Early development evaluation of AZD8081: a substrate for the NK receptors

The purpose of the present study was to find out if AZD8081, a dual neurokinin (NK)1/2 receptor antagonist, was suitable for development of an oral, solid immediate release (IR) formulation and in a further perspective also as an oral extended release (ER) formulation. AZD8081 is a base with pK(a) values <2.5 and about 8.5. The measured intrinsic solubility is about 0.1 mg/mL and the solubility in FaSSIF (fasted simulated small intestinal fluid) is about 3.2 mg/mL. Aqueous buffer solutions are stable for at least 1 month between pH 1-7 up to 37°C. In the solid-state, a mixture of amorphous and crystalline substance showed significant chemical instability in the initial stress testing studies. No degradation was, however, observed for highly crystalline material at similar conditions. It is concluded that the impurity profile and/or the present solid-state of the batches affect the stability of the substance. The amorphous contribution of the substance is the main cause to the observed degradation in solid-state. Crystalline AZD8081 is polymorphic with two known monotropic forms, form A and form B. Both forms are only slightly hygroscopic ansolvates with melting points of approximately 108°C and 117°C, respectively. Form B is the more stable of the two forms and is therefore most suited for further development. The candidate is suitable for development of standard IR formulations since no specific limitations of significance for formulation development were identified. In addition, the good stability in human intestinal fluid and in colon slurry makes AZD8081 a suitable candidate for ER formulation.

Pulmonary net release of tissue-type plasminogen activator during porcine primary and secondary acute lung injury

BACKGROUND

Tissue-type plasminogen activator (tPA) is a key mediator of fibrinolysis. Matching of pulmonary perfusion and ventilation is a critical denominator of oxygenation in acute lung injury (ALI). This study investigates pulmonary venoarterial plasma tPA gradients in association with acute ALI induced by bronchoalveolar lavage (BAL) and endotoxinemia (ETX).

METHODS

Twenty-one anaesthetized, ventilated pigs were allocated to control (CTRL, n=5), bronchoalveolar saline lavage (BAL, n=8) or infusion of Escherichia coli endotoxin (ETX, n=8). Total tPA was analyzed in plasma (ELISA calibrated for porcine tPA). The inflammatory response was assessed by TNFa levels (ELISA). All variables were assessed at baseline and 2 h following ALI.

RESULTS

Bronchoalveolar lavage and ETX induced similar increases in pulmonary shunt whereas pulmonary vascular resistance was significantly more increased in ETX animals. Cardiac output remained stable in BAL animals but decreased in ETX animals. The pulmonary venoarterial tPA plasma gradient increased in ETX animals, yielding a positive pulmonary net flux of tPA, which was absent in BAL animals. TNFalpha levels increased in ETX, but not in BAL, animals. A significant correlation was observed between TNFalpha and tPA plasma levels in ETX animals. All variables remained unchanged in CTRL animals.

CONCLUSION

Plasma changes of tPA levels support a pulmonary release of tPA in early experimental ALI induced by acute ETX but not lavage, and are related to the inflammatory response. Despite increased vascular fibrinolytic capacity in ETX animals, pulmonary dysfunction was not different from BAL animals. The results demonstrate the close relation between inflammation and coagulation in early ALI.

Regionally differentiated fibrinolytic responses during volume-resuscitated acute endotoxemia in pigs

BACKGROUND

Microcirculatory dysfunction and formation of microthrombi are common in sepsis as a result of a procoagulant state. A profibrinolytic change has however, been reported in early sepsis. This study investigates systemic and regional (pulmonary, preportal, hepatic, renal) fibrinolytic capacity as mirrored by fluxes of tissue-type plasminogen activator (t-PA) in response to acute endotoxemia and volume resuscitation.

METHODS

Eight anaesthetized, ventilated pigs (24-29 kg) were instrumented for systemic and regional haemodynamic monitoring. Aortic, pulmonary arterial, portal, hepatic and renal venous blood samples were collected. Following baseline stabilisation, Escherichia coli endotoxin was infused for 120 min. During the last 30 min of infusion, volume resuscitation was initiated targeting baseline cardiac output, and animals were observed for 3 h. Total tPA was analyzed by ELISA calibrated for porcine tPA. Net organ tPA fluxes were calculated based on in/outflowing plasma concentrations and regional blood flows.

RESULTS

Preportal release and hepatic extraction of tPA was observed at baseline. Pulmonary and renal net fluxes of tPA were not significantly different from zero. Endotoxemia increased plasma tPA levels in all investigated vascular beds. Preportal tPA release increased approximately 10-fold and hepatic extraction increased approximately 12-fold in non-resuscitated acute endotoxemia. No significant changes in pulmonary or renal tPA fluxes were observed. Volume resuscitation restored net fluxes to baseline values while plasma levels remained elevated approximately twofold compared with baseline.

CONCLUSION

Acute endotoxemia induces a prompt, marked and regionally differentiated pro-fibrinolytic response that cannot be discerned based on systemic levels of circulating tPA and that was normalized during volume resuscitation.

The effect of gem-difluorination on the conformation and properties of a model macrocyclic system

Conformational control of drug candidates to engineer improved potency and ADME properties is an ongoing area of research. Macrocyclic rings tend to offer a greater degree of rigidity than non-cyclised small molecules, and, as a result they are perfect platforms to instil conformational controls. In this study, the difluoroalkoxyphenyl moiety is examined as a tool to alter the conformation of macrocycles. A fluorinated and non-fluorinated macrocyclic matched pair is compared in terms of conformation preferences and related ADME properties. The synthesised macrocycles are found to give similar major conformations exhibiting a trans amide in the macrocyclic backbone. However, for the fluorinated macrocycle, the major trans amide conformation is in equilibrium with a cis amide minor conformation, seen by 1H NMR in a 4 : 1 ratio of trans/cis. The conformational fits for the minor fluorinated isomer demonstrate the out of plane preference of the difluoroalkoxy system encouraging the amide within the macrocycle backbone to adopt a cis conformation. The fluorinated macrocycle was less metabolically stable compared to the non-fluorinated, postulated to be a result of the interconversion of trans amide to the cis amide, which potentially could be more readily metabolised.

Beliefs concerning dietary practices during pregnancy and lactation. A qualitative study among Iranian women residing in Sweden

Growing multiculturalism in Sweden challenges health professionals to provide safe and culturally meaningful care. Differences between the health--disease explanatory models of lay persons and health professionals may lead to communication problems, which ultimately could affect health outcomes. The aim of this study was to explore beliefs about food and health during pregnancy and lactation. Increased knowledge and understanding among health professionals on such issues should facilitate culturally congruent nutrition counselling. Individual interviews were performed among first-generation Iranian female immigrants in the county of Stockholm. The interviews followed a set of predefined key questions. Content analysis of interview transcripts followed a grounded theory approach. Five major categories emerged, which referred to 'hot-cold' values, foetal attributes, satisfaction of cravings, survival of the mother, and quantity and quality of breast milk. 'Mother's diet provides strength that sustains life' emerged as the most relevant core concept. This study demonstrated maternal strength to be important for a successful pregnancy outcome and lactation. Displacement of food items caused by migration in combination with a strong adherence to Iranian health beliefs could potentially cause food choices with detrimental health effects.