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Docci L, Milani N, Ramp T, Romeo AA, Godoy P, Franyuti DO, Krähenbühl S, Gertz M, Galetin A, Parrott N, Fowler S. Exploration and application of a liver-on-a-chip device in combination with modelling and simulation for quantitative drug metabolism studies. Lab Chip 2022; 22:1187-1205. [PMID: 35107462 DOI: 10.1039/d1lc01161h] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Microphysiological systems (MPS) are complex and more physiologically realistic cellular in vitro tools that aim to provide more relevant human in vitro data for quantitative prediction of clinical pharmacokinetics while also reducing the need for animal testing. The PhysioMimix liver-on-a-chip integrates medium flow with hepatocyte culture and has the potential to be adopted for in vitro studies investigating the hepatic disposition characteristics of drug candidates. The current study focusses on liver-on-a-chip system exploration for multiple drug metabolism applications. Characterization of cytochrome P450 (CYP), UDP-glucuronosyl transferase (UGT) and aldehyde oxidase (AO) activities was performed using 15 drugs and in vitro to in vivo extrapolation (IVIVE) was assessed for 12 of them. Next, the utility of the liver-on-a-chip for estimation of the fraction metabolized (fm) via specific biotransformation pathways of quinidine and diclofenac was established. Finally, the metabolite identification opportunities were also explored using efavirenz as an example drug with complex primary and secondary metabolism involving a combination of CYP, UGT and sulfotransferase enzymes. A key aspect of these investigations was the application of mathematical modelling for improved parameter calculation. Such approaches will be required for quantitative assessment of metabolism and/or transporter processes in systems where medium flow and system compartments result in non-homogeneous drug concentrations. In particular, modelling was used to explore the effect of evaporation from the medium and it was found that the intrinsic clearance (CLint) might be underestimated by up to 40% for low clearance compounds if evaporation is not accounted for. Modelling of liver-on-a-chip in vitro data also enhanced the approach to fm estimation allowing objective assessment of metabolism models of different complexity. The resultant diclofenac fm,UGT of 0.64 was highly comparable with values reported previously in the literature. The current study demonstrates the integration of mathematical modelling with experimental liver-on-a-chip studies and illustrates how this approach supports generation of high quality of data from complex in vitro cellular systems.
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Affiliation(s)
- Luca Docci
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
- Clinical Pharmacology & Toxicology, University Hospital, Schanzenstrasse 55, 4031, Basel, Switzerland
| | - Nicolò Milani
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
- Centre for Applied Pharmacokinetic Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Thomas Ramp
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Andrea A Romeo
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Patricio Godoy
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Daniela Ortiz Franyuti
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Stephan Krähenbühl
- Clinical Pharmacology & Toxicology, University Hospital, Schanzenstrasse 55, 4031, Basel, Switzerland
| | - Michael Gertz
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Aleksandra Galetin
- Centre for Applied Pharmacokinetic Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Neil Parrott
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Stephen Fowler
- Pharmaceutical Sciences, Roche Pharma Research and Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, 4070, Basel, Switzerland.
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Wang Z, Paragas EM, Nagar S, Korzekwa K. Complex Cytochrome P450 Kinetics Due to Multisubstrate Binding and Sequential Metabolism. Part 1. Theoretical Considerations. Drug Metab Dispos 2021; 49:1090-1099. [PMID: 34503952 PMCID: PMC11022900 DOI: 10.1124/dmd.121.000553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
Complexities in P450-mediated metabolism kinetics include multisubstrate binding, multiple-product formation, and sequential metabolism. Saturation curves and intrinsic clearances were simulated for single-substrate and multisubstrate models using derived velocity equations and numerical solutions of ordinary differential equations (ODEs). Multisubstrate models focused on sigmoidal kinetics because of their dramatic impact on clearance predictions. These models were combined with multiple-product formation and sequential metabolism, and simulations were performed with random error. Use of single-substrate models to characterize multisubstrate data can result in inaccurate kinetic parameters and poor clearance predictions. Comparing results for use of standard velocity equations with ODEs clearly shows that ODEs are more versatile and provide better parameter estimates. It would be difficult to derive concentration-velocity relationships for complex models, but these relationships can be easily modeled using numerical methods and ODEs. SIGNIFICANCE STATEMENT: The impact of multisubstrate binding, multiple-product formation, and sequential metabolism on the P450 kinetics was investigated. Numerical methods are capable of characterizing complicated P450 kinetics.
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Affiliation(s)
- Zeyuan Wang
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Erickson M Paragas
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Swati Nagar
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Ken Korzekwa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
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Green TP, Binns HJ, Wu H, Ariza AJ, Perrin EM, Quadri M, Hornik CP, Cohen‐Wolkowiez M. Estimation of Body Fat Percentage for Clinical Pharmacokinetic Studies in Children. Clin Transl Sci 2021; 14:509-517. [PMID: 33142010 PMCID: PMC7993323 DOI: 10.1111/cts.12896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
Obesity is a prevalent childhood condition and the degree of adiposity appears likely to be an important covariate in the pharmacokinetics (PKs) of many drugs. We undertook these studies to facilitate the evaluation and, where appropriate, quantification of the covariate effect of body fat percentage (BF%) on PK parameters in children. We examined two large databases to determine the values and variabilities of BF% in children with healthy body weights and in those with obesity, comparing the accuracy and precision of BF% estimation by both clinical methods and demographically derived techniques. Additionally, we conducted simulation studies to evaluate the utility of the several methods for application in clinical trials. BF% was correlated with body mass index (BMI), but was highly variable among both children with healthy body weights and those with obesity. Bio-impedance and several demographically derived techniques produced mean estimates of BF% that differed from dual x-ray absorptiometry by < 1% (accuracy) and a SD of 5% or less (precision). Simulation studies confirmed that when the differences in precision among the several methods were small compared with unexplained between-subject variability of a PK parameter, the techniques were of similar value in assessing the contribution of BF%, if any, as a covariate for that PK parameter. The combination of sex and obesity stage explained 68% of the variance of BF% with BMI. The estimation of BF% from sex and obesity stage can routinely be applied to PK clinical trials to evaluate the contribution of BF% as a potential covariate.
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Affiliation(s)
- Thomas P. Green
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Helen J. Binns
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
- Department of Preventive MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Huali Wu
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Adolfo J. Ariza
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
| | - Eliana M. Perrin
- Duke Center for Childhood Obesity Research and Division of Primary CareDepartment of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Maheen Quadri
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
| | - Christoph P. Hornik
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
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Lisibach A, Benelli V, Ceppi MG, Waldner-Knogler K, Csajka C, Lutters M. Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review. Eur J Clin Pharmacol 2021; 77:147-162. [PMID: 33011824 DOI: 10.1007/s00228-020-0299x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/10/2020] [Indexed: 05/23/2023]
Abstract
PURPOSE Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug's side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. METHODS We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. RESULTS Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. CONCLUSION There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.
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Affiliation(s)
- Angela Lisibach
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Valérie Benelli
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
| | - Marco Giacomo Ceppi
- Department of Neurorehabilitation, RehaClinic, Bad Zurzach, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Monika Lutters
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
- Swiss Federal Institute of Technology, Zurich, Switzerland
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van Groen BD, Pilla Reddy V, Badée J, Olivares‐Morales A, Johnson TN, Nicolaï J, Annaert P, Smits A, de Wildt SN, Knibbe CAJ, de Zwart L. Pediatric Pharmacokinetics and Dose Predictions: A Report of a Satellite Meeting to the 10th Juvenile Toxicity Symposium. Clin Transl Sci 2021; 14:29-35. [PMID: 32702198 PMCID: PMC7877839 DOI: 10.1111/cts.12843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/13/2022] Open
Abstract
On April 24, 2019, a symposium on Pediatric Pharmacokinetics and Dose Predictions was held as a satellite meeting to the 10th Juvenile Toxicity Symposium. This symposium brought together scientists from academia, industry, and clinical research organizations with the aim to update each other on the current knowledge on pediatric drug development. Through more knowledge on specific ontogeny profiles of drug metabolism and transporter proteins, integrated into physiologically-based pharmacokinetic (PBPK) models, we have gained a more integrated understanding of age-related differences in pharmacokinetics (PKs), Relevant examples were presented during the meeting. PBPK may be considered the gold standard for pediatric PK prediction, but still it is important to know that simpler methods, such as allometry, allometry combined with maturation function, functions based on the elimination pathway, or linear models, also perform well, depending on the age range or the mechanisms involved. Knowledge from different methods and information sources should be combined (e.g., microdosing can reveal early read-out of age-related differences in exposure), and such results can be a value to verify models. To further establish best practices for dose setting in pediatrics, more in vitro and in vivo research is needed on aspects such as age-related changes in the exposure-response relationship and the impact of disease on PK. New information coupled with the refining of model-based drug development approaches will allow faster targeting of intended age groups and allow more efficient design of pediatric clinical trials.
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Affiliation(s)
- Bianca D. van Groen
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children’s HospitalRotterdamThe Netherlands
- Roche Pharma and Early Development (pRED)Roche Innovation Center BaselBaselSwitzerland
| | | | - Justine Badée
- Center for Pharmacometrics & Systems PharmacologyDepartment of PharmaceuticsUniversity of Florida at Lake NonaOrlandoFloridaUSA
- Modelling & SimulationNovartis Institutes for Biomedical ResearchBaselSwitzerland
| | | | | | - Johan Nicolaï
- Development ScienceUCB BioPharma SRLBraine‐l’AlleudBelgium
| | - Pieter Annaert
- Drug Delivery and DispositionKU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuvenBelgium
| | - Anne Smits
- Neonatal Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Saskia N. de Wildt
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children’s HospitalRotterdamThe Netherlands
- Department of Pharmacology and ToxicologyRadboud Institute for Health SciencesRadboud UniversityNijmegenThe Netherlands
| | - Catherijne A. J. Knibbe
- Systems Biomedicine and PharmacologyLeiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
- Department of Clinical PharmacySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Loeckie de Zwart
- Drug Metabolism and PharmacokineticsJanssen R&D, a Division of Janssen Pharmaceutica NVBeerseBelgium
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Katsiadaki I, Schwarz TI, Cousins ARO, Scott AP. The Uptake of Ethinyl-Estradiol and Cortisol From Water by Mussels ( Mytilus spp.). Front Endocrinol (Lausanne) 2021; 12:794623. [PMID: 34975764 PMCID: PMC8714933 DOI: 10.3389/fendo.2021.794623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Previous toxicokinetic studies have shown that mussels (Mytilus spp.) can readily absorb the three main mammalian sex steroids, estradiol (E2), testosterone (T) and progesterone (P) from water. They also have a strong ability to store E2 and the 5α-reduced metabolites of T and P in the form of fatty acid esters. These esters were shown to have half-lives that were measured in weeks (i.e. they were not subject to fast depuration). The present study looked at the toxicokinetic profile of two other common steroids that are found in water, the potent synthetic oestrogen, (ethinyl-estradiol) (EE2; one of the two components of 'the pill'), and cortisol, a natural stress steroid in vertebrates. In the first three hours of uptake, tritiated EE2 was found to be taken up at a similar rate to tritiated E2. However, the levels in the water plateaued sooner than E2. The ability of the animals to both esterify and sulphate EE2 was found to be much lower than E2, but nevertheless did still take place. After 24 h of exposure, the majority of radiolabelled EE2 in the animals was present in the form of free steroid, contrary to E2, which was esterified. This metabolism was reflected in a much lower half-life (of only 15 h for EE2 in the mussels as opposed to 8 days for E2 and >10 days for T and P). Intriguingly, hardly any cortisol (in fact none at all in one of the experiments) was absorbed by the mussels. The implications of this finding in both toxicokinetic profiling and evolutionary significance (why cortisol might have evolved as a stress steroid in bony fishes) are discussed.
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Affiliation(s)
- Ioanna Katsiadaki
- Centre for Environment, Fisheries and Aquaculture Science, Weymouth Laboratory, Weymouth, United Kingdom
- *Correspondence: Ioanna Katsiadaki,
| | - Tamar I. Schwarz
- Centre for Environment, Fisheries and Aquaculture Science, Weymouth Laboratory, Weymouth, United Kingdom
| | - Alex R. O. Cousins
- Centre for Environment, Fisheries and Aquaculture Science, Lowestoft Laboratory, Lowestoft, United Kingdom
| | - Alexander P. Scott
- Centre for Environment, Fisheries and Aquaculture Science, Weymouth Laboratory, Weymouth, United Kingdom
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Lee S, Lee Y, Kim AH, Yoon S, Lee J, Ji SC, Yoon SH, Lee S, Yu KS, Jang IJ, Cho JY. Urinary metabolic markers reflect on hepatic, not intestinal, CYP3A activity in healthy subjects. Drug Metab Pharmacokinet 2020; 36:100374. [PMID: 33348239 DOI: 10.1016/j.dmpk.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/25/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
Intestinal cytochrome P450 3A (CYP3A) plays an important role in oral drug metabolism, but only endogenous metabolic markers for measuring hepatic CYP3A activity were identified. Our study evaluated whether hepatic CYP3A markers reflected intestinal CYP3A activity. An open-label, three-period, six-treatment, one-sequence clinical trial was performed in 16 healthy Korean males. In the control phase, all subjects received a single dose of intravenous (IV) and oral midazolam (1 mg and 5 mg, respectively). Clarithromycin (500 mg) was administered twice daily for 4 days to inhibit hepatic and intestinal CYP3A, and 500 mL of grapefruit juice was given to inhibit intestinal CYP3A. Clarithromycin significantly inhibited total CYP3A activity, and the clearance of IV and apparent clearance of oral midazolam decreased by 0.15- and 0.32-fold, respectively. Grapefruit juice only reduced the apparent clearance of oral midazolam by 0.84-fold, which indicates a slight inhibition of intestinal CYP3A activity. Urinary markers, including 6β-OH-cortisol/cortisol and 6β-OH-cortisone/cortisone, were significantly decreased 0.5-fold after clarithromycin administration but not after grapefruit juice. The fold changes in 6β-OH-cortisol/cortisol and 6β-OH-cortisone/cortisone did not correlate to changes in intestinal availability but did correlate to hepatic availability. In conclusion, endogenous metabolic markers are only useful to measure hepatic, but not intestinal, CYP3A activity.
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Affiliation(s)
- Soyoung Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Yujin Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Andrew HyoungJin Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Sumin Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Jieon Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Sang Chun Ji
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Seo Hyun Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Zhou H, He Y, Yang J, Wan H, Wang L, Wan H. Transport properties of paeoniflorin and amygdalin across caco-2 cell monolayer model and their modulation of cytochrome p450 metabolism. Pak J Pharm Sci 2020; 33:1569-1575. [PMID: 33583789] [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: 06/12/2023]
Abstract
Paeoniflorin and amygdalin are two major active saponins constituents in some Chinese herbal formulas used for cardio-cerebrovascular diseases. However, their intestinal absorption property and metabolic characteristics have not been clarified. The aim of this work was to study the absorption property of Paeoniflorin and Amygdalin across Caco-2 cell monolayer and their metabolic characteristics on the activity of cytochrome P450 (CYP450) enzyme. The results showed that the transport amount of Paeoniflorin and Amygdalin was positively correlated with the time and concentrations, and the transport amount from AP side to BL side was higher than that from BL to AP. The absorptions of Paeoniflorin and Amygdalin were reduced by P-glycoprotein, which provided the pharmacokinetic basis for their clinical application. Furthermore, we demonstrated that Paeoniflorin and Amygdalin had obvious inhibiting effects on CYP2C9 and CYP2E1. The transports of Paeoniflorin and Amygdalin across Caco-2 cell monolayer model were deduced as the passive transport, which indicated that the present bioassay system was appropriate and reliable for the evaluation of the transport characteristics and metabolic characteristics of active ingredient groups in Bu-yang-huan-wu decoction. Moreover, this research method may also be suitable for the appropriate bioactivity and metabolic characteristics analysis of other plant extracts.
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Affiliation(s)
- Huifen Zhou
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu He
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiehong Yang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Haofang Wan
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liqin Wang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haitong Wan
- Zhejiang Chinese Medical University, Hangzhou, China
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9
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Zhou Y, Oh MH, Kim YJ, Kim EY, Kang J, Chung S, Ju C, Kim WK, Lee K. Metabolism and Pharmacokinetics of SP-8356, a Novel (1 S)-(-)-Verbenone Derivative, in Rats and Dogs and Its Implications in Humans. Molecules 2020; 25:molecules25081775. [PMID: 32294954 PMCID: PMC7221793 DOI: 10.3390/molecules25081775] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 01/04/2023] Open
Abstract
(1S,5R)-4-((E)-3,4-dihydroxy-5-methoxystryryl)-6,6-dimethylbicylco[3.1.1]hept-3-en-2-one (SP-8356) is a novel (1S)-(−)-verbenone derivative that is currently in preclinical development for the treatment of ischemic stroke and atherosclerosis. This report aimed at characterization of the metabolism and pharmacokinetic properties of SP-8356. Following intravenous dose in rats and dogs, plasma concentrations of SP-8356 declined rapidly with high clearance (CL) and short half-life; after oral administration in both species, its plasma levels were below the quantitation limit. Fourteen circulating metabolites, formed by mono-oxygenation, demethylation, glucuronidation, catechol O-methylation, sulfation and oxidation (bioactivation) followed by glutathione (GSH) conjugation, were tentatively identified in both species. Urinary excretion of SP-8356 appeared to be minimal in rats, compared to its metabolites. GSH conjugate of SP-8356 was also formed during incubation with rat liver S9 fraction consistent with oxidative bioactivation; this bioactivation was almost completely inhibited by the cofactors for glucuronidation, sulfation and methylation, indicating that it may be abolished by competing metabolic reactions in the body. The human pharmacokinetics of SP-8356 was predicted to be similar to that of the animals based on the current in vitro metabolic stability results. In summary, rapid phase II metabolism appears to be mainly responsible for its suboptimal pharmacokinetics, such as high CL and low oral absorption. Because of competing metabolic reactions, potential safety risks related to SP-8356 bioactivation may be low.
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Affiliation(s)
- Yuanyuan Zhou
- College of pharmacy, Korea University, Sejong 30019, Korea
| | - Mun Hwan Oh
- College of pharmacy, Korea University, Sejong 30019, Korea
| | - Yeon Joon Kim
- College of pharmacy, Korea University, Sejong 30019, Korea
| | - Eun-yeong Kim
- College of pharmacy, Korea University, Sejong 30019, Korea
| | - Jinhong Kang
- College of pharmacy, Korea University, Sejong 30019, Korea
| | - Sung Chung
- Research Headquarters, Shin Poong Pharm. Co., Ltd., Ansan, Gyeonggi 15610, Korea
| | - Chung Ju
- Research Headquarters, Shin Poong Pharm. Co., Ltd., Ansan, Gyeonggi 15610, Korea
| | - Won-Ki Kim
- Departments of Biomedical Sciences and Neuroscience, College of Medicine, Korea University, Seoul 02841, Korea
- Institute of Inflammation Control, Korea University, Seoul 02841, Korea
| | - Kiho Lee
- College of pharmacy, Korea University, Sejong 30019, Korea
- Institute of Pharmaceutical Science and Translational Research, Korea University, Sejong 30019, Korea
- Biomedical Research Center, Korea University Guro Hospital, Seoul 08308, Korea
- Correspondence: ; Tel.: +82-44-860-1616
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Kharel Y, Huang T, Salamon A, Harris TE, Santos WL, Lynch KR. Mechanism of sphingosine 1-phosphate clearance from blood. Biochem J 2020; 477:925-935. [PMID: 32065229 PMCID: PMC7059866 DOI: 10.1042/bcj20190730] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
The interplay of sphingosine 1-phosphate (S1P) synthetic and degradative enzymes as well as S1P exporters creates concentration gradients that are a fundamental to S1P biology. Extracellular S1P levels, such as in blood and lymph, are high relative to cellular S1P. The blood-tissue S1P gradient maintains endothelial integrity while local S1P gradients influence immune cell positioning. Indeed, the importance of S1P gradients was recognized initially when the mechanism of action of an S1P receptor agonist used as a medicine for multiple sclerosis was revealed to be inhibition of T-lymphocytes' recognition of the high S1P in efferent lymph. Furthermore, the increase in erythrocyte S1P in response to hypoxia influences oxygen delivery during high altitude acclimatization. However, understanding of how S1P gradients are maintained is incomplete. For example, S1P is synthesized but is only slowly metabolized by blood yet circulating S1P turns over quickly by an unknown mechanism. Prompted by the counterintuitive observation that blood S1P increases markedly in response to inhibition S1P synthesis (by sphingosine kinase 2 (SphK2)), we studied mice wherein several tissues were made deficient in either SphK2 or S1P degrading enzymes. Our data reveal a mechanism whereby S1P is de-phosphorylated at the hepatocyte surface and the resulting sphingosine is sequestered by SphK phosphorylation and in turn degraded by intracellular S1P lyase. Thus, we identify the liver as the primary site of blood S1P clearance and provide an explanation for the role of SphK2 in this process. Our discovery suggests a general mechanism whereby S1P gradients are shaped.
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Affiliation(s)
- Yugesh Kharel
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, U.S.A
| | - Tao Huang
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, U.S.A
| | - Anita Salamon
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, U.S.A
| | - Thurl E. Harris
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, U.S.A
| | - Webster L. Santos
- Department of Chemistry and VT Center for Drug Discovery, Virginia Tech, Blacksburg, VA 24061, U.S.A
| | - Kevin R. Lynch
- Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, U.S.A
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11
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Takebe N, Beumer JH, Kummar S, Kiesel BF, Dowlati A, O'Sullivan Coyne G, Piekarz R, Rubinstein L, Fogli LK, Vaishampayan U, Goel S, O'Bryant CL, El‐Rayes BF, Chung V, Lenz H, Kim R, Belani CP, Tuscano JM, Schelman W, Moore N, Doroshow JH, Chen AP. A phase I pharmacokinetic study of belinostat in patients with advanced cancers and varying degrees of liver dysfunction. Br J Clin Pharmacol 2019; 85:2499-2511. [PMID: 31271459 PMCID: PMC6848909 DOI: 10.1111/bcp.14054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS The histone deacetylase inhibitor belinostat has activity in various cancers. Because belinostat is metabolized by the liver, reduced hepatic clearance could lead to excessive drug accumulation and increased toxicity. Safety data in patients with liver dysfunction are needed for this drug to reach its full potential in the clinic. METHODS We performed a phase 1 trial to determine the safety, maximum tolerated dose (MTD) and pharmacokinetics of belinostat in patients with advanced cancer and varying degrees of liver dysfunction. RESULTS Seventy-two patients were enrolled and divided into cohorts based on liver function. In patients with mild dysfunction, the MTD was the same as the recommended phase 2 dose (1000 mg/m2 /day). Belinostat was well tolerated in patients with moderate and severe liver dysfunction, although the trial was closed before the MTD in these cohorts could be determined. The mean clearance of belinostat was 661 mL/min/m2 in patients with normal liver function, compared to 542, 505 and 444 mL/min/m2 in patients with mild, moderate and severe hepatic dysfunction. Although this trial was not designed to assess clinical activity, of the 47 patients evaluable for response, 13 patients (28%) experienced stable disease. CONCLUSION While a statistically significant difference in clearance indicates increased belinostat exposure with worsening liver function, no relationship was observed between belinostat exposure and toxicity. An assessment of belinostat metabolites revealed significant differences in metabolic pathway capability in patients with differing levels of liver dysfunction. Further studies are needed to establish formal dosing guidelines in this patient population.
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Affiliation(s)
- Naoko Takebe
- Early Clinical Trials Development Program, Developmental Therapeutics Clinic, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - Jan H. Beumer
- Cancer Therapeutics ProgramUPMC Hillman Cancer CenterPittsburghPAUSA
- Department of Pharmaceutical SciencesUniversity of Pittsburgh School of PharmacyPittsburghPAUSA
- Division of Hematology‐Oncology, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Shivaani Kummar
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - Brian F. Kiesel
- Cancer Therapeutics ProgramUPMC Hillman Cancer CenterPittsburghPAUSA
- Department of Pharmaceutical SciencesUniversity of Pittsburgh School of PharmacyPittsburghPAUSA
| | - Afshin Dowlati
- University Hospitals Seidman Cancer Center and Case Western Reserve UniversityClevelandOHUSA
| | - Geraldine O'Sullivan Coyne
- Early Clinical Trials Development Program, Developmental Therapeutics Clinic, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - Richard Piekarz
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - Lawrence Rubinstein
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - Laura K. Fogli
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | | | - Sanjay Goel
- Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkNYUSA
| | | | | | | | - Heinz‐Josef Lenz
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Richard Kim
- Department of Gastrointestinal OncologyMoffitt Cancer Center and Research InstituteTampaFLUSA
| | - Chandra P. Belani
- Penn State Cancer InstitutePenn State Health Milton S. Hershey Medical CenterHersheyPAUSA
| | - Joseph M. Tuscano
- Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCAUSA
| | | | - Nancy Moore
- Early Clinical Trials Development Program, Developmental Therapeutics Clinic, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
| | - James H. Doroshow
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
- Center for Cancer ResearchNational Cancer InstituteBethesdaMDUSA
| | - Alice P. Chen
- Early Clinical Trials Development Program, Developmental Therapeutics Clinic, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMDUSA
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12
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Thémans P, Marquet P, Winkin JJ, Musuamba FT. Towards a Generic Tool for Prediction of Meropenem Systemic and Infection-Site Exposure: A Physiologically Based Pharmacokinetic Model for Adult Patients with Pneumonia. Drugs R D 2019; 19:177-189. [PMID: 31090024 PMCID: PMC6544603 DOI: 10.1007/s40268-019-0268-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop a physiologically based pharmacokinetic model for meropenem using a retrograde approach, which could serve as a basis for prediction of the systemic and infection-site drug exposures in different populations and indications. We intended this model to be a useful tool to inform (local) pharmacokinetic-based optimal dosing of meropenem in different settings. METHODS We developed a reduced physiologically based pharmacokinetic model with NONMEM software using a top-down approach. We used historical (previously published) data for model development and qualification. We used steady-state systemic and infection-site concentrations from 60 adult patients diagnosed with severe lung infection for model development and internal evaluation. The data included rich plasma and sparse epithelial lining fluid samples. We based the internal validation of the model on successful numerical convergence, adequate precision in parameter estimation, acceptable goodness-of-fit plot with no indication of bias, and acceptable performance of visual predictive checks. We performed external validation by fitting the model to independent data from five previously published studies: four studies in patients with pneumonia, with different grades of renal impairment, and one study in morbidly obese patients. RESULTS We successfully fitted a reduced physiologically based pharmacokinetic model with six compartments (arterial and venous pools, infection site [lungs], liver, kidneys and rest of the body) to the data and adequately estimated model parameters. We successfully qualified the model (internally and externally) using established methods. Estimated values for tissue-to-plasma partition coefficients were 0.2629 and 0.1946 for lungs and non-fat tissues (kidneys and liver), respectively. Estimated total clearance was 8.174 L/h for a typical patient with a glomerular filtration rate of 65 mL/min. Consistent with the known mechanism of meropenem elimination and previously published models, renal clearance accounted for 70% of total clearance. The model had good predictive performances on data from five different sources including populations with different characteristics with regard to body size, renal function and morbidity. CONCLUSIONS We successfully developed a physiologically based pharmacokinetic model for meropenem in adult patients to be used as a basis for prediction of concentrations in different groups of patients, and eventually for effective dose individualisation in different subgroups of the population.
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Affiliation(s)
- Pauline Thémans
- Department of Mathematics, Namur Institute for Complex Systems (naXys), University of Namur, Namur, Belgium
| | | | - Joseph J Winkin
- Department of Mathematics, Namur Institute for Complex Systems (naXys), University of Namur, Namur, Belgium
| | - Flora T Musuamba
- INSERM UMR 1248, Université de Limoges, Limoges, France.
- Federal Agency for Medicines and Health Products, Place Victor Horta 40/40, 1060, Brussels, Belgium.
- Faculty of Pharmacy, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
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13
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Hebenstreit D, Pichler R, Heidegger I. Drug-Drug Interactions in Prostate Cancer Treatment. Clin Genitourin Cancer 2019; 18:e71-e82. [PMID: 31677899 DOI: 10.1016/j.clgc.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022]
Abstract
Polypharmacy is associated with an increased risk of drug-drug interactions (DDIs), which can cause serious and debilitating drug-induced adverse events. With a steadily aging population and associated increasing multimorbidity and polypharmacy, the potential for DDIs becomes considerably important. Prostate cancer (PCa) is the most common cancer in men and occurs mostly in elderly men in the Western world. Therefore, the aim of this review is to give an overview of DDIs in PCa therapy to better understand pharmacodynamic and pharm kinetic side effects as well as their interactions with other medications. Last, we explore potential future strategies, which might help to optimize treatment and reduce adverse events patients with polypharmacy and PCa.
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Affiliation(s)
- Doris Hebenstreit
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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14
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Gillman AG, Rebec GV, Pecoraro NC, Kosobud AEK. Circadian entrainment by food and drugs of abuse. Behav Processes 2019; 165:23-28. [PMID: 31132444 DOI: 10.1016/j.beproc.2019.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
Circadian rhythms organize behavior and physiological processes to be appropriate to the predictable cycle of daily events. These rhythms are entrained by stimuli that provide time of day cues (zeitgebers), such as light, which regulates the sleep-wake cycle and associated rhythms. But other events, including meals, social cues, and bouts of locomotor activity, can act as zeitgebers. Recent evidence shows that most organs and tissues contain cells that are capable of some degree of independent circadian cycling, suggesting the circadian system is broadly and diffusely distributed. Within laboratory studies of behavior, circadian rhythms tend to be treated as a complication to be minimized, but they offer a useful model of predictable shifts in behavioral tendencies. In the present review, we summarize the evidence that formed the basis for a hypothesis that drugs of abuse can entrain circadian rhythms and describe the outcome of a series of experiments designed to test that hypothesis. We propose that such drug-entrained rhythms may contribute to demonstrated daily variations in drug metabolism, tolerance, and sensitivity to drug reward. Of particular importance, these rhythms may be evoked by a single episode of drug taking, strengthen with repeated episodes, and re-emerge after long periods of abstinence, thereby contributing to drug abuse, addiction, and relapse.
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Affiliation(s)
- Andrea G Gillman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - George V Rebec
- Program in Neuroscience, Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Norman C Pecoraro
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Ann E K Kosobud
- Dept. of Neurology, IU School of Medicine, 362 W 15th St, GH 4600, Indianapolis, Indiana, 46202-2266, United States.
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15
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Djukanović L, Ležaić V, Bukvić D, Mirković D, Marić I. Increased Glomerular Filtration Rate in Early Stage of Balkan Endemic Nephropathy. ACTA ACUST UNITED AC 2019; 55:medicina55050155. [PMID: 31108979 PMCID: PMC6572402 DOI: 10.3390/medicina55050155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/04/2019] [Revised: 03/01/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
Background: A previous study indicated that Balkan endemic nephropathy (BEN) patients in the early stage of the disease had significantly higher creatinine clearance (Ccr) than healthy persons. The aim of the study was to assess whether tubular creatinine secretion affects Ccr in early stages of BEN and to check the applicability of serum creatinine-based glomerular filtration rate (GFR) equations in these patients. Methods: The study involved 21 BEN patients with estimated GFR (eGFR) above 60 mL/min/1.73 m2, excluding any conditions that could affect GFR or tubular creatinine secretion, and 15 healthy controls. In all participants Ccr with and without cimetidine and iohexol clearance (mGFR) were measured and eGFR calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease Study (MDRD) equations. Glomerular hyperfiltration cutoff (GFR-HF) was calculated. Results: There was no significant difference between the groups in Ccr before and after cimetidine or for eGFR, but mGFR was significantly higher in BEN patients than in controls (122.02 ± 28.03 mL/min/1.73 m2 vs. 101.15 ± 27.32 mL/min/1.73 m2; p = 0.032). Cimetidine administration reduced Ccr by 10% in both groups. The ratio of Ccr to mGFR was significantly above one in seven BEN patients and five controls and their mGFR values were similar. Seven other patients and eight controls had this ratio equal to one, while values below one were recorded for seven more patients and two controls. mGFR of all these 14 patients was significantly higher than that of healthy controls (129.88 ± 27.52 mL/min/1.73 m2 vs. 107.43 ± 19.51 mL/min/1.73 m2; p = 0.009). Mean GFR-HF was significantly higher than mGFR in controls, but these two values were similar in BEN patients. eGFR underestimated mGFR in both BEN patients and controls. Conclusion: The ratio of Ccr to mGFR and mGFR to GFR-HF indicated that elevated mGFR in early stages of BEN could be explained by increased glomerular filtration, but tubular creatinine secretion augmented Ccr in a smaller proportion of patients, who did not differ from healthy subjects.
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Affiliation(s)
| | - Višnja Ležaić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Department of Nephrology, Clinical Centre of Serbia, 11000 Belgrade, Serbia.
| | - Danica Bukvić
- Special Hospital for Endemic Nephropathy, 11550 Lazarevac, Serbia.
| | - Dušan Mirković
- Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
- Centre for Medical Biochemistry, Clinical Centre of Serbia, 11000 Belgrade, Serbia.
| | - Ivko Marić
- Special Hospital for Endemic Nephropathy, 11550 Lazarevac, Serbia.
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16
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Villalobos-García D, Hernández-Muñoz R. Lactate-stimulated ethanol oxidation: Revisiting an old hypothesis. Biochem Pharmacol 2019; 164:283-288. [PMID: 30981876 DOI: 10.1016/j.bcp.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/24/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
Liver slices from starved rats and incubated without other substrates oxidized ethanol at a rate of 4.1 µmols • h-1 • g-1. Addition of 10 mmols • L-1 lactate increased this rate 2-fold. 4-methylpyrazole (4-MP), an alcohol dehydrogenase (ADH) inhibitor, drastically decreased the rate of ethanol oxidation, but did not inhibit the stimulation due to lactate. In the same context, liver acetaldehyde production, as the main by-product of ethanol oxidation, appeared to be much less inhibited by 4-MP in the presence of lactate. Aminotriazole (a catalase inhibitor), however, completely inhibited the stimulation. Furthermore, 2-hydroxybut-3-ynoate, an alpha-hydroxy acid oxidase inhibitor, completely abolished the stimulated ethanol oxidation promoted by lactate. Moreover, to determine the origin of the H2O2 produced, we did liver subcellular fractionation and then analyzed their content in peroxisomes, mitochondria and catalase. We observed that cytoplasm and peroxisomes appears to be the main producers of H2O2, and that the acceleration of ethanol oxidation by lactate is completely dependent on catalase. In conclusion, the H2O2 necessary to boost the catalase-dependent oxidation of ethanol appears to come from cytoplasm and peroxisomes, and is produced by the enzyme lactate oxidase.
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Affiliation(s)
- Daniel Villalobos-García
- Departamento de Biología Celular y Desarrollo, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM). Ciudad de México 04510, Mexico; Programa de Posgrado en Ciencias Químicas, UNAM, Mexico
| | - Rolando Hernández-Muñoz
- Departamento de Biología Celular y Desarrollo, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM). Ciudad de México 04510, Mexico.
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17
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Salman S, Hibbert J, Page-Sharp M, Manning L, Simmer K, Doherty DA, Patole S, Batty KT, Strunk T. Effects of maturation and size on population pharmacokinetics of pentoxifylline and its metabolites in very preterm infants with suspected late-onset sepsis or necrotizing enterocolitis: a pilot study incorporating clinical outcomes. Br J Clin Pharmacol 2018; 85:147-159. [PMID: 30281170 DOI: 10.1111/bcp.13775] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/03/2018] [Revised: 08/08/2018] [Accepted: 09/09/2018] [Indexed: 01/10/2023] Open
Abstract
AIMS Infection-induced inflammation is associated with adverse long-term outcomes in preterm infants. Pentoxifylline (PTX) is a candidate for adjunct immunomodulatory therapy in preterm infants with late-onset sepsis (LOS) and necrotizing enterocolitis (NEC), but pharmacokinetic data in this population are extremely limited. This study aims to characterize the pharmacokinetic properties of intravenous PTX and its metabolites in preterm infants. METHOD An open label pilot clinical study of intravenous PTX as an adjunct therapy in preterm infants (gestation <32 weeks) with suspected LOS or NEC was undertaken. PTX was infused for 12 h for two days (60 mg kg-1 per 12 h), and in infants with confirmed diagnosis of LOS or NEC, for 6 h for another 4 days (30 mg kg-1 per 6 h). Plasma concentrations of PTX and its principal metabolites from collected blood samples were measured using a validated LCMS assay. NONMEM was used to analyse the data using population pharmacokinetic modelling. RESULTS The preterm infants (n = 26) had a median (range) gestation of 24.8 weeks (23.3-30.4) and birthweight of 689 g (370-1285). PTX was well tolerated and without treatment-limiting adverse effects. Changes in size (weight) and maturation were successfully modelled for PTX and metabolites. After allometric scaling, clearance increased with postmenstrual age, increasing by approximately 30% per week for PTX and M1 (lisofylline) and simulations of current dosing demonstrated a six-fold difference in exposure between 24 and 35 weeks postmenstrual age. CONCLUSIONS The developed model can be used to explore dosing strategies based on size and maturation for preterm infants.
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MESH Headings
- Administration, Intravenous
- Body Weight/physiology
- Drug Therapy, Combination/methods
- Enterocolitis, Necrotizing/blood
- Enterocolitis, Necrotizing/drug therapy
- Female
- Humans
- Infant
- Infant, Extremely Premature/blood
- Infant, Extremely Premature/physiology
- Infant, Newborn
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/drug therapy
- Infant, Very Low Birth Weight/blood
- Infant, Very Low Birth Weight/physiology
- Male
- Metabolic Clearance Rate/physiology
- Models, Biological
- Pentoxifylline/administration & dosage
- Pentoxifylline/pharmacokinetics
- Phosphodiesterase Inhibitors/administration & dosage
- Phosphodiesterase Inhibitors/pharmacokinetics
- Pilot Projects
- Sepsis/blood
- Sepsis/drug therapy
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Sam Salman
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Julie Hibbert
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Madhu Page-Sharp
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Laurens Manning
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Crawley, WA, Australia
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, WA, Australia
| | - Sanjay Patole
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Crawley, WA, Australia
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Kevin T Batty
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Tobias Strunk
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Crawley, WA, Australia
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, WA, Australia
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18
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Toth EL, Li H, Dzierlenga AL, Clarke JD, Vildhede A, Goedken M, Cherrington NJ. Gene-by-Environment Interaction of Bcrp -/- and Methionine- and Choline-Deficient Diet-Induced Nonalcoholic Steatohepatitis Alters SN-38 Disposition. Drug Metab Dispos 2018; 46:1478-1486. [PMID: 30166404 PMCID: PMC6193212 DOI: 10.1124/dmd.118.082081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/09/2018] [Indexed: 12/21/2022] Open
Abstract
Disease progression to nonalcoholic steatohepatitis (NASH) has profound effects on the expression and function of drug-metabolizing enzymes and transporters, which provide a mechanistic basis for variable drug response. Breast cancer resistance protein (BCRP), a biliary efflux transporter, exhibits increased liver mRNA expression in NASH patients and preclinical NASH models, but the impact on function is unknown. It was shown that the transport capacity of multidrug resistance protein 2 (MRP2) is decreased in NASH. SN-38, the active irinotecan metabolite, is reported to be a substrate for Bcrp, whereas SN-38 glucuronide (SN-38G) is a Mrp2 substrate. The purpose of this study was to determine the function of Bcrp in NASH through alterations in the disposition of SN-38 and SN-38G in a Bcrp knockout (Bcrp-/- KO) and methionine- and choline-deficient (MCD) model of NASH. Sprague Dawley [wild-type (WT)] rats and Bcrp-/- rats were fed either a methionine- and choline-sufficient (control) or MCD diet for 8 weeks to induce NASH. SN-38 (10 mg/kg) was administered i.v., and blood and bile were collected for quantification by liquid chromatography-tandem mass spectrometry. In Bcrp-/- rats on the MCD diet, biliary efflux of SN-38 decreased to 31.9%, and efflux of SN-38G decreased to 38.7% of control, but WT-MCD and KO-Control were unaffected. These data indicate that Bcrp is not solely responsible for SN-38 biliary efflux, but rather implicate a combined role for BCRP and MRP2. Furthermore, the disposition of SN-38 and SN-38G is altered by Bcrp-/- and NASH in a gene-by-environment interaction and may result in variable drug response to irinotecan therapy in polymorphic patients.
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Affiliation(s)
- Erica L Toth
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - Hui Li
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - Anika L Dzierlenga
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - John D Clarke
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - Anna Vildhede
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - Michael Goedken
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
| | - Nathan J Cherrington
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (E.L.T., H.L., A.L.D., N.J.C.); Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.D.C.); Pharmacokinetics, Dynamics, and Metabolism, Medicine Design, Pfizer Worldwide Research and Development, Groton, Connecticut (A.V.); and Research Pathology Services, Rutgers University, Newark, New Jersey (M.G.)
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19
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Zheng X, Wu F, Lin X, Shen L, Feng Y. Developments in drug delivery of bioactive alkaloids derived from traditional Chinese medicine. Drug Deliv 2018; 25:398-416. [PMID: 29378456 PMCID: PMC6058676 DOI: 10.1080/10717544.2018.1431980] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/01/2017] [Revised: 01/13/2018] [Accepted: 01/20/2018] [Indexed: 12/19/2022] Open
Abstract
The bioactive alkaloids (e.g. vincristine, hydroxycamptothecin, ligustrazine, and so on) from traditional Chinese medicine (TCM) have exerted potent efficacies (e.g. anti-tumor, anti-inflammation, immunosuppression, etc.). However, a series of undesirable physicochemical properties (like low solubility and weak stability) and baneful pharmacokinetic (PK) profiles (e.g. low bioavailability, short half time, rapid clearance, etc.) have severely restricted their applications in clinic. In addition, some side effects (like cumulative toxicities caused by high-frequency administration and their own toxicities) have recently been reported and also confined their clinical uses. Therefore, developments in drug delivery of such alkaloids are of significance in improving their drug-like properties and, thus, treatment efficiencies in clinic. Strategies, including (i) specific delivery via liposomes; (ii) sustained delivery via nanoparticles, gels, and emulsions; and (iii) transdermal delivery via ethosomes, solid lipid nanoparticles, and penetrating enhancers, have been reported to improve the pharmacokinetic and physicochemical characters of problematic TCM alkaloids, decline their adverse effects, and thus, boost their curative efficacies. In this review, the recent reports in this field were comprehensively summarized with the aim of providing an informative reference for relevant readers.
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Affiliation(s)
- Xiao Zheng
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Fei Wu
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Xiao Lin
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Lan Shen
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Yi Feng
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
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20
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Detienne G, De Haes W, Mergan L, Edwards SL, Temmerman L, Van Bael S. Beyond ROS clearance: Peroxiredoxins in stress signaling and aging. Ageing Res Rev 2018; 44:33-48. [PMID: 29580920 DOI: 10.1016/j.arr.2018.03.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
Abstract
Antioxidants were long predicted to have lifespan-promoting effects, but in general this prediction has not been well supported. While some antioxidants do seem to have a clear effect on longevity, this may not be primarily as a result of their role in the removal of reactive oxygen species, but rather mediated by other mechanisms such as the modulation of intracellular signaling. In this review we discuss peroxiredoxins, a class of proteinaceous antioxidants with redox signaling and chaperone functions, and their involvement in regulating longevity and stress resistance. Peroxiredoxins have a clear role in the regulation of lifespan and survival of many model organisms, including the mouse, Caenorhabditis elegans and Drosophila melanogaster. Recent research on peroxiredoxins - in these models and beyond - has revealed surprising new insights regarding the interplay between peroxiredoxins and longevity signaling, which will be discussed here in detail. As redox signaling is emerging as a potentially important player in the regulation of longevity and aging, increased knowledge of these fascinating antioxidants and their mode(s) of action is paramount.
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Affiliation(s)
- Giel Detienne
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
| | - Wouter De Haes
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
| | - Lucas Mergan
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
| | - Samantha L Edwards
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
| | - Liesbet Temmerman
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
| | - Sven Van Bael
- Department of Biology, KU Leuven, Naamsestraat 59, 3000 Leuven, Belgium.
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21
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Waidyanatha S, Black SR, Snyder RW, Yueh YL, Sutherland V, Patel PR, Watson SL, Fennell TR. Disposition and metabolism of the bisphenol analogue, bisphenol S, in Harlan Sprague Dawley rats and B6C3F1/N mice and in vitro in hepatocytes from rats, mice, and humans. Toxicol Appl Pharmacol 2018; 351:32-45. [PMID: 29753715 DOI: 10.1016/j.taap.2018.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/07/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/31/2022]
Abstract
With the removal of bisphenol A (BPA) from many consumer products, the potential use of alternatives such as bisphenol S (BPS) and its derivatives is causing some concerns. These studies investigated the comparative in vitro hepatic clearance and metabolism of BPS and derivatives and the disposition and metabolism of BPS in rats and mice following gavage and intravenous administration. The clearance of BPS and its derivatives was slower in human hepatocytes than in rodents. In male rats following gavage administration of 50, 150, and 500 mg/kg [14C]BPS the main route of excretion was via urine; the urinary excretion decreased (72 to 48%) and the fecal excretion increased (16 to 30%) with increasing dose. The disposition was similar in female rats and male and female mice following gavage administration. Radioactivity remaining in tissues at 72 h in both species and sexes was ≤2.4%. In bile duct cannulated rats 53% of a gavage dose was secreted in bile suggesting extensive enterohepatic recirculation of [14C]BPS. Following an intravenous dose in rats and mice, the pattern of excretion was similar to gavage. These data suggest that the dose excreted in feces folowing gavage administration is likely the absorbed dose. Urinary metabolites included the glucuronide and sulfate conjugates with a moderate amount of parent. The pattern of in vitro hepatic metabolsim was similar to in vivo with some difference among derivatives. These data suggest that similar to other bisphenol analogues, BPS was well absorbed following oral expsosure and extensively excreted with minimal tissue retention.
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Affiliation(s)
- Suramya Waidyanatha
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
| | - Sherry R Black
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
| | - Rodney W Snyder
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
| | - Yun Lan Yueh
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
| | - Vicki Sutherland
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Purvi R Patel
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
| | - Scott L Watson
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
| | - Timothy R Fennell
- RTI International, Discovery Sciences, Research Triangle Park, NC, USA
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22
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Riedl MA, Grivcheva-Panovska V, Moldovan D, Baker J, Yang WH, Giannetti BM, Reshef A, Andrejevic S, Lockey RF, Hakl R, Kivity S, Harper JR, Relan A, Cicardi M. Recombinant human C1 esterase inhibitor for prophylaxis of hereditary angio-oedema: a phase 2, multicentre, randomised, double-blind, placebo-controlled crossover trial. Lancet 2017; 390:1595-1602. [PMID: 28754491 DOI: 10.1016/s0140-6736(17)31963-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 06/26/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hereditary angio-oedema is a recurrent, oedematous disorder caused by deficiency of functional C1 inhibitor. Infusions of plasma-derived C1 esterase inhibitor deter attacks of hereditary angio-oedema, but the prophylactic effect of recombinant human C1 esterase inhibitor has not been rigorously studied. We aimed to assess the efficacy of recombinant human C1 esterase inhibitor for prophylaxis of hereditary angio-oedema. METHODS We conducted this phase 2, multicentre, randomised, double-blind, placebo-controlled crossover trial at ten centres in Canada, the Czech Republic, Israel, Italy, Macedonia, Romania, Serbia, and the USA. We enrolled patients aged 13 years or older with functional C1-inhibitor concentrations of less than 50% of normal and a history of four or more attacks of hereditary angio-oedema per month for at least 3 months before study initiation. Patients were randomly assigned centrally (1:1:1:1:1:1), via an interactive response technology system with fixed allocation, to receive one of six treatment sequences. During each sequence, patients received intravenous recombinant human C1 esterase inhibitor (50 IU/kg; maximum 4200 IU) twice weekly, recombinant human C1 esterase inhibitor once weekly and placebo once weekly, and placebo twice weekly, each for 4 weeks with a 1 week washout period between crossover. All patients, investigators, and study personnel who participated in patient care were masked to group allocation during the study. The primary efficacy endpoint was the number of attacks of hereditary angio-oedema observed in each 4 week treatment period. Attack symptoms were recorded daily. The primary efficacy analysis was done in the intention-to-treat population. Safety was assessed in all patients who received at least one injection of study medication. This study is registered with ClinicalTrials.gov, number NCT02247739. FINDINGS Between Dec 29, 2014, and May 3, 2016, we enrolled 35 patients, of whom 32 (91%) underwent randomisation (intention-to-treat population) and 26 (81%) completed the study. The mean number of attacks of hereditary angio-oedema over 4 weeks was significantly reduced with recombinant human C1 esterase inhibitor twice weekly (2·7 attacks [SD 2·4]) and once weekly (4·4 attacks [3·2]) versus placebo (7·2 attacks [3·6]), with mean differences of -4·4 attacks (p<0·0001) and -2·8 attacks (p=0·0004), respectively. We recorded adverse events in ten (34%) of 29 patients given twice-weekly recombinant human C1 esterase inhibitor, 13 (45%) of 29 patients given the once-weekly regimen, and eight (29%) of 28 patients given placebo. Headache (twice-weekly treatment) and nasopharyngitis (once-weekly treatment) were the most common adverse events. Two (7%) adverse events (fatigue and headache) were deemed possibly related to treatment with recombinant human C1 esterase inhibitor, but both resolved without additional treatment. No thrombotic or thromboembolic events, systemic allergic reactions (including anaphylaxis), or neutralising antibodies were reported. INTERPRETATION Prophylaxis with recombinant human C1 esterase inhibitor provided clinically relevant reductions in frequency of hereditary angio-oedema attacks and was well tolerated. In view of the pharmacokinetic profile of recombinant human C1 esterase inhibitor, our results suggest that efficacy of C1-inhibitor replacement therapy might not be a direct function of plasma trough concentrations of C1 inhibitor. FUNDING Pharming Technologies.
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Affiliation(s)
- Marc A Riedl
- Department of Medicine, University of California, San Diego, San Diego, CA, USA.
| | | | | | - James Baker
- Baker Allergy Asthma Dermatology, Lake Oswego, OR, USA
| | - William H Yang
- Ottawa Allergy Research Corporation, Ottawa, ON, Canada; University of Ottawa Medical School, Ottawa, ON, Canada
| | | | - Avner Reshef
- Sheba Medical Center, University of Tel Aviv, Tel-Hashomer, Israel
| | | | - Richard F Lockey
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Roman Hakl
- St Anne's University Hospital in Brno, Czech Republic
| | | | - Joseph R Harper
- Department of Clinical Research and Medical Affairs, Pharming Healthcare, Berkeley Heights, NJ, USA
| | - Anurag Relan
- Department of Clinical Research and Medical Affairs, Pharming Healthcare, Berkeley Heights, NJ, USA
| | - Marco Cicardi
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Universita degli Studi di Milano, Milan, Italy
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23
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Guevara KA, Milanick MA. Clarifying renal clearance by visualizing virtual volumes. Adv Physiol Educ 2017; 41:441-443. [PMID: 28679585 DOI: 10.1152/advan.00006.2017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/02/2017] [Accepted: 06/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Kevin A Guevara
- Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri
| | - Mark A Milanick
- Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri
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24
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Sheng YL, Chen X, Hou XO, Yuan X, Yuan BS, Yuan YQ, Zhang QL, Cao X, Liu CF, Luo WF, Hu LF. Urate promotes SNCA/α-synuclein clearance via regulating mTOR-dependent macroautophagy. Exp Neurol 2017; 297:138-147. [PMID: 28821398 DOI: 10.1016/j.expneurol.2017.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/04/2017] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 11/17/2022]
Abstract
Serum urate levels are reported to be significantly lowered in patients with Parkinson's disease (PD) and inversely correlated to the risk and progression of PD. However, the mechanism by which urate affects PD is poorly understood. Here we showed that treatment with uric acid (UA) resulted in an autophagy activity enhancement in PC12 cells in dose- and time-dependent manners, as indicated by LC3-II increase and P62 decrease. Moreover, UA was still able to increase the LC3-II level and the number of LC3 puncta in the presence of Bafilomycin A1, a lysosomal inhibitor. These changes of autophagic markers were preceded by mTOR inhibition and ULK1 activation. Co-treatment with 3-benzyl-5-((2-nitrophenoxy) methyl)-dihydrofuran-2(3H)-one (3BDO), an mTOR activator, abolished the UA-induced LC3-II increase. More importantly, UA reduced SNCA/α-synuclein accumulation in PC12 cells that overexpress wildtype or A53T mutant SNCA, and this was blocked by Bafilomycin A1 co-treatment. The in vivo study showed that UA administration was able to modulate the levels of autophagy markers, increase the autophagosome/autolysosome formation, and reduce SNCA accumulation in the midbrain of SNCAA53T transgenic mice. Taken together, our findings suggest that UA could induce autophagy activation via an mTOR-dependent signaling and ameliorate SNCA accumulation. This implicates that urate-elevating agent may become a potential strategy for PD therapy.
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Affiliation(s)
- Yu-Lan Sheng
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Xing Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Xiao-Ou Hou
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Xin Yuan
- Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Bao-Shi Yuan
- Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Yu-Qing Yuan
- Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Qi-Lin Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Xian Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Wei-Feng Luo
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psychiatric-Diseases, Soochow University, Suzhou, Jiangsu 215123, China
| | - Li-Fang Hu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psychiatric-Diseases, Soochow University, Suzhou, Jiangsu 215123, China.
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25
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Strömberg EA, Hooker AC. The effect of using a robust optimality criterion in model based adaptive optimization. J Pharmacokinet Pharmacodyn 2017; 44:317-324. [PMID: 28386710 PMCID: PMC5514236 DOI: 10.1007/s10928-017-9521-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/30/2016] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
Optimizing designs using robust (global) optimality criteria has been shown to be a more flexible approach compared to using local optimality criteria. Additionally, model based adaptive optimal design (MBAOD) may be less sensitive to misspecification in the prior information available at the design stage. In this work, we investigate the influence of using a local (lnD) or a robust (ELD) optimality criterion for a MBAOD of a simulated dose optimization study, for rich and sparse sampling schedules. A stopping criterion for accurate effect prediction is constructed to determine the endpoint of the MBAOD by minimizing the expected uncertainty in the effect response of the typical individual. 50 iterations of the MBAODs were run using the MBAOD R-package, with the concentration from a one-compartment first-order absorption pharmacokinetic model driving the population effect response in a sigmoidal EMAX pharmacodynamics model. The initial cohort consisted of eight individuals in two groups and each additional cohort added two individuals receiving a dose optimized as a discrete covariate. The MBAOD designs using lnD and ELD optimality with misspecified initial model parameters were compared by evaluating the efficiency relative to an lnD-optimal design based on the true parameter values. For the explored example model, the MBAOD using ELD-optimal designs converged quicker to the theoretically optimal lnD-optimal design based on the true parameters for both sampling schedules. Thus, using a robust optimality criterion in MBAODs could reduce the number of adaptations required and improve the practicality of adaptive trials using optimal design.
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Affiliation(s)
- Eric A Strömberg
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Andrew C Hooker
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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26
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Mason A, Engelen MPKJ, Ivanov I, Toffolo GM, Deutz NEP. A four-compartment compartmental model to assess net whole body protein breakdown using a pulse of phenylalanine and tyrosine stable isotopes in humans. Am J Physiol Endocrinol Metab 2017; 313:E63-E74. [PMID: 28270442 PMCID: PMC6109702 DOI: 10.1152/ajpendo.00362.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/05/2016] [Revised: 02/07/2017] [Accepted: 03/03/2017] [Indexed: 11/22/2022]
Abstract
The stable isotopes of phenylalanine (Phe) and tyrosine (Tyr) are often used to study whole body protein metabolism in humans. Noncompartmental approaches give limited physiological insight in the compartmental characteristics. We therefore developed a compartmental mathematical model of Phe/Tyr metabolism to describe protein fluxes by using stable tracer dynamic data in plasma following intravenous bolus of l-[ring-13C6]Phe and l-[ring-2H4]Tyr in healthy subjects. The model consists of four compartments describing Phe/Tyr kinetics. Because the model is a priori nonidentifiable, it is quantified in terms of two uniquely identifiable submodels representing two limit case scenarios, based on known physiology. The two submodels, identified by using the software SAAM II, fit well the experimental data of all individuals and provide an unbiased overview of the metabolic pathway in terms of intervals of validity of the non-uniquely identifiable variables. The model provides estimates of the flux from Phe to Tyr [4.1 ± 1.0 µmol·kg fat-free mass (FFM)-1·h-1 (mean ± SE)] and intervals of validity of the flux and pool estimates. Our preferred submodel yielded protein breakdown flux (50.5 ± 5.2 µmol·kg FFM-1·h-1), net protein breakdown (4.1 ± 1.0 µmol·kg FFM-1·h-1), Tyr from Phe hydroxylation (~12%), hydroxylated Phe (~8%), and flux ratio of Tyr to Phe arising from protein catabolism (0.68), consistent with available literature. The other submodel suggest that the assumptions made by noncompartmental analysis are consistently underestimated. Our accurate and detailed model for estimating Phe/Tyr metabolic pathways in humans might be essential to applications in a variety of scenarios describing whole body protein synthesis and breakdown in health and disease.
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Affiliation(s)
- Alvise Mason
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas
- Department of Information Engineering, Universita' degli Studi di Padova, Padua, Italy; and
| | - Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas
| | - Ivan Ivanov
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
| | - Gianna M Toffolo
- Department of Information Engineering, Universita' degli Studi di Padova, Padua, Italy; and
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas;
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27
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Molteni M, Bo M, Di Minno G, Di Pasquale G, Genovesi S, Toni D, Verdecchia P. Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients. Intern Emerg Med 2017; 12:425-435. [PMID: 28439778 DOI: 10.1007/s11739-017-1660-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/29/2017] [Indexed: 12/16/2022]
Abstract
Dabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney disease (CKD) are per se at high risk of stroke, bleeding and mortality. Although there is evidence of clinical benefit of anticoagulation in these patients, anticoagulant therapy requires caution and demands careful clinical monitoring, regardless of the drug used. In patients with no contraindication to its use, the clinical benefit of DE versus warfarin is independent of renal function. The elderly with AF are frequently undertreated because of the perception of high bleeding risk and limited clinical benefit. However, the clinical benefit of anticoagulation is independent of patient age, and age per se should not represent a contraindication to anticoagulation. DE has been extensively studied in the elderly, both in randomized clinical trials and in observational studies: DE 150 mg BID should not be used in patients 80 years of age or older, while DE 110 mg BID is as safe as warfarin. Intracranial haemorrhages reduction by DE compared with warfarin is preserved in the elderly. Therefore, mild and moderate CKD and being elderly should not deter physicians from prescribing DE. Furthermore, the availability of a specific antidote is expected to improve the safety of the use of DE in clinical practice.
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Affiliation(s)
- Mauro Molteni
- Internal Medicine, Vimercate Hospital, Vimercate, MB, Italy.
| | - Mario Bo
- Geriatrics and Bone Metabolic Diseases Division, Città della Salute e della Scienza-Molinette University Hospital, Turin, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Simonetta Genovesi
- Nephrology Unit, Department of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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28
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Moriyama B, Obeng AO, Barbarino J, Penzak SR, Henning SA, Scott SA, Agúndez J, Wingard JR, McLeod HL, Klein TE, Cross SJ, Caudle KE, Walsh TJ. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy. Clin Pharmacol Ther 2017; 102:45-51. [PMID: 27981572 DOI: 10.1002/cpt.583] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 11/07/2022]
Abstract
Voriconazole, a triazole antifungal agent, demonstrates wide interpatient variability in serum concentrations, due in part to variant CYP2C19 alleles. Individuals who are CYP2C19 ultrarapid metabolizers have decreased trough voriconazole concentrations, delaying achievement of target blood concentrations; whereas poor metabolizers have increased trough concentrations and are at increased risk of adverse drug events. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for the use of voriconazole for treatment based on CYP2C19 genotype (updates at https://cpicpgx.org/guidelines/ and www.pharmgkb.org).
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Affiliation(s)
- B Moriyama
- National Institutes of Health Clinical Center Pharmacy Department, Bethesda, Maryland, USA
| | - A Owusu Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pharmacy, The Mount Sinai Hospital, New York, New York, USA
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Barbarino
- Department of Genetics, Stanford University, Stanford, California, USA
| | - S R Penzak
- Department of Pharmacotherapy, University of North Texas, System College of Pharmacy, Fort Worth, Texas, USA
| | - S A Henning
- National Institutes of Health Clinical Center Pharmacy Department, Bethesda, Maryland, USA
| | - S A Scott
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jag Agúndez
- Department of Pharmacology, University of Extremadura, Cáceres, Spain
| | - J R Wingard
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - H L McLeod
- DeBartolo Family Personalized Medicine Institute, Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida, USA
| | - T E Klein
- Department of Genetics, Stanford University, Stanford, California, USA
| | - S J Cross
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee, USA
| | - K E Caudle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - T J Walsh
- Transplantation-Oncology Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology and Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, New York, USA
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Calvier EAM, Krekels EHJ, Välitalo PAJ, Rostami-Hodjegan A, Tibboel D, Danhof M, Knibbe CAJ. Allometric Scaling of Clearance in Paediatric Patients: When Does the Magic of 0.75 Fade? Clin Pharmacokinet 2017; 56:273-285. [PMID: 27510367 PMCID: PMC5315734 DOI: 10.1007/s40262-016-0436-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allometric scaling on the basis of bodyweight raised to the power of 0.75 (AS0.75) is frequently used to scale size-related changes in plasma clearance (CLp) from adults to children. A systematic assessment of its applicability is undertaken for scenarios considering size-related changes with and without maturation processes. A physiologically-based pharmacokinetic (PBPK) simulation workflow was developed in R for 12,620 hypothetical drugs. In scenario one, only size-related changes in liver weight, hepatic blood flow, and glomerular filtration were included in simulations of 'true' paediatric CLp. In a second scenario, maturation in unbound microsomal intrinsic clearance (CLint,mic), plasma protein concentration, and haematocrit were also included in these simulated 'true' paediatric CLp values. For both scenarios, the prediction error (PE) of AS0.75-based paediatric CLp predictions was assessed, while, for the first scenario, an allometric exponent was also estimated based on 'true' CLp. In the first scenario, the PE of AS0.75-based paediatric CLp predictions reached up to 278 % in neonates, and the allometric exponent was estimated to range from 0.50 to 1.20 depending on age and drug properties. In the second scenario, the PE sensitivity to drug properties and maturation was higher in the youngest children, with AS0.75 resulting in accurate CLp predictions above 5 years of age. Using PBPK principles, there is no evidence for one unique allometric exponent in paediatric patients, even in scenarios that only consider size-related changes. As PE is most sensitive to the allometric exponent, drug properties and maturation in younger children, AS0.75 leads to increasingly worse predictions with decreasing age.
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Affiliation(s)
- Elisa A M Calvier
- Division of Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Gorlaeus Laboratories, Einsteinweg, 552333 CC, Leiden, The Netherlands
| | - Elke H J Krekels
- Division of Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Gorlaeus Laboratories, Einsteinweg, 552333 CC, Leiden, The Netherlands
| | - Pyry A J Välitalo
- Division of Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Gorlaeus Laboratories, Einsteinweg, 552333 CC, Leiden, The Netherlands
| | | | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Meindert Danhof
- Division of Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Gorlaeus Laboratories, Einsteinweg, 552333 CC, Leiden, The Netherlands
| | - Catherijne A J Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Gorlaeus Laboratories, Einsteinweg, 552333 CC, Leiden, The Netherlands.
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Hull K. Renal clearance: using an interactive activity to visualize a tricky concept. Adv Physiol Educ 2016; 40:458-461. [PMID: 27697960 DOI: 10.1152/advan.00059.2016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Kerry Hull
- Department of Biology, Bishop's University, Sherbrooke, Quebec, Canada
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Chu Y, Luo Y, Qu L, Zhao C, Jiang M. Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance. Pharm Biol 2016; 54:2802-2806. [PMID: 27251880 DOI: 10.1080/13880209.2016.1183684] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/23/2016] [Indexed: 06/05/2023]
Abstract
CONTEXT Augmented renal clearance (ARC) refers to enhanced renal elimination of circulating solute, and has attracted wide attention in recent years. OBJECTIVE This study evaluates the effects of ARC on serum vancomycin concentration in patients administered vancomycin. MATERIALS AND METHODS This was a retrospective study in patients receiving vancomycin treatment at a dose of 1000 mg in every 12 h and undergoing serum monitoring admitted over a 2-year period (May 2013 to May 2015), in order to estimate the influence of ARC on serum vancomycin concentration. In this study, statistical comparisons were made on the results from patients grouped according to creatinine clearance (CLcr). RESULTS One hundred forty-eight patients were enrolled in our study. The results showed that ARC patients were significantly younger, with a significantly lower Scr and higher GFR. The CLcr and steady-state trough concentrations of serum vancomycin exhibited a logarithmic correlation (Rs = -0.699, R2 = 0.488, p < 0.01) in the patients included in our study. The trough vancomycin concentrations of 62.9% patients in high CLcr group were under 10 μg/mL. DISCUSSION AND CONCLUSION Since ARC was significantly associated with subtherapeutic serum vancomycin concentration, it was necessary to devise adjusted dosage regimens for these patients based on their CLcr.
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Affiliation(s)
- Yang Chu
- a Department of Pharmacy , the First Affiliated Hospital of China Medical University , Shenyang , China
- b Department of the First Clinical Pharmacy , China Medical University , Shenyang , China
| | - Yifan Luo
- a Department of Pharmacy , the First Affiliated Hospital of China Medical University , Shenyang , China
- b Department of the First Clinical Pharmacy , China Medical University , Shenyang , China
| | - Lianyue Qu
- a Department of Pharmacy , the First Affiliated Hospital of China Medical University , Shenyang , China
- b Department of the First Clinical Pharmacy , China Medical University , Shenyang , China
| | - Chunyang Zhao
- a Department of Pharmacy , the First Affiliated Hospital of China Medical University , Shenyang , China
- b Department of the First Clinical Pharmacy , China Medical University , Shenyang , China
| | - Mingyan Jiang
- a Department of Pharmacy , the First Affiliated Hospital of China Medical University , Shenyang , China
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Wada T, Hagiwara A, Uemura T, Yahagi N, Kimura A. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med 2016; 11:737-43. [PMID: 26837207 DOI: 10.1007/s11739-016-1392-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/09/2016] [Indexed: 01/24/2023]
Abstract
Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P < 0.001). Using the CART analysis, a prediction rule for active bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.
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Affiliation(s)
- Tomoki Wada
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Tatsuki Uemura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Naoki Yahagi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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Abstract
Two peptides, pramlintide (37 amino acids), an analog of human amylin, and exenatide, synthetic exendin-4 (39 amino acids), are both in late-stage clinical development as potential new treatments for people with diabetes. Both are potential long-term treatments, and there is the likelihood that some women will become pregnant while using one of these peptide therapies. Therefore, it was important to evaluate the potential for each peptide to cross the placental barrier and thereby result in exposure to the fetus. This was examined using ex vivo perfusions of human placentas. The fetal and maternal side of a cotyledon were cannulated and perfused first with buffer, and then with radioactive antipyrine in order to establish the integrity of the system and the perfusion constants. Either pramlintide or exenatide was then added to each acceptable cotyledon perfusate on the maternal side. Each peptide was evaluated at an initial concentration near the therapeutic plasma concentration and at approximately 10-50 times that concentration in each of the three cotyledons. Maternal and fetal perfusate samples were assayed for peptide concentrations using an immunoassay. The ratio of fetal-to-maternal peptide concentrations during equilibrium perfusion were extremely low (pramlintide ≤ 0.006, exenatide 5 ≤ 0.017). These data demonstrate negligible passage of either peptide across the placental barrier. It is, therefore, likely that maternal use of either peptide during gestation will result in negligible exposure to the fetus.
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Abstract
Delayed extubation occurs after isoflurane anesthesia, especially following prolonged surgical duration. We aimed to determine the arterial blood concentrations of isoflurane and the correlation with end-tidal concentrations for predicting emergence from general anesthesia.Thirty-four American Society of Anesthesiologists physical status class I-II gynecologic patients were included. General anesthesia was maintained with a fixed 2% inspiratory isoflurane in 6 L/minute oxygen, which was discontinued after surgery. One milliliter of arterial blood was obtained for the determination of isoflurane concentration by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuation, in addition to the time of eye opening to verbal command, defined as awakening. Inspiratory and end-tidal concentrations were simultaneously detected by an infrared analyzer.The mean awakening arterial blood concentration of isoflurane was 0.20%, which was lower than the simultaneous end-tidal concentration 0.23%. The differences between arterial and end-tidal concentrations during emergence fell into an acceptable range (±1.96 standard deviation). After receiving a mean time of 108-minute general anesthesia, the time to eye opening after discontinuing isoflurane was 18.5 minutes (range 11-30, median 18 minutes), without statistical significance with anesthesia duration (P = 0.078) and body mass index (P = 0.170).We demonstrated the awakening arterial blood concentration of isoflurane in female patients as 0.20%. With well-assisted ventilation, the end-tidal concentration could be an indicator for the arterial blood concentration to predict emergence from shorter duration of isoflurane anesthesia.
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Affiliation(s)
- Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital
| | - Chih-Cherng Lu
- Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei
| | - Che-Hao Hsu
- Department of Anesthesiology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Joseph V. Pergolizz
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | - Cheng-Chang Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei
- Correspondence: Shung-Tai Ho, Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, 4F, Chung-Cheng Building, No. 201, Sec. 2, Shipai Rd, Taipei City 112, Taiwan (e-mail: )
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Zander J, Döbbeler G, Nagel D, Maier B, Scharf C, Huseyn-Zada M, Jung J, Frey L, Vogeser M, Zoller M. Piperacillin concentration in relation to therapeutic range in critically ill patients--a prospective observational study. Crit Care 2016; 20:79. [PMID: 27039986 PMCID: PMC4819271 DOI: 10.1186/s13054-016-1255-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 12/02/2015] [Accepted: 02/24/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Piperacillin levels after standard dosing have been shown frequently to be subtherapeutic, especially when renal clearance was augmented. Here, we aimed to determine if piperacillin was in its therapeutic range in a typically heterogeneous intensive care unit patient group, and also to describe target attainment dependent on daily dosage, creatinine clearance, and renal replacement therapy (RRT). METHODS Sixty patients with severe infections were included in this monocentric prospective observational study. Patients received 4.5 g of piperacillin-tazobactam two to three times daily by intermittent infusion depending on renal function according to clinical guidelines. Over 4 days, multiple serum samples (median per patient, 29; in total, 1627) were obtained to determine total piperacillin concentrations using ultra-high-performance liquid chromatography/tandem mass spectrometry. RESULTS A high heterogeneity of patient characteristics was observed (e.g., on day 1: creatinine clearance 2-233 mL/min and ten patients on RRT). Piperacillin trough levels showed inter-individual variation from 123 to >1785-fold on different study days. Each day, approximately 50% and 60% of the patients had piperacillin levels below the target ranges 1 and 2, respectively [defined for the calculated unbound piperacillin fraction according to the literature as 100% time above MIC (100%fT > MIC) (target range 1) and ≥ 50%fT > 4 × MIC (target range 2); MIC = 16 mg/L]. Whereas only the minority of patients who received piperacillin-tazobactam three times daily (TID) reached target 1 (38% on day 1), most patients who received piperacillin-tazobactam only twice daily (BID) because of severely impaired renal function reached this target (100% on day 1). Patients with RRT had significant higher percentages of fT > MIC. Zero percent, 55% and 100% of patients without RRT who received antibiotics TID reached target 1 when creatinine clearance was > 65 mL/min, 30-65 mL/min and < 30 mL/min, respectively. In patients with causative strains only sensitive to piperacillin-tazobactam of all antibiotics given to the patient, piperacillin levels negatively correlated with CRP concentrations of day 4 (p < 0.05). CONCLUSIONS A dosage of 4.5 g piperacillin-tazobactam TID seems to be frequently insufficient in critically ill patients, and also in patients where renal function is mildly to moderately impaired. For these patients, prescription of 4.5 g piperacillin-tazobactam four times daily could be considered. TRIAL REGISTRATION Clinicaltrials.gov NCT01793012. Registered 24 January 2013.
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Affiliation(s)
- Johannes Zander
- />Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Gundula Döbbeler
- />Department of Anaesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Dorothea Nagel
- />Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Barbara Maier
- />Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christina Scharf
- />Department of Anaesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Mikayil Huseyn-Zada
- />Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Jette Jung
- />Max von Pettenkofer-Institute, Ludwig-Maximilians-University of Munich, Marchioninistrasse 17, 81377 Munich, Germany
| | - Lorenz Frey
- />Department of Anaesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Vogeser
- />Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Zoller
- />Department of Anaesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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st. [NOAK in atrial fibrillation and renal failure]. MMW Fortschr Med 2016; 158:16. [PMID: 27119860 DOI: 10.1007/s15006-016-7852-6] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Hein H, Püschel K, Schaper A, Iwersen-Bergmann S. [Accidental ingestion of methadone by children and suggestions for better prevention]. Arch Kriminol 2016; 237:38-46. [PMID: 26934765] [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: 06/05/2023]
Abstract
Despite the medial attention attracted by the presented case in January 2012 and the determined measures taken to minimize the risk of accidental poisoning for children in the direct surroundings of substituted persons, we recently faced two more cases of methadone-intoxicated children in Hamburg. We believe that the most important step to increase awareness of the dangerous effects of methadone for children might be the storage of methadone in lockable boxes, which would make it safe from access by children and third parties. Moreover this way of storing reminds the patients of the risks resulting from their medication. Repeated and comprehensive instruction appears to be the best protection against cases like this to counteract careless handling of the substitution medication.
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Abstract
BACKGROUND Interindividual variability in methadone disposition remains unexplained, and methadone accidental overdose in pain therapy is a significant public health problem. Cytochrome P4502B6 (CYP2B6) is the principle determinant of clinical methadone elimination. The CYP2B6 gene is highly polymorphic, with several variant alleles. CYP2B6.6, the protein encoded by the CYP2B6*6 polymorphism, deficiently catalyzes methadone metabolism in vitro. This investigation determined the influence of CYP2B6*6, and other allelic variants encountered, on methadone concentrations, clearance, and metabolism. METHODS Healthy volunteers in genotype cohorts CYP2B6*1/*1 (n = 21), CYP2B6*1/*6 (n = 20), and CYP2B6*6/*6 (n = 17), and also CYP2B6*1/*4 (n = 1), CYP2B6*4/*6 (n = 3), and CYP2B6*5/*5 (n = 2) subjects, received single doses of IV and oral methadone. Plasma and urine methadone and metabolite concentrations were determined by tandem mass spectrometry. RESULTS Average S-methadone apparent oral clearance was 35 and 45% lower in CYP2B6*1/*6 and CYP2B6*6/*6 genotypes, respectively, compared with CYP2B6*1/*1. R-methadone apparent oral clearance was 25 and 35% lower in CYP2B6*1/*6 and CYP2B6*6/*6 genotypes, respectively, compared with CYP2B6*1/*1. R- and S-methadone apparent oral clearance was threefold and fourfold greater in CYP2B6*4 carriers. IV and oral R- and S-methadone metabolism was significantly lower in CYP2B6*6 carriers compared with that of CYP2B6*1 homozygotes and greater in CYP2B6*4 carriers. Methadone metabolism and clearance were lower in African Americans in part because of the CYP2B6*6 genetic polymorphism. CONCLUSIONS CYP2B6 polymorphisms influence methadone plasma concentrations, because of altered methadone metabolism and thus clearance. Genetic influence is greater for oral than IV methadone and S- than R-methadone. CYP2B6 pharmacogenetics explains, in part, interindividual variability in methadone elimination. CYP2B6 genetic effects on methadone metabolism and clearance may identify subjects at risk for methadone toxicity and drug interactions.
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Affiliation(s)
- Evan D. Kharasch
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University in St. Louis, St. Louis, MO
- Department of Biochemistry and Molecular Biophysics, Washington University in St. Louis, St. Louis, MO
| | - Karen J. Regina
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University in St. Louis, St. Louis, MO
| | - Jane Blood
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University in St. Louis, St. Louis, MO
| | - Christina Friedel
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University in St. Louis, St. Louis, MO
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Affiliation(s)
- Matthias Graw
- Institut für Rechtsmedizin der LMU, Nußbaumstr. 26, D-80336, München, Deutschland,
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Zang YX, Ge JL, Huang LH, Gao F, Lv XS, Zheng WW, Hong SB, Zhu ZJ. Leaf and root glucosinolate profiles of Chinese cabbage (Brassica rapa ssp. pekinensis) as a systemic response to methyl jasmonate and salicylic acid elicitation. J Zhejiang Univ Sci B 2015; 16:696-708. [PMID: 26238545 PMCID: PMC4534547 DOI: 10.1631/jzus.b1400370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 12/29/2014] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
Glucosinolates (GSs) are an important group of defensive phytochemicals mainly found in Brassicaceae. Plant hormones jasmonic acid (JA) and salicylic acid (SA) are major regulators of plant response to pathogen attack. However, there is little information about the interactive effect of both elicitors on inducing GS biosynthesis in Chinese cabbage (Brassica rapa ssp. pekinensis). In this study, we applied different concentrations of methyl jasmonate (MeJA) and/or SA onto the leaf and root of Chinese cabbage to investigate the time-course interactive profiles of GSs. Regardless of the site of the elicitation and the concentrations of the elicitors, the roots accumulated much more GSs and were more sensitive and more rapidly responsive to the elicitors than leaves. Irrespective of the elicitation site, MeJA had a greater inducing and longer lasting effect on GS accumulation than SA. All three components of indole GS (IGS) were detected along with aliphatic and aromatic GSs. However, IGS was a major component of total GSs that accumulated rapidly in both root and leaf tissues in response to MeJA and SA elicitation. Neoglucobrassicin (neoGBC) did not respond to SA but to MeJA in leaf tissue, while it responded to both SA and MeJA in root tissue. Conversion of glucobrassicin (GBC) to neoGBC occurred at a steady rate over 3 d of elicitation. Increased accumulation of 4-methoxy glucobrassicin (4-MGBC) occurred only in the root irrespective of the type of elicitors and the site of elicitation. Thus, accumulation of IGS is a major metabolic hallmark of SA- and MeJA-mediated systemic response systems. SA exerted an antagonistic effect on the MeJA-induced root GSs irrespective of the site of elicitation. However, SA showed synergistic and antagonistic effects on the MeJA-induced leaf GSs when roots and leaves are elicitated for 3 d, respectively.
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Affiliation(s)
- Yun-xiang Zang
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China
| | - Jia-li Ge
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China
| | - Ling-hui Huang
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China
| | - Fei Gao
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China
| | - Xi-shan Lv
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China
| | - Wei-wei Zheng
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China;
| | - Seung-beom Hong
- Department of Biotechnology, University of Houston-Clear Lake, Houston, TX 77058-1098, USA
| | - Zhu-jun Zhu
- Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, Research Center of Bio-Breeding Industry, School of Agricultural and Food Science, Zhejiang A & F University, Lin'an 311300, China;
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Harskamp-van Ginkel MW, Hill KD, Becker K, Testoni D, Cohen-Wolkowiez M, Gonzalez D, Barrett JS, Benjamin DK, Siegel DA, Banks P, Watt KM. Drug Dosing and Pharmacokinetics in Children With Obesity: A Systematic Review. JAMA Pediatr 2015; 169:678-85. [PMID: 25961828 PMCID: PMC4494887 DOI: 10.1001/jamapediatrics.2015.132] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Obesity affects nearly one-sixth of US children and results in alterations to body composition and physiology that can affect drug disposition, possibly leading to therapeutic failure or toxic side effects. The depth of available literature regarding obesity's effect on drug safety, pharmacokinetics, and dosing in obese children is unknown. OBJECTIVE To perform a systematic literature review describing the current evidence of the effect of obesity on drug disposition in children. EVIDENCE REVIEW We searched the MEDLINE, Cochrane, and EMBASE databases (January 1, 1970-December 31, 2012) and included studies if they contained data on drug clearance, volume of distribution, or drug concentration in obese children (aged ≤18 years). We compared exposure and weight-normalized volume of distribution and clearance between obese and nonobese children. We explored the association between drug physicochemical properties and clearance and volume of distribution. FINDINGS Twenty studies met the inclusion criteria and contained pharmacokinetic data for 21 drugs. The median number of obese children studied per drug was 10 (range, 1-112) and ages ranged from newborn to 29 years (1 study described pharmacokinetics in children and adults together). Dosing schema varied and were either a fixed dose (6 [29%]) or based on body weight (10 [48%]) and body surface area (4 [19%]). Clinically significant pharmacokinetic alterations were observed in obese children for 65% (11 of 17) of the studied drugs. Pharmacokinetic alterations resulted in substantial differences in exposure between obese and nonobese children for 38% (5 of 13) of the drugs. We found no association between drug lipophilicity or Biopharmaceutical Drug Disposition Classification System class and changes in volume of distribution or clearance due to obesity. CONCLUSIONS AND RELEVANCE Consensus is lacking on the most appropriate weight-based dosing strategy for obese children. Prospective pharmacokinetic trials in obese children are needed to ensure therapeutic efficacy and enhance drug safety.
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Affiliation(s)
- Margreet W. Harskamp-van Ginkel
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin D. Hill
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kristian Becker
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Daniela Testoni
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Daniel Gonzalez
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Jeffrey S. Barrett
- Department of Clinical Pharmacology and Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Daniel K. Benjamin
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - David A. Siegel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Patricia Banks
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kevin M. Watt
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
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Cupisti A, Morelli E, Ciardella F, Schipani G, Guidi A, Barsotti G. Dietary proteins affect proteinuria in primary membranous glomerulonephritis with nephrotic syndrome and normal renal function. Contrib Nephrol 2015; 83:166-9. [PMID: 2100708 DOI: 10.1159/000418794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Cupisti
- I Clinica Medica, Università di Pisa, Italia
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43
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DasGupta K, Jefferson JW. Treatment of mania in the medically ill. Adv Psychosom Med 2015; 21:138-62. [PMID: 7801825 DOI: 10.1159/000423625] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- K DasGupta
- Citadel Psychiatric Clinic, Fort Wayne, Ind
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44
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Abstract
This chapter has reviewed the prevalence of cancer and of psychiatric syndromes in the cancer setting. Guidelines have been given for the evaluation and treatment of specific psychiatric syndromes, as well as several special problems found in the cancer setting. In general, the major principle of using psychiatric medications in the patient with cancer or advanced AIDS is to use them to improve comfort, and not to withhold them when they may be of benefit.
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Affiliation(s)
- S Bluestine
- Memorial Sloan-Kettering Cancer Center, New York, N.Y
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45
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Pietravalle P, Morano S, De Rossi MG, Mariani G, Cristina G, Ghirlanda G, Cotroneo P, Clementi A, Di Mario U. Protein charge permselectivity in type 2 and type 1 diabetes. Contrib Nephrol 2015; 101:135-8. [PMID: 8467666 DOI: 10.1159/000422121] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P Pietravalle
- Department of Endocrinology Clinica Medica 2, University La Sapienza, Rome, Italy
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46
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Affiliation(s)
- S A Epstein
- Department of Psychiatry, Georgetown University Medical Center, Washington, D.C
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47
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Hidaka S, Kakuta S, Okada H, Chimata M, Nagase M. Exercise-induced proteinuria in diseases with metabolic disorders. Contrib Nephrol 2015; 83:136-43. [PMID: 2100704 DOI: 10.1159/000418789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Hidaka
- First Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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48
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Affiliation(s)
- L E Krahn
- Department of Psychiatry and Psychology, Mayo Clinic and Foundation, Rochester, Minn
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49
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Donadio C, Tramonti G, Giordani R, Lucchetti A, Calderazzi A, Ferrari P, Bianchi C. Renal effects and nephrotoxicity of contrast media in renal patients. Contrib Nephrol 2015; 101:241-50. [PMID: 8467681 DOI: 10.1159/000422138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- C Donadio
- Unità di Nefrologia, Clinica Medica 2, Università di Pisa, Italia
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50
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Hamdi H, De La Torre-Roche R, Hawthorne J, White JC. Impact of non-functionalized and amino-functionalized multiwall carbon nanotubes on pesticide uptake by lettuce (Lactuca sativa L.). Nanotoxicology 2015; 9:172-80. [PMID: 24716640 DOI: 10.3109/17435390.2014.907456] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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] [Indexed: 02/02/2023]
Abstract
The effect of non-functionalized and amino-functionalized multiwall carbon nanotube (CNT) exposure, as well as the impact of CNT presence on coexistent pesticide accumulation, was investigated in lettuce (Lactuca sativa L.). Lettuce seeds were sown directly into CNT-amended vermiculite (1000 mg L(-1)) to monitor phytotoxicity during germination and growth. During growth, lettuce seedlings were subsequently exposed to chlordane (cis-chlordane [CS], trans-chlordane [TC] and trans-nonachlor [TN]) and p,p'-DDE (all at 100 ng/L) in the irrigation solution for a 19-d growth period. CNT exposure did not significantly influence seed germination (82-96%) or plant growth. Similarly, pesticide exposure had no impact on plant growth, total pigment production or tissue lipid peroxidation. After 19 d, the root content of total chlordane and p,p'-DDE was 390 and 73.8 µg g(-1), respectively; in plants not exposed to CNTs, the shoot levels were 1.58 and 0.40 µg g(-1), respectively. The presence and type of CNT significantly influenced pesticide availability to lettuce seedlings. Non-functionalized CNT decreased the root and shoot pesticide content by 88% and 78%, respectively, but amino-functionalized CNT effects were significantly more modest, with decreases of 57% in the roots and 23% in the shoots, respectively. The presence of humic acid completely reversed the reduced accumulation of pesticides induced by amino-functionalized CNT, likely due to strong competition over adsorption sites on the nanomaterial (NM). These findings have implications for food safety and for the use of engineered NMs in agriculture, especially with leafy vegetables.
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Affiliation(s)
- Helmi Hamdi
- Water Research and Technology Center, University of Carthage , Soliman , Tunisia and
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