In situ RHAMM protein expression in acute myeloid leukemia blasts suggests poor overall survival.

Treatment options for patients with high-risk acute myeloid leukemia (AML) include high-dose chemotherapy regimens in combination with allogeneic hematopoietic stem cell transplantation, which takes advantage of the donor T-cell-mediated graft-versus-leukemia effect. Together with beneficial responses observed in assays targeted at leukemia-associated antigens (LAA), this encouraged research on cancer vaccines and adoptive cellular therapies in AML. The receptor for hyaluronic acid-mediated motility (RHAMM, CD168) was identified as one of the most promising LAA in AML. Thus far, little is known about in situ expression in leukemic bone marrow blasts or the prognostic role of RHAMM and its interaction partners in AML. We immunohistochemically analyzed the expression and prognostic significance of RHAMM on trephine bone marrow biopsies from 71 AML cases that had been evaluated for cytogenetics and presence of FLT3-internal tandem duplications and NPM1 mutations. Fifty-five patients (77%) were treated with curative intent, while 16 (23%) received the most appropriate supportive care. Twenty of 71 (28%) AML cases were considered RHAMM+. Receiver operating characteristic curves showed significant discriminatory power considering overall survival (OS) in AML patients treated curatively for RHAMM (p = 0.015). Multivariable analysis revealed that expression of RHAMM in >5% of leukemic blasts identifies a subgroup of curatively treated cases with adverse OS independent of failures to achieve complete remission. RHAMM not only represents a promising LAA with specific T-cell responses in AML but, if assessed in situ on blasts, also a probable prognostic factor.

Effect of SR 49059, a V1a vasopressin receptor antagonist, in Raynaud's phenomenon.

OBJECTIVE: To assess whether vasopressin V1a receptor blockade reduces the abnormal vasoactive response to cold in patients suffering from Raynaud's phenomenon (RP). METHODS: SR 49059, an orally active, non-peptidic vasopressin V1a receptor antagonist, was given orally (300 mg once daily) to 20 patients with RP in a single-centre, double-blind, placebo-controlled, randomized cross-over study with two 7-day periods of treatment separated by 21 days of washout. Bilateral finger systolic blood pressure and skin temperature were assessed before and after immersion of the hand in cold water for 3 min (15 degrees C) during the screening phase and three times (before and 2 and 4 h after drug intake) on days 1 and 7 of each of the two treatment periods. Recovery of digital pressure and skin temperature was measured 0, 10, 20 and 32 min after the end of the cold immersion test. RESULTS: SR 49059 significantly attenuated the cold-induced fall in systolic pressure by 14.5% (95% confidence interval 0-29; P = 0.045) on the most affected hand on day 7 compared with placebo. Temperature recovery after the end of the cold test showed a trend to enhancement 2 and 4 h after SR 49059 on day 7 (P = 0.060 and P = 0.062 respectively). The beneficial effects on finger pressure and temperature recovery were obtained without changes in supine blood pressure or in heart rate. CONCLUSION: SR 49059 given orally once a day for 7 days to patients with RP showed favourable effects compared with placebo on finger systolic pressure and temperature recovery after cold immersion, without inducing side-effects.

Training Diaries during Altitude Training Camp in Two Olympic Champions: An Observational Case Study.

Traditionally, Live High-Train High (LHTH) interventions were adopted when athletes trained and lived at altitude to try maximising the benefits offered by hypoxic exposure and improving sea level performance. Nevertheless, scientific research has proposed that the possible benefits of hypoxia would be offset by the inability to maintain high training intensity at altitude. However, elite athletes have been rarely recruited as an experimental sample, and training intensity has almost never been monitored during altitude research. This case study is an attempt to provide a practical example of successful LHTH interventions in two Olympic gold medal athletes. Training diaries were collected and total training volumes, volumes at different intensities, and sea level performance recorded before, during and after a 3-week LHTH camp. Both athletes successfully completed the LHTH camp (2090 m) maintaining similar absolute training intensity and training volume at high-intensity (> 91% of race pace) compared to sea level. After the LHTH intervention both athletes obtained enhancements in performance and they won an Olympic gold medal. In our opinion, LHTH interventions can be used as a simple, yet effective, method to maintain absolute, and improve relative training intensity in elite endurance athletes. Key PointsElite endurance athletes, with extensive altitude training experience, can maintain similar absolute intensity during LHTH compared to sea level.LHTH may be considered as an effective method to increase relative training intensity while maintaining the same running/walking pace, with possible beneficial effects on sea level performance.Training intensity could be the key factor for successful high-level LHTH camp.

Mechanism of hcnA mRNA recognition in the Gac/Rsm signal transduction pathway of Pseudomonas fluorescens.

In the plant-beneficial bacterium Pseudomonas fluorescens CHA0, the expression of antifungal exoproducts is controlled by the GacS/GacA two-component system. Two RNA binding proteins (RsmA, RsmE) ensure effective translational repression of exoproduct mRNAs. At high cell population densities, GacA induces three small RNAs (RsmX, RsmY, RsmZ) which sequester both RsmA and RsmE, thereby relieving translational repression. Here we systematically analyse the features that allow the RNA binding proteins to interact strongly with the 5' untranslated leader mRNA of the P. fluorescens hcnA gene (encoding hydrogen cyanide synthase subunit A). We obtained evidence for three major RsmA/RsmE recognition elements in the hcnA leader, based on directed mutagenesis, RsmE footprints and toeprints, and in vivo expression data. Two recognition elements were found in two stem-loop structures whose existence in the 5' leader region was confirmed by lead(II) cleavage analysis. The third recognition element, which overlapped the hcnA Shine-Dalgarno sequence, was postulated to adopt either an open conformation, which would favour ribosome binding, or a stem-loop structure, which may form upon interaction with RsmA/RsmE and would inhibit access of ribosomes. Effective control of hcnA expression by the Gac/Rsm system appears to result from the combination of the three appropriately spaced recognition elements.

An international university network for online teaching of pathology in Frenchspeaking countries

Introduction: Building online courses is a highly time consuming task for teachers of a single university. Universities working alone create high-quality courses but often cannot cover all pathological fields. Moreover this often leads to duplication of contents among universities, representing a big waste of teacher time and energy. We initiated in 2011 a French university network for building mutualized online teaching pathology cases, and this network has been extended in 2012 to Quebec and Switzerland. Method: Twenty French universities (see & for details), University Laval in Quebec and University of Lausanne in Switzerland are associated to this project. One e-learning Moodle platform (http://moodle.sorbonne-paris-cite.fr/) contains texts with URL pointing toward virtual slides that are decentralized in several universities. Each university has the responsibility of its own slide scanning, slide storage and online display with virtual slide viewers. The Moodle website is hosted by PRES Sorbonne Paris Cité, and financial supports for hardware have been obtained from UNF3S (http://www.unf3s.org/) and from PRES Sorbonne Paris Cité. Financial support for international fellowships has been obtained from CFQCU (http://www.cfqcu.org/). Results: The Moodle interface has been explained to pathology teachers using web-based conferences with screen sharing. The teachers added then contents such as clinical cases, selfevaluations and other media organized in several sections by student levels and pathological fields. Contents can be used as online learning or online preparation of subsequent courses in classrooms. In autumn 2013, one resident from Quebec spent 6 weeks in France and Switzerland and created original contents in inflammatory skin pathology. These contents are currently being validated by senior teachers and will be opened to pathology residents in spring 2014. All contents of the website can be accessed for free. Most contents just require anonymous connection but some specific fields, especially those containing pictures obtained from patients who agreed for a teaching use only, require personal identification of the students. Also, students have to register to access Moodle tests. All contents are written in French but one case has been translated into English to illustrate this communication (http://moodle.sorbonne-pariscite.fr/mod/page/view.php?id=261) (use "login as a guest"). The Moodle test module allows many types of shared questions, making it easy to create personalized tests. Contents that are opened to students have been validated by an editorial committee composed of colleagues from the participating institutions. Conclusions: Future developments include other international fellowships, the next one being scheduled for one French resident from May to October 2014 in Quebec, with a study program centered on lung and breast pathology. It must be kept in mind that these e-learning programs highly depend on teachers' time, not only at these early steps but also later to update the contents. We believe that funding resident fellowships for developing online pathological teaching contents is a win-win situation, highly beneficial for the resident who will improve his knowledge and way of thinking, highly beneficial for the teachers who will less worry about access rights or image formats, and finally highly beneficial for the students who will get courses fully adapted to their practice.

N-acetylcysteine normalizes neurochemical changes in the glutathione-deficient schizophrenia mouse model during development.

BACKGROUND: Glutathione (GSH) is the major cellular redox-regulator and antioxidant. Redox-imbalance due to genetically impaired GSH synthesis is among the risk factors for schizophrenia. Here we used a mouse model with chronic GSH deficit induced by knockout (KO) of the key GSH-synthesizing enzyme, glutamate-cysteine ligase modulatory subunit (GCLM).¦METHODS: With high-resolution magnetic resonance spectroscopy at 14.1 T, we determined the neurochemical profile of GCLM-KO, heterozygous, and wild-type mice in anterior cortex throughout development in a longitudinal study design.¦RESULTS: Chronic GSH deficit was accompanied by an elevation of glutamine (Gln), glutamate (Glu), Gln/Glu, N-acetylaspartate, myo-Inositol, lactate, and alanine. Changes were predominantly present at prepubertal ages (postnatal days 20 and 30). Treatment with N-acetylcysteine from gestation on normalized most neurochemical alterations to wild-type level.¦CONCLUSIONS: Changes observed in GCLM-KO anterior cortex, notably the increase in Gln, Glu, and Gln/Glu, were similar to those reported in early schizophrenia, emphasizing the link between redox imbalance and the disease and validating the model. The data also highlight the prepubertal period as a sensitive time for redox-related neurochemical changes and demonstrate beneficial effects of early N-acetylcysteine treatment. Moreover, the data demonstrate the translational value of magnetic resonance spectroscopy to study brain disease in preclinical models.

Influence of emergence timing of weeds on the establishment of woody natives and ground cover species

Les invasions biològiques són produïdes per espècies transportades per l'home fora de la regió d'origen a altres regions on s'estableixen i expandeixen. Són actualment de les majors causes de perduda de biodiversitat, amb el canvi d'usos del sòl, tret rellevant en zones insulars. Comprendre mecanismes de competència amb les espècies autòctones és clau per gestionar el problema. L’experiment evidencia diferències de creixement de 7 plantes natives australianes (3 espècies d’eucaliptus, 3 espècies d’acàcia, 1 pasturatge natiu), competint intraespecífica (entre mateixa espècie) i interespecíficament (acàcies o eucaliptus convivint amb pasturatge natiu) plantejant tres tractaments (sense males herbes, males herbes i males herbes a posteriori) per definir la naturalesa de la interacció dels diferents tipus funcionals d'espècies. S’analitzen tendències temporals de creixement de plàntules, així com la supervivència. S’ha detectat una moderada correlació entre taxes de creixement d’espècies i mida de la llavor, (p ≈ 0.6), així com una correlació entre la supervivència i la humitat del sòl (p ≈ 0.5); efectes estacionals. A curt termini i en escenari de primavera la convivència amb males herbes reporta creixement nul. Tractaments sense males herbes, presenten major supervivència en escenaris en competència interespecífica. A llarg termini les espècies amb major supervivència són les que conviuen amb pasturatge natiu i sense males herbes, indicant un efecte beneficiós en espècies millor adaptades a la sequera (E. loxophleba).

Two novel MvaT-like global regulators control exoproduct formation and biocontrol activity in root-associated Pseudomonas fluorescens CHA0.

Pseudomonas fluorescens CHA0 protects various crop plants against root diseases caused by pathogenic fungi. Among a range of exoproducts excreted by strain CHA0, the antifungal compounds 2,4-diacetylphloroglucinol (DAPG) and pyoluteorin (PLT) are particularly relevant to the strain's biocontrol potential. Here, we report on the characterization of MvaT and MvaV as novel regulators of biocontrol activity in strain CHA0. We establish the two proteins as further members of an emerging family of MvaT-like regulators in pseudomonads that are structurally and functionally related to the DNA-binding protein H-NS. In mvaT and mvaV in frame-deletion mutants of strain CHA0, PLT production was enhanced about four- and 1.5-fold, respectively, whereas DAPG production remained at wild-type levels. Remarkably, PLT production was increased up to 20-fold in an mvaT mvaV double mutant. DAPG biosynthesis was almost completely repressed in this mutant. The effects on antibiotic production could be confirmed by following expression of gfp-based reporter fusions to the corresponding biosynthetic genes. MvaT and MvaV also influenced levels of other exoproducts, motility, and physicochemical cell-surface properties to various extents. Compared with the wild type, mvaT and mvaV mutants had an about 20% reduced capacity (in terms of plant fresh weight) to protect cucumber from a root rot caused by Pythium ultimum. Biocontrol activity was nearly completely abolished in the double mutant Our findings indicate that MvaT and MvaV act together as further global regulatory elements in the complex network controlling expression of biocontrol traits in plant-beneficial pseudomonads.

One-step nucleic acid amplification (OSNA): a new road to better staging in colon cancer patients?

Introduction: Approximately one fifth of stage I and II colon cancer patients will suffer from recurrent disease. This is partly due to the presence of small nodal tumour infiltrates, which are undetected by standard histopathology using Haematoxylin & Eosin (H&E) staining on one slice and thus may not receive beneficial adjuvant therapy. A new diagnostic, semi-automatic system, called one-step nucleic acid amplification (OSNA), was recently designed for the detection of cytokeratin 19 (CK19) mRNA as a surrogate for lymph node metastases. The objective of the present investigation was to compare the performance of OSNA with both standard H&E as well as intensive histopathologic analyses in the detection of colon cancer lymph node micro- and macro-metastases.Methods: In this prospective study 313 lymph nodes from 22 consecutive stage I - III colon cancer patients were assessed. Half of each lymph node was analysed initially based on one slice of H&E followed by an intensive histologic work-up (5 levels of H&E and immuno-histochemistry staining for each slice), the other half was analysed using OSNA.Results: All OSNA results were available after less than 40 minutes. Fifty-one lymph nodes were positive and 246 lymph nodes negative with both OSNA and standard H&E. OSNA was more sensitive to detect small nodal tumor infiltrates compared to H&E (11 OSNA pos. /H&E neg.). Compared to intensive histopathologic analyses, OSNA had a sensitivity of 94.5% and a specificity of 97.6% to detect lymph node micro- and macro-metastases with a concordance rate of 97.1%. An upstaging due to OSNA was found in 2/13 (15.3%) initially node negative colon cancer patients.Conclusion: OSNA appears to be a powerful and promising molecular tool for the detection of lymph node macro- and micro-metastases in colon cancer patients. OSNA has a similar performance in the detection of micro- and macro-metastases compared to intensive histopathologic investigations and appears to be superior to standard histology with H&E. Since the use of OSNA allows the analysis of the whole lymph node, the problem of sampling bias and undetected tumor deposits due to uninvestigated material will be overcome in the future and OSNA may thus improve staging in colon cancer patients. It is hoped that this improved staging will lead to better patient selection for adjuvant therapy and consecutively improved local and distant control as well as better overall survival.

Callings in career: A typological approach to essential and optional components

A sense of calling in career is supposed to have positive implications for individuals and organizations but current theoretical development is plagued with incongruent conceptualizations of what does or does not constitute a calling. The present study used cluster analysis to identify essential and optional components of a presence of calling among 407 German undergraduate students from different majors. Three types of calling merged: "negative career self-centered", "pro-social religious", and "positive varied work orientation". All types could be described as vocational identity achieved (high commitment/high self-exploration), high in career confidence and career engagement. Not defining characteristics were centrality of work or religion, endorsement of specific work values, or positivity of core self-evaluations. The results suggest that callings entail intense self-exploration and might be beneficial because they correspond with identity achievement and promote career confidence and engagement while not necessarily having pro-social orientations. Suggestions for future research, theory and practice are suggested.

Ultrastructural evidence of exosome secretion by progenitor cells in adult mouse myocardium and adult human cardiospheres.

The demonstration of beneficial effects of cell therapy despite the persistence of only few transplanted cells in vivo suggests secreted factors may be the active component of this treatment. This so-called paracrine hypothesis is supported by observations that culture media conditioned by progenitor cells contain growth factors that mediate proangiogenic and cytoprotective effects. Cardiac progenitor cells in semi-suspension culture form spherical clusters (cardiospheres) that deliver paracrine signals to neighboring cells. A key component of paracrine secretion is exosomes, membrane vesicles that are stored intracellularly in endosomal compartments and are secreted when these structures fuse with the cell plasma membrane. Exosomes have been identified as the active component of proangiogenic effects of bone marrow CD34(+) stem cells in mice and the regenerative effects of embryonic mesenchymal stem cells in infarcted hearts in pigs and mice. Here, we provide electron microscopic evidence of exosome secretion by progenitor cells in mouse myocardium and human cardiospheres. Exosomes are emerging as an attractive vector of paracrine signals delivered by progenitor cells. They can be stored as an "off-the-shelf" product. As such, exosomes have the potential for circumventing many of the limitations of viable cells for therapeutic applications in regenerative medicine.

Iowa's Mississippi River Trail Plan, 2003

The Mississippi River Trail (MRT) is a world-class bicycle trail that will follow the Mississippi River all the way from its headwaters in Minnesota to the Gulf of Mexico. The trail is partially completed; much of it is still in the planning and development stages. When complete, the MRT will Link over 2,000 miles of recreational trails through 10 states, including 280 miles in Iowa. Designated as a National Millennium Trail, the MRT will preserve natural environments along the river, stimulate economic growth in river communities, and provide bicyclists access to a variety of landscapes, history, and culture. The Iowa Department of Transportation commissioned the Center for Transportation Research and Education at Iowa State University to develop a plan for a safe, economically beneficial, and scenic MRT route through Iowa. This report presents the MRT plan for Iowa. It is organized in the following chapters: Executive Summary; (1) Introduction - vision statement and objectives; (2) Iowa MRT Minimum Design Standards; (3) Iowa MRT Route Analysis; (4) Recommended Improvement Plan; (5) MRT Implementation; and (6) Estimated Benefits and Impacts of the Iowa MRT. Additional information is provided in the following appendices: (A) GIS Analysis for the MRT; (B) Iowa MRT Maps; (C) Public Input; (D) Public Comments; and (E) References.

GacS sensor domains pertinent to the regulation of exoproduct formation and to the biocontrol potential of Pseudomonas fluorescens CHA0.

In the root-colonizing biocontrol strain CHA0 of Pseudomonas fluorescens, cell density-dependent synthesis of extracellular, plant-beneficial secondary metabolites and enzymes is positively regulated by the GacS/GacA two-component system. Mutational analysis of the GacS sensor kinase using improved single-copy vectors showed that inactivation of each of the three conserved phosphate acceptor sites caused an exoproduct null phenotype (GacS-), whereas deletion of the periplasmic loop domain had no significant effect on the expression of exoproduct genes. Strain CHA0 is known to synthesize a solvent-extractable extracellular signal that advances and enhances the expression of exoproduct genes during the transition from exponential to stationary growth phase when maximal exoproduct formation occurs. Mutational inactivation of either GacS or its cognate response regulator GacA abolished the strain's response to added signal. Deletion of the linker domain of the GacS sensor kinase caused signal-independent, strongly elevated expression of exoproduct genes at low cell densities. In contrast to the wild-type strain CHA0, the gacS linker mutant and a gacS null mutant were unable to protect tomato plants from crown and root rot caused by Fusarium oxysporum f. sp. radicis-lycopersici in a soil-less microcosm, indicating that, at least in this plant-pathogen system, there is no advantage in using a signal-independent biocontrol strain.

Comment diminuer son risque cardiovasculaire avec l'alimentation? Rôle des graisses consommées [Nutritional advice to help reduce the cardiovascular risk. Update of the Swiss Federal Office of Public Health's recommendations on fat consumption].

The Swiss Federal Office of Public Health's (FOPH) updated its recommendations on fat consumption in 2013. The report recommends that maximum 10% of the daily caloric intake should come from saturated fatty acids, and the total fat intake should account for 20-35%. There is no limitation to dietary cholesterol consumption. Recent studies have shown that replacing consumption of saturated fatty acids by unsaturated fatty acids is more beneficial in terms of cardiovascular prevention than a low fat diet. The purpose of this article is to review the FOPH recommendations on dietary fat as well as the current evidence about their cardiovascular benefit, and to provide a translation of these scientific recommendations into clinical advice.

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.