hospital Clínic, 08036 Barcelona, Spain
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Millán O, Ruiz P, Fortuna V, Navasa M, Brunet M. Nuclear factor of activated T cells as potential pharmacodynamic biomarker for the risk of acute and subclinical rejection in de novo liver recipients. Liver Int 2020; 40:931-946. [PMID: 31883422 DOI: 10.1111/liv.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Nuclear factor of activated T cell-regulated gene expression (NFAT-RGE) has been proposed as a pharmacodynamic biomarker for tacrolimus (Tac) and cyclosporine (CsA). Our aim was to evaluate the role of NFAT-RGE in modulating intralymphocytary IL-2 and IFN-γ expression and its clinical utility as an early non-invasive predictive biomarker for the risk of acute rejection (AR) and infection in de novo liver transplant (LT) recipients. METHODS Fifty-six LT recipients treated with Tac or CsA [with and without mycophenolate mofetil (MMF)] were included: 30 free of rejection or infection, 11 rejectors (T cell-mediated acute rejection), 5 with subclinical rejection (SCR) and 10 with cytomegalovirus (CMV) infection. Within the first 3 months after transplantation, NFAT-RGE of IL-2, IFN-γ and GM-CSF and intralymphocytary synthesis of IL-2 and IFN-γ were evaluated by real-time PCR and flow cytometry respectively. RESULTS A significant increase in NFAT-RGE was observed in patients who experienced TCMAR (75% [42-100%]) or SCR (41% [18-78%]) compared with patients without rejection or infection (14% [2-23%]). Positive correlations between the %NFAT-RGE-IFN and both the %CD8CD69IFN-γ and %CD4CD69IFN-γ and between the %NFAT-RGE-IL2 and the %CD8CD69IL2 were observed. NFAT-RGE was significantly lower in CMV+ patients than in non-infected patients. Finally, an inverse correlation between the Tac or CsA concentration and inhibition of NFAT-RGE were observed. CONCLUSIONS Sequential post-transplantation NFAT-RGE monitoring combined with intralymphocytary IL-2 and IFN-γ before transplantation and at the first and third month post-transplantation may be key predictive and diagnostic biomarkers for the risk of TCMAR and SCR and better guide CNi therapy in LT patients.
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Affiliation(s)
- Olga Millán
- Biomedical Research Centre in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Pablo Ruiz
- Liver Transplant Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- Biomedical Research Centre in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Transplant Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Biomedical Research Centre in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Millán O, Ruiz P, Orts L, Ferré P, Crespo G, Santana M, Fortuna V, Quintairos L, Navasa M, Brunet M. Monitoring of miR-181a-5p and miR-155-5p Plasmatic Expression as Prognostic Biomarkers for Acute and Subclinical Rejection in de novo Adult Liver Transplant Recipients. Front Immunol 2019; 10:873. [PMID: 31068943 PMCID: PMC6491707 DOI: 10.3389/fimmu.2019.00873] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/05/2019] [Indexed: 12/26/2022] Open
Abstract
Background and Aims: News strategies for the accurate assessment of the state of immunosuppression (IS) in liver transplant recipients are needed to prevent rejection and minimize drug-related side effects. miRNAs can potentially be used as diagnostic or prognostic biomarkers in transplant patients. This study evaluated the capacity of a plasmatic miRNA panel (miR-155-5p, miR-122-5p, miR-181a-5p, and miR148-3p) as an early non-invasive prognostic and diagnostic biomarker for T cell-mediated acute rejection (TCMAR) and subclinical rejection (SCR) in adult liver recipients. Methods: A total of 145 liver recipients were included. All patients received a calcineurin inhibitor with or without mycophenolate mofetil and methylprednisolone. Plasmatic miRNA expression was assessed by qPCR before and at different time-points after liver transplantation. Results: Seventeen patients experienced TCMAR, and eight were diagnosed with SCR during the protocol biopsy at the 3rd month post-transplantation. Pre-transplantation, miR-155-5p expression was significantly higher in TCMAR patients and in SCR patients than in non-rejectors, and miR-181a-5p expression was also significantly higher in SCR patients than in non-rejectors. Post-transplantation, before transaminase-level modification, significantly increased miR-181a-5p, miR-155-5p, and miR-122-5p expression was observed in TCMAR and SCR patients. Binary logistic regression analyses showed, post-transplantation, that TCMAR risk was better predicted by individual expression of miR-181a-5p (LOGIT = -6.35 + 3.87*miR-181a-5p), and SCR risk was better predicted by the combination of miR-181a-5p and miR-155-5p expression (LOGIT = -5.18 + 2.27*miR-181a-5p+1.74*miR-155-5p). Conclusions: Pre-transplantation plasmatic miR-155-5p expression may be useful for stratifying low-immunologic-risk patients, and post-transplantation miR-181a-5p and miR-155-5p may be candidates for inclusion in early, non-invasive prognostic biomarker panels to prevent TCMAR or SCR and better identify patient candidates for IS minimization. Large prospective randomized multicenter trials are needed to refine the cut-off values and algorithms and validate the clinical usefulness of these biomarkers.
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Affiliation(s)
- Olga Millán
- Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Center (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Pablo Ruiz
- Liver Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lara Orts
- Liver Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Paula Ferré
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Center (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Gonzalo Crespo
- Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miguel Santana
- Liver Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Center (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Luís Quintairos
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Center (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miguel Navasa
- Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Pharmacology and Toxicology, Biochemistry and Molecular Genetics, Biomedical Diagnostic Center (CDB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Espinosa-Martínez L, Fortea A, Oriolo G, González-Rodríguez A, Brunet M, Fortuna V, Parellada E. Antipsychotic therapy amongst Cytochrome P450 2D6 poor metabolizers in the clinical practice: A case report. Actas Esp Psiquiatr 2017; 45:248-255. [PMID: 29044450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Laura Espinosa-Martínez
- Departamento de Psiquiatría y Psicología, Instituto de Neurociencias, Hospital Clínic. Barcelona, España
| | - Adriana Fortea
- Departamento de Psiquiatría y Psicología, Instituto de Neurociencias, Hospital Clínic. Barcelona, España
| | - Giovanni Oriolo
- Departamento de Psiquiatría y Psicología, Instituto de Neurociencias, Hospital Clínic. Barcelona, España
| | - Alexandre González-Rodríguez
- Barcelona Clinic Schizophrenia Unit (BCSU), Instituto de Neurociencias, Hospital Clínic de Barcelona, Universidad de Barcelona. Barcelona, España
| | - Mercè Brunet
- Unitat de Farmacologia i Toxicologia. Centre de Diagnòstic Biomèdic, Hospital Clínic. Barcelona, España
| | - Virginia Fortuna
- Unitat de Farmacologia i Toxicologia. Centre de Diagnòstic Biomèdic, Hospital Clínic. Barcelona, España
| | - Eduard Parellada
- Departamento de Psiquiatría y Psicología, Instituto de Neurociencias, Hospital Clínic. Barcelona, España Barcelona Clinic Schizophrenia Unit (BCSU), Instituto de Neurociencias, Hospital Clínic de Barcelona, Universidad de Barcelona. Barcelona, España Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS). Barcelona, España Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Barcelona, España
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Millán O, Jiménez O, Fortuna V, Barceló J, Brunet M. Role of FK778 Alone or in Combination with Tacrolimus or mTOR Inhibitors as an Immunomodulator of Immunofunctions: In Vitro Evaluation of T Cell Proliferation and the Expression of Lymphocyte Surface Antigens. Int J Immunopathol Pharmacol 2016. [DOI: 10.1177/039463200601900209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We evaluated the in vitro capacity of FK778, alone or in combination with other immunosuppressive drugs: Tacrolimus (TRL); Sirolimus (SRL), Everolimus (EVL), to inhibit clonal expansion of T-lymphocytes and expression of lymphocyte-activation surface antigens; secondly, we compared the immunosuppressive potential of FK778 combined with TRL, SRL and EVL with the same combinations using Mycophenolic acid (MPA) as antimetabolite. Lymphocyte proliferation was assessed by 3H-Thymidine incorporation, in whole blood cultures stimulated with ConA. The effect of FK778 on alloresponse was evaluated by MLC and the expression of lymphocyte surface antigens by cytometry. FK778, TRL, SRL and EVL showed a high in vitro capacity to inhibit lymphocyte proliferation in a concentration-dependent way. Combinations of FK778 with TRL, SRL, or EVL presented an additive effect, especially FK778+TRL. Similar inhibition capacity of the clonal expansion was observed, when FK778 was combined with TRL, SRL or EVL, respecting the same combinations but using MPA instead of FK778. In addition, FK778 inhibited the expression of lymphocyte surface antigens involved in activation, co-stimulatory and apoptosis signals. In conclusion, FK778 inhibits the proliferative response induced by mitogeneic and allogeneic stimuli and the expression of surface antigens. Combinations of FK778 with TRL or mTOR inhibitors presented an additive effect and their action on T cell proliferation was similar to that of combinations with MPA. Since FK778, TRL and mTOR inhibitors present different action mechanisms and involve different cellular targets, these combinations may help prevent episodes of allorejection in organ transplants. FK778 and mTOR inhibitors may represent an alternative treatment for patients with renal failure.
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Affiliation(s)
| | | | | | - J.J. Barceló
- Servicio de Inmunología, IDIBAPS, Hospital Clínic, Universitat de Barcelona, Spain
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Boix F, Millan O, San Segundo D, Mancebo E, Rimola A, Fabrega E, Fortuna V, Mrowiec A, Castro-Panete MJ, Peña JDL, Llorente S, Minguela A, Bolarin JM, Paz-Artal E, Lopez-Hoyos M, Brunet M, Muro M. High expression of CD38, CD69, CD95 and CD154 biomarkers in cultured peripheral T lymphocytes correlates with an increased risk of acute rejection in liver allograft recipients. Immunobiology 2016; 221:595-603. [PMID: 26850323 DOI: 10.1016/j.imbio.2016.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023]
Abstract
The mayor goal still outstanding into the solid organ transplantation field involves the search of surrogate biomarkers able to predict several clinical events, such as acute rejection (AR) or opportunistic infection. In the present multicenter study, a series of interesting surface antigens with important activator or inhibitory immune functions on cultured peripheral T cells were monitored in liver transplant recipients drawn at baseline and up to one year after transplantation. Sixty-four patients were included in the multicenter study during 3 years. Pre- and post-transplantation surface antigens levels displayed significant differences between AR and non acute rejection (NAR) groups, and also this differential expression was used to construct a risk predictive model based on a composite panel of outcome biomarkers (CD38, CD69, CD95 and CD154). The model was able to stratify these patients at high risk of AR. These preliminary results could provide basic information to improve the immunosuppressive treatment and it might better help to predict AR episodes.
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Affiliation(s)
- Francisco Boix
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Olga Millan
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - David San Segundo
- Immunology Service, University Hospital ́Marques Valdecillá-IDIVAL, Santander, Spain
| | - Esther Mancebo
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Antoni Rimola
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain
| | - Emilio Fabrega
- Digestive Medicine, University Hospital ́Marques de Valdecillá-IDIVAL, Santander, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain
| | - Anna Mrowiec
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Maria J Castro-Panete
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Jesus de la Peña
- Pathology Service, Clinical University Hospital ́Virgen de la Arrixacá, Murcia, Spain
| | - Santiago Llorente
- Nephrology Service, Clinical University Hospital ́Virgen de la Arrixacá, Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Jose M Bolarin
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Estela Paz-Artal
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Marcos Lopez-Hoyos
- Immunology Service, University Hospital ́Marques Valdecillá-IDIVAL, Santander, Spain
| | - Mercé Brunet
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Manuel Muro
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Casals G, Hernández C, Hidalgo S, Morales B, López-Púa Y, Castro P, Fortuna V, Martínez JA, Brunet M. Development and validation of a UHPLC diode array detector method for meropenem quantification in human plasma. Clin Biochem 2014; 47:223-7. [PMID: 25128839 DOI: 10.1016/j.clinbiochem.2014.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/11/2014] [Accepted: 08/02/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Meropenem is a β-lactam antibiotic frequently used to treat serious infections in intensive care unit patients. The main objective was to develop and validate a sensitive and specific ultra high performance liquid chromatography method with photodiode array detection for the quantitation of meropenem in human plasma. The applicability of the method for meropenem monitoring was also examined. DESIGN AND METHODS The validation of the method was performed following the FDA's guidelines for bioanalytical methods. In parallel, the method was applied for monitoring meropenem in forty plasma samples from ten critically ill patients treated intravenously at a total dose of 1 g. Drug levels were measured in each patient at 0 h, 2 h, 4 h and 8 h after meropenem infusion. RESULTS With this method, intraday and day-to-day variation was below 10%; intraday and day-to-day accuracy was between 94% and 114%; the limit of quantification was 0.5 μg/mL and recovery was above 70%. The method was successfully applied to quantitate meropenem concentrations and the results showed significant pharmacokinetic interindividual variability. Of special interest is that 50% of treated patients had meropenem plasma levels below the minimum inhibitory concentration at 8h after the start of infusion, which was strongly related to creatinine clearance >60 mL/min. CONCLUSIONS The method meets the requirements to be applied for meropenem concentration measurements in pharmacokinetics studies and clinical routine. The results suggest the need for therapeutic drug monitoring of meropenem in treated critically-ill patients.
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Affiliation(s)
- Gregori Casals
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics, Centro de Diagnóstico Biomédico, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Hospital Clínic de Barcelona, Barcelona University, C/Villarroel 170, 08036 Barcelona, Spain.
| | - Cristina Hernández
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain
| | - Susana Hidalgo
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics, Centro de Diagnóstico Biomédico, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Hospital Clínic de Barcelona, Barcelona University, C/Villarroel 170, 08036 Barcelona, Spain
| | - Blai Morales
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics, Centro de Diagnóstico Biomédico, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Hospital Clínic de Barcelona, Barcelona University, C/Villarroel 170, 08036 Barcelona, Spain
| | - Yolanda López-Púa
- Direcció de Qualitat i Seguretat Clínica, Hospital Clínic, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics, Centro de Diagnóstico Biomédico, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Hospital Clínic de Barcelona, Barcelona University, C/Villarroel 170, 08036 Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain
| | - Mercè Brunet
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics, Centro de Diagnóstico Biomédico, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Hospital Clínic de Barcelona, Barcelona University, C/Villarroel 170, 08036 Barcelona, Spain
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Millán O, Rafael-Valdivia L, Torrademé E, López A, Fortuna V, Sánchez-Cabus S, López-Púa Y, Rimola A, Brunet M. Intracellular IFN-γ and IL-2 expression monitoring as surrogate markers of the risk of acute rejection and personal drug response in de novo liver transplant recipients. Cytokine 2012; 61:556-64. [PMID: 23265966 DOI: 10.1016/j.cyto.2012.10.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/26/2012] [Accepted: 10/27/2012] [Indexed: 01/09/2023]
Abstract
Biomarker monitoring is needed in transplantation to reflect individual response to immunosuppressive drugs and graft outcome. We evaluated intracellular expression and soluble production of interferon-(IFN)-γ and interleukin-(IL)-2 as predictive biomarkers of acute rejection (AR) and personal drug response. Pharmacokinetic-pharmacodynamic profiles were determined in 47 de novo liver recipients treated with tacrolimus, mycophenolate mofetil and prednisone. Of the 47 patients, AR occurred in nine. There were no differences in drug concentrations between rejectors and non-rejectors. A pre-transplantation cut-off value of 55.80% for %CD8(+)-IFN-γ(+) identified patients at high risk of AR with a sensitivity of 75% and a specificity of 82%. In the first week post-transplantation, patients with a % inhibition for soluble IFN-γ, %CD8(+)-IFN-γ(+) and %CD8(+)-IL2(+) lower than 40% developed AR, showing low susceptibility to immunosuppressive drugs. Therefore, effector-T-cell response monitoring may help physicians to identify personal response to treatment and patients at high risk of AR.
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Affiliation(s)
- O Millán
- Farmacología y Toxicología, Centro de Diagnóstico Biomédico, IDIBAPS, Hospital Clínico, Universidad de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
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Millán O, Jiménez O, Fortuna V, Barceló JJ, Brunet M. Role of FK778 alone or in combination with tacrolimus or mTOR inhibitors as an immunomodulator of immunofunctions: in vitro evaluation of T cell proliferation and the expression of lymphocyte surface antigens. Int J Immunopathol Pharmacol 2006; 19:317-30. [PMID: 16831299] [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: 05/10/2023] Open
Abstract
We evaluated the in vitro capacity of FK778, alone or in combination with other immunosuppressive drugs: Tacrolimus (TRL); Sirolimus (SRL), Everolimus (EVL), to inhibit clonal expansion of T-lymphocytes and expression of lymphocyte-activation surface antigens; secondly, we compared the immunosuppressive potential of FK778 combined with TRL, SRL and EVL with the same combinations using Mycophenolic acid (MPA) as antimetabolite. Lymphocyte proliferation was assessed by 3H-Thymidine incorporation, in whole blood cultures stimulated with ConA. The effect of FK778 on alloresponse was evaluated by MLC and the expression of lymphocyte surface antigens by cytometry. FK778, TRL, SRL and EVL showed a high in vitro capacity to inhibit lymphocyte proliferation in a concentration-dependent way. Combinations of FK778 with TRL, SRL, or EVL presented an additive effect, especially FK778+TRL. Similar inhibition capacity of the clonal expansion was observed, when FK778 was combined with TRL, SRL or EVL, respecting the same combinations but using MPA instead of FK778. In addition, FK778 inhibited the expression of lymphocyte surface antigens involved in activation, co-stimulatory and apoptosis signals. In conclusion, FK778 inhibits the proliferative response induced by mitogeneic and allogeneic stimuli and the expression of surface antigens. Combinations of FK778 with TRL or mTOR inhibitors presented an additive effect and their action on T cell proliferation was similar to that of combinations with MPA. Since FK778, TRL and mTOR inhibitors present different action mechanisms and involve different cellular targets, these combinations may help prevent episodes of allorejection in organ transplants. FK778 and mTOR inhibitors may represent an alternative treatment for patients with renal failure.
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Affiliation(s)
- O Millán
- Pharmacology Laboratory (CDB), Hospital Clinic, University of Barcelona, C/Villaroel 170, 08036 Barcelona, Spain
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Brunet M, Millán O, Jiménez O, Campistol JM, Vidal E, Rojo I, Oppenheimer F, Fortuna V, Martorell J. New concepts in cyclosporine pharmacokinetic and dynamic monitoring: the impact of concomitant immunosuppression on target C2 concentrations. Transplant Proc 2004; 36:437S-441S. [PMID: 15041382 DOI: 10.1016/j.transproceed.2003.12.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a correlation between cyclosporine (CsA) pharmacokinetics (PK) and pharmacodynamics (PD), especially 2 hours after drug administration. AIM To evaluate the relationship between CsA PK and PD profiles in two groups of stable renal transplant patients treated with CsA alone or CsA plus mycophenolate mofetil (CsA+MMF), so as to define the best target for C2 and clarify the impact of concomitant immunosuppression. METHODS Thirty-eight stable renal transplant recipients were treated with CsA (n=20) or CsA+MMF (n=18). Twelve nontreated normal healthy controls (NHC) were also included. Calcineurin activity (CNa), IL-2 production, and CsA levels were measured at 0 and 2 hours postdose. RESULTS There were no significant differences in median CsA C2 values and CNa between the CsA alone and the CsA+MMF groups (388 microg/L and 497.5 microg/L and CNa 2h; 3.92% alkaline phosphatase [AP]; 3.94% AP, respectively). In vitro production of IL-2 was significantly lower in the CsA+MMF group than in the CsA group (median IL-2 2h: 280.52 ng/L, 169.48 ng/L, P<.001). The correlations (r) between C2 and CNa 2h were: CsA r=0.74; CsA+MMF r=0.84 (P<.001 in both cases). CONCLUSIONS In stable renal transplant patients, median CsA C2 values below 500 microg/L were associated with inhibition of CNa and IL-2 synthesis. CNa and IL-2 production may be good biological markers of CsA immunosuppression. The measurement of CNa depends mainly on CsA concentration, whereas in vitro IL-2 production reflects the effect of both CsA and MMF. Further studies are necessary to define the optimal C2 target concentration and the possible impact of concomitant immunosuppression.
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Affiliation(s)
- M Brunet
- Department of Servei de Farmacologia y Toxicologia, IDIBAPS, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
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Berlescu ME, Andrei R, Fortuna V, Gottlieb H. [Current assessments of electroconvulsive therapy]. Rev Med Chir Soc Med Nat Iasi 1990; 94:91-3. [PMID: 2075344] [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: 12/30/2022]
Abstract
As the therapeutical effects of the current psychopharmacotherapy did not live up the expectations, in the last 10-15 years a tendency towards up-to-dating some older therapeutical methods, restrained for various reasons, was noticed. The up-to-dated electroconvulsive therapy proves to be highly efficient in some major mental affections. This paper is intended as a review of the literature and seems to reveal some advantages of the electroconvulsive therapy as compared to some chemotherapeutic agents, but only if used in precisely restricted specific conditions.
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Teodorescu F, Moisa O, Boişteanu P, Fortuna V, Serban F. [The dynamics of ethanol metabolism in patients with chronic alcoholism]. Rev Med Chir Soc Med Nat Iasi 1989; 93:699-703. [PMID: 2636771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The results of the investigations carried out in alcoholics and nonalcoholics regarding certain aspects of ethanol metabolism are presented. The marked interindividual differences in alcohol blood levels and intergroup differences in acetaldehyde levels, through a projection in dynamic process, are commented upon. The programmed ethanolic load induced changes in blood alcohol, within comparable limits, irrespective of subjects' state. At all intervals of postintake determinations, the acetaldehyde concentrations were higher in the alcoholic subjects. No dose-effect relation between the involved elements (ethanol metabolite) was found.
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Maione G, Fortuna V, Pepe P, Cicia S, Del Prete M. [Carcinoma of the male urethra. Considerations on a clinical case]. Minerva Urol 1982; 34:121-6. [PMID: 7110094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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