NONUNIFORM RECOVERY OF EXCITABILITY IN VENTRICULAR MUSCLE

Recovery of excitability of ventricular muscle was measured at numerous points in exposed dog ventricles at varying distances along six radial axes from a primary point of stimulation. Temporal dispersion of recovery of excitability at various points equidistant from the point of stimulation was minimal after a basic beat but was increased after an early premature beat. The degree of dispersion following a basic beat was increased by stimulation of the cardiac sympathetic nerves, administration of chloroform, ouabain intoxication, administration of higher doses of quinidine, myocardial ischemia, and hypothermia, but it was decreased by administration of sympathomimetic amines.

Chiral monolithic columns for enantioselective capillary electrochromatography prepared by copolymerization of a monomer with quinidine functionality. 1. Optimization of polymerization conditions, porous properties, and chemistry of the stationary phase

Monolithic columns for chiral capillary electrochromatography have been prepared within the confines of untreated fused-silica capillaries in a single step by a simple copolymerization of mixtures of O-[2-(methacryloyloxy)ethylcarbamoyl]-10,11-dihydroquinidine , ethylene dimethacrylate, and glycidyl methacrylate or 2-hydroxyethyl methacrylate in the presence of mixture of cyclohexanol and 1-dodecanol as a porogenic solvent. The porous properties of the monolithic columns can easily be controlled through changes in the composition of the binary porogenic solvent. Although both thermal- and UV light-initiated polymerizations afford useful capillary columns, monoliths prepared using the former approach exhibit better chromatographic properties. The ability to control pore size independently of the polymerization mixture composition enables the preparation of monoliths with varying percentages of the chiral monomer and cross-linker, as well as the optimization of their separation properties. Very good separations of model racemate (R,S)-N-3,5-dinitrobenzoylleucine were achieved using an optimized monolithic CEC column, with high efficiencies of up to 74000 plates/m for the retained peaks.

Polymorphous ventricular tachycardia: clinical characterization, therapy, and the QT interval

Forty-five consecutive patients with polymorphous ventricular tachycardia (PVT) were studied. The arrhythmia proved to be of a drug-related cause in 27 and due to an electrolyte disorder in four patients. Coexistent cardiac diseases without metabolic or drug-related abnormalities included ischemic heart disease in three, cardiomyopathy in three, and mitral valve prolapse in two. PVT was exercise-induced in four and associated with bradyarrhythmias in two. A prolonged QT or corrected QT interval was inconsistently related to the occurrence of PVT. In patients in whom PVT was induced by certain type I drugs, other type I antiarrhythmic drugs were usually either ineffective or resulted in aggravation of arrhythmia. For the group as a whole, treatment with lidocaine resulted in inconsistent beneficial effects, while cardiac pacing was almost universally effective for those with drug-induced PVT, regardless of the length of the QT interval. Long-term amiodarone therapy proved safe and effective for 12 of the 24 patients with drug-induced PVT who required long-term therapy for their original arrhythmia. We conclude that identification of PVT is the key clinical issue and that the QT interval is not necessarily the prime abnormality nor the variable to be considered in predicting success of therapy. Temporary cardiac pacing appears to be very effective in the short-term management of these patients. Use of type I antiarrhythmic agents in patients with drug-induced PVT generally resulted in aggravation of arrhythmia. In contrast, long-term amiodarone therapy for control of the original arrhythmia appears to be a promising approach for those with PVT associated with type I agents.

The Changes in Cardiac Output with Reversion of Atrial Fibrillation to Sinus Rhythm

Twelve patients were reverted from atrial fibrillation to sinus rhythm by the technic of "cardioversion." Brief, light anesthesia was the only drug employed. Under conditions of comparable oxygen consumption cardiac output was measured first in atrial fibrillation and then in sinus rhythm. Eleven patients were studied at rest and five during exercise.

Ten of the 11 patients studied at rest showed a reduced arteriovenous oxygen difference with sinus rhythm and seven of the 11 increased cardiac output 0.6 L./min. or greater, an average increase of 34 per cent. All five patients studied at exercise decreased the arteriovenous oxygen difference with sinus rhythm and cardiac output rose 1.1 L./min. or greater in all, an average increase of 17 per cent.

IMMUNOREACTIONS INVOLVING PLATELETS

A steric and kinetic model for the sequence and mechanism of reactions leading to formation of a complex from an antibody, a haptene (quinidine), and a cell membrane (platelets), and to fixation of complement by the complex was deduced from the effects of varying the initial concentration of each component of the complex on the amount of complement fixed, from kinetic aspects of the sequential reactions, and from other chemical and physical properties of the various components involved. Theoretical results calculated using equations based on the model, which were derived by Dr. Terrell L. Hill, were similar in all respects to experimental results. Results of this study were consistent with the possibilities that the protein moiety of a haptenic antigen involved in development of an antibody which attaches to a cell is not necessarily a component of the cell, and that the cell reacts with the antibody by virtue of having a surface favorable for non-specific adsorption of certain haptene-antibody complexes.

Selection of alternative CYP3A4 probe substrates for clinical drug interaction studies using in vitro data and in vivo simulation

Understanding the potential for cytochrome P450-mediated drug-drug interactions (DDIs) is a critical step in the drug discovery process. DDIs of CYP3A4 are of particular importance because of the number of marketed drugs that are cleared by this enzyme. In response to studies that suggested the presence of several binding regions within the CYP3A4 active site, multiple probe substrates are often used for in vitro CYP3A4 DDI studies, including midazolam (the clinical standard), felodipine/nifedipine, and testosterone. However, the design of clinical CYP3A4 DDI studies may be confounded for cases such as 1-(2-hydroxy-2-methylpropyl)-N-[5-(7-methoxyquinolin-4-yloxy)pyridin-2-yl]-5-methyl-3-oxo-2-phenyl-2,3-dihydro-1H-pyrazole-4-carboxamide (AMG 458), with which testosterone is predicted to exhibit a clinically relevant DDI whereas midazolam and felodipine/nifedipine are not. To develop an appropriate path forward for such clinical DDI studies, the inhibition potency of 20 known inhibitors of CYP3A4 were measured in vitro using 8 clinically relevant CYP3A4 probe substrates and testosterone. Hierarchical clustering suggested four probe substrate clusters: testosterone; felodipine; midazolam, buspirone, quinidine, and sildenafil; and simvastatin, budesonide, and fluticasone. The in vivo sensitivities of six clinically relevant CYP3A4 probe substrates (buspirone, cyclosporine, nifedipine, quinidine, sildenafil, and simvastatin) were determined in relation to midazolam from literature DDI data. Buspirone, sildenafil, and simvastatin exhibited similar or greater sensitivity than midazolam to CYP3A4 inhibition in vivo. Finally, Simcyp was used to predict the in vivo magnitude of CYP3A4 DDIs caused by AMG 458 using midazolam, sildenafil, simvastatin, and testosterone as probe substrates.

P-glycoprotein-mediated intestinal and biliary digoxin transport in humans

BACKGROUND AND AIMS

Intestinal transport by P-glycoprotein is a recently recognized determinant of drug disposition. However, direct measurements of transporter-mediated drug elimination into isolated segments of human small intestine are lacking.

METHODS

Using a recently developed intestinal perfusion catheter, we perfused in healthy volunteers two 20-cm jejunal segments with and without the P-glycoprotein inhibitor quinidine before and during administration of the P-glycoprotein inducer rifampin (INN, rifampicin).

RESULTS

Within 3 hours after intravenous administration of digoxin (1 mg), perfusate samples were collected. We found that 0.45% +/- 0.24% and 0.83% +/- 0.60% of the digoxin dose were eliminated into a jejunal segment and into bile, respectively. Perfusion of the isolated segment with quinidine reduced intestinal digoxin elimination (0.23% +/- 0.08%, P =.031). During rifampin, intestinal digoxin elimination was 0.80 +/- 0.59 (P =.383). Enterocyte P-glycoprotein content correlated with the area under the plasma concentration-time curve of digoxin (Spearman nonparametric correlation coefficient [r(S)] = -0.73, P =.003) and digoxin nonrenal clearance (r(S) = 0.52, P =.056), as well as with intraluminal and plasma concentrations of quinidine (r(S) = 0.55, P =.041 and r(S) = -0.67, P =.009, respectively).

CONCLUSION

Using segmental intestinal perfusion, we provide direct evidence that intestinal P-glycoprotein mediates substantial drug elimination after intravenous administration from the systemic circulation into the gut lumen and prevents entry of luminally administered P-glycoprotein substrates into the enterocytes. These data also highlight the relative importance of direct intestinal drug secretion in comparison with drug elimination through bile.

Chiral monolithic columns for enantioselective capillary electrochromatography prepared by copolymerization of a monomer with quinidine functionality. 2. Effect of chromatographic conditions on the chiral separations

The effect of chromatographic conditions on the performance of chiral monolithic poly(O-[2-(methacryloyloxy)-ethylcarbamoyl]-10,11-dihydroqui nidine-co-ethylene dimethacrylate-co-2-hydroxyethyl methacrylate) columns in the capillary electrochromatography of enantiomers has been studied. The flow velocity was found to be proportional to the pore size of the monolith and both the pH and the composition of the mobile phase. The length of both open and monolithic segments of the capillary column was found to exert a substantial effect on the run times. The use of monoliths as short as 8.5 cm and the "short-end" injection technique enabled the separations to be achieved in approximately 5 min despite the high retentitivity of the quinidine selector. Very high column efficiencies of close to 250000 plates/m and good selectivities were achieved for the separations of numerous enantiomers using the chiral monolithic capillaries with the optimized chromatographic conditions.

Effect of high K, low K, and quinidine on QRS duration and ventricular action potential

Perfusion of isolated rabbit hearts with high potassium, low potassium, and quinidine solutions caused a diffuse widening of the QRS complex with no change in shape. These QRS changes were correlated with the magnitude and upstroke velocity of the ventricular transmembrane potential. An increase of QRS duration by 132% produced by high K was accompanied by a decrease of the action potential, resting potential, and upstroke velocity. A similar increase in QRS duration produced by quinidine was accompanied by a slow upstroke velocity but no change in magnitude of the action potential or resting potential. An increase of QRS duration by 49% produced by low K was accompanied by an increased action and resting potential, and upstroke velocity. We attributed the QRS changes produced by high K and quinidine, at least partly, to a slow conduction in the ventricle, caused by a slow upstroke velocity of the action potential. The QRS changes produced by low K could be explained by hyperpolarization. Early arrhythmias caused by low K were due to atrioventricular conduction disturbances.

Quinidine as a cause of sudden death

Sudden death and arterial embolism are unpredictable hazards of quinidine therapy for atrial fibrillation that act as deterrents to its most effective use. In this paper an attempt is made to determine the incidence of these accidents as reported in the literature. The mechanism of sudden death is also examined. The difficulty of determining the role of quinidine in producing these accidents in seriously ill patients is clarified.

A comparison of the anti-arrhythmic actions of I.C.I. 50172 and (--)-propranolol and their effects on intracellular cardiac action potentials and other features of cardiac function

1. I.C.I. 50172 had marked quinidine-like effects on intracellular cardiac action potentials at concentrations above 20 mg/l. (6.61 x 10(-5)M). The rate of rise and overshoot of the action potential, conduction velocity and contractions were decreased. (-)-Propranolol had similar effects at less than 1/30 this concentration.2. I.C.I. 50172 had 1/100 the activity of (-)-propranolol as a local anaesthetic. Since this is also the ratio of their in vitro beta-receptor blocking activities, I.C.I. 50172 provides no net increase in specificity of beta-receptor blockade.3. In contrast, the in vivo activity of I.C.I. 50172 in protecting anaesthetized guinea-pigs against ouabain-induced ventricular fibrillation was 40% that of (-)-propranolol.4. Structure-activity relations of beta-receptor blocking drugs are discussed.