Comparative study of the clinical and anti-microbial efficacy of tongue cleaners

Candida species have frequently been isolated from the oral cavities of a variety of patients, such as elderly people, dentures users, immunocompromised and health patients. Yeasts may be associated with immune response and local factors such as poor oral hygiene. It was evaluated effectiveness of tongue cleaner showing which types would be preferred by patients, changes in tongue coating and in saliva yeasts counting. Thirty patients were selected and randomly distributed into three groups. This crossover blind study evaluated the effect of tongue cleaning using: a plastic and a steel tongue scraper and a nylon soft-bristle toothbrush. All patients were instructed to use the cleaners twice a day for one week (fifteen-day wash-out period). Saliva and tongue coating samples were collected from each patient from each test period, the yeasts were counted by colony forming units per mL (CFU/ mL) and the species were identified. The patients were questioned about cleaner preference. An increase in the percentage of patients with no tongue coating after scraping was observed. A reduction in the mean number of Candida species in tongue coating was observed only after nylon soft-bristle toothbrush cleaner. Candida albicans was the prevalent species. Volunteers preferred to the steel tongue scraper (60%). Tongue cleaners reduced the tongue coating and the mean number of saliva's yeasts. Degree of tongue coating favors the Candida species colonization.

Efeitos do cloridrato de remifentanil, administrado em infusão contínua, na concentração alveolar mínima(CAM) de isofluorano em felinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação in situ da capacidade remineralizadora de selantes que contenham fosfato de cálcio amorfo e/ou fluoreto

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da infusão contínua de lidocaína em equinos submetidos à distensão ileal

Pós-graduação em Cirurgia Veterinária - FCAV

Influência da quantidade de dentifrício e concentração de fluoreto na retenção intrabucal de fluoreto em crianças

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Elastografia acoustic radiation force impulse (ARFI), doppler e ultrassonografia contrastada do baço canino

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ultrassonografia modo B de alta resolução modo Doppler e uso de contraste de microbolhas na avaliação testicular de gatos domésticos

Pós-graduação em Medicina Veterinária - FCAV

Efeitos da suplementação de taurina ou flavonóides de cacau associado à achocolatado sobre a composição corporal, metabolismo de carboidratos e proteinas, desempenho fisico, dano muscular e estresse oxidativo em atletas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da suplementação de taurina ou flavonóides de cacau associado à achocolatado sobre a composição corporal, metabolismo de carboidratos e proteinas, desempenho fisico, dano muscular e estresse oxidativo em atletas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Arthrospira platensis biomass with high protein content cultivated in continuous process using urea as nitrogen source

Aims: Arthrospira platensis has been studied for single-cell protein production because of its biomass composition and its ability of growing in alternative media. This work evaluated the effects of different dilution rates (D) and urea concentrations (N0) on A.similar to platensis continuous culture, in terms of growth, kinetic parameters, biomass composition and nitrogen removal. Methods and results: Arthrospira platensis was continuously cultivated in a glass-made vertical column photobioreactor agitated with Rushton turbines. There were used different dilution rates (0.040.44 day-1) and urea concentrations (0.5 and 5 mmol l-1). With N0 = 5 mmol l-1, the maximum steady-state biomass concentration was1415 mg l-1, achieved with D = 0.04 day-1, but the highest protein content (71.9%) was obtained by applying D = 0.12 day-1, attaining a protein productivity of 106.41 mg l-1 day-1. Nitrogen removal reached 99% on steady-state conditions. Conclusions: The best results were achieved by applying N0 = 5 mmol l-1; however, urea led to inhibitory conditions at D = 0.16 day-1, inducing the system wash-out. The agitation afforded satisfactory mixture and did not harm the trichomes structure. Significance and Impact of the Study: These results can enhance the basis for the continuous removal of nitrogenous wastewater pollutants using cyanobacteria, with an easily assembled photobioreactor.

Fluoride plus CO2 laser against the progression of caries in root dentin

Purpose: To evaluate the effect of a 1.23% acidulated phosphate fluoride (APF) gel combined with CO2 laser in protecting carious root dentin against further cariogenic challenges. Methods: After a 7-day lead-in period, 12 volunteers wore an intraoral palatal device containing four carious root dentin slabs, treated with APF and APF+CO2 or placebo and placebo+CO2. After a 14-day wash-out period, volunteers were crossed-over to the other treatment arm. During both intraoral phases, specimens were submitted to cariogenic challenges and then evaluated for cross-sectional Knoop microhardness. Results: Two-way ANOVA demonstrated that there was significant effect for both main factors: CO2 laser irradiation (P< 0.0001) and gel treatment (P< 0.0001), and that there was no interaction between them (P= 0.4706). Protection of carious root dentin against further cariogenic challenges may be provided by APF fluoride gel and CO2 laser, but no additive benefit was found by combining such strategies. (Am J Dent 2012;25:114-117).

Impatto di rifaximina sul microbiota intestinale: selezione di bifidobatteri antibiotico resistenti

The ideal approach for the long term treatment of intestinal disorders, such as inflammatory bowel disease (IBD), is represented by a safe and well tolerated therapy able to reduce mucosal inflammation and maintain homeostasis of the intestinal microbiota. A combined therapy with antimicrobial agents, to reduce antigenic load, and immunomodulators, to ameliorate the dysregulated responses, followed by probiotic supplementation has been proposed. Because of the complementary mechanisms of action of antibiotics and probiotics, a combined therapeutic approach would give advantages in terms of enlargement of the antimicrobial spectrum, due to the barrier effect of probiotic bacteria, and limitation of some side effects of traditional chemiotherapy (i.e. indiscriminate decrease of aggressive and protective intestinal bacteria, altered absorption of nutrient elements, allergic and inflammatory reactions). Rifaximin (4-deoxy-4’-methylpyrido[1’,2’-1,2]imidazo[5,4-c]rifamycin SV) is a product of synthesis experiments designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a non systemic antibiotic with a broad spectrum of antibacterial action, covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually non absorbed, its bioavailability within the gastrointestinal tract is rather high with intraluminal and faecal drug concentrations that largely exceed the MIC values observed in vitro against a wide range of pathogenic microorganisms. The gastrointestinal tract represents therefore the primary therapeutic target and gastrointestinal infections the main indication. The little value of rifaximin outside the enteric area minimizes both antimicrobial resistance and systemic adverse events. Fermented dairy products enriched with probiotic bacteria have developed into one of the most successful categories of functional foods. Probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” (FAO/WHO, 2002), and mainly include Lactobacillus and Bifidobacterium species. Probiotic bacteria exert a direct effect on the intestinal microbiota of the host and contribute to organoleptic, rheological and nutritional properties of food. Administration of pharmaceutical probiotic formula has been associated with therapeutic effects in treatment of diarrhoea, constipation, flatulence, enteropathogens colonization, gastroenteritis, hypercholesterolemia, IBD, such as ulcerative colitis (UC), Crohn’s disease, pouchitis and irritable bowel syndrome. Prerequisites for probiotics are to be effective and safe. The characteristics of an effective probiotic for gastrointestinal tract disorders are tolerance to upper gastrointestinal environment (resistance to digestion by enteric or pancreatic enzymes, gastric acid and bile), adhesion on intestinal surface to lengthen the retention time, ability to prevent the adherence, establishment and/or replication of pathogens, production of antimicrobial substances, degradation of toxic catabolites by bacterial detoxifying enzymatic activities, and modulation of the host immune responses. This study was carried out using a validated three-stage fermentative continuous system and it is aimed to investigate the effect of rifaximin on the colonic microbial flora of a healthy individual, in terms of bacterial composition and production of fermentative metabolic end products. Moreover, this is the first study that investigates in vitro the impact of the simultaneous administration of the antibiotic rifaximin and the probiotic B. lactis BI07 on the intestinal microbiota. Bacterial groups of interest were evaluated using culture-based methods and molecular culture-independent techniques (FISH, PCR-DGGE). Metabolic outputs in terms of SCFA profiles were determined by HPLC analysis. Collected data demonstrated that rifaximin as well as antibiotic and probiotic treatment did not change drastically the intestinal microflora, whereas bacteria belonging to Bifidobacterium and Lactobacillus significantly increase over the course of the treatment, suggesting a spontaneous upsurge of rifaximin resistance. These results are in agreement with a previous study, in which it has been demonstrated that rifaximin administration in patients with UC, affects the host with minor variations of the intestinal microflora, and that the microbiota is restored over a wash-out period. In particular, several Bifidobacterium rifaximin resistant mutants could be isolated during the antibiotic treatment, but they disappeared after the antibiotic suspension. Furthermore, bacteria belonging to Atopobium spp. and E. rectale/Clostridium cluster XIVa increased significantly after rifaximin and probiotic treatment. Atopobium genus and E. rectale/Clostridium cluster XIVa are saccharolytic, butyrate-producing bacteria, and for these characteristics they are widely considered health-promoting microorganisms. The absence of major variations in the intestinal microflora of a healthy individual and the significant increase in probiotic and health-promoting bacteria concentrations support the rationale of the administration of rifaximin as efficacious and non-dysbiosis promoting therapy and suggest the efficacy of an antibiotic/probiotic combined treatment in several gut pathologies, such as IBD. To assess the use of an antibiotic/probiotic combination for clinical management of intestinal disorders, genetic, proteomic and physiologic approaches were employed to elucidate molecular mechanisms determining rifaximin resistance in Bifidobacterium, and the expected interactions occurring in the gut between these bacteria and the drug. The ability of an antimicrobial agent to select resistance is a relevant factor that affects its usefulness and may diminish its useful life. Rifaximin resistance phenotype was easily acquired by all bifidobacteria analyzed [type strains of the most representative intestinal bifidobacterial species (B. infantis, B. breve, B. longum, B. adolescentis and B. bifidum) and three bifidobacteria included in a pharmaceutical probiotic preparation (B. lactis BI07, B. breve BBSF and B. longum BL04)] and persisted for more than 400 bacterial generations in the absence of selective pressure. Exclusion of any reversion phenomenon suggested two hypotheses: (i) stable and immobile genetic elements encode resistance; (ii) the drug moiety does not act as an inducer of the resistance phenotype, but enables selection of resistant mutants. Since point mutations in rpoB have been indicated as representing the principal factor determining rifampicin resistance in E. coli and M. tuberculosis, whether a similar mechanism also occurs in Bifidobacterium was verified. The analysis of a 129 bp rpoB core region of several wild-type and resistant bifidobacteria revealed five different types of miss-sense mutations in codons 513, 516, 522 and 529. Position 529 was a novel mutation site, not previously described, and position 522 appeared interesting for both the double point substitutions and the heterogeneous profile of nucleotide changes. The sequence heterogeneity of codon 522 in Bifidobacterium leads to hypothesize an indirect role of its encoded amino acid in the binding with the rifaximin moiety. These results demonstrated the chromosomal nature of rifaximin resistance in Bifidobacterium, minimizing risk factors for horizontal transmission of resistance elements between intestinal microbial species. Further proteomic and physiologic investigations were carried out using B. lactis BI07, component of a pharmaceutical probiotic preparation, as a model strain. The choice of this strain was determined based on the following elements: (i) B. lactis BI07 is able to survive and persist in the gut; (ii) a proteomic overview of this strain has been recently reported. The involvement of metabolic changes associated with rifaximin resistance was investigated by proteomic analysis performed with two-dimensional electrophoresis and mass spectrometry. Comparative proteomic mapping of BI07-wt and BI07-res revealed that most differences in protein expression patterns were genetically encoded rather than induced by antibiotic exposure. In particular, rifaximin resistance phenotype was characterized by increased expression levels of stress proteins. Overexpression of stress proteins was expected, as they represent a common non specific response by bacteria when stimulated by different shock conditions, including exposure to toxic agents like heavy metals, oxidants, acids, bile salts and antibiotics. Also, positive transcription regulators were found to be overexpressed in BI07-res, suggesting that bacteria could activate compensatory mechanisms to assist the transcription process in the presence of RNA polymerase inhibitors. Other differences in expression profiles were related to proteins involved in central metabolism; these modifications suggest metabolic disadvantages of resistant mutants in comparison with sensitive bifidobacteria in the gut environment, without selective pressure, explaining their disappearance from faeces of patients with UC after interruption of antibiotic treatment. The differences observed between BI07-wt e BI07-res proteomic patterns, as well as the high frequency of silent mutations reported for resistant mutants of Bifidobacterium could be the consequences of an increased mutation rate, mechanism which may lead to persistence of resistant bacteria in the population. However, the in vivo disappearance of resistant mutants in absence of selective pressure, allows excluding the upsurge of compensatory mutations without loss of resistance. Furthermore, the proteomic characterization of the resistant phenotype suggests that rifaximin resistance is associated with a reduced bacterial fitness in B. lactis BI07-res, supporting the hypothesis of a biological cost of antibiotic resistance in Bifidobacterium. The hypothesis of rifaximin inactivation by bacterial enzymatic activities was verified by using liquid chromatography coupled with tandem mass spectrometry. Neither chemical modifications nor degradation derivatives of the rifaximin moiety were detected. The exclusion of a biodegradation pattern for the drug was further supported by the quantitative recovery in BI07-res culture fractions of the total rifaximin amount (100 μg/ml) added to the culture medium. To confirm the main role of the mutation on the β chain of RNA polymerase in rifaximin resistance acquisition, transcription activity of crude enzymatic extracts of BI07-res cells was evaluated. Although the inhibition effects of rifaximin on in vitro transcription were definitely higher for BI07-wt than for BI07-res, a partial resistance of the mutated RNA polymerase at rifaximin concentrations > 10 μg/ml was supposed, on the basis of the calculated differences in inhibition percentages between BI07-wt and BI07-res. By considering the resistance of entire BI07-res cells to rifaximin concentrations > 100 μg/ml, supplementary resistance mechanisms may take place in vivo. A barrier for the rifaximin uptake in BI07-res cells was suggested in this study, on the basis of the major portion of the antibiotic found to be bound to the cellular pellet respect to the portion recovered in the cellular lysate. Related to this finding, a resistance mechanism involving changes of membrane permeability was supposed. A previous study supports this hypothesis, demonstrating the involvement of surface properties and permeability in natural resistance to rifampicin in mycobacteria, isolated from cases of human infection, which possessed a rifampicin-susceptible RNA polymerase. To understand the mechanism of membrane barrier, variations in percentage of saturated and unsaturated FAs and their methylation products in BI07-wt and BI07-res membranes were investigated. While saturated FAs confer rigidity to membrane and resistance to stress agents, such as antibiotics, a high level of lipid unsaturation is associated with high fluidity and susceptibility to stresses. Thus, the higher percentage of saturated FAs during the stationary phase of BI07-res could represent a defence mechanism of mutant cells to prevent the antibiotic uptake. Furthermore, the increase of CFAs such as dihydrosterculic acid during the stationary phase of BI07-res suggests that this CFA could be more suitable than its isomer lactobacillic acid to interact with and prevent the penetration of exogenous molecules including rifaximin. Finally, the impact of rifaximin on immune regulatory functions of the gut was evaluated. It has been suggested a potential anti-inflammatory effect of rifaximin, with reduced secretion of IFN-γ in a rodent model of colitis. Analogously, it has been reported a significant decrease in IL-8, MCP-1, MCP-3 e IL-10 levels in patients affected by pouchitis, treated with a combined therapy of rifaximin and ciprofloxacin. Since rifaximin enables in vivo and in vitro selection of Bifidobacterium resistant mutants with high frequency, the immunomodulation activities of rifaximin associated with a B. lactis resistant mutant were also taken into account. Data obtained from PBMC stimulation experiments suggest the following conclusions: (i) rifaximin does not exert any effect on production of IL-1β, IL-6 and IL-10, whereas it weakly stimulates production of TNF-α; (ii) B. lactis appears as a good inducer of IL-1β, IL-6 and TNF-α; (iii) combination of BI07-res and rifaximin exhibits a lower stimulation effect than BI07-res alone, especially for IL-6. These results confirm the potential anti-inflammatory effect of rifaximin, and are in agreement with several studies that report a transient pro-inflammatory response associated with probiotic administration. The understanding of the molecular factors determining rifaximin resistance in the genus Bifidobacterium assumes an applicative significance at pharmaceutical and medical level, as it represents the scientific basis to justify the simultaneous use of the antibiotic rifaximin and probiotic bifidobacteria in the clinical treatment of intestinal disorders.

Contributo di un software di quantificazione del segnale contrastografico(SonoLiver®) nella diagnosi ecografica di Epatocarcinoma su Cirrosi.

Introduzione La diagnosi di HCC con le tecniche di immagine ed in particolare con CEUS su fegato cirrotico secondo le ultime linee guida prevede un comportamento contrastografico di ipervascolarizzazione nella fase arteriosa e wash-out nella fase tardiva. CEUS è ormai una metodica accettata per la diagnosi ma il wash out nella fase tardiva presenta notevoli difficoltà nel determinare il comportamento contrastografico in quanto valutato soggettivamente su display, infatti il giudizio di tale fase dipende molto dall’operatore e non è rarissimo che nascono discordanza tra operatori anche per piccole differenze. Recentemente è stato proposto un nuovo software(SonoLiver, Bracco, Italy) in grado di quantificare la perfusione delle lesione durante CEUS. Pertanto lo scopo di questo studio pilota è quello di valutare l’impatto di SonoLiver nel rilevare caratteristiche contrastografiche tipiche dell’HCC e valutare la riproducibilità tra due operatori. Pazienti e metodi: Sono stati presi in considerazione 20 noduli (di dimensioni tra 12-95 mm) con diagnosi di HCC in 20 pazienti con cirrosi . La CEUS è stata valutata dapprima ad occhio nudo su display e successivamente con le curve ottenute con DVP da parte di due operatori diversi in cieco, dopo un periodo di formazione adeguata. Sono state quindi analizzate le performance di ciascuna metodica sia in termini di variabilità tra i due operatori che la variabilità tra CEUS ad occhio nudo e CEUS con SonoLiver dello stesso operatore. Risultati:Operatore 1 ha rilevato ipervascolarizzazione in fase arteriosa in 17 su 20 pazienti con valutazione ad occhio nudo su schermo e su 19/20 con le curve ottenute con DVP (+10% sensibilità) mentre operatore 2 ha rilevato ipervascolarizzazione in fase arteriosa19/20 pazienti sia con valutazione ad occhio nudo che con le curve DVP. Nella fase tardiva il wash-out è stato rilevato in 7/20 ad occhio nudo e 10/20 pazienti con le curve DVP (sensibilità aumenta da 35% a 50%) mentre operatore 2 ha rilevato rispettivamente 8/20 e 11/20 (sensibilità aumenta da 40% a 55%). La riproducibilità tra i due operatori rimane invariata con la valutazione di Sonoliver sia nella fase arteriosa che nella fase tardiva. Conclusione:La quantificazione perfusionale con SonoLiver sembra essere uno strumento promettente nella diagnosi di HCC su fegato cirrotico, aumentando aspetti tipici contrastografici.

Automatisierte Flüssigchromatographie mit Säulenschaltung und Ultraviolettspektroskopie oder Massenspektrometrie für therapeutisches Drug Monitoring von Antipsychotika und Antidepressiva

Therapeutisches Drug Monitoring (TDM) wird zur individuellen Dosiseinstellung genutzt, um die Effizienz der Medikamentenwirkung zu steigern und das Auftreten von Nebenwirkungen zu senken. Für das TDM von Antipsychotika und Antidepressiva besteht allerdings das Problem, dass es mehr als 50 Medikamente gibt. Ein TDM-Labor muss dementsprechend über 50 verschiedene Wirkstoffe und zusätzlich aktive Metaboliten messen. Mit der Flüssigchromatographie (LC oder HPLC) ist die Analyse vieler unterschiedlicher Medikamente möglich. LC mit Säulenschaltung erlaubt eine Automatisierung. Dabei wird Blutserum oder -plasma mit oder ohne vorherige Proteinfällung auf eine Vorsäule aufgetragen. Nach Auswaschen von störenden Matrixbestandteilen werden die Medikamente auf einer nachgeschalteten analytischen Säule getrennt und über Ultraviolettspektroskopie (UV) oder Massenspektrometrie (MS) detektiert. Ziel dieser Arbeit war es, LC-Methoden zu entwickeln, die die Messung möglichst vieler Antipsychotika und Antidepressiva erlaubt und die für die TDM-Routine geeignet ist. Eine mit C8-modifiziertem Kieselgel gefüllte Säule (20 µm 10x4.0 mm I.D.) erwies sich in Vorexperimenten als optimal geeignet bezüglich Extraktionsverhalten, Regenerierbarkeit und Stabilität. Mit einer ersten HPLC-UV-Methode mit Säulenschaltung konnten 20 verschiedene Psychopharmaka einschließlich ihrer Metabolite, also insgesamt 30 verschiedene Substanzen quantitativ erfasst werden. Die Analysenzeit betrug 30 Minuten. Die Vorsäule erlaubte 150 Injektionen, die analytische Säule konnte mit mehr als 300 Plasmainjektionen belastet werden. Abhängig vom Analyten, musste allerdings das Injektionsvolumen, die Flussrate oder die Detektionswellenlänge verändert werden. Die Methode war daher für eine Routineanwendung nur eingeschränkt geeignet. Mit einer zweiten HPLC-UV-Methode konnten 43 verschiedene Antipsychotika und Antidepressiva inklusive Metaboliten nachgewiesen werden. Nach Vorreinigung über C8-Material (10 µm, 10x4 mm I.D.) erfolgte die Trennung auf Hypersil ODS (5 µm Partikelgröße) in der analytischen Säule (250x4.6 mm I.D.) mit 37.5% Acetonitril im analytischen Eluenten. Die optimale Flussrate war 1.5 ml/min und die Detektionswellenlänge 254 nm. In einer Einzelprobe, konnten mit dieser Methode 7 bis 8 unterschiedliche Substanzen gemessen werden. Für die Antipsychotika Clozapin, Olanzapin, Perazin, Quetiapin und Ziprasidon wurde die Methode validiert. Der Variationskoeffizient (VK%) für die Impräzision lag zwischen 0.2 und 6.1%. Im erforderlichen Messbereich war die Methode linear (Korrelationskoeffizienten, R2 zwischen 0.9765 und 0.9816). Die absolute und analytische Wiederfindung lagen zwischen 98 und 118 %. Die für das TDM erforderlichen unteren Nachweisgrenzen wurden erreicht. Für Olanzapin betrug sie 5 ng/ml. Die Methode wurde an Patienten für das TDM getestet. Sie erwies sich für das TDM als sehr gut geeignet. Nach retrospektiver Auswertung von Patientendaten konnte erstmalig ein möglicher therapeutischer Bereich für Quetiapin (40-170 ng/ml) und Ziprasidon (40-130 ng/ml) formuliert werden. Mit einem Massenspektrometer als Detektor war die Messung von acht Neuroleptika und ihren Metaboliten möglich. 12 Substanzen konnten in einem Lauf bestimmt werden: Amisulprid, Clozapin, N-Desmethylclozapin, Clozapin-N-oxid, Haloperidol, Risperidon, 9-Hydroxyrisperidon, Olanzapin, Perazin, N-Desmethylperazin, Quetiapin und Ziprasidon. Nach Vorreinigung mit C8-Material (20 µm 10x4.0 mm I.D.) erfolgte die Trennung auf Synergi MAX-RP C12 (4 µm 150 x 4.6 mm). Die Validierung der HPLC-MS-Methode belegten einen linearen Zusammenhang zwischen Konzentration und Detektorsignal (R2= 0,9974 bis 0.9999). Die Impräzision lag zwischen 0.84 bis 9.78%. Die für das TDM erforderlichen unteren Nachweisgrenzen wurden erreicht. Es gab keine Hinweise auf das Auftreten von Ion Suppression durch Matrixbestandteile. Die absolute und analytische Wiederfindung lag zwischen 89 und 107 %. Es zeigte sich, dass die HPLC-MS-Methode ohne Modifikation erweitert werden kann und anscheinend mehr als 30 verschiedene Psychopharmaka erfasst werden können. Mit den entwickelten flüssigchromatographischen Methoden stehen neue Verfahren für das TDM von Antipsychotika und Antidepressiva zur Verfügung, die es erlauben, mit einer Methode verschiedene Psychopharmaka und ihre aktiven Metabolite zu messen. Damit kann die Behandlung psychiatrischer Patienten insbesondere mit Antipsychotika verbessert werden.

Sensibilisierung hitzeevozierter Ionenströme an nozizeptiven Spinalganglienneuronen der Ratte

Die freien Endigungen von Spinalganglienneuronen sind für die Detektion schmerzhafter Reize verantwortlich. Dabei rufen thermische, chemische oder mechanische Reize Ionenströme über die Membran und dadurch Membranpotentialänderungen hervor. Diese noxisch induzierten Ströme sind in großem Ausmaß durch chemische Substanzen und andere Reize modulierbar. Der Ionenkanal TRPV1 ist für die Detektion zahlreicher chemischer Reize und zumindest eines Teils der noxischen Hitzereize verantwortlich. Im Rahmen dieser Arbeit wurden einige der Mechanismen geklärt, die zur schnellen Sensibilisierung hitzeevozierter Ionenströme führen. Hierfür wurden akut dissoziierte Spinalganglienneurone der Ratte als Modell ihrer peripheren Endigung verwendet und mittels Ganzzellableitung in der patch-clamp-Technik untersucht. Die Verwendung von Trypsin während der Präparation von Spinalganglienneuronen hat keinen funktionellen Einfluss auf hitze- oder capsaicininduzierte Ströme, verbessert aber die Untersuchungsbedingungen für das patch-clamp-Verfahren. Bei 144 akut dissoziierten Spinalganglienneuronen wurden die Stromantworten auf drei im Abstand von 40 s durch Überspülen mit 45,3 bis 46,3°C heißer Extrazellularlösung applizierte einsekündige Hitzereize gemessen. Dabei ließen sich repetitiv reproduzierbare hitzeinduzierte Einwärtsströme von etwa 160 pA erzielen; es konnte keine Tachyphylaxie und nahezu keine Inaktivierung beobachtet werden. Direkt vor dem zweiten Hitzereiz wurden die Neurone für zwei Sekunden mit Extrazellularlösung überspült, die Kontrolllösung, 0,5 μM Capsaicin, 10 μM Natriumnitroprussid oder 10 μM YC-1 enthielt. Es fand sich kein Hinweis, dass Stickstoffmonoxid oder die Guanylatzyklase einen signifikanten Beitrag zur Sensibilisierung von hitzeinduzierten Strömen in Spinalganglienneuronen leisten, wobei ein durch den Versuchsaufbau bedingtes Auswaschen zytosolischer Faktoren, die für den Signalweg notwendig sind, nicht ausgeschlossen werden kann. Bei einer Konzentration von 0,5 μM löst Capsaicin für zwei Sekunden einen sehr kleinen Einwärtsstrom von etwa 33 pA aus und führt innerhalb von zwei Sekunden zu einer schnell reversiblen Sensibilisierung von hitzeinduzierten Einwärtsströmen in Spinalganglienneuronen (p<0,01). Das Ausmaß der Sensibilisierung ist proportional zur Größe des capsaicininduzierten Stromes (r=−0,7, p<0,001). Konstant halten der intrazellulären Calciumkonzentration mittels des Calciumchelators BAPTA verhindert die capsaicininduzierte Sensibilisierung hitzeinduzierter Ströme an Spinalganglienneuronen. Demzufolge beruht die capsaicininduzierte Sensibilisierung trotz der schnellen Kinetik nicht auf einer synergistischen Wirkung der beiden Agonisten Capsaicin und Hitze auf ihren gemeinsamen Rezeptor; vielmehr ist sie von einer Erhöhung der intrazellulären freien Calciumkonzentration abhängig. Funktionelle Änderungen der zellulären Funktion werden häufig durch Proteinkinasen vermittelt. Die zur Gruppe der MAP-Kinasen gehörende ERK (extracellular signal related kinase) wird bei Membrandepolarisation und Calciumeinstrom in die Zelle durch MEK (MAPK/extracellular signal related kinase kinase) aktiviert. Blockade der MEK/ERK-Kaskade durch den spezifischen MEK-Hemmstoff U0126 führt ebenfalls zu einer Aufhebung der Sensibilisierung der Hitzeantworten durch Capsaicin. Applikation von Capsaicin führt innerhalb von zwei Sekunden zu einer schnell reversiblen Sensibilisierung hitzeevozierter Ionenströme an nozizeptiven Spinalganglienneuronen. Diese Sensibilisierung wird durch einen Calciumeinstrom in die Zelle und die dadurch eintretende Aktivierung von Proteinkinasen hervorgerufen. Die MEK/ERK-Kaskade ist ein sehr schnell (deutlich unter 2 s) aktivierbares intrazelluläres Signalsystem, welches bei der Regulation der Empfindlichkeit nozizeptiver Spinalganglienneurone eine entscheidende Rolle spielt; die schnelle Kinetik ist dabei nur durch eine membranständige oder zumindest membrannahe Lokalisation dieser Proteinkinasen erklärbar. Durch Applikation zehnsekündiger Hitzereize lässt sich ebenfalls eine Sensibilisierung hitzeevozierter Ionenströme auslösen, die ebenso ausgeprägt ist, wie die Sensibilisierung durch 0,5 μM Capsaicin (p<0,005). Durch das immer größere Verständnis der Funktionsweise des nozizeptiven Systems ergeben sich ständig neue Ansätze für die Entwicklung neuer Analgetika. So könnte durch Modulation spezifischer intrazellulärer Proteinkinasen der Phosphorylierungszustand und damit die Aktivierbarkeit von Ionenkanälen, die der Transduktion noxischer Reize dienen, positiv beeinflusst werden. Neuere, noch spezifischere Inhibitoren der MEK können der Forschung und später auch der Therapie neue Möglichkeiten eröffnen.