Current clinical pharmacology最新文献

Background: This review elucidates ongoing research, which show improved delivery of anticancer drugs alone and/ or enclosed in carriers collectively called nanomedicines to cross the BBB/ BTB to kill tumor cells and impact patient survival. We highlighted various advances in understanding the mechanism of BTB function that has an impact on anticancer therapeutics delivery. We discussed latest breakthroughs in developing pharmaceutical strategies, including nanomedicines and delivering them across BTB for brain tumor management and treatment.

Methods: We performed an extensive literature search and highlighted important studies on the regulation of BTB permeability with respect to nanotech-based nanomedicines for targeted treatment of brain tumors. We have reviewed research articles that describe the development of specialized molecules and nanospheres, which carry payload of anticancer agents to brain tumor cells across the BBB/ BTB and avoid drug efflux systems. We highlighted research on the identification and development of targeted anti-cancer drug delivery to brain tumors. In addition, we discussed multimeric molecular therapeutics and nanomedicines that were encapsulated in nanospheres for treatment and monitoring of brain tumors.

Results: In this context, we quoted our research on large conductance calcium-activated potassium channels (BKCa) and ATP-dependent potassium channels (KATP) as portals of enhanced antineoplastic drugs delivery. We showed that several innovative drug delivery agents such as liposomes, polymeric nanoparticles, dendrimers and many such tools can be utilized to improve anticancer drugs and nanomedicines across the BTB to reach brain tumor cells.

Conclusion: This review might interest both academic and drug company scientists involved in drug delivery to brain tumors. We further seek to present evidence that BTB modulators can be clinically developed as combination drug or/ and as stand-alone anticancer drugs. Eventually, it is expected that unrelenting effort from the scientific community in developing novel drug delivery methods should increase the survival rate of brain tumor patients, which is dismally low presently.

Background: Epileptic children and adolescent have a significantly low serum level of vitamin D due to the effect of antiepileptic drugs on the vitamin D metabolism. Those patients are at risk of cardiovascular events.

Objective: This study aimed to show that epileptic patients who treated with antiepileptic drugs supplemented with vitamin D are free from the electrocardiograph changes compared with those treated with antiepileptic drugs.

Method: This cross-sectional study included, 121 epileptic patients aged < 18 years of both genders with a history of idiopathic generalized tonic clonic seizure. They grouped into Group I (n=20) patients without medical treatment, Group II (n=76) patients treated with antiepileptic drugs, and vitamin D Group III (n=25) patients treated with antiepileptic drugs supplemented with vitamin D3 vitamin D. Each participant subjected to the electrocardiogram investigation at the time of entry into the study.

Results: Group III patients had a significant decrease of QRS complex, QRS dispersion QTcorrected, and TQ duration compared with Group II. Group I patients, had a significant increase of QRS complex duration, compared with Group II patients. Four patients of Group II showed a significant prolonged QT-interval in the QT nomogram. Three patients had a JT index (an indicator of ventricular hyperpolarization) more than the normal cutoff level of 112. The area under the curve of receiving operating characteristics showed significant favorable effects of vitamin D supplementation on the different variables of electrocardiograph.

Conclusion: Vitamin D supplementation may correct the changes in the electrocardiograph observed in idiopathic generalized tonic clonic seizure treated with antiepileptic medicines, and our observations warrant larger studies.

Dietary long chain polyunsaturated fatty acids belong to omega (ω)-3, -6 or -9 series. Both experimental and clinical studies demonstrated the beneficial effect of ω -3 fatty acids of fish oil, Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) against human ailments including cardiovascular diseases and rheumatoid arthritis. They are metabolized in cyclooxygenase and lipooxygenase pathways and also by cytochrome P450 isozymes. Biological importance of DHA in the development of brain and retina are well established. Recent studies highlighted the beneficial effect of ω-3 fatty acids in Alzheimer's Disease (AD) which may be attributed to their antioxidant, anti-inflammatory, antiapoptotic and neurotrophic properties. The effect was obtained by the consumption of either individual or combination of ω -3 fatty acids. The anti-inflammatory effect can be ascribed to the decreased cytokines and monocytic chemotactic protein-1 level by suppressing the nuclear factor-kappa B. Further, they inhibit cyclooxygenase-2 and nitric oxide synthase-2 activities. The antiapoptotic activity is due to the lowered Bax/Bcl ratio or caspase 3 levels. They can induce the transcription factor, nuclear erythroid factor-2 mediated expression of superoxide dismutase- 2 in order to facilitate the antioxidant effect. Both DHA and EPA can enhance the nerve growth factor level. Overall, they are beneficial to improve the cognitive function in very mild AD and major depressive disorder. Despite the beneficial effects, ω-3 fatty acids are easily prone to peroxidation. This review article discusses the recent update on the roles of ω -3 fatty acids in AD.

Background: The molecular mechanism of silencing genes using small interference RNA is as particular and innovative phenomenon as the proposed delivery systems to release them. Recent advances in RNAi have resulted in the development of multiple siRNA candidates that are currently being evaluated in preclinical / clinical instances. SNALP®, Atuplex® and Rondel® technologies stand out; they are mainly based on polymers, cyclodextrins or lipids.

Method: The objective of this work is to review the main features that Gene Therapy Medicinal Product under current clinical evaluation present from a pharmaceutical technology point of view; it tries to bring up theoretical concepts that give scientific support to the interpretation of data obtained during pharmaceutical development process. It is basically focused on improving the translation from bench/theoretical concepts to bedside of non viral vectors carrying siRNA.

Results: The extensive presence of lipid-based nanoparticle non-viral systems in clinical stages is due to the advantages of their formulations. These include: safety, low immunogenicity, high degree of material properties control, function tuning and ability to impact pharmacokinetics and in vivo biodistribution. This work presents a pharmaceutical approach so as to improve the potential of success in siRNA delivery using liposomal systems.

Conclusion: Formulation design should be increasingly addressed with industrial criteria; it should be based on quality by design and on the estimation of critical attributes that affect product performance, and supported by a range of characterization techniques and appropriate analytical methods.

Background: The causal link between upper limb restlessness and cervical disc prolapsus is still unclear, and the exact role of the spinal cord in the origination of limb restlessness is not yet completely understood.

Methods: Here we have evaluated the therapeutic effect of pramipexole (0.5 mg/kg) in a 47-year old male with cervical disc prolapsus who described restlessness in his upper limb and neck.

Results: The patient felt significantly better, and his symptoms improved near to complete after five days when we initiated 0.5 mg/day pramipexole treatment.

Conclusion: In our present paper, we provide more evidence for the role of pramipexole (0.5 mg/day) in limb restlessness which is associated with cervical disc herniation. In this context, we also have discussed the underlying pathophysiology which seems to be responsible for the restlessness symptoms of the patients.

Background: Osteogenesis imperfecta is a rare metabolic disorder associated with reduced mineralization of bone and corresponds to increased fracture risk. We carried out the present network meta-analysis comparing all the medical interventions for osteogenesis imperfecta.

Method: Electronic databases were searched for randomized controlled clinical trials evaluating the use of drugs in patients with osteogenesis imperfecta. Percent change in BMD was the primary and fracture risk reduction and adverse events were the secondary outcome measures. The weighted mean difference was the pooled estimate for primary outcome and odds ratio with 95% confidence interval for the secondary outcome measures. Direct and mixed treatment comparisons between the interventions were carried out by inverse heterogeneity model. Sub-group analyses were carried out on children, adults and within bisphosphonate groups. The trial sequential analysis was carried out for the comparison of oral bisphosphonates with placebo.

Results: A total of 16 studies were included evaluating oral and intravenous bisphosphonates, teriparatide, anti-sclerostin antibody, high dose vitamin D and recombinant growth hormone (rGH) combined with intravenous bisphosphonates. Oral bisphosphonates and teriparatide were observed with a statistically significant increase in BMD compared to placebo. Also, only oral bisphosphonates were associated with significant reduction in the fracture risk but when the alpha error was adjusted for the information accrued till date as well as when the results of a trial were excluded, no significant difference was observed. Either low or very low quality was observed for pooled estimates of the key comparisons.

Conclusion: Oral bisphosphonates and teriparatide significantly increase BMD but are not associated with fracture risk reduction. Of the available interventions, oral bisphosphonates could perform better than others in osteogenesis imperfecta. This evidence should be considered preliminary and may change with future head-to-head clinical trials.

Background: The current study investigates the cytotoxicity mechanism of common drugs with piperazine ring such as cetirizine, olanzapine and buspirone on human lymphocytes.

Methods: The viability of lymphocytes, reactive oxygen species (ROS) formation, mitochondrial membrane potential (MMP) collapse, lysosomal integrity, content of glutathione and lipid peroxidation was determined.

Results: Buspirone and cetirizine showed more toxicity than olanzapine on human lymphocytes with an IC50 value of 200 µg/ml, after 6 h of incubation. Significant ROS formation, MMP collapse, lipid peroxidation, lysosomal damage and elevation of glutathione disulfide (GSSG) were observed in treated lymphocytes concentrations (4, 20, 40 µg/ml) of buspirone and cetirizine.

Conclusion: Our results show the exposure of human lymphocytes with buspirone and cetirizine, which usually happens during the poisoning, triggers oxidative stress and organelle damages. Our study suggests that using antioxidants, mitochondrial and lysosomal protective agents can protect blood lymphocytes, from probable side effects of these highly consumed medications.

Background: Blinatumomab is a bispecific T-cell engager (BiTE®) antibody construct targeting CD3ε on T cells and CD19 on B cells. We describe the relationship between pharmacokinetics (PK) of blinatumomab and pharmacodynamic (PD) changes in peripheral lymphocytes, serum cytokines, and tumor size in patients with non-Hodgkin lymphoma (NHL).

Methods: In a phase 1 study, 76 patients with relapsed/refractory NHL received blinatumomab by continuous intravenous infusion at various doses (0.5 to 90 µg/m2/day). PD changes were analyzed with respect to dose, blinatumomab concentration at steady state (Css), and cumulative area under the concentration-versus-time curve (AUCcum).

Results: B-cell depletion occurred within 48 hours at doses ≥5 µg/m2/day, followed first-order kinetics, and was blinatumomab exposure-dependent. Change in tumor size depended on systemic blinatumomab exposure and treatment duration and could be fitted to an Emax model, which predicted a 50% reduction in tumor size at AUCcum of ≥1,340 h×µg/L and Css of ≥1,830 pg/mL, corresponding to a blinatumomab dose of 47 µg/m2/day for 28 days. The magnitude of transient cytokine elevation, observed within 1-2 days of infusion start, was dose-dependent, with less pronounced elevation at low starting doses.

Conclusion: B-lymphocyte depletion following blinatumomab infusion was exposure-dependent. Transient cytokine elevation increased with dose; it was less pronounced at low starting doses. Tumor response was a function of exposure, suggesting utility for the PK/PD relationship in dose selection for future studies, including NHL and other malignant settings.