Pharmacokinetics, efficacy, and safety of pravastatin in children : Studies in children with heterozygous familial hypercholesterolemia and in pediatric cardiac transplant recipients

Background. Hyperlipidemia is a common concern in patients with heterozygous familial hypercholesterolemia (HeFH) and in cardiac transplant recipients. In both groups, an elevated serum LDL cholesterol level accelerates the development of atherosclerotic vascular disease and increases the rates of cardiovascular morbidity and mortality. The purpose of this study is to assess the pharmacokinetics, efficacy, and safety of cholesterol-lowering pravastatin in children with HeFH and in pediatric cardiac transplant recipients receiving immunosuppressive medication. Patients and Methods. The pharmacokinetics of pravastatin was studied in 20 HeFH children and in 19 pediatric cardiac transplant recipients receiving triple immunosuppression. The patients ingested a single 10-mg dose of pravastatin, and plasma pravastatin concentrations were measured up to 10/24 hours. The efficacy and safety of pravastatin (maximum dose 10 to 60 mg/day and 10 mg/day) up to one to two years were studied in 30 patients with HeFH and in 19 cardiac transplant recipients, respectively. In a subgroup of 16 HeFH children, serum non-cholesterol sterol ratios (102 x mmol/mol of cholesterol), surrogate estimates of cholesterol absorption (cholestanol, campesterol, sitosterol), and synthesis (desmosterol and lathosterol) were studied at study baseline (on plant stanol esters) and during combination with pravastatin and plant stanol esters. In the transplant recipients, the lipoprotein levels and their mass compositions were analyzed before and after one year of pravastatin use, and then compared to values measured from 21 healthy pediatric controls. The transplant recipients were grouped into patients with transplant coronary artery disease (TxCAD) and patients without TxCAD, based on annual angiography evaluations before pravastatin. Results. In the cardiac transplant recipients, the mean area under the plasma concentration-time curve of pravastatin [AUC(0-10)], 264.1 * 192.4 ng.h/mL, was nearly ten-fold higher than in the HeFH children (26.6 * 17.0 ng.h/mL). By 2, 4, 6, 12 and 24 months of treatment, the LDL cholesterol levels in the HeFH children had respectively decreased by 25%, 26%, 29%, 33%, and 32%. In the HeFH group, pravastatin treatment increased the markers of cholesterol absorption and decreased those of synthesis. High ratios of cholestanol to cholesterol were associated with the poor cholesterol-lowering efficacy of pravastatin. In cardiac transplant recipients, pravastatin 10 mg/day lowered the LDL cholesterol by approximately 19%. Compared with the patients without TxCAD, patients with TxCAD had significantly lower HDL cholesterol concentrations and higher apoB-100/apoA-I ratios at baseline (1.0 ± 0.3 mmol/L vs. 1.4 ± 0.3 mmol/L, P = 0.031; and 0.7 ± 0.2 vs. 0.5 ± 0.1, P = 0.034) and after one year of pravastatin use (1.0 ± 0.3 mmol/L vs. 1.4 ± 0.3 mmol/L, P = 0.013; and 0.6 ± 0.2 vs. 0.4 ± 0.1, P = 0.005). Compared with healthy controls, the transplant recipients exhibited elevated serum triglycerides at baseline (median 1.3 [range 0.6-3.2] mmol/L vs. 0.7 [0.3-2.4] mmol/L, P=0.0002), which negatively correlated with their HDL cholesterol concentration (r = -0.523, P = 0.022). Recipients also exhibited higher apoB-100/apoA1 ratios (0.6 ± 0.2 vs. 0.4 ± 0.1, P = 0.005). In addition, elevated triglyceride levels were still observed after one year of pravastatin use (1.3 [0.5-3.5] mmol/L vs. 0.7 [0.3-2.4] mmol/L, P = 0.0004). Clinically significant elevations in alanine aminotransferase, creatine kinase, or creatinine ocurred in neither group. Conclusions. Immunosuppressive medication considerably increased the plasma pravastatin concentrations. In both patient groups, pravastatin treatment was moderately effective, safe, and well tolerated. In the HeFH group, high baseline cholesterol absorption seemed to predispose patients to insufficient cholesterol-lowering efficacy of pravastatin. In the cardiac transplant recipients, low HDL cholesterol and a high apoB-100/apoA-I ratio were associated with development of TxCAD. Even though pravastatin in the transplant recipients effectively lowered serum total and LDL cholesterol concentrations, it failed to normalize their elevated triglyceride levels and, in some patients, to prevent the progression of TxCAD.

Laser damage studies in nonlinear optical crystal sodium p-nitrophenolate dihydrate

We report the surface laser damage threshold in sodium p-nitrophenolate dihydrate, a nonlinear optical crystal. The experiment is performed with a pulsed Nd:YAG laser in TEM00 mode. The single shot damage thresholds are 11.16 +/- 0.28GWcm(-2) and 1.25 +/- 0.02GWcm(-2) for 1064 nm and 532 nm laser wavelengths respectively. A close correlation between the laser damage threshold and mechanical hardness is observed. A possible mechanism of laser damage is discussed.

Aggregation studies in crystals of apolar helical peptides: Boc-Aib-Val-Ala-Leu-Aib-Val-Ala-Leu-Aib-OMe

In the crystal, the backbone of Boc-(Aib-Val-Ala-Leu)2-Aib-OMe adopts a helical form with four alpha-type hydrogen bonds in the middle, flanked by 3(10)-type hydrogen bonds at either end. The helical molecules stack in columns with head-to-tail hydrogen bonds, either directly between NH and CO, or bridged by solvent molecules. The packing of the helices is parallel, even in space group P2(1). Cell parameters are a = 9.837(2) A, b = 15.565(3) A, c = 20.087(5) A, beta = 96.42(2) degrees, dcalc = 1.091 g/cm3 for C46H83N9O12.1.5H2O.0.67CH3OH. There appears to be some hydration of the backbone in this apolar helix.

Studies in terpenoids-XIII. Magnetic anisotropy2 in and stereochemistry of some gem-dimethylcyclobutanoids related to pinonic acid

The chemical shifts of “axial” vs “equatorial” Me protons of some gem-dimethylcyclobutanoids derived from α-pinene, arising from magnetic anisotropy of the ring and as influenced by vicinal substituents, are discussed. Conformational aspects of some cis- and trans-pinonic, pinononic and pinic acids have been elucidated on the basis of NMR evidence.

Studies in bubble formation — III

Bubble formation from single horizontal orifices submerged in Newtonian liquids has been investigated for such chamber volumes that both the pressure inside the chamber and flow rate into the bubble are time dependent. The data collected show that under these conditions the bubble volume decreases exponentially with increase in orifice submergence. The equations for the generalized two stage model of bubble formation, taking the variation of gas flow rate with time into account, have been derived. These equations reduce to the cases of constant gas flow rate and constant pressure when adequate constraints are imposed. The results obtained under intermediate conditions have been quantitatively explained on the basis of these equations.

Studies in bubble formation—II bubble formation under constant pressure conditions

Bubble formation under constant pressure conditions has been investigated for wide range of variation of liquid properties.Air bubbles were formed from single horizontal orifices submerged in liquids whose viscosity varied from 1·0 to 600 cPs and surface tension from 37 to 72 dyn/cm. Air flow rate was varied from 2 to 250 cm3/sec and the orifice diameter from 0·0515 to 0·4050 cm.

Studies in bubble formation—I bubble formation under constant flow conditions

A model based on two step mechanism of bubble formation is proposed. The resulting equations are used to explain the discrepancies existing in the literature. Data have been collected over a wide range of variables to test the model.

Studies in sesquiterpenes—XXIX *1: Structure of himachalenes

α-and β-Himachalenes, the two major sesquiterpene components of the essential oil of Himalayan deodar (Cedrus deodara, Loud.) are shown to represent a new sequiterpenoid carbon framework. Evidence is presented which establishes their gross structures.

Studies in the hydrolysis of metal ions -Part I.Copper

The hydrolysis of cupric ion has been studied at various ionic strengths (0·01, 0·05, 0·1 and 0·5 M). The results are analyzed employing 'core + links' theory, log-log plot, normalization plot, and extrapolation method for obtaining the pure mononuclear curve. The stability constants of Cu2(OH)2++, Cu3(OH)4++, Cu(OH)+ and Cu(OH)2 have been reported.