191 resultados para Anticancer Drugs
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The capabilities of a high-resolution (HR), accurate mass spectrometer (Exactive-MS) operating in full scan MS mode was investigated for the quantitative LC/MS analysis of drugs in patients' plasma samples. A mass resolution of 50,000 (FWHM) at m/z 200 and a mass extracted window of 5 ppm around the theoretical m/z of each analyte were used to construct chromatograms for quantitation. The quantitative performance of the Exactive-MS was compared with that of a triple quadrupole mass spectrometer (TQ-MS), TSQ Quantum Discovery or Quantum Ultra, operating in the conventional selected reaction monitoring (SRM) mode. The study consisted of 17 therapeutic drugs including 8 antifungal agents (anidulafungin, caspofungin, fluconazole, itraconazole, hydroxyitraconazole posaconazole, voriconazole and voriconazole-N-oxide), 4 immunosuppressants (ciclosporine, everolimus, sirolimus and tacrolimus) and 5 protein kinase inhibitors (dasatinib, imatinib, nilotinib, sorafenib and sunitinib). The quantitative results obtained with HR-MS acquisition show comparable detection specificity, assay precision, accuracy, linearity and sensitivity to SRM acquisition. Importantly, HR-MS offers several benefits over TQ-MS technology: absence of SRM optimization, time saving when changing the analysis from one MS to another, more complete information of what is in the samples and easier troubleshooting. Our work demonstrates that U/HPLC coupled to Exactive HR-MS delivers comparable results to TQ-MS in routine quantitative drug analyses. Considering the advantages of HR-MS, these results suggest that, in the near future, there should be a shift in how routine quantitative analyses of small molecules, particularly for therapeutic drugs, are performed.
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Newer antiepileptic drugs (AEDs) are increasingly prescribed and seem to have a comparable efficacy as the classical AEDs; however, their impact on status epilepticus (SE) prognosis has received little attention. In our prospective SE database (2006-2010), we assessed the use of older versus newer AEDs (levetiracetam, pregabalin, topiramate, lacosamide) over time and its relationship to outcome (return to clinical baseline conditions, new handicap, or death). Newer AEDs were used more often toward the end of the study period (42% of episodes versus 30%). After adjustment for SE etiology, SE severity score, and number of compounds needed to terminate SE, newer AEDs were independently related to a reduced likelihood of return to baseline (p<0.001) but not to increased mortality. These findings seem in line with recent findings on refractory epilepsy. Also, in view of the higher price of the newer AEDs, well-designed, prospective assessments analyzing the impact of newer AEDs on efficacy and tolerability in patients with SE appear mandatory.
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3 Summary 3. 1 English The pharmaceutical industry has been facing several challenges during the last years, and the optimization of their drug discovery pipeline is believed to be the only viable solution. High-throughput techniques do participate actively to this optimization, especially when complemented by computational approaches aiming at rationalizing the enormous amount of information that they can produce. In siiico techniques, such as virtual screening or rational drug design, are now routinely used to guide drug discovery. Both heavily rely on the prediction of the molecular interaction (docking) occurring between drug-like molecules and a therapeutically relevant target. Several softwares are available to this end, but despite the very promising picture drawn in most benchmarks, they still hold several hidden weaknesses. As pointed out in several recent reviews, the docking problem is far from being solved, and there is now a need for methods able to identify binding modes with a high accuracy, which is essential to reliably compute the binding free energy of the ligand. This quantity is directly linked to its affinity and can be related to its biological activity. Accurate docking algorithms are thus critical for both the discovery and the rational optimization of new drugs. In this thesis, a new docking software aiming at this goal is presented, EADock. It uses a hybrid evolutionary algorithm with two fitness functions, in combination with a sophisticated management of the diversity. EADock is interfaced with .the CHARMM package for energy calculations and coordinate handling. A validation was carried out on 37 crystallized protein-ligand complexes featuring 11 different proteins. The search space was defined as a sphere of 15 R around the center of mass of the ligand position in the crystal structure, and conversely to other benchmarks, our algorithms was fed with optimized ligand positions up to 10 A root mean square deviation 2MSD) from the crystal structure. This validation illustrates the efficiency of our sampling heuristic, as correct binding modes, defined by a RMSD to the crystal structure lower than 2 A, were identified and ranked first for 68% of the complexes. The success rate increases to 78% when considering the five best-ranked clusters, and 92% when all clusters present in the last generation are taken into account. Most failures in this benchmark could be explained by the presence of crystal contacts in the experimental structure. EADock has been used to understand molecular interactions involved in the regulation of the Na,K ATPase, and in the activation of the nuclear hormone peroxisome proliferatoractivated receptors a (PPARa). It also helped to understand the action of common pollutants (phthalates) on PPARy, and the impact of biotransformations of the anticancer drug Imatinib (Gleevec®) on its binding mode to the Bcr-Abl tyrosine kinase. Finally, a fragment-based rational drug design approach using EADock was developed, and led to the successful design of new peptidic ligands for the a5ß1 integrin, and for the human PPARa. In both cases, the designed peptides presented activities comparable to that of well-established ligands such as the anticancer drug Cilengitide and Wy14,643, respectively. 3.2 French Les récentes difficultés de l'industrie pharmaceutique ne semblent pouvoir se résoudre que par l'optimisation de leur processus de développement de médicaments. Cette dernière implique de plus en plus. de techniques dites "haut-débit", particulièrement efficaces lorsqu'elles sont couplées aux outils informatiques permettant de gérer la masse de données produite. Désormais, les approches in silico telles que le criblage virtuel ou la conception rationnelle de nouvelles molécules sont utilisées couramment. Toutes deux reposent sur la capacité à prédire les détails de l'interaction moléculaire entre une molécule ressemblant à un principe actif (PA) et une protéine cible ayant un intérêt thérapeutique. Les comparatifs de logiciels s'attaquant à cette prédiction sont flatteurs, mais plusieurs problèmes subsistent. La littérature récente tend à remettre en cause leur fiabilité, affirmant l'émergence .d'un besoin pour des approches plus précises du mode d'interaction. Cette précision est essentielle au calcul de l'énergie libre de liaison, qui est directement liée à l'affinité du PA potentiel pour la protéine cible, et indirectement liée à son activité biologique. Une prédiction précise est d'une importance toute particulière pour la découverte et l'optimisation de nouvelles molécules actives. Cette thèse présente un nouveau logiciel, EADock, mettant en avant une telle précision. Cet algorithme évolutionnaire hybride utilise deux pressions de sélections, combinées à une gestion de la diversité sophistiquée. EADock repose sur CHARMM pour les calculs d'énergie et la gestion des coordonnées atomiques. Sa validation a été effectuée sur 37 complexes protéine-ligand cristallisés, incluant 11 protéines différentes. L'espace de recherche a été étendu à une sphère de 151 de rayon autour du centre de masse du ligand cristallisé, et contrairement aux comparatifs habituels, l'algorithme est parti de solutions optimisées présentant un RMSD jusqu'à 10 R par rapport à la structure cristalline. Cette validation a permis de mettre en évidence l'efficacité de notre heuristique de recherche car des modes d'interactions présentant un RMSD inférieur à 2 R par rapport à la structure cristalline ont été classés premier pour 68% des complexes. Lorsque les cinq meilleures solutions sont prises en compte, le taux de succès grimpe à 78%, et 92% lorsque la totalité de la dernière génération est prise en compte. La plupart des erreurs de prédiction sont imputables à la présence de contacts cristallins. Depuis, EADock a été utilisé pour comprendre les mécanismes moléculaires impliqués dans la régulation de la Na,K ATPase et dans l'activation du peroxisome proliferatoractivated receptor a (PPARa). Il a également permis de décrire l'interaction de polluants couramment rencontrés sur PPARy, ainsi que l'influence de la métabolisation de l'Imatinib (PA anticancéreux) sur la fixation à la kinase Bcr-Abl. Une approche basée sur la prédiction des interactions de fragments moléculaires avec protéine cible est également proposée. Elle a permis la découverte de nouveaux ligands peptidiques de PPARa et de l'intégrine a5ß1. Dans les deux cas, l'activité de ces nouveaux peptides est comparable à celles de ligands bien établis, comme le Wy14,643 pour le premier, et le Cilengitide (PA anticancéreux) pour la seconde.
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Purpose: Current experimental data suggest that CD4+CD25+Foxp3+regulatory T cells (Tregs) based immunotherapy would be of greatinterest to promote donor-specific immune tolerance in transplantation(Tx). Whether and how adoptive transfer of Tregs could be bestcombined with current immunosuppressive regimens in clinicalsettings remains to be defined. Using an experimental Tx model,we had previously shown that the transfer of antigen-specific Tregspromoted long-term skin allograft acceptance in lymphopenic mice,in the absence of any immunosuppressive drug. However, allograftsurvival was only slightly prolonged when Tregs were transferredalone into non-lymphopenic mice, suggesting that in more stringentconditions such as in clinical settings adjuvant therapies may beneeded to effectively control alloreactive T cells (Teff).Methods and Materials: Here we have investigated the effects ofvarious immunosuppressive drugs on the survival, proliferation andeffector function of Teff and Tregs in response to alloantigens in in vitroassays and in our in vivo Tx model.Results: Teff proliferation was inhibited in a dose-dependant mannerby rapamycin and cyclosporine A, while anti-CD154 only marginallyaffected Teff proliferation and survival in vitro. Rapamycin promotedapoptosis of Teff as compared to Tregs that were more resistant underthe same culture conditions. In vivo, the transfer of donor-specificTregs could be advantageously combined with rapamycin andanti-CD154 to significantly prolong MHC-mismatched skin allograftsurvival in non-lymphopenic recipients.Conclusion: Taken together, our data indicate thatimmunosuppressive drugs differentially target T-cell subsets and couldpromote Tregs expansion and/or function while controlling the Teff pool.
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Differences in efficacy and safety of drugs among patients are a recognized problem in pharmacotherapy. The reasons are multifactorial and, therefore, the choice of a drug and its dosage for a particular patient based on different clinical and genetic factors is suggested to improve the clinical outcome. Four drugs are currently used for the treatment of Alzheimer's disease: three acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and the N-methyl-D-aspartate-antagonist memantine. For these drugs, a high interindividual variability in plasma levels was observed, which might influence the response to treatment. The main objective of this thesis was to provide a better understanding of clinical and genetic factors affecting the plasma levels of antidementia drugs. Furthermore, the relationship between plasma levels, genetic variations and side effects was assessed. For this purpose, a pharmacogenetic study was conducted including 300 patients from a naturalistic clinical setting. Analytical methods for the simultaneous measurement of antidementia drugs in plasma have been developed and validated using liquid chromatography methods coupled with mass spectrometry detection. Presently, these methods are used in the therapeutic drug monitoring service of our laboratory. The routine use of therapeutic drug monitoring for antidementia drugs cannot yet be recommended with the available data, but it may be beneficial for some patients in special clinical cases such as insufficient treatment response, side effects or drug interactions. Donepezil and galantamine are extensively metabolized by the liver enzymes cytochromes P450 (CYP) 2D6 and 3A and are substrates of the drug transporter P-glycoprotein. The relationship of variations in genes affecting the activity of these metabolic enzymes and drug transporter (CYP2D6, CYP3A, POR, NR1I2, ABCB1) with donepezil and galantamine plasma levels was investigated. The CYP2D6 genotype appeared to be the major genetic factor involved in the pharmacokinetics of these two drugs. Thus, CYP2D6 poor metabolizers demonstrated significantly higher drug plasma levels than extensive metabolizers. Additionally, in the donepezil study population, the frequency of side effects was significantly increased in poor metabolizers. Lower donepezil plasma levels were observed in ultra rapid metabolizers, which might expose those patients to the risk of non-response. Memantine is mainly eliminated unchanged by the kidney, with implication of tubular secretion by renal transporters. A population pharmacokinetic model was developed to quantify the effects of clinical factors and genetic variations in renal cation transporters (SLC22A1/2/5, SLC47A1, ABCB1), and nuclear receptors (NR1I2, NR1I3, PPARG) involved in transporter expression, on memantine plasma levels. In addition to the renal function and gender, a genetic variation in the nuclear receptor Pregnane-X-Receptor (NR1I2) significantly affected memantine elimination. These findings suggest that an individualized therapy approach for antidementia drugs, taking into account clinical characteristics and genetic background of a patient, might increase efficacy and safety of the treatment. - Les différences interindividuelles dans l'efficacité et la tolérance des médicaments sont un problème connu en pharmacothérapie. Les raisons sont multiples, et le choix du médicament et de la dose, basé sur des facteurs cliniques et génétiques spécifiques au patient, peut contribuer à améliorer la réponse clinique. Quatre médicaments sont couramment utilisés dans le traitement de la maladie d'Alzheimer : trois inhibiteurs de l'acétylcholinestérase (donépézil, galantamine, rivastigmine) et un antagoniste du récepteur N-méthyl-D-aspartate, la mémantine. Une forte variabilité interindividuelle dans les taux plasmatiques de ces quatre composés a été observée, ce qui pourrait influencer la réponse au traitement. L'objectif principal de ce travail de thèse est de mieux comprendre les facteurs cliniques et génétiques influençant les taux des médicaments pro-cognitifs. En outre, des associations entre les taux, la variabilité génétique et les effets secondaires ont été recherchées. Dans ce but, 300 patients sous traitement avec un médicament pro-cognitif ont été recrutés pour une étude pharmacogénétique. Des méthodes de dosage simultané de médicaments pro-cognitifs par chromatographie liquide couplée à la spectrométrie de masse ont été développées et validées. Ces méthodes sont actuellement utilisées dans le service de suivi thérapeutique de notre unité. Malgré le fait qu'un suivi des taux sanguins des pro-cognitifs ne puisse pas encore être recommandé en routine, un dosage peut être utile dans des cas cliniques spécifiques, comme une réponse insuffisante, une intolérance ou une interaction médicamenteuse. Le donépézil et la galantamine sont fortement métabolisés par les cytochromes P450 (CYP) 2D6 et 3A, et sont également substrats du transporteur P-glycoprotéine. Les associations entre les polymorphismes génétiques de ces enzymes, cofacteur, récepteur nucléaire et transporteur (CYP2D6, CYP3A, POR, NR1I2, ABCB1) et les taux de donépézil et de galantamine ont été étudiées. Le génotype du CYP2D6 a été montré comme le facteur génétique majeur impliqué dans la pharmacocinétique de ces deux médicaments. Ainsi, les métaboliseurs déficients du CYP2D6 ont démontré des taux plasmatiques significativement plus élevés comparé aux bons métaboliseurs. De plus, dans la population traitée avec le donépézil, la fréquence des effets secondaires était plus élevée chez les métaboliseurs déficients. Des taux plasmatiques bas ont été mesurés chez les métaboliseurs ultra-rapides traités avec le donépézil, ce qui pourrait être un facteur de risque à une non-réponse au traitement. La mémantine est principalement éliminée sous forme inchangée par les reins, et partiellement par sécrétion tubulaire grâce à des transporteurs rénaux. Un modèle de cinétique de population a été développé pour quantifier les effets des différents facteurs cliniques et de la variabilité génétique des transporteurs rénaux (SLC22A1/2/5, SLC47A1, ABCB1) et des récepteurs nucléaires (NR1I2, NR1I3, PPARG, impliqués dans l'expression des transporteurs) sur les taux plasmatiques de mémantine. En plus de la fonction rénale et du genre, une variation génétique dans le récepteur nucléaire Pregnane-X-Receptor (NR1I2) a montré une influence significative sur l'élimination de la mémantine. Ces résultats suggèrent qu'une approche thérapeutique individualisée, prenant en compte des facteurs cliniques et génétiques du patient, pourrait améliorer l'efficacité et la sécurité du traitement pro-cognitif.
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Candida albicans is one of the most important opportunistic fungal pathogens. It can cause serious fungal diseases in immunocompromised patients, including those with cancer. Treatment failures due to the emergence of drug-resistant C. albicans strains have become a serious clinical problem. Resistance incidents were often mediated by fungal efflux pumps which are closely related to the human ABC transporter P-glycoprotein (P-gp). P-gp is often overexpressed in cancer cells and confers resistance to many cytotoxic drugs. We examined whether cytotoxic drugs commonly used for cancer treatment (doxorubicin and cyclophosphamide) could alter the expression of genes responsible for the development of fluconazole resistance in Candida cells in the way they can influence homologous genes in cancer cell lines. ABC transporters (CDR1 and CDR2) and other resistance genes (MDR1 and ERG11) were tested by real-time PCR for their expression in C. albicans cells at the mRNA level after induction by antineoplastic drugs. The results were confirmed by a lacZ gene reporter system and verified at the protein level using GFP and immunoblotting. We showed that doxorubicin is a potent inducer of CDR1/CDR2 expression in C. albicans at both the mRNA and protein level and thus causes an increase in fluconazole MIC values. However, cyclophosphamide, which is not a substrate of human P-gp, did not induce ABC transporter expression in C. albicans. Neither doxorubicin nor cyclophosphamide could influence the expression of the other resistance genes (MDR1 and ERG11). The induction of CDR1/CDR2 by doxorubicin in C. albicans and the resulting alteration of antifungal susceptibility might be of clinical relevance for the antifungal treatment of Candida infections occurring after anticancer chemotherapy with doxorubicin.
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Objectives: Many drugs, both illicit or for medication, are known to influence driving abilities and increase risks of accidents. We explored the prevalence of psychoactive substances in a random sample of drivers in Switzerland. Methods: Saliva samples from 1078 random drivers were collected at 24 different locations in Western Switzerland from October 2006 to April 2008 for complete toxicological analysis using liquid chromatography/tandem mass spectrometry. Results: Provisional results are available for 437 drivers. 6.2% (CI95% 4.1 to 8.9) were under the influence of illicit drugs and 8.7% under psychoactive medication (CI95% 6.2 to 11.7). 37 drivers (8.5%) were under the influence of alcohol of which 14 (3.2%) were above 0.8 mg/L. 21 drivers (4.8%) were under the combined influence of more than one psychoactive substance; however only 4 drivers (0.9%) were under both the influence of medication and alcohol. Looking more specifically at illicit substances, 22 (5.0%) were positive to cocaine, 5 (1.1%) to cannabis, and 2 (0.5%) to amphetamines ; for psychoactive medication, 17 (3.9%) were positive to benzodiazepines, 16 (3.7%) to antidepressors, 7 (1.6%) to opiates, 7 (1.6%) to neuroleptics, and 3 (0.7%) to other substances influencing driving abilities. 17/21 drivers did not self-report their consumption of drugs whereas only 9/35 failed mentioning their medication. Men drivers were 3.2 times (CI95% 1.1 to 9.5) more likely to be under the influence of illicit drugs than women. Full results will be reported when laboratory data will be available in April. Conclusions: Driving under the influence of psychoactive substances is common. In Western Switzerland, prevention messages could focus on men, driving under medication or cocaine.
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In this article, we offer an overview of the compared quantitative importance of biotransformation reactions in the metabolism of drugs and other xenobiotics, based on a meta-analysis of current research interests. Also, we assess the relative significance the enzyme (super)families or categories catalysing these reactions. We put the facts unveiled by the analysis into a drug discovery context and draw some implications. The results confirm the primary role of cytochrome P450-catalysed oxidations and UDP-glucuronosyl-catalysed glucuronidations, but they also document the marked significance of several other reactions. Thus, there is a need for several drug discovery scientists to better grasp the variety of drug metabolism reactions and enzymes and their consequences.
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An assay for the simultaneous analysis of pharmaceutical compounds and their metabolites from micro-whole blood samples (i.e. 5 microL) was developed using an on-line dried blood spot (on-line DBS) device coupled with hydrophilic interaction/reversed-phase (HILIC/RP) LC/MS/MS. Filter paper is directly integrated to the LC device using a homemade inox desorption cell. Without any sample pretreatment, analytes are desorbed from the paper towards an automated system of valves linking a zwitterionic-HILIC column to an RP C18 column. In the same run, the polar fraction is separated by the zwitterionic-HILIC column while the non-polar fraction is eluted on the RP C18. Both fractions are detected by IT-MS operating in full scan mode for the survey scan and in product ion mode for the dependant scan using an ESI source. The procedure was evaluated by the simultaneous qualitative analysis of four probes and their relative phase I and II metabolites spiked in whole blood. In addition, the method was successfully applied to the in vivo monitoring of buprenorphine metabolism after the administration of an intraperitoneal injection of 30 mg/kg on adult female Wistar rat.
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Studies on the cellular disposition of targeted anticancer tyrosine kinases inhibitors (TKIs) have mostly focused on imatinib while the functional importance of P-glycoprotein (Pgp) the gene product of MDR1 remains controversial for more recent TKIs. By using RNA interference-mediated knockdown of MDR1, we have investigated and compared the specific functional consequence of Pgp on the cellular disposition of the major clinically in use TKIs imatinib, dasatinib, nilotinib, sunitinib and sorafenib. siRNA-mediated knockdown in K562/Dox cell lines provides a unique opportunity to dissect the specific contribution of Pgp to TKIs intracellular disposition. In these conditions, abrogating specifically Pgp-mediated efflux in vitro revealed the remarkable and statistically significant cellular accumulation of imatinib (difference in cellular levels between Pgp-expressing and silenced cells, at high and low incubation concentration, respectively: 6.1 and 6.6), dasatinib (4.9 and 5.6), sunitinib (3.7 and 7.3) and sorafenib (1.2 and 1.4), confirming that these TKIs are all substrates of Pgp. By contrast, no statistically significant difference in cellular disposition of nilotinib was observed as a result of MDR1 expression silencing (differences: 1.1 and 1.5) indicating that differential expression and/or function of Pgp is unlikely to affect nilotinib cellular disposition. This study enables for the first time a direct estimation of the specific contribution of one transporter among the various efflux and influx carriers involved in the cellular trafficking of these major TKIs in vitro. Knowledge on the distinct functional consequence of Pgp expression for these various TKIs cellular distribution is necessary to better appreciate the efficacy, toxicity, and potential drug-drug interactions of TKIs with other classes of therapeutic agents, at the systemic, tissular and cellular levels.
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Chronic intake of non steroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced risk of developing gastrointestinal tumors, in particular colon cancer. Increasing evidence indicates that NSAID exert tumor-suppressive activity on pre-malignant lesions (polyps) in humans and on established experimental tumors in mice. Some of the tumor-suppressive effects of NSAIDs depend on the inhibition of cyclooxygenase-2 (COX-2), a key enzyme in the synthesis of prostaglandins and thromboxane, which is highly expressed in inflammation and cancer. Recent findings indicate that NSAIDs exert their anti-tumor effects by suppressing tumor angiogenesis. The availability of COX-2-specific NSAIDs opens the possibility of using this drug class as anti-angiogenic agents in combination with chemotheapy or radiotherapy for the treatment of human cancer. Here we will briefly review recent advances in the understanding of the mechanism by which NSAIDs suppress tumor angiogenesis and discuss their potential clinical application as anti-cancer agents.
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Anthracene derivatives of ruthenium(II) arene compounds with 1,3,5-triaza-7-phosphatricyclo[3.3.1.1]decane (pta) or a sugar phosphite ligand, viz., 3,5,6-bicyclophosphite-1,2-O-isopropylidene-α-d-glucofuranoside, were prepared in order to evaluate their anticancer properties compared to the parent compounds and to use them as models for intracellular visualization by fluorescence microscopy. Similar IC(50) values were obtained in cell proliferation assays, and similar levels of uptake and accumulation were also established. The X-ray structure of [{Ru(η(6)-C(6)H(5)CH(2)NHCO-anthracene)Cl(2)(pta)] is also reported.
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Memory and effector T cells have the potential to counteract cancer progression, but often fail to control the disease, essentially because of three main stumbling blocks. First, clonal deletion leads to relatively low numbers or low-to-intermediate T cell receptor (TCR) affinity of self/tumor-specific T cells. Second, the poor innate immune stimulation by solid tumors is responsible for inefficient priming and boosting. Third, T cells are suppressed in the tumor microenvironment by inhibitory signals from other immune cells, stroma and tumor cells, which induces T cell exhaustion, as demonstrated in metastases of melanoma patients. State-of-the-art adoptive cell transfer and active immunotherapy can partially overcome the three stumbling blocks. The reversibility of T cell exhaustion and novel molecular insights provide the basis for further improvements of clinical immunotherapy.