Pharmacogenetic Study on Antidementia Drugs

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.

Natalizumab versus Interferon B-1b to prevent CDMS in patients with CIS and poor prognostic factors: research protocol

About 85% of multiple sclerosis (MS) cases start as clinically isolated syndrome (CIS).When patients present with a CIS, clinicians face with many questions, most of themrelated with prognosis and treatment. Thereby, patients with CIS have been focus ofresearch. Several studies have demonstrated a relationship between positive IgM lipidspecific oligoclonal band pattern in CSF and higher lesion load on MRI brain scan, higher number of relapses and greater disability, even at the first stages of the disease. On the other hand, no studies have used this previous evidence to treat with more aggressive disease modifying therapy in initial stages of disease course to prevent the earlier axonal damage. The aim of this study is to assess the most effective approved treatment for MS and current therapy for CIS patients presenting high risk to develop CDMS and with biomarkers of poor prognosis. Among this group of patients any disease activity will eventually lead to disability. Therefore, the earlier the treatment is initiated, the more effective to prevent disability will be. It is considered that “time lost is brain lost” and since once damage is established, there is no therapy to be regained later on. In this phase III clinical trial, 172 patients will be randomized 1:1 to receive Interferon β-1b or natalizumab over 96 weeks. Time to develop clinical definitive multiple sclerosis (CDMS) will be included as primary endpoint. Other secondary endpoints will include clinical data, magnetic resonance imaging (MRI) measurements and quality of life tests

Natalizumab versus Interferon B-1b to prevent CDMS in patients with CIS and poor prognostic factors: research protocol

About 85% of multiple sclerosis (MS) cases start as clinically isolated syndrome (CIS).When patients present with a CIS, clinicians face with many questions, most of themrelated with prognosis and treatment. Thereby, patients with CIS have been focus ofresearch. Several studies have demonstrated a relationship between positive IgM lipidspecific oligoclonal band pattern in CSF and higher lesion load on MRI brain scan, higher number of relapses and greater disability, even at the first stages of the disease. On the other hand, no studies have used this previous evidence to treat with more aggressive disease modifying therapy in initial stages of disease course to prevent the earlier axonal damage. The aim of this study is to assess the most effective approved treatment for MS and current therapy for CIS patients presenting high risk to develop CDMS and with biomarkers of poor prognosis. Among this group of patients any disease activity will eventually lead to disability. Therefore, the earlier the treatment is initiated, the more effective to prevent disability will be. It is considered that “time lost is brain lost” and since once damage is established, there is no therapy to be regained later on. In this phase III clinical trial, 172 patients will be randomized 1:1 to receive Interferon β-1b or natalizumab over 96 weeks. Time to develop clinical definitive multiple sclerosis (CDMS) will be included as primary endpoint. Other secondary endpoints will include clinical data, magnetic resonance imaging (MRI) measurements and quality of life tests

Pro-inflammatory cytokines induce the transcription factors C/EBPbeta and C/EBPdelta in astrocytes.

The transcription factors CCAAT/enhancer binding protein (C/EBP)-beta and -delta are key regulators for the expression of the acute phase genes in the liver, such as complement component C3 and antichymotrypsin. In the brain, these acute phase proteins are produced in response to pro-inflammatory cytokines by the reactive astrocytes, in particular those surrounding the amyloid plaques of Alzheimer's disease brains. Here we show that lipopolysaccharides (LPS), IL-1beta, and TNFalpha induce the expression of the c/ebpbeta and -delta genes in mouse primary astrocytes. This induction precedes the expression of the acute phase genes coding for the complement component C3 and the mouse homologue of antichymotrypsin. The induction of these two acute phase genes by LPS is blocked by cycloheximide, whereas this protein synthesis inhibitor does not affect the expression of the c/ebp genes. Altogether, our data support a role as immediate-early genes for c/ebpbeta and -delta, whose expression is induced by pro-inflammatory cytokines in mouse cortical astrocytes. In the liver, these transcription factors are known to play an important role in inflammation and energy metabolism regulation. Therefore, C/EBPbeta and -delta could be pivotal transcription factors involved in brain inflammation, in addition to their previously demonstrated role in brain glycogen metabolism regulation (Cardinaux and Magistretti. J Neurosci 16:919-929, 1996).

Cultural events as tourism supply in coastal Catalan resorts

During the last three decades, the number of tourism events has been growing in Catalan coastal resorts because of the recover of Catalan cultural traditions, festivals and folklore, and also because of tourism growth. Catalan tourism resorts use events as catalysers for new supply and as a mean to differentiate and singularize themselves from their competitors. The tourism potential of cultural events is undeniable but there are some problems that prevent a more effective impact as economic and regional development agents. This paper reflects some discussions and conclusions obtained from the analysis of 264 valid responses of a survey made to different Catalan event organizers in 2008 and 2009. We describe and characterize cultural event supply in coastal resorts in order to study the events tourism importance, their capacity to generate and spread economic development, and their managerial model. The analysis is made in a geographical basis, comparing the results of the territorial organization of events of the city of Barcelona, coastal and inland municipalities. Finally some considerations about event regional tourism policy and tourism development are discussed.

ZigBee/ZigBee PRO security assessment based on compromised cryptographic keys

Sensor networks have many applications in monitoring and controlling of environmental properties such as sound, acceleration, vibration and temperature. Due to limitedresources in computation capability, memory and energy, they are vulnerable to many kinds of attacks. The ZigBee specification based on the 802.15.4 standard, defines a set of layers specifically suited to sensor networks. These layers support secure messaging using symmetric cryptographic. This paper presents two different ways for grabbing the cryptographic key in ZigBee: remote attack and physical attack. It also surveys and categorizes some additional attacks which can be performed on ZigBee networks: eavesdropping, spoofing, replay and DoS attacks at different layers. From this analysis, it is shown that some vulnerabilities still in the existing security schema in ZigBee technology.

La Costa Brava ante los nuevos retos del turismo

The first section of this paper summarises the most relevant charateristics of the contemporary tourist model, also called postfordist or postmodernist. In the second part the traditional tourist model developed in the Costa Brava in the past decades, is reviewed. Emphasising the saturation of tourist facilities on the coast line, expansive urban growth, thanks to a tolerant administration, poor complementary supply and concentrated demand in few markets and the proximity of Barcelona conurbation, stressed by second homes. In the third section, some strategies developed in recent years to readapt the Costa Brava to the new tendencies in tourism, are presented. Incorporation of the inland to the tourist product, new planning policics, lessening urban densities and height, and a change in mind in favour of protected natural areas, diversification of demand with new markets, specially form Eastern Europe (although this might be considered as a continuation ofthe traditional tourist model) and the emergence of local strategies oriented towards the creation of new tourist products based upon natural and cultural resources

Forecasting tourism demand to Catalonia: neural networks vs. time series models

The increasing interest aroused by more advanced forecasting techniques, together with the requirement for more accurate forecasts of tourismdemand at the destination level due to the constant growth of world tourism, has lead us to evaluate the forecasting performance of neural modelling relative to that of time seriesmethods at a regional level. Seasonality and volatility are important features of tourism data, which makes it a particularly favourable context in which to compare the forecasting performance of linear models to that of nonlinear alternative approaches. Pre-processed official statistical data of overnight stays and tourist arrivals fromall the different countries of origin to Catalonia from 2001 to 2009 is used in the study. When comparing the forecasting accuracy of the different techniques for different time horizons, autoregressive integrated moving average models outperform self-exciting threshold autoregressions and artificial neural network models, especially for shorter horizons. These results suggest that the there is a trade-off between the degree of pre-processing and the accuracy of the forecasts obtained with neural networks, which are more suitable in the presence of nonlinearity in the data. In spite of the significant differences between countries, which can be explained by different patterns of consumer behaviour,we also find that forecasts of tourist arrivals aremore accurate than forecasts of overnight stays.

Evaluation de la qualité des sites internet francophones traitant de la dépendance à l'alcool [Assessing the quality of French language web sites pertaining to alcohol dependency]

The objective of this article is to systematically assess the quality of web-based information in French language on the alcohol dependence. The authors analysed, using a standardised pro forma, the 20 most highly ranked pages identified by 3 common internet search engines using 2 keywords. Results show that a total of 45 sites were analysed. The authors conclude that the overall quality of the sites was relatively poor, especially for the description of possible treatments, however with a wide variability. Content quality was not correlated with other aspects of quality such as interactivity, aesthetic or accountability.

Typpeä sisältävien jätevesien käsittely 2-n-PRO menetelmällä

Työssä tutkittiin kaksivaiheisen typenpoistoprosessin (2-N-PRO) soveltuvuutta Joutsenon Kukkuroinmäen aluejätekeskuksen kompostointilaitoksen jätevesille pilot-kokein 12.1.- 5.4.2006. Kompostilaitoksella on jätevesien esikäsittelytarve korkeista ammoniumtyppipitoisuuksista johtuen. Pilot-laitteisto koostuu sekoitussäiliöstä, strippaustornista ja katalyyttipolttimesta. Käsiteltävän jäteveden pH nostetaan korkealle tasolle, jolloin ammoniumtyppi muuttuu ammoniakiksi. Vesi johdetaan strippaustorniin, jossa se sadetetaan tornin pohjalle. Ammoniakki erottuu sadetuksessa ilmaan, joka imetään katalyyttipolttimelle. Katalyyttinen poltin käsittelee ammoniakkia typpikaasuksi. Pilot-kokeet suoritettiin jatkuvatoimisesti. Laitteisto pystyy erottamaan jätevedestä ammoniumtyppeä ammoniakiksi ja käsittelemään ammoniakin pääosin typpikaasuksi. Lisäksi suoritettiin panoskoe, jonka tulokset tukevat jatkuvatoimisesta käytöstä saatuja tuloksia.

Identification of a Poor-Prognosis BRAF-Mutant-Like Population of Patients With Colon Cancer.

PURPOSE Our purpose was development and assessment of a BRAF-mutant gene expression signature for colon cancer (CC) and the study of its prognostic implications. Materials and METHODS A set of 668 stage II and III CC samples from the PETACC-3 (Pan-European Trails in Alimentary Tract Cancers) clinical trial were used to assess differential gene expression between c.1799T>A (p.V600E) BRAF mutant and non-BRAF, non-KRAS mutant cancers (double wild type) and to construct a gene expression-based classifier for detecting BRAF mutant samples with high sensitivity. The classifier was validated in independent data sets, and survival rates were compared between classifier positive and negative tumors. Results A 64 gene-based classifier was developed with 96% sensitivity and 86% specificity for detecting BRAF mutant tumors in PETACC-3 and independent samples. A subpopulation of BRAF wild-type patients (30% of KRAS mutants, 13% of double wild type) showed a gene expression pattern and had poor overall survival and survival after relapse, similar to those observed in BRAF-mutant patients. Thus they form a distinct prognostic subgroup within their mutation class. CONCLUSION A characteristic pattern of gene expression is associated with and accurately predicts BRAF mutation status and, in addition, identifies a population of BRAF mutated-like KRAS mutants and double wild-type patients with similarly poor prognosis. This suggests a common biology between these tumors and provides a novel classification tool for cancers, adding prognostic and biologic information that is not captured by the mutation status alone. These results may guide therapeutic strategies for this patient segment and may help in population stratification for clinical trials.

Hedge-rahastojen menestysmittaus

Tutkimuksen tavoitteena on selvittää miten hedge-rahastot eroavat ns. normaaleista osakerahastoista ja kuinka suomalaiset hedge-rahastot ovat pärjänneet tutkimusjaksolla 2003-2005. Tutkimuksen empiirisen osan aineisto on kerätty julkisesti saatavilla olevasta informaatiosta. Aineistoon on kerätty seitsemän suomalaista ja yksi ruotsalainen hedge-rahasto. Empiirinen osa mittaa rahastojen menestymistä siihen sopiviksi valituilla menestysmittareilla. Tulokset osoittavat, että suomalaiset hedge-rahastot ovat pärjänneet käytetyillä mittareilla tutkimusperiodilla verrattain huonosti. Tutkittavista rahastoista tutkimuksessa parhaiten menestyi ruotsalainen Erik Penser Hedge Fond.

Palveluhankintojen analysointi ja mittaaminen, case Stora Enso Saimaa Services Oy

Tutkimuksen tavoitteena oli luoda Stora Enso Saimaa Services Oy:lle palveluhankintojen suorituskyvyn mittaristo Balanced Scorecardin avulla. Yrityksen palveluhankintakentän kirjavuuden vuoksi työ rajattiin koskemaan vain Etelä-Karjalan Yrityksiltä (= EKY) ostettavia kunnossapitopalveluja. Mittariston muodostamisen lähtökohtana oli hankintatoimen strateginen tavoite, kokonaiskustannusten alentaminen. Tämä tavoite konkretisoituu parhaiten hankintojen elinkaarikustannusten minimoimisena. Työssä käytettiin kvalitatiivista tutkimusmenetelmää. Tutkimuskohdetta analysoitiin tapaustutkimusmenetelmällä. Aineisto kerättiin sisäisille asiakkaille suunnatulla puolistrukturoidulla haastatteluilla, ostajien ajankäytönseurantakyselyllä sekä osallistuvalla havainnoinnilla. Haastatteluja tehtiin 10 ja kyselyjä 6. Palveluhankintojen elinkaarikustannusten ja mittaamisen osalta on tehty tutkimuksia hyvin vähän. EKY-palveluhankintoihin onnistuttiin kuitenkin luomaan tasapainotettu mittaristo palvelujen erityispiirteet huomioiden. EKY-elinkaarikustannusanalysoinnissa keskityttiin palveluhankintojen keskeisiin kustannuskomponentteihin kuten transaktiokustannusteoriaan, hintojen määräytymiseen ja huonon laadun kustannuksiin. Näiden pohjalta kriittisiksi palveluhankintojen menestystekijöiksi nousivat mm. ostajien ajankäytön suuntaaminen strategisiin työtehtäviin, hintojen hallinta sekä toimittajien laadun arviointi. Nämä tekijät muotoiltiin EKY-palveluhankintojen tuloskorttiin ja niihin valittiin hankintatoimen mittausmalleista sopivat suorituskyvyn mittarit. Mittarit jaettiin EKY-palveluhankintoihin määriteltyihin neljään näkökulmaan Balanced Scorecard -prosessin mukaisesti.