Intensity modulated radiation therapy or stereotactic fractionated radiotherapy for infratentorial ependymoma in children: a multicentric study.

This study was to evaluate the treatment dosimetry, efficacy and toxicity of intensity modulated radiation therapy (IMRT) and fractionated stereotactic radiotherapy (FSRT) in the management of infratentorial ependymoma. Between 1999 and 2007, seven children (median age, 3.1 years) with infratentorial ependymoma were planned with either IMRT (3 patients) or SFRT (4 patients), the latter after conventional posterior fossa irradiation. Two children underwent gross total resection. Median prescribed dose was 59.4 Gy (range, 55.8-60). The median follow-up for surviving patients was 4.8 years (range, 1.3-8). IMRT (median dose, 59.4 Gy) and FSRT (median dose, 55.8 Gy) achieved similar optimal target coverage. Percentages of maximum doses delivered to the cochleae (59.5 vs 85.0% Gy; P = 0.05) were significantly inferior with IMRT, when compared to FSRT planning. Percentages of maximum doses administered to the pituitary gland (38.2 vs 20.1%; P = 0.05) and optic chiasm (38.1 vs 14.1%; P = 0.001) were, however, significantly higher with IMRT, when compared to FSRT planning. No recurrences were observed at the last follow-up. The estimated 3-year progression-free survival and overall survival were 87.5 and 100%, respectively. No grade >1 acute toxicity was observed. Two patients presented late adverse events (grade 2 hypoacousia) during follow-up, without cognitive impairment. IMRT or FSRT for infratentorial ependymomas is effective and associated with a tolerable toxicity level. Both treatment techniques were able to capitalize their intrinsic conformal ability to deliver high-dose radiation. Larger series of patients treated with these two modalities will be necessary to more fully evaluate these delivery techniques.

Monitoring drug therapy.

Drug development has improved over recent decades, with refinements in analytical techniques, population pharmacokinetic-pharmacodynamic (PK-PD) modelling and simulation, and new biomarkers of efficacy and tolerability. Yet this progress has not yielded improvements in individualization of treatment and monitoring, owing to various obstacles: monitoring is complex and demanding, many monitoring procedures have been instituted without critical assessment of the underlying evidence and rationale, controlled clinical trials are sparse, monitoring procedures are poorly validated and both drug manufacturers and regulatory authorities take insufficient account of the importance of monitoring. Drug concentration and effect data should be increasingly collected, analyzed, aggregated and disseminated in forms suitable for prescribers, along with efficient monitoring tools and evidence-based recommendations regarding their best use. PK-PD observations should be collected for both novel and established critical drugs and applied to observational data, in order to establish whether monitoring would be suitable. Methods for aggregating PK-PD data in systematic reviews should be devised. Observational and intervention studies to evaluate monitoring procedures are needed. Miniaturized monitoring tests for delivery at the point of care should be developed and harnessed to closed-loop regulated drug delivery systems. Intelligent devices would enable unprecedented precision in the application of critical treatments, i.e. those with life-saving efficacy, narrow therapeutic margins and high interpatient variability. Pharmaceutical companies, regulatory agencies and academic clinical pharmacologists share the responsibility of leading such developments, in order to ensure that patients obtain the greatest benefit and suffer the least harm from their medicines.

The impact of fasting on the interpretation of triglyceride levels for predicting myocardial infarction risk in HIV-positive individuals: the D:A:D study.

We assessed whether fasting modifies the prognostic value of these measurements for the risk of myocardial infarction (MI). Analyses used mixed effect models and Poisson regression. After confounders were controlled for, fasting triglyceride levels were, on average, 0.122 mmol/L lower than nonfasting levels. Each 2-fold increase in the latest triglyceride level was associated with a 38% increase in MI risk (relative rate, 1.38; 95% confidence interval, 1.26-1.51); fasting status did not modify this association. Our results suggest that it may not be necessary to restrict analyses to fasting measurements when considering MI risk.

On-line desorption of dried blood spot: A novel approach for the direct LC/MS analysis of micro-whole blood samples.

The aim of this work is to present a new concept, called on-line desorption of dried blood spots (on-line DBS), allowing the direct analysis of a dried blood spot coupled to liquid chromatography mass spectrometry device (LC/MS). The system is based on an inox cell which can receive a blood sample (10 microL) previously spotted on a filter paper. The cell is then integrated into LC/MS system where the analytes are desorbed out of the paper towards a column switching system ensuring the purification and separation of the compounds before their detection on a single quadrupole MS coupled to atmospheric pressure chemical ionisation (APCI) source. The described procedure implies that no pretreatment is necessary in spite the analysis is based on whole blood sample. To ensure the applicability of the concept, saquinavir, imipramine, and verapamil were chosen. Despite the use of a small sampling volume and a single quadrupole detector, on-line DBS allowed the analyses of these three compounds over their therapeutic concentrations from 50 to 500 ng/mL for imipramine and verapamil and from 100 to 1000 ng/mL for saquinavir. Moreover, the method showed good repeatability with relative standard deviation (RSD) lower than 15% based on two levels of concentration (low and high). Function responses were found to be linear over the therapeutic concentration for each compound and were used to determine the concentrations of real patient samples for saquinavir. Comparison of the founded values with those of a validated method used routinely in a reference laboratory showed a good correlation between the two methods. Moreover, good selectivity was observed ensuring that no endogenous or chemical components interfered with the quantitation of the analytes. This work demonstrates the feasibility and applicability of the on-line DBS procedure for bioanalysis.

Effect of Anti-Strip Agents on Temperature Susceptibility of Asphalt Cements, MLR-87-01, 1987

Anti-strip agents can effect the temperature susceptibility of asphalt cement. This concern was expressed at the 33rd Annual Bituminous Conference in St. Paul, Minnesota by Mr. David Gendell, Director of Highway Operations. This study compares viscosity-temperature relationships of asphalt cement with and without anti-strip agent addition.

ADME pharmacogenetics: investigation of the pharmacokinetics of the antiretroviral agent lopinavir coformulated with ritonavir.

BACKGROUND: An ADME (absorption, distribution, metabolism and excretion)-pharmacogenetics association study may identify functional variants relevant to the pharmacokinetics of lopinavir co-formulated with ritonavir (LPV/r), a first-line anti-HIV agent. METHODS: An extensive search of literature and web resources helped select ADME genes and single nucleotide polymorphisms (SNPs, functional and HapMap tagging SNPs) with a proven or potentially relevant role in LPV/r pharmacokinetics. The study followed a two-stage design. Stage 1 (discovery) considered a Caucasian population (n=638) receiving LPV/r, where we selected 117 individuals with low LPV clearance (cases) and 90 individuals with high clearance (controls). Genotyping was performed by a 1536-SNP customized GoldenGate Illumina BeadArray. Stage 2 (confirmation) represented a replication study of candidate SNPs from the stage 1 in 148 individuals receiving LPV/r. The analysis led to formal population pharmacokinetic-pharmacogenetic modeling of demographic, environmental and candidate SNP effects. RESULTS: One thousand three hundred and eighty SNPs were successfully genotyped. Nine SNPs prioritized by the stage 1 analysis were brought to replication. Stage 2 confirmed the contribution of two functional SNPs in SLCO1B1, one functional SNP in ABCC2 and a tag SNP of the CYP3A locus in addition to body weight effect and ritonavir coadministration. According to the population pharmacokinetic-pharmacogenetic model, genetic variants explained 5% of LPV variability. Individuals homozygous rs11045819 (SLCO1B1*4) had a clearance of 12.6 l/h, compared with 5.4 l/h in the reference group, and 3.9 l/h in individuals with two or more variant alleles of rs4149056 (SLCO1B1*5), rs717620 (ABCC2) or rs6945984 (CYP3A). A subanalysis confirmed that although a significant part of the variance in LPV clearance was attributed to fluctuation in ritonavir levels, genetic variants had an additional effect on LPV clearance. CONCLUSION: The two-stage strategy successfully identified genetic variants affecting LPV/r pharmacokinetics. Such a general approach of ADME pharmacogenetics should be generalized to other drugs.

Safety concerns about CCR5 as an antiviral target.

PURPOSE OF REVIEW: Clinical trials of CCR5 antagonists attest to their efficacy and tolerance in HIV treatment. However, there has been debate on their long-term safety because of the role of CCR5 in innate immunity. This review highlights gaps in our understanding of epidemiology of infections that are modulated by CCR5, in particular, in HIV-infected individuals. RECENT FINDINGS: In the mouse model, CCR5 has a role in the response against pathogens as diverse as Toxoplama gondii, West Nile virus, Mycobacterium tuberculosis, herpes simplex virus, Trypanosoma cruzi, Cryptococcus neoformans, Chlamydia trachomatis, Listeria, and plasmodia. In human cohorts, individuals carrying the defective CCR5Delta32 allele present an increased susceptibility to flavivirus (West Nile virus and tickborne encephalitis virus). The selective pressures that led to the spread of loss-of-function CCR5 mutations in humans (CCR5Delta32), and in mangabeys (CCR5Delta24) are not understood. SUMMARY: The recent availability of CCR5 antagonists has raised concern that genetic, biological, or chemical CCR5 knockout, although beneficial against some pathogens (i.e. HIV), could be deleterious for other processes implicated in pathogen response. The consequences of long-term pharmaceutical intervention on CCR5 should be carefully assessed through rigorous postmarketing surveillance.

Fistulizing Crohn's disease.

Fistulas are common in Crohn's disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators. Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas.

HIV - recentes avanços na pesquisa de fármacos

The development of new antiretroviral drugs is a dynamic process that is continuously fueled by identification of new molecular targets and new compounds for know targets. The current available drugs can be classified into five categories: nucleoside analogues reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors and entry inhibitors (fusion inhibitors and CCR5 antagonist). In addition, the maturation inhibitors may be considered as potential target for chemotherapeutic intervention. This review presents some anti-HIV agents that have already gone through the advance development process for final approval for the treatment of AIDS.

Adherence to drug therapy in kidney disease

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4%). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4%) at the baseline period of the study than after 1 year of the study (26.8%). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22%) was lower than the percentage of non-adherent patients who became adherent (50%). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.

Prevention of enzymatic browning of yacon flour by the combined use of anti-browning agents and the study of its chemical composition

Yacon roots present functional properties because of the high levels of fructooligosaccharides (FOS), which are considered as prebiotic fibers. In addition, yacon roots are rich in phenolic compounds. During the processing of yacon, the freshly cut surface undergoes rapid enzymatic browning. Control of enzymatic browning during processing is very important to preserve the appearance of yacon flour. In this study, it was evaluated the combined effect of anti-browning agents (ascorbic acid, citric acid and L-cysteine) on the inhibition of enzymatic browning of yacon, using Response Surface Methodology. The yacon pre-treated with anti-browning agents in concentrations of 15.0 mM for ascorbic acid, 7.5 mM for citric acid and 10.0 mM for L-cysteine was used for the processing of flour. Yacon flour presented an attractive color and good sensory properties, without residual aroma. The contents of FOS and phenolic compounds obtained in yacon flour were 28.60 g.100 g- 1 and 1.35 g.100 g- 1. Yacon flour can be considered as a potential functional food, especially due to high levels of FOS, which allows for its use in formulation of various foods.

Étude de la traduction IRES-dépendante du VIH-1

Le virus de l’immunodéficience humaine de type 1 (VIH-1) est responsable de la pandémie du SIDA (syndrome de l’immunodéficience acquise). Des souches virales résistantes aux antirétroviraux actuellement utilisés apparaissent rapidement. Il est donc important d’identifier de nouvelles cibles dans le cycle de réplication du VIH-1 pour développer de nouveaux agents contre ce virus. La traduction des protéines de structure et des enzymes du VIH-1 est une étape essentielle du cycle de réplication virale. Ces protéines sont exprimées à partir de l’ARN messager (ARNm) pleine-longueur (ARNmPL) à la fin du cycle de réplication. L’ARNmPL du VIH-1 peut utiliser un mode d’initiation de la traduction coiffe-dépendant, comme la majorité des ARNm cellulaires, mais peut aussi utiliser un mode d’initiation alternatif, car sa région 5’ non-traduite (5’UTR) contient un site interne d’entrée du ribosome (IRES), ce qui lui permet d’initier la traduction suivant un mode IRES-dépendant. L’initiation IRES-dépendante permet à l’ARNmPL d’être traduit quand l’initiation coiffe-dépendante est inhibée. L’activité de l’IRES de la région 5’UTR de l’ARNmPL du VIH-1 (IRES5’UTR) est faible dans des conditions physiologiques, mais est stimulée lorsque la cellule est arrêtée à la transition G2/M du cycle cellulaire, un arrêt qu’induit l’infection par le VIH-1. Une grande portion de l’IRES5’UTR, que nous nommons IRES5’UTRc, est présente dans tous les ARNm viraux et a une activité semblable à celle de l’ IRES5’UTR, ce qui indique que le mode IRES-dépendant peut être utilisé par tous les messagers du VIH-1. Lors de mes études doctorales, j’ai caractérisé le fonctionnement de l’IRES5’UTR du VIH-1. J’ai transfecté des cellules lymphocytaires Jurkat T, dérivées des cibles naturelles du VIH-1, avec un vecteur dual-luciférase contenant les séquences codantes des luciférases de la Renilla (Rluc) et de la luciole (Fluc) séparées par la région 5’UTR de l’ARNmPL du VIH-1. La traduction de la Rluc est coiffe-dépendante alors que celle de la Fluc dépend de l’IRES5’UTR. J’ai d’abord effectué une analyse mutationnelle et j’ai identifié trois régions qui stimulent l’activité de l’IRES5’UTR et une tige-boucle qui réprime l’activité de cet IRES, que j’ai nommée IRENE (IRES negative element). J’ai montré que l’effet répresseur d’IRENE est aboli lorsque les cellules sont soumises à un stress oxydatif, un type de stress induit lors d’une infection par le VIH-1. Nous proposons que IRENE maintiendrait l’IRES5’UTR dans une conformation peu active dans des conditions physiologiques. On sait que les IRES sont activés par divers facteurs cellulaires, appelés ITAF (IRES trans-acting factors). Nous proposons que l’IRES5’UTR adopterait une conformation active suite à la liaison d’un ITAF exprimé ou relocalisé lors d’un stress oxydatif. Ces travaux ont fait l’objet d’une publication (Gendron et al., 2011, Nucleic Acids Research, 39, 902-912). J’ai ensuite étudié l’effet de la protéine virale Tat sur l’activité de l’IRES5’UTR. En plus de son rôle essentiel dans la transactivation de la transcription des ARNm viraux, Tat stimule leur traduction coiffe-dépendante, en empêchant l’inhibition d’un facteur d’initiation canonique, eIF2, induite par la protéine kinase modulée par l’ARN double-brin (PKR) et en déroulant la structure TAR présente à l’extrémité 5’ de tous les ARNm du VIH-1. Elle affecte aussi l’expression de plusieurs gènes cellulaires. J’ai montré que les isoformes Tat86 et Tat72, mais non Tat101, stimulent l’activité de l’IRES5’UTR. Cet effet est indépendant de PKR et de TAR, mais dépendrait de la conformation de Tat. Nous proposons que Tat activerait un facteur de transcription cellulaire qui déclenche l’expression d’un ITAF de l’IRES5’UTR ou encore qu’elle activerait directement un tel ITAF. J’ai de plus montré que PKR stimule l’activité de l’IRES5’UTR, ce qui est surprenant puisque PKR est une protéine antivirale. Cet effet est indépendant de l’inhibition d’eIF2 par PKR et pourrait résulter de l’activation d’un ITAF. Sachant qu’une portion active de l’IRES5’UTR, IRES5’UTRc, est présente dans tous les ARNm viraux, notre hypothèse est que la stimulation de cet IRES par PKR permettait de traduire l’ARNm de Tat au début du cycle de réplication, ce qui permettrait ensuite la traduction coiffe-dépendante des ARNm du VIH-1, qui est stimulée par Tat. Ces travaux font l’objet d’un manuscrit (Gendron et al., soumis à RNA). Mes résultats, couplés aux données de la littérature, me conduisent à la conclusion que, à la fin du cycle de réplication du VIH-1, l’activité de l’IRES5’UTR est stimulée par le stress oxydatif, l’arrêt en G2/M et la présence de quantités élevées de Tat, alors que la traduction coiffe-dépendante est compromise. L’initiation IRES-dépendante serait alors indispensable pour que le VIH-1 traduise l’ARNmPL. L’IRES5’UTR constituerait donc une cible très intéressante pour développer des agents anti-VIH.

Efficacy of a combined drug therapy for ameliorating noise-induced hearing loss

Experiments investigated the median effective dose of antiepileptic drugs and synthetic glucocorticoids for the prevention and treatment of noise-induced hearing loss for C57BL/6J mice. We also tested the possible synergistic effects of combining drugs from the two drug families.

Synthesis and cytotoxicity studies of new dimethylamino-functionalised and aryl-substituted titanocene anti-cancer agents

From the carbolithiation of 6-N,N-dimethylamino fulvene (3a) and different lithiated aryl species [p-N,N-dimethylanilinyl lithium, p-anisyl lithium and 4-lithio-benzo[1.3]dioxole (2a-c)], the corresponding lithium cyclopentadienide intermediates 4a-c were formed. These three lithiated intermediates underwent a transmetallation reaction with TiCl4 resulting in dimethylamino-functionalised and aryl-substituted titanocenes 5a-c. When these titanocenes were tested against LLC-PK cells, the IC50 values obtained were of 54, 45 and 26 mu M for titanocenes 5a, b and c, respectively. The most cytotoxic titanocene in this paper, 5c is approximately 10 times less cytotoxic than cis-platin, which showed an IC50 value of 3.3 mu M, when tested on the LLC-PK cell line, but approximately 100 times better than titanocene dichloride. (C) 2007 Elsevier Masson SAS. All rights reserved.