A probable dual mode of action for both L- and D-lactate neuroprotection in cerebral ischemia.

Lactate has been shown to offer neuroprotection in several pathologic conditions. This beneficial effect has been attributed to its use as an alternative energy substrate. However, recent description of the expression of the HCA1 receptor for lactate in the central nervous system calls for reassessment of the mechanism by which lactate exerts its neuroprotective effects. Here, we show that HCA1 receptor expression is enhanced 24 hours after reperfusion in an middle cerebral artery occlusion stroke model, in the ischemic cortex. Interestingly, intravenous injection of L-lactate at reperfusion led to further enhancement of HCA1 receptor expression in the cortex and striatum. Using an in vitro oxygen-glucose deprivation model, we show that the HCA1 receptor agonist 3,5-dihydroxybenzoic acid reduces cell death. We also observed that D-lactate, a reputedly non-metabolizable substrate but partial HCA1 receptor agonist, also provided neuroprotection in both in vitro and in vivo ischemia models. Quite unexpectedly, we show D-lactate to be partly extracted and oxidized by the rodent brain. Finally, pyruvate offered neuroprotection in vitro whereas acetate was ineffective. Our data suggest that L- and D-lactate offer neuroprotection in ischemia most likely by acting as both an HCA1 receptor agonist for non-astrocytic (most likely neuronal) cells as well as an energy substrate.

Markers of iron metabolism and metabolic syndrome in Swiss adults

Plusieurs études populationnelles ont montré l'existence d'une association entre des taux sanguins élevés de transferrine et le syndrome métabolique (SM). Bien que cette association soit bien établie, restent encore à être décrites les associations entre le SM et les autres marqueurs sanguins du métabolisme du fer, tels que le fer, la transferrine (Tsf), la capacité totale de fixation de la transferrine (CTF) ou la saturation de la transferrine (SaTsf) sanguins. Le but de notre étude a été d'identifier les associations entre les différents marqueurs du métabolisme du fer (fer, ferritine, Tsf, CTF et SaTsf) et le SM. Les données de l'étude CoLaus, récoltées entre 2003 et 2006, ont été utilisées. Le SM était défini selon les critères du National Cholesterol Education Program Adult Panel III. L'analyse statistique a été faite en stratifiant selon le genre ainsi que le status ménopausal chez les femmes. Des 6733 participants, 1235 (18%) ont été exclus de fait d'absence de données concernant les variables qui nous intéressaient, ou chez qui nous avons soupçonné une possible hémochromatose non diagnostiquée (SaTsf> 50%). Des 5498 participants restant (âge moyen ± écart-type: 53 ± 11 ans), 2596 étaient des hommes, 1285 des femmes pré- et 1617 des femmes postménopausées. La prévalence du SM était de 29,4% chez les hommes, 8,3% et 25,5% chez les femmes pré- et postménopausées, respectivement. Dans les trois groupes, la prévalence du SM était la plus haute dans les quartiles les plus élevés de ferritine, Tsf et CTF, ainsi que dans le quartile le plus bas de SaTsf. Après ajustement sur l'âge, l'indice de masse corporelle, la protéine C réactive, la consommation de tabac et/ou d'alcool, la prise de suppléments en fer et les marqueurs hépatiques, l'appartenance au quartile le plus élevé de ferritine, Tsf ou CTF était associée à un risque plus important de SM chez les hommes et les femmes postménopausées : Odds ratio (OR) et [intervalle de confiance à 95%] pour la ferritine 1.44 [1.07-1.94] et 1.47 [0.99-2.17]; pour la Tsf et la CTF, OR=1.43 [1.06-1.91] et 2.13 [1.44-3.15] pour les hommes et les femmes postménopausées, respectivement. Au contraire, l'appartenance au quartile le plus élevé de la SaTsf était associé à un risque moins important de SM: OR=0.77 [0.57-1.05] et 0.59 [0.39-0.90] pour les hommes et les femmes postménopausées, respectivement. Il n'y avait aucune association entre les marqueurs sanguins du métabolisme du fer et le SM chez les femmes préménopausées, ni entre le fer sanguin et le SM chez les trois groupes. En conclusion, la majorité des marqueurs sanguins du métabolisme du fer, mais pas le fer lui-même, sont associés de manière indépendante au SM chez les hommes et les femmes postménopausées. -- Context: Excessive iron storage has been associated with metabolic syndrome (MS). Objective: To assess the association between markers of iron metabolism and MS in a healthy population. Design: Cross-sectional study conducted between 2003 and 2006. Setting: Population-based study in Lausanne, Switzerland. Patients: 5,498 participants aged 35-75 years, stratified by sex and menopausal status. Participants with transferrin saturation (TSAT) >50% were excluded. Intervention: None. Main Outcome Measures: serum iron, ferritin, transferrin, total iron binding capacity (TIBC) and TSAT. MS was defined according to ATP-III criteria. Results: Prevalence of MS was 29.4% in men, 8.3% in premenopausal and 25.5% in postmenopausal women. On bivariate analysis, the highest prevalence of MS occurred in the highest quartiles of serum ferritin, transferrin and TIBC, and in the lowest quartile of TSAT. After multivariate adjustment for age, body mass index, C-reactive protein, smoking, alcohol, liver markers and iron supplementation, men and postmenopausal women in the highest quartile of serum ferritin, transferrin and TIBC had a higher risk of presenting with MS: for ferritin, Odds ratio and [95% CI]=1.44 [1.07-1.94] for men and 1.47 [0.99-2.17] for postmenopausal women; for transferrin and TIBC, OR=1.43 [1.06-1.91] and 2.13 [1.44-3.15], Participants in the highest quartile of TSAT had a lower risk of MS: OR=0.77 [0.57-1.05] for men and 0.59 [0.39-0.90] for postmenopausal women. No association was found between iron and MS and between markers of iron metabolism and MS in premenopausal women. Conclusion: Ferritin, transferrin, TIBC are positively and TSAT is negatively associated with MS in men and postmenopausal women.

Effect of diet composition and ration size on key enzyme activities of glycolysis-gluconeogenesis, pentose phosphate pathway and amino acid metabolism in liver of Sparus aurata

The effects of diet composition and ration size on the activities of key enzymes involved in intermediary metabolism were studied in the liver of gilthead sea bream (Sparus aurata). Highcarbohydrate, low-protein diets stimulated 6-phosphofructo 1-kinase (EC 2.7.1.11), pyruvate kinase (EC 2.7.1.40), glucose-6-phosphate dehydrogenase (EC 1.1.1.49) and 6-phosphogluconate dehydrogenase (EC 1.1.1.44) enzyme activities, while they decreased alanine aminotransferase (EC 2.6.1.2) activity. A high degree of correlation was found between food ration size and the activity of the enzymes 6-phosphofructo 1-kinase, pyruvate kinase, glucose-6-phosphate dehydrogenase (positive correlations) and fructose-1,6-bisphosphatase (EC 3.1.3.11) (negative correlation). These correlations matched well with the high correlation also found between ration size and growth rate in starved fish refed for 22 d. Limited feeding (5 g/kg body weight) for 22 d decreased the activities of the key enzymes for glycolysis and lipogenesis, and alanine aminotransferase activity. The findings presented here indicate a high level of metabolic adaptation to both diet type and ration size. In particular, adaptation of enzyme activities to the consumption of a diet with a high carbohydrate level suggests that a carnivorous fish like Sparus aurata can tolerate partial replacement of protein by carbohydrate in the commercial diets supplied in culture. The relationship between enzyme activities, ration size and fish growth indicates that the enzymes quickly respond to dietary manipulations of cultured fish.

Effect of diet composition and ration size on key enzyme activities of glycolysis-gluconeogenesis, pentose phosphate pathway and amino acid metabolism in liver of Sparus aurata

The effects of diet composition and ration size on the activities of key enzymes involved in intermediary metabolism were studied in the liver of gilthead sea bream (Sparus aurata). Highcarbohydrate, low-protein diets stimulated 6-phosphofructo 1-kinase (EC 2.7.1.11), pyruvate kinase (EC 2.7.1.40), glucose-6-phosphate dehydrogenase (EC 1.1.1.49) and 6-phosphogluconate dehydrogenase (EC 1.1.1.44) enzyme activities, while they decreased alanine aminotransferase (EC 2.6.1.2) activity. A high degree of correlation was found between food ration size and the activity of the enzymes 6-phosphofructo 1-kinase, pyruvate kinase, glucose-6-phosphate dehydrogenase (positive correlations) and fructose-1,6-bisphosphatase (EC 3.1.3.11) (negative correlation). These correlations matched well with the high correlation also found between ration size and growth rate in starved fish refed for 22 d. Limited feeding (5 g/kg body weight) for 22 d decreased the activities of the key enzymes for glycolysis and lipogenesis, and alanine aminotransferase activity. The findings presented here indicate a high level of metabolic adaptation to both diet type and ration size. In particular, adaptation of enzyme activities to the consumption of a diet with a high carbohydrate level suggests that a carnivorous fish like Sparus aurata can tolerate partial replacement of protein by carbohydrate in the commercial diets supplied in culture. The relationship between enzyme activities, ration size and fish growth indicates that the enzymes quickly respond to dietary manipulations of cultured fish.

Effects of Weight Loss on Adipose Tissue, Liver and Heart Metabolism in Humans

Obesity has become the leading cause of many chronic diseases, such as type 2 diabetes and cardiovascular diseases. The prevalence of obesity is high in developed countries and it is also a major cause of the use of health services. Ectopic fat accumulation in organs may lead to metabolic disturbances, such as insulin resistance.Weight loss with very-low-energy diet is known to be safe and efficient. Weight loss improves whole body insulin sensitivity, but its effects on tissue and organ level in vivo are not well known. The aims of the studies were to investigate possible changes of weight loss in glucose and fatty acid uptake and perfusion and fat distribution at tissue and organ level using positron emission tomography and magnetic resonance imaging and spectroscopy in 34 healthy obese subjects. The results showed that whole-body insulin sensitivity increased after weight loss with very-low-energy diet and this is associated with improved skeletal muscle insulin-stimulated glucose uptake, but not with adipose tissue, liver or heart glucose uptake. Liver insulin resistance decreased after weight loss. Liver and heart free fatty acid uptakes decreased concomitantly with liver and heart triglyceride content. Adipose tissue and myocardial perfusion decreased. In conclusion, enhanced skeletal muscle glucose uptake leads to increase in whole-body insulin sensitivity when glucose uptake is preserved in other organs studied. These findings suggest that lipid accumulation found in the liver and the heart in obese subjects without co-morbidies is in part reversible by reduced free fatty acid uptake after weight loss. Reduced lipid accumulation in organs may improve metabolic disturbances, e.g. decrease liver insulin resistance. Keywords: Obesity, weight loss, very-low-energy diet, adipose tissue metabolism, liver metabolism, heart metabolism, positron emission tomography

Foliar photochemical processes and carbon metabolism under favourable and adverse winter conditions in a Mediterranean mixed forest, Catalonia (Spain)

Evergreen trees in the Mediterranean region must cope with a wide range of environmental stresses from summer drought to winter cold. The mildness of Mediterranean winters can periodically lead to favourable environmental conditions above the threshold for a positive carbon balance, benefitting evergreen woody species more than deciduous ones. The comparatively lower solar energy input in winter decreases the foliar light saturation point. This leads to a higher susceptibility to photoinhibitory stress especially when chilly (< 12 C) or freezing temperatures (< 0 C) coincide with clear skies and relatively high solar irradiances. Nonetheless, the advantage of evergreen species that are able to photosynthesize all year round where a significant fraction can be attributed to winter months, compensates for the lower carbon uptake during spring and summer in comparison to deciduous species. We investigated the ecophysiological behaviour of three co-occurring mature evergreen tree species (Quercus ilex L., Pinus halepensis Mill., and Arbutus unedo L.). Therefore, we collected twigs from the field during a period of mild winter conditions and after a sudden cold period. After both periods, the state of the photosynthetic machinery was tested in the laboratory by estimating the foliar photosynthetic potential with CO2 response curves in parallel with chlorophyll fluorescence measurements. The studied evergreen tree species benefited strongly from mild winter conditions by exhibiting extraordinarily high photosynthetic potentials. A sudden period of frost, however, negatively affected the photosynthetic apparatus, leading to significant decreases in key physiological parameters such as the maximum carboxylation velocity (Vc,max), the maximum photosynthetic electron transport rate (Jmax), and the optimal fluorometric quantum yield of photosystem II (Fv/Fm). The responses of Vc,max and Jmax were highly species specific, with Q. ilex exhibiting the highest and P. halepensis the lowest reductions. In contrast, the optimal fluorometric quantum yield of photosystem II (Fv/Fm) was significantly lower in A. unedo after the cold period. The leaf position played an important role in Q. ilex showing a stronger winter effect on sunlit leaves in comparison to shaded leaves. Our results generally agreed with the previous classifications of photoinhibition-tolerant (P. halepensis) and photoinhibitionavoiding (Q. ilex) species on the basis of their susceptibility to dynamic photoinhibition, whereas A. unedo was the least tolerant to photoinhibition, which was chronic in this species. Q. ilex and P. halepensis seem to follow contrasting photoprotective strategies. However, they seemed equally successful under the prevailing conditions exhibiting an adaptive advantage over A. unedo. These results show that our understanding of the dynamics of interspecific competition in Mediterranean ecosystems requires consideration of the physiological behaviour during winter which may have important implications for long-term carbon budgets and growth trends.

Disseny i elaboració d'un gimnàs on-line

L’evolució que ha experimentat la societat, les grans ciutats, la industrialització i molts altres factors han modificat l’estil de vida de les persones accentuant-ne, irremediablement, el sedentarisme i l’abstinència de realitzar exercici físic. La pràctica esportiva i/o d’exercici físic realitzada sota les condicions recomanades pels professionals, és beneficiosa per millorar el nivell de salut o mantenir-lo en tot el possible, ja que provoca modificacions beneficioses sobre el metabolisme, el sistema cardiovascular i l’aparell locomotor. Lamentablement, l’hàbit de realitzar exercici físic no és comú en totes les persones, ja sigui per l’estil de vida que genera incompatibilitats d’horaris amb la feina, fills i familiars o bé per mandra o desgana d’haver d’aprofitar aquelles estones de temps lliure per dedicar-los al culte del cos i de la salut. Els efectes negatius que suposa una modalitat de vida sedentària per a la salut són notablement elevats, amb la qual cosa, cal buscar sistemes per augmentar l’ interès de la població per la pràctica de l’esport i l’activitat física. La creació d’aquest projecte neix de la idea d’unir el fet d’enginyar un mètode per incrementar l’interès de les persones per l’exercici físic amb els avenços tecnològics que s’han realitzat aquesta última dècada relacionats amb el desenvolupament web i multimèdia. A grans trets, la idea general d’aquest projecte es basa en el cas d’un gimnàs real i en actiu, amb necessitat de crear un portal web que serveixi alhora de pàgina web informativa i d’eina de gestió acadèmica del centre proporcionant certes funcionalitats als clients tot presentant-los una nova modalitat de realitzar exercici físic dirigit: realitzar-lo des de casa. Per desenvolupar tot el sistema informàtic que ho durà a terme, després de realitzar una recerca, anàlisi i elecció de les eines mitjançant les quals poder-ho realitzar, s’ha optat per crear l’entorn web mitjançant els llenguatges HTML i PHP en combinació amb els fulls d’estil CSS. Pel que fa a l’entorn de desenvolupament, s’ha utilitzat Notepad++ i com a entorn de proves, WAMP Server. Per últim, pel que fa a la transmissió del contingut multimèdia (vídeos de les sessions d’activitats) s’ha utilitzat Flash Media Interactive Server en combinació de Flash Media Live Encoder per codificar-ne el contingut. L’usuari final, des de qualsevol punt del planeta, podrà realitzar (sempre i quan disposi del temps i el material necessari i una connexió a Internet) en temps real i en directe les classes dirigides que es realitzen al centre. Tanmateix, també s’ha desenvolupat una botiga virtual on qualsevol persona podrà comprar-hi, entre d’altres coses relacionades amb la pràctica de l’exercici físic, tot el material necessari per realitzar qualsevol de les activitats que s’imparteixen al gimnàs i ho rebrà còmodament a casa. Aprofitar unes circumstàncies econòmiques adverses per generar una nova manera de captar clients proporcionant-los una alternativa econòmica, diferent, nova i original d’anar al gimnàs. Temps de crisis, temps d’oportunitats. Aquesta és la moralitat que pretén donar aquest projecte.

Caracterização físico-química de filmes comestíveis de amido adicionado de acerola (Malphigia emarginata D.C.)

Edibles films are an alternative to synthetic materials used for packing food products. Barbados cherry is rich in vitamin C and carotenoids. The aim of this study was to characterize and develop films by casting from cassava starch, lyophilized Barbados cherry pulp and glycerol. The films were characterized with respect to thickness, water vapor permeability (WVP), water solubility, vitamin C, carotene and mechanical properties. The interaction of pulp and glycerol reduced film thickness. An increase in pulp concentration up to 60% increased WVP but beyond this concentration reduced both WVP and solubility leading to an increased level of vitamin C and β carotene in the films.

Quantificação dos isômeros ácido L-ascórbico e ácido D-iso-ascórbico em geleias de frutas por cromatografia líquida de alta eficiência

Ascorbic acid has important nutritional characteristics such as high antioxidant potential, preventing diverse damage and diseases in the tissues and the process of aging. Different isomeric forms of the ascorbic acid can be found in nature and each one have different potential antioxidant and different activity pro-vitamin C. This work examined a method to detect and quantify the isomers L-ascorbic acid (LAA) and D-iso-ascorbic acid (DIAA) in jelly fruit. The method showed acceptable selectivity, linearity, repeatability and recovery. DIAA was not found in the analyzed samples, but LAA was found up to 605 mg in 100 g of sample.

Acid-base Balance and Oxidative Metabolism in Calcified Tissues

The calcified tissues, comprising bone and cartilage, are metabolically active tissues that bind and release calcium, bicarbonate and other substances according to systemic needs. Understanding the regulation of cellular metabolism in bone and cartilage is an important issue, since a link between the metabolism and diseases of these tissues is clear. An essential element in the function of bone-resorbing osteoclasts, namely regulation of bicarbonate transport, has not yet been thoroughly studied. Another example of an important but at the same time fairly unexplored subject of interest in this field is cartilage degeneration, an important determinant for development of osteoarthritis. The link between this and oxidative metabolism has rarely been studied. In this study, we have investigated the significance of bicarbonate transport in osteoclasts. We found that osteoclasts possess several potential proteins for bicarbonate transport, including carbonic anhydrase IV and XIV, and an electroneutral bicarbonate co-transporter NBCn1. We have also shown that inhibiting the function of these proteins has a significant impact on bone resorption and osteoclast morphology. Furthermore, we have explored oxidative metabolism in chondrocytes and found that carbonic anhydrase III (CA III), a protein linked to the prevention of protein oxidation in muscle cells, is also present in mouse chondrocytes, where its expression correlates with the presence of reactive oxygen species. Thus, our study provides novel information on the regulation of cellular metabolism in calcified tissues.

The Role of Cytochrome P450 3A Inducers and Inhibitors in the Metabolism and the Effects of Oxycodone

Oxycodone is an opioid used in the treatment of moderate or severe pain. It is principally metabolized in the liver by cytochrome P450 3A (CYP3A) enzymes whereas approximately 10% is metabolized by CYP2D6. Little is known about the interactions between oxycodone and other drugs, herbals and nutritional substances. In this work the effects of CYP3A inducers rifampicin and St. John’s wort and CYP3A inhibitors voriconazole, grapefruit juice, ritonavir and lopinavir/ritonavir were investigated on the pharmacokinetics and pharmacodynamics of oxycodone. All studies were randomized, balanced, placebo-controlled crossover clinical studies in healthy volunteers. The plasma concentrations of oxycodone and its metabolites were determined for 48 hours and pharmacodynamic parameters were recorded for 12 hours in each study. Pharmacokinetic parameters were calculated by noncompartmental methods. Rifampicin decreased the plasma concentrations, analgesic effects, and oral bioavailability of oral oxycodone. St. John’s wort reduced the concentrations of oxycodone and diminished the self-reported drug effect. Voriconazole increased the exposure to oral oxycodone by 3.6-fold whereas grapefruit juice, which inhibits predominantly the intestinal CYP3A, elevated the mean concentrations of oxycodone by 1.7-fold. Ritonavir and lopinavir/ritonavir increased the mean AUC of oxycodone by 3.0- and 2.6-fold, respectively, and prolonged its elimination half-life. In spite of increased oxycodone plasma concentrations during concomitant administration of CYP3A inhibitors, the analgesic effects were not increased. These studies show that the induction or inhibition of CYP3A alters the pharmacokinetics and pharmacologic effects of oxycodone. The exposure to oxycodone decreased after induction and increased after inhibition of CYP3A. As a conclusion, the clinicians should avoid concomitant administration of CYP3A inducers or inhibitors and oral oxycodone. If this is not possible, they should be prepared to interactions leading to impaired analgesia after CYP3A inducers or increased adverse effects after CYP3A inhibitors and oral oxycodone.

On Glucose Metabolism in Patients with the m.3243A>G Mutation

Background: The m.3243A>G mutation in mitochondrial DNA is the most common cause for mitochondrial diabetes. In addition, unexpected deaths related to the m.3243A>G associate with encephalopathy and cardiomyopathy. Failing mitochondrial respiratory chain in neurons, myocytes and beta cells is considered to underlie the multiorgan manifestations of the m.3243A>G. Aims: The primary aim of the study was to characterize the organ-specific glucose metabolism in patients with m.3243A>G and secondly, to study patients with or without signs of diabetes, cardiomyopathy or encephalopathy. The insulin-stimulated glucose metabolism in brain, heart, skeletal muscle, adipose tissue and liver were measured with 2-deoxy-2-[18F]fluoro-α-D-glucose in 15 patients and 14 controls. Brain oxygen metabolism was assessed with [15O]oxygen and insulin secretion was modelled based on oral glucose tolerance test. Results: The glucose oxidation in brain was globally decreased in patients with or without clinical encephalopathy. The insulin-stimulated glucose influx to skeletal muscle and adipose tissue was decreased in patients with or without diabetes as the hepatic glucose metabolism was normal. Impaired beta cell function and myocardial glucose uptake were associated with the high m.3243A>G heteroplasmy. Conclusions: This cross-sectional study suggests that: 1) The ability of insulin to stimulate glucose metabolism in skeletal muscle and adipose tissue is weakened before the beta cell failure results in mitochondrial diabetes. 2) Glucose oxidation defect is detected in otherwise unaffected cerebral regions in patients with the m.3243A>G, thus it likely precedes the clinical encephalopathy. 3) Uneconomical glucose hypometabolism during hyperinsulinemia contributes to the cardiac vulnerability in patients with high m.3243A>G heteroplasmy

Effects of cytochrome P450 enzyme inhibitors and inducers on the metabolism of S-ketamine

The human body eliminates foreign compounds primarily by metabolizing them to hydrophilic forms to facilitate effective excretion through the kidneys. Cytochrome P450 (CYP) enzymes in the liver and intestine contribute to the metabolism of many drugs. Pharmacokinetic drugdrug interactions occur if the activity of CYPs are inhibited or induced by another drug. Prescribing multiple drugs to the improve effectiveness of therapy or to treat coexisting diseases is a common practice in clinical medicine. Polypharmacy predisposes patients to adverse effects because of the profound unpredictability in CYP enzymatic-mediated drug metabolism. S-ketamine is a phencyclidine derivative which functions as an antagonist of the N-methyl-Daspartate (NMDA) receptor in the central nervous system. It is a unique anaesthetic producing “dissociative anaesthesia” in high doses and analgesia in low doses. Studies with human liver microsomes suggest that ketamine is metabolized primarily via CYP3A4 and CYP2B6 enzymes. In this thesis, in healthy volunteers, randomized and controlled cross-over studies were conducted to investigate the effects of different CYP inducers and inhibitors on the pharmacokinetics and pharmacodynamics of oral and intravenous S-ketamine. The plasma concentrations of ketamine and its metabolite, norketamine, were determined at different timepoints over a 24 hour period. Other pharmacodynamic variables were examined for 12 hours. Results of these studies showed that the inhibition of the CYP3A4 pathway by clarithromycin or grapefruit juice increased the exposure to oral S-ketamine by 2.6- and 3.0-fold. Unexpectedly, CYP3A4 inhibition by itraconazole caused no significant alterations in the plasma concentrations of oral S-ketamine. CYP3A4 induction by St. John´s wort or rifampicin decreased profoundly the concentrations of oral S-ketamine. However, after rifampicin, there were no significant differences in the plasma concentrations of S-ketamine when it was administered intravenously. This demonstrated that rifampicin inhibited the metabolism of Sketamine at the intestinal level. When CYP2B6 was inhibited by ticlopidine, there was a 2.4- fold increase in the exposure of S-ketamine. These studies demonstrated that low dose oral Sketamine is metabolized both via CYP3A4 and CYP2B6 pathways. The concomitant use of drugs that affect CYP3A4 or CYP2B6, during oral S-ketamine treatment, may cause clinically significant drug-drug interactions.