Pharmacology Research & Perspectives最新文献

Experiential learning (EL) is a high-impact teaching practice. Despite this, it can be challenging to embed EL into educational curricula at scale due to resource constraints, such as the number of faculty members available to supervise research projects. Here we report on two distinct elective courses in a Pharmacology curriculum, both of which incorporate EL in different ways. The first course, Pharmacology and Toxicology in Society, involves community partnerships and a focus on harm reduction and drug misuse. The second course, Biomedical Incubator Capstone Project, includes student teams working as a simulated biotechnology startup. Our research questions were: (1) To what extent did students perceive gains in their skills in four domains: teamwork, career preparedness, critical thinking and problem solving, and application of theory to practice ? (2) Did student responses differ between the two EL courses? We surveyed students in both courses over three iterations to assess their perceived gains in skills across these four domains. Surveys contained both quantitative (Likert) elements and qualitative open-ended questions. We conducted mixed methods analyses of student responses. Overall student responses were positive to Likert prompts (87%-96% either agreed or strongly agreed) exploring these domains. Thematic analysis of responses to open-ended questions highlighted the transformative nature of EL experiences in both courses. Our work highlights the finding that strikingly different EL experiences can result in similar student perceptions of gains in teamwork, career preparedness, critical thinking and problem solving, and application of theory to practice. The work demonstrates the effectiveness of expanded opportunities for quality EL in Pharmacology programs and beyond.

Variability in low-density lipoprotein cholesterol (LDL-C) has emerged as a potential independent cardiovascular risk factor, but the impact of short-term discontinuation of statins on LDL-C remains to be defined. Furthermore, the relationship between individual statin metabolites and changes in LDL-C has not yet been examined. The present study aimed to investigate changes in LDL-C concentrations during a four-day discontinuation of atorvastatin therapy and to examine correlations between the half-lives of atorvastatin metabolites and LDL-C concentrations. This pharmacokinetic intervention study included 60 adults with confirmed adherence to atorvastatin, using doses of 20 mg (N = 20), 40 mg (N = 20), or 80 mg (N = 20) at study start. Atorvastatin was then discontinued, and blood samples were collected from day zero to day four. We assessed daily concentrations of LDL-C and of atorvastatin with its metabolites by liquid chromatography-tandem mass spectrometry. The mean (SD) LDL-C at baseline was 1.84 (0.6) mmol/L. LDL-C increased on average by 0.50 mmol/L (27%) from day zero to day four. The increase in LDL-C was significant already 48 h after the last statin intake and was affected by individual variation in baseline concentrations and the slope of the daily increase. A moderate correlation was found between differences in LDL-C concentrations and the half-lives of hydroxylated atorvastatin metabolites. In conclusion, 4 days without atorvastatin resulted in an almost 30% increase in LDL-C concentrations, and the increase was significant already after the first omitted dose. The half-lives of hydroxylated atorvastatin metabolites showed a moderate correlation with the increase in LDL-C concentrations.

The recent review of a new drug application for MDMA-assisted therapy for posttraumatic stress disorder by the United States' Food and Drug Administration (FDA) highlighted epistemological and methodological challenges for evidence assessments. Similar challenges will also be faced in reviews of other compounds in early- and late-stage development, like psilocybin for depression. The regulatory demand for two successful phase 3 randomized controlled trials (RCTs) seems problematic, given a current lack of agreement on what constitutes "success", particularly when psychoactive drug administration is concomitant with (psycho)therapy. These complex arrangements challenge the internal validity of estimated average treatment effect through comparison with conventional control conditions. This paper reviews the assumptions behind RCTs' current "gold-standard" status in the hierarchy of evidence-based medicine (EBM). Recapitulating known epistemic limits of randomization and blinding, it emphasizes the urgent need to avoid the extrapolation fallacy. The resulting argument is that the degree of trustworthiness that efficacy-reported in RCTs-will reliably predict effectiveness-in target populations outside RCTs-depends on what type of psychedelic treatments will be regulated. If "stand-alone" drugs for large-scale prescription and consumption, trustworthiness should be graded low. On the other hand, for regulation of drug-assisted (psycho) therapies, the degree of trustworthiness can be considered high. The reason being that these two treatment approaches are based on different causal claims with distinct external validities. Therefore, careful assessment of support factors in each is recommended to prevent detrimental consequences, from potential rejection of effective therapies up to medical reversal of eventually approved drugs.

Interstitial lung disease (ILD) is a clinically relevant adverse event associated with biologic agent use. However, the current incidence of ILD remains unclear as large-scale risk assessments of biologic agents have not been conducted. The aim of this study was to clarify the association between biologic agent use and ILD development in clinical practice by detecting adverse event signals using a spontaneous adverse drug reaction database. The VigiBase database is used for spontaneous adverse event reporting. The analysis focused on nine biologics used to treat psoriasis, rheumatoid arthritis, and Crohn's disease. The safety of each biologic agent was evaluated using the information component signal detection method. There were 32,520,983 reports in VigiBase, of which 68,489 (0.21%) were for ILD. Signals were mainly detected for tumor necrosis factor-α inhibitors when the information component for ILD caused by biologic agents was calculated. Comorbidity analysis in patients who developed ILD and analysis of the time from the start of treatment with each drug to ILD onset showed differences for each biologic agent. ILD is a serious adverse effect of biologic agents, and there are several cases in which a causal relationship with ILD development cannot be ruled out. The occurrence of interstitial ILD should be noted when using biologics, particularly TNF-α inhibitors.

Nurturing learning systems that are respectful and welcoming to diverse individuals is a step towards improving the experience of all students in pharmacology and toxicology (Pharm-Tox). This paper evaluates the Pharm-Tox curriculum at the University of Toronto with a critical lens towards the incorporation of content that is Equitable, Diverse, Inclusive, acknowledges Indigeneity, and is Accessible (EDIIA). A curriculum mapping approach examined the undergraduate Pharm-Tox curriculum to identify EDIIA gaps and areas for improvement. Key stakeholders that contributed to the curriculum mapping process were undergraduate students, teaching faculty, and an external research associate who identified EDIIA themes used to evaluate existing course materials. The curriculum map identified areas to improve EDIIA integration in individual courses and resulted in the design of course-specific recommendations. Centrally housed department resources were also developed to mitigate barriers to faculty implementation of the EDIIA recommendations. These resources included an internal EDIIA handbook on appropriate language in the classroom, a guide to creating accessible and inclusive PowerPoint slides, and a pre-course survey to identify the student population and their needs. Resources were well received by faculty, and to assess the impact of EDIIA recommendations on student learning, ongoing review of curricular changes will be conducted through student surveys. The recommendations from this curriculum mapping process encourage faculty to explore opportunities for EDIIA integration in the undergraduate Pharm-Tox curriculum with the goal of strengthening the existing curriculum and improving the student learning experience.

Oxidation of dopamine can cause various side effects, which ultimately leads to cell death and contributes to Parkinson's disease (PD). To counteract dopamine oxidation, newly synthesized dopamine is quickly transported into vesicles via vesicular monoamine transporter 2 (VMAT2) for storage. VMAT2 expression is reduced in patients with PD, and studies have shown increased accumulation of dopamine oxidation byproducts and α-synuclein in animals with low VMAT2 expression. Conversely, animals that overexpress VMAT2 show better protection for dopamine neurons. Based on these findings, this study used histone deacetylase inhibitors (HDACi) to increase VMAT2 expression, reduce dopamine-induced oxidative stress, and evaluate the resulting behavioral improvements in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD animal model. LMK-235 not only increased VMAT2 expression at various concentrations in the SH-SY5Y cell line differentiated into dopaminergic cells but also demonstrated effective cytoprotective properties in several toxicity assays. It significantly raised VMAT2 expression in both the striatum and the ventral tegmental area of an MPTP-induced PD model, supporting its role in reversing behavioral abnormalities linked to PD. In addition to these results, coadministration of LMK-235 with L-DOPA, a standard therapy for PD, restored typical behavioral patterns, highlighting the potential of HDACi in alleviating PD symptoms. The expression of VMAT2 induced by LMK-235, an inhibitor of Class IIa histone deacetylases primarily found in the nervous system, aids in sequestering dopamine into vesicles, potentially enhancing cell survival by inhibiting dopamine oxidation. Additionally, upregulation of VMAT2 has been shown to offer effective protection against MPTP-induced toxicity and significantly improve behavioral abnormalities associated with PD. Coadministration with L-DOPA produced the most notable improvement in behavioral outcomes. Altogether, these findings suggest that the overexpression of VMAT2 may offer a promising strategy for developing treatments for PD by mitigating dopaminergic neuron death resulting from dopamine oxidation.

Binimetinib is a MEK1/2 inhibitor particularly active in cells harboring activating mutations in the MAP kinase pathway, especially in BRAF and NRAS. Binimetinib, in combination with encorafenib, has received marketing approval in several jurisdictions for the treatment of patients with BRAF V600E or V600K mutant melanoma. The absorption, distribution, metabolism, and excretion of binimetinib were evaluated by administering a carbon 14-labeled binimetinib 45 mg dose (containing 40 μCi of radiolabeled material) to 6 healthy male participants. A total of 62.3% of the radioactivity was eliminated in the feces, while 31.4% was eliminated in the urine. The overall recovery of radioactivity in the excreta for all 6 participants was 93.6% (3.27%), indicating that good mass balance was achieved. The total percentage of the dose in the excreta of all metabolites containing the N-demethylation clearance of binimetinib by CYP1A2 and CYP2C19 was approximately 17.8%. The contribution of direct glucuronidation to the clearance of binimetinib was estimated to be 61.2% and represented the majority of the clearance. Additionally, excretion of unchanged binimetinib into the urine was estimated to have contributed 6.9% to the overall clearance. Based on study results, binimetinib is at least ≈ 50% absorbed, but based on its PK properties and because its glucuronide conjugates are unstable in the GI tract, absorption is thought to be significantly higher.

Medicine repurposing is a strategy to identify new uses for the existing medicines for the purpose of addressing areas of unmet medical need. This paper aims to provide horizon scanning intelligence on repurposed medicines that are evaluated by non-commercial organizations such as academia and highlights opportunities for further research to improve patient health outcomes. A scan of the clinical landscape of non-commercially sponsored repurposed medicines is routinely conducted by the NIHR Innovation Observatory (IO). This ongoing project involves a horizon scan of clinical trial registries and the IO's internal horizon scanning Medicines Innovation Database to identify potential candidate medicines used as monotherapy or in combination to treat new indications outside the scope of their licensed indication. In addition to making these data publicly available, the output also supports the NHS England Medicines Repurposing Programme. The snapshot scan reported here (trials completing April 2020-March 2023) identified a total of 528 technologies (meaning, a single product or combination of medicinal products targeting a specific indication in one or more related trials). The technologies were classified according to their characteristics and targeted therapeutic indications as well as revealing the least treated disease conditions. The candidate medicines identified in this scan could potentially receive tailored support toward adoption into practice and policy. The NIHR IO regularly provides this scan as a source of intelligence on repurposed medicines. This provides valuable insights into innovation trends, gaps, and areas of unmet clinical need.

Laboratory measurements used for safety assessments in clinical trials are subject to the limits of the used laboratory equipment. These limits determine the range of values which the equipment can accurately measure. When observations fall outside the measurable range, this creates a problem in estimating parameters of the normal distribution. It may be tempting to use methods of estimation that are easy to implement, however selecting an incorrect method may lead to biased estimates (under- or overestimation) and change the research outcomes, for example, incorrect result of two-sample test about means when comparing two populations or biased estimation of regression line. In this article, we consider the use of four methods: ignoring unmeasured observations, replacing unmeasured observations with a multiple of the limit, using a truncated normal distribution, and using a normal distribution with censored observations. To compare these methods we designed a simulation study and measured their accuracy in several different situations using relative error $\frac{\hat{\mu }-\mu }{\mu }$ , ratio $\frac{\hat{\sigma }}{\sigma }$ , and mean square errors of both parameters. Based on the results of this simulation study, if the amount of observations outside of measurable range is below 40%, we recommend using a normal distribution with censored observations in practice. These recommendations should be incorporated into guidelines for good statistical practice. If the amount of observations outside of measurable range exceeds 40%, we advise not to use the data for any statistical analysis. To illustrate how the choice of method can affect the estimates, we applied the methods to real-life laboratory data.

The increasing utilization of cannabis products combined with lack of data regarding potential cannabis-prescription drug interactions is concerning. This study aimed to review published case reports and FDA Adverse Event Reporting System (FAERS) spontaneous reports to assess cannabis-drug interactions in persons aged 18 and over. A literature search identified 20 case reports that were each assessed for drug interaction causality using the Drug Interaction Probability Scale. Data collected from the FAERS revealed a greater proportion of reports mentioning serious outcomes, including death, when cannabis was used concomitantly with controlled substances compared to noncontrolled substances. Fisher's exact test showed a statistically significant difference between the controlled and noncontrolled groups (p = 0.043). Overall, these findings emphasize the need for additional research and vigilant monitoring of cannabis use when combined with other medications.