Analytical methods for the quantitative determination of selective serotonin reuptake inhibitors for therapeutic drug monitoring purposes in patients.

Five selective serotonin reuptake inhibitors (SSRIs) have been introduced recently: citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. Although no therapeutic window has been defined for SSRIs, in contrast to tricyclic antidepressants, analytical methods for therapeutic drug monitoring of SSRIs are useful in several instances. SSRIs differ widely in their chemical structure and in their metabolism. The fact that some of them have N-demethylated metabolites, which are also SSRIs, requires that methods be available which allow therapeutic drug monitoring of the parent compounds and of these active metabolites. most procedures are based on prepurification of the SSRIs by liquid-liquid extraction before they are submitted to separation by chromatographic procedures (high-performance liquid chromatography, gas chromatography, thin layer chromatography) and detection by various detectors (UV, fluorescence, electrochemical detector, nitrogen-phosphorus detector, mass spectrometry). This literature review shows that most methods allow quantitative determination of SSRIs in plasma, in the lower ng/ml range, and that they are, therefore, suitable for therapeutic drug monitoring purposes of this category of drugs.

Absorption and pharmacokinetics of grapefruit flavanones in beagles

The present study evaluated the pharmacokinetics of three different grapefruit flavanone forms in dog plasma and demonstrated their absorption after an oral intake of a grapefruit extract; pharmacokinetic parameters of these forms were also determined. Ten healthy beagles were administered 70 mg citrus flavonoids as a grapefruit extract contained in capsules, while two additional dogs were used as controls and given an excipient. The grapefruit flavanone naringin, along with its metabolites naringenin and naringenin glucuronide, was detected in dog plasma. Blood samples were collected between 0 and 24 h after administration of the extract. Naringin reached its maximun plasma concentration at around 80 min, whereas naringenin and naringenin glucuronide reached their maximun plasma concentrations at around 20 and 30 min, respectively. Maximum plasma concentrations of naringin, naringenin and naringenin glucuronide (medians and ranges) were 0·24 (0·05 2·08), 0·021 (0·001 0·3) and 0·09 (0·034 0·12) mmol/l, respectively. The areas under the curves were 23·16 l (14·04 70·62) min £ mmol/for nariningin, 1·78 (0·09 4·95) min £ mmol/l for naringenin and 22·5 (2·74 99·23) min £ mmol/l for naringenin glucuronide. The median and range values for mean residence time were 3·3 (1·5 9·3), 2·8 (0·8 11·2) and 8·0 (2·3 13·1) h for naringin, naringenin and naringenin glucuronide, respectively. The results of the present study demonstrate the absorption of grapefruit flavanones via the presence of their metabolites in plasma, thus making an important contribution to the field since the biological activities ascribed to these compounds rely on their specific forms of absorption.

Absorption and pharmacokinetics of green tea catechins in beagles

The present study evaluates for the first time in dogs, the kinetics of green tea catechins and their metabolic forms in plasma and urine. Ten beagles were administered 173 mg (12·35 mg/kg body weight) of catechins as a green tea extract, in capsules. Blood samples were collected during 24 h after intake and urine samples were collected during the following periods of time: 02, 26, 68 and 824 h. Two catechins with a galloyl moiety and three conjugated metabolites were detected in plasma. Most of the detected forms in plasma reached their maximum plasma concentration (Cmax) at around 1 h. Median Cmax for (2)-epigallocatechin-3-gallate (EGCG), (2)-epicatechin-3-gallate (ECG), (2)-epigallocatechin glucuronide (EGCglucuronide), (2)-epicatechin glucuronide (EC-glucuronide), (2)-epicatechin sulphate (EC sulphate) were 0·3 (range 0·11·9), 0·1 (range 00·4), 0·8 (range 0·23·9), 0·2 (range 0·1 1·7) and 1 (range 0·33·4) mmol/l, respectively. The areas under the plasma concentration v. time curves (AUC0!24) were 427 (range 1021185) mmol/l £ min for EGC-glucuronide, 112 (range 53919) mmol/l £ min for EC-sulphate, 71 (range 26306) mmol/l £ min for EGCG, 40 (range 12258) mmol/l £ min for EC-glucuronide and 14 (range 0·1124) mmol/l £ min for ECG. The values of mean residence time (MRT0!24) were 5 (range 216), 2 (range 111), 10 (range 213), 3 (range 216) and 2·4 (range 118) h for EGCG, ECG, EGC-glucuronide, EC-glucuronide and EC sulphate, respectively. In urine, catechins were present as conjugated forms, suggesting bile excretion of EGCG and ECG. Green tea catechins are absorbed following an oral administration and EGC-glucuronide is the metabolic form that remains in the organism for a longer period of time, suggesting that this compound could suffer an enterohepatic cycle.

Absorption and pharmacokinetics of grapefruit flavanones in beagles

The present study evaluated the pharmacokinetics of three different grapefruit flavanone forms in dog plasma and demonstrated their absorption after an oral intake of a grapefruit extract; pharmacokinetic parameters of these forms were also determined. Ten healthy beagles were administered 70 mg citrus flavonoids as a grapefruit extract contained in capsules, while two additional dogs were used as controls and given an excipient. The grapefruit flavanone naringin, along with its metabolites naringenin and naringenin glucuronide, was detected in dog plasma. Blood samples were collected between 0 and 24 h after administration of the extract. Naringin reached its maximun plasma concentration at around 80 min, whereas naringenin and naringenin glucuronide reached their maximun plasma concentrations at around 20 and 30 min, respectively. Maximum plasma concentrations of naringin, naringenin and naringenin glucuronide (medians and ranges) were 0·24 (0·05 2·08), 0·021 (0·001 0·3) and 0·09 (0·034 0·12) mmol/l, respectively. The areas under the curves were 23·16 l (14·04 70·62) min £ mmol/for nariningin, 1·78 (0·09 4·95) min £ mmol/l for naringenin and 22·5 (2·74 99·23) min £ mmol/l for naringenin glucuronide. The median and range values for mean residence time were 3·3 (1·5 9·3), 2·8 (0·8 11·2) and 8·0 (2·3 13·1) h for naringin, naringenin and naringenin glucuronide, respectively. The results of the present study demonstrate the absorption of grapefruit flavanones via the presence of their metabolites in plasma, thus making an important contribution to the field since the biological activities ascribed to these compounds rely on their specific forms of absorption.

Four-hour infusions of synthetic atrial natriuretic peptide in normal volunteers.

Two doses of synthetic atrial natriuretic peptide (0.5 and 5.0 micrograms/min) and its vehicle were infused intravenously for 4 hours in eight salt-loaded normal volunteers, and the effect on blood pressure, heart rate, renal hemodynamics, solute excretion, and secretion of vasoactive hormones was studied. The 0.5 micrograms/min infusion did not alter blood pressure or heart rate, whereas the 5.0 micrograms/min infusion significantly reduced the mean pressure by 20/9 mm Hg after 2.5 to 3 hours and increased the heart rate slightly. Inulin clearance was not significantly changed, but the mean p-aminohippurate clearance fell by 13 and 32% with the lower and higher doses, respectively. Urinary excretion of sodium and chloride increased slightly with the lower dose. With the higher dose, a marked increase in urinary excretion of sodium, chloride, and calcium was observed, reaching a peak during the second hour of the infusion. Potassium and phosphate excretion did not change significantly. A brisk increase in urine flow rate and fractional water excretion was seen only during the first hour of the high-dose infusion. Signs and symptoms of hypotension were observed in two subjects. No change in plasma renin activity, angiotensin II, or aldosterone was observed during either infusion, but a marked increase occurred after discontinuation of the high-dose infusion. In conclusion, the 5 micrograms/min infusion induced a transient diuretic effect, delayed maximal natriuretic activity, and a late fall in blood pressure, with no change in inulin clearance but a dose-related decrease in p-aminohippurate clearance. Despite large amounts of sodium excreted and blood pressure reduction, no counterregulatory changes were observed in the renin-angiotensin-aldosterone system or plasma vasopressin levels during the infusion.

The anticancer drug tamoxifen counteracts the pathology in a mouse model of duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a severe disorder characterized by progressive muscle wasting,respiratory and cardiac impairments, and premature death. No treatment exists so far, and the identification of active substances to fight DMD is urgently needed. We found that tamoxifen, a drug used to treat estrogen-dependent breast cancer, caused remarkable improvements of muscle force and of diaphragm and cardiac structure in the mdx(5Cv) mouse model of DMD. Oral tamoxifen treatment from 3 weeks of age for 15 months at a dose of 10 mg/kg/day stabilized myofiber membranes, normalized whole body force, and increased force production and resistance to repeated contractions of the triceps muscle above normal values. Tamoxifen improved the structure of leg muscles and diminished cardiac fibrosis by~ 50%. Tamoxifen also reduced fibrosis in the diaphragm, while increasing its thickness,myofiber count, and myofiber diameter, thereby augmenting by 72% the amount of contractile tissue available for respiratory function. Tamoxifen conferred a markedly slower phenotype to the muscles.Tamoxifen and its metabolites were present in nanomolar concentrations in plasma and muscles,suggesting signaling through high-affinity targets. Interestingly, the estrogen receptors ERa and ERb were several times more abundant in dystrophic than in normal muscles, and tamoxifen normalized the relative abundance of ERb isoforms. Our findings suggest that tamoxifen might be a useful therapy for DMD.

Neuropeptide Y and corticotropin-releasing hormone in CSF mark response to antidepressive treatment with citalopram.

Neuropeptides appear to play a role in the pathophysiology of depression and electroconvulsive treatment and lithium affect these compounds in human cerebrospinal fluid (CSF) and rodent brain. Consequently, we investigated whether long-term treatment with the selective serotonin reuptake inhibitor (SSRI) citalopram (Cit) would also affect neuropeptides in CSF of depressed patients. Changes in CSF monoamine metabolites were also explored. CSF concentrations of corticotropin-releasing hormone (CRH)-like immunoreactivity (-LI), neuropeptide Y (NPY)-LI, and Cit were determined in 21 patients with major depression. Lumbar puncture was performed in the morning at baseline and was repeated after at least 4 wk of Cit treatment (40 mg/d). The severity of depression was assessed by the Hamilton Rating Scale for Depression (HAMD). Cit treatment was associated with a significant increase in NPY-LI and decrease in CRH-LI. An evaluation of the relationship between changes in concentrations of NPY-LI, CRH-LI, and the clinical response showed significant correlations between these parameters. Significant NPY and CRH changes in CSF following treatment as well as correlations to changes in HAMD support the hypothesis that these two peptides play a role in affective disorders and are markers of therapeutic response.

Arabidopsis Basic Helix-Loop-Helix Transcription Factors MYC2, MYC3, and MYC4 Regulate Glucosinolate Biosynthesis, Insect Performance, and Feeding Behavior.

Arabidopsis thaliana plants fend off insect attack by constitutive and inducible production of toxic metabolites, such as glucosinolates (GSs). A triple mutant lacking MYC2, MYC3, and MYC4, three basic helix-loop-helix transcription factors that are known to additively control jasmonate-related defense responses, was shown to have a highly reduced expression of GS biosynthesis genes. The myc2 myc3 myc4 (myc234) triple mutant was almost completely devoid of GS and was extremely susceptible to the generalist herbivore Spodoptera littoralis. On the contrary, the specialist Pieris brassicae was unaffected by the presence of GS and preferred to feed on wild-type plants. In addition, lack of GS in myc234 drastically modified S. littoralis feeding behavior. Surprisingly, the expression of MYB factors known to regulate GS biosynthesis genes was not altered in myc234, suggesting that MYC2/MYC3/MYC4 are necessary for direct transcriptional activation of GS biosynthesis genes. To support this, chromatin immunoprecipitation analysis showed that MYC2 binds directly to the promoter of several GS biosynthesis genes in vivo. Furthermore, yeast two-hybrid and pull-down experiments indicated that MYC2/MYC3/MYC4 interact directly with GS-related MYBs. This specific MYC-MYB interaction plays a crucial role in the regulation of defense secondary metabolite production and underlines the importance of GS in shaping plant interactions with adapted and nonadapted herbivores.

Etude de la toxicité hépatique de la cocaïne associée à de l'alcool: Effets de l'éthanol sur le métabolisme de la cocaïne dan les hépatocytes de rat en suspension et dans un modèle enzymatique humain

Le but essentiel de notre travail a été d?étudier la capacité du foie, premier organe de métabolisation des xénobiotiques, à dégrader la cocaïne en présence d?éthanol, à l?aide de deux modèles expérimentaux, à savoir un modèle cellulaire (les hépatocytes de rat en suspension) et un modèle acellulaire (modèle reconstitué in vitro à partir d?enzymes purifiées de foie humain). La première partie a pour objectifs de rechercher les voies de métabolisation de la cocaïne qui sont inhibées et / ou stimulées en présence d?éthanol, sur hépatocytes isolés de rat. Dans ce but, une méthode originale permettant de séparer et de quantifier simultanément la cocaïne, le cocaéthylène et huit de leurs métabolites respectifs a été développée par Chromatographie Phase Gazeuse couplée à la Spectrométrie de Masse (CPG / SM). Nos résultats préliminaires indiquent que l?éthanol aux trois concentrations testées (20, 40 et 80 mM) n?a aucun effet sur la cinétique de métabolisation de la cocaïne. Notre étude confirme que l?addition d?éthanol à des cellules hépatiques de rat en suspension supplémentées en cocaïne résulte en la formation précoce de benzoylecgonine et de cocaéthylène. L?apparition retardée d?ecgonine méthyl ester démontre l?activation d?une deuxième voie de détoxification. La production tardive d?ecgonine indique une dégradation de la benzoylecgonine et de l?ecgonine méthyl ester. De plus, la voie d?oxydation intervenant dans l?induction du stress oxydant en produisant de la norcocaïne est tardivement stimulée. Enfin, notre étude montre une métabolisation complète de la concentration initiale en éthanol par les hépatocytes de rat en suspension. La deuxième partie a pour but de déterminer s?il existe d?autres enzymes que les carboxylesterases formes 1 et 2 humaines ayant une capacité à métaboliser la cocaïne seule ou associée à de l?éthanol. Pour ce faire, une méthode de micropurification par chromatographie liquide (Smart System®) a été mise au point. Dans le cadre de nos dosages in situ de la cocaïne, du cocaéthylène, de la benzoylecgonine, de l?acide benzoïque et de la lidocaïne, une technique par Chromatographie Liquide Haute Performance couplée à une Détection par Barrette de Diode (CLHP / DBD) et une méthode de dosage de l?éthanol par Chromatographie Phase Gazeuse couplée à une Détection par Ionisation de Flamme équipée d?un injecteur à espace de tête (espace de tête CPG / DIF) ont été développées. La procédure de purification nous a permis de suspecter la présence d?autres enzymes que les carboxylesterases formes 1 et 2 de foie humain impliquées dans le métabolisme de la cocaïne et déjà isolées. A partir d?un modèle enzymatique reconstitué in vitro, nos résultats préliminaires indiquent que d?autres esterases que les formes 1 et 2 de foie humain sont impliquées dans l?élimination de la cocaïne, produisant benzoylecgonine et ecgonine méthyl ester. De plus, nous avons montré que les sensibilités de ces enzymes à l?éthanol sont variables.<br/><br/>The main purpose of our work was to study the ability of the liver, as the first organ to metabolise xenobiotic substances, to degrade cocaine in the presence of ethanol. In order to do this, we used two experimental models, namely a cellular model (rat liver cells in suspension) and an a-cellular model (model reconstructed in vitro from purified human liver enzymes). The purpose of the first part of our study was to look for cocaine metabolising processes which were inhibited and / or stimulated by the presence of ethanol, in isolated rat liver cells. With this aim in mind, an original method for simultaneously separating and quantifying cocaine, cocaethylene and eight of their respective metabolites was developed by Vapour Phase Chromatography coupled with Mass Spectrometry (VPC / MS). Our preliminary results point out that ethanol at three tested concentrations (20, 40 et 80 mM) have no effect on the kinetic of metabolisation of cocaine. Our study confirms that the addition of alcohol to rat liver cells in suspension, supplemented with cocaine, results in the premature formation of ecgonine benzoyl ester and cocaethylene. The delayed appearance of ecgonine methyl ester shows that a second detoxification process is activated. The delayed production of ecgonine indicates a degradation of the ecgonine benzoyl ester and the ecgonine methyl ester. Moreover, the oxidising process which occurs during the induction of the oxidising stress, producing norcocaine, is stimulated at a late stage. Finally, our study shows the complete metabolisation of the initial alcohol concentration by the rat liver cells in suspension. The second part consisted in determining if enzymes other than human carboxylesterases 1 and 2, able to metabolise cocaine on its own or with alcohol, existed. To do this, a micropurification method us ing liquid phase chromatography (Smart System®) was developed. A technique based on High Performance Liquid Chromatography coupled with a Diode Array Detection (HPLC / DAD) in the in situ proportioning of cocaine, cocaethylene, ecgonine benzoyl ester, benzoic acid and lidocaine, and a method for proportioning alcohol by quantifying the head space using Vapour Phase Chromatography coupled with a Flame Ionisation Detection (head space VPC / FID) were used. The purification procedure pointed to the presence of enzymes other than the human liver carboxylesterases, forms 1 and 2, involved in the metabolism of cocaine and already isolated. The preliminary results drawn from an enzymatic model reconstructed in vitro indicate that human liver carboxylesterases, other than forms 1 and 2, are involved in the elimination of cocaine, producing ecgonine benzoyl ester and ecgonine methyl ester. Moreover, we have shown that the sensitivity of these enzymes to alcohol is variable.

Investigation phytochimique des plantes aquatiques Potamogeton pectinatus L., P. lucens L., P. perfoliatus L. et P. crispus L. (Potamogetonaceae)

Dans le cadre de la recherche de nouveaux composés naturels, les métabolites secondaires de plantes aquatiques indigènes, les potamots Potamogeton pectinatus L., P. lucens L., P. perfoliatus L. et P. crispus L. (Potamogetonaceae), ont été étudiés. Par leur position écologique et évolutive particulière entre environnement terrestre et aquatique, les plantes aquatiques ou macrophytes pourraient en effet avoir sélectionné des composés avec des caractéristiques originales. Les extraits dichlorométhaniques (apolaires) des potamots ont été analysés par HPLCUV, HPLC-MS, HPLC-RMN et GC-MS, et testés contre diverses cibles biologiques. Sur la base de ces résultats, les extraits apolaires de P. pectinatus et P. lucens ont été étudiés de manière plus approfondie. Ils ont été fractionnés sur des colonnes ouvertes et par VLC, LPLC, MPLC, CPC et HPLC semi-préparative. Une partie de leurs constituants ont été isolés et leurs structures déterminées par des méthodes spectroscopiques, en particulier par RMN et par MS. Quinze composés ont été ainsi isolés de P. pectinatus et P. lucens, dont sept sont des nouveaux produits naturels. Parmi ces quinze produits, neuf sont des diterpènes ent-labdanes contenant un noyau furane ou un groupe lactonique, dont six sont décrits ici pour la première fois. Certains de ces diterpènes ont montré une activité algicide, ce qui indique une de leurs fonctions possible dans les potamots, et un de ces labdanes, le méthyl-15,16-époxy-12-oxo-8(17),13(16),14-ent-labatrièn-19-oate, a également des propriétés anti-inflammatoires. Les composés présents dans les extraits méthanoliques (polaires) n?ont pas été isolés, mais quatorze d?entre eux ont pu être identifiés par HPLC-UV, HPLC-MS et HPLCRMN. Une majorité de ces constituants sont des flavonoïdes connus, des dérivés glycosylés de l?apigénine, la lutéoline et le chrysoériol, également présents en tant qu?aglycones. Plusieurs ent-labdanes glycosylés ont pu être également identifiés dans ces extraits, parmi lesquels un nouveau composé dont la structure a pu être partiellement déterminée. En conclusion, ce travail a permis de mieux connaître la phytochimie de plusieurs plantes aquatiques de Suisse, et d?isoler de nouveaux produits naturels avec des propriétés biologiques et pharmacologiques intéressantes.<br/><br/>The secondary metabolites of Swiss freshwater plants, the pondweeds Potamogeton pectinatus L., P. lucens L., P. perfoliatus L. and P. crispus L. (Potamogetonaceae), were investigated. Because of their peculiar habitat, in-between aquatic and terrestrial life, aquatic plants should produce secondary metabolites with original chemical or biological features. Their apolar extracts were analysed by HPLC-UV, HPLC-MS, HPLC-NMR and GCMS, and were tested with different bioassays. Based on these results, the apolar extracts of P. pectinatus and P. lucens were investigated more extensively. They were fractionated on open columns, and by VLC, LPLC, MPLC, CPC and semi-preparative HPLC. Their constituents were isolated and their structures elucidated by spectroscopic methods as MS and NMR. Fifteen compounds could be isolated from P. pectinatus and P. lucens, and seven were new natural products. Nine of them were ent-labdane diterpenes with a furan moiety or a lactone group, and six of these labdanes were reported here for the first time as natural products. Some of these diterpenes showed an algaecide effect. This activity indicated their potential ecological function in pondweeds. One compound, methyl-15,16-epoxy-12-oxo-8(17),13(16),14-ent-labatrien-19-oate, revealed also some anti-inflammatory properties. The constituents of polar extracts were not isolated, but fourteen of them could be identified by HPLC-UV, HPLC-MS and HPLC-NMR. The major part of these compounds was known flavonoids as apigenin, lutolin, chrysoeriol and their glycosylated derivatives. Several glycosylated ent-labdanes were also identified, and the structure of a new labdane dihexoside was partially elucidated. In conclusion this study allowed a better knowledge of the phytochemistry of Swiss aquatic plants, and the isolation of new natural products with interesting biological and pharmacological properties.

Métabolisme d'antidépresseurs dans différentes espèces : aspects méthodologiques et pharmacogénétiques, perspectives cliniques

Résumé pour large public Unité de Biochimie et Psychopharmacologie Clinique, Centre de neurosciences Psychiatrique, Département de Psychiatrie Adulte, Faculté de Biologie et de Médecine, Université de Lausanne Lors de la prise d'un médicament, celui-ci va passer par différentes étapes que sont l'absorption, la distribution, le métabolisme et enfin l'élimination. Ces quatre étapes sont regroupées sous le nom de pharmacocinétique. A noter que ces quatre paramètres sont dynamiques et en constante évolution. Durant cette thèse, nous avons investigué différents aspects de la pharmacocinétique, tout d'abord par une revue de la littérature sur la glycoprotéine-P (Pgp). Récemment découverte, cette protéine de membrane est située aux endroits stratégiques de l'organisme comme la barrière hématoencéphalée, le placenta ou les intestins où elle influencera l'entrée de différentes substances, en particulier les médicaments. La Pgp serait impliquée dans les phénomènes de résistances aux agents thérapeutiques en oncologie. La Pgp influence donc l'absorption des médicaments, et son impact en clinique, en termes d'efficacité de traitement et de toxicité prend chaque jour plus d'importance. Ensuite nous avons mis au point une méthode d'analyse quantitative d'un antidépresseur d'une nouvelle génération : la mirtazapine (Remeron®). La nouveauté réside dans la façon dont la mirtazapine interagit avec les neurotransmetteurs impliqués dans la dépression que sont la sérotonine et la noradrénaline. Cette méthode utilise la chromatographie liquide pour séparer la mirtazapine de ses principaux métabolites dans le sang. La spectrométrie de masse est utilisée pour les détecter et les quantifier. Les métabolites sont des substances issues de réactions chimiques entre la substance mère, la mirtazapine, et généralement des enzymes hépatiques, dans le but de rendre cette substance plus soluble en vue de son élimination. Cette méthode permet de quantifier la mirtazapine et ses métabolites dans le sang de patients traités et de déterminer la variation des taux plasmatiques chez ces patients. Puis nous avons étudié le métabolisme d'un autre antidépresseur, le citalopram, qui a un métabolisme complexe. Le citalopram est un racémate, c'est-à-dire qu'il existe sous forme de deux entités chimiques (R-(-) et S-(+) citalopram) qui ont le même nombre d'éléments mais arrangés différemment dans l'espace. La voie métabolique cérébrale du citalopram est sous le contrôle d'une enzyme, la monoamine oxydase (MAO), conduisant à une forme acide du citalopram (l'acide propionique du citalopram). La MAO existe sous deux formes : MAO-A et MAO-B. Nous avons utilisé des souris déficientes d'un gène, celui de la MAO-A, pour mieux en comprendre le métabolisme en les comparants à des souris sauvages (sans déficience de ce gène). Nous avons utilisé le citalopram et deux de ses métabolites (le déméthylcitaloprarn et le didéméthyícitalopram) comme substrats pour tester la formation in vitro de l'acide propionique du citalopram. Nos résultats montrent que la MAO-A favorise la formation de l'entité R-(-) et présente une plus grande affinité pour le citalopram, tandis que la MAO-B métabolise préférentiellement l'entité S-(+) et a une plus grande affinité pour les deux métabolites déméthylés. De plus, la déficience en MAO-A est partiellement compensée parla MAO-B chez les souris déficientes du gène de la MAO-A. Enfin, nous avons étudié une deuxième voie métabolique du citalopram qui s'est avérée toxique chez le chien Beagle. Celle-ci est catalysée par une autre famille d'enzymes, les cytochromes P-450, et mène aux métabolites déméthylés et didéméthylés du citalopram. Nous avons utilisé des tissus hépatiques de chiens Beagle. Plusieurs cytochromes P-450 sont impliqués dans le métabolisme du citalopram menant à sa forme déméthylée, ceci tant chez l'homme que chez le chien. Par contre, dans le métabolisme de la forme déméthylée menant à 1a forme didéméthylée, un seul cytochrome P-450 serait impliqué chez l'Homme, tandis qu'ils seraient plusieurs chez le chien. L'activité enzymatique produisant la forme didéméthylée est beaucoup plus importante chez le chien comparé à l'homme. Cette observation soutien l'hypothèse que des taux élevés de la forme didéméthylée participent à la toxicité spécifique du citalopram chez le chien. Nous pouvons conclure que plusieurs famille d'enzymes sont impliquées tant au niveau cérébral qu'hépatique dans la métabolisation de médicaments psychotropes. Sachant que les enzymes peuvent être stimulées ou inhibées, il importe de pouvoir suivre au plus prés les taux plasmatiques des différents psychotropes et de leurs métabolites. Résumé Unité de Biochimie et Psychopharmacologie Clinique, Centre de neurosciences Psychiatrique, Département de Psychiatrie Adulte, Faculté de Biologie et de Médecine, Université de Lausanne La plupart des médicaments subissent une transformation enzymatique dans l'organisme. Les substances issues de cette métabolisation ne sont pas toujours dotées d'une activité pharmacologique. Il s'est avéré par conséquent indispensable de suivre les taux plasmatiques d'une substance et de ses métabolites et d'établir ou non l'existence d'une relation avec l'effet clinique observé. Ce concept nommé « therapeutic drag monitoring » (TDM) est particulièrement utile en psychiatrie ou un manque de compliance des patients est fréquemment observé. Les médicaments psychotropes ont un métabolisme principalement hépatique (cytochromes P-450) et parfois cérébral (monoamines oxydases), comme pour le citalopram par exemple. Une méthode stéréosélective de chromatographie liquide couplée à la spectrométrie de masse a été développée pour analyser les énantiomères R-(-) et S-(+) d'un antidépresseur agissant sur les récepteurs noradrénergiques et sérotoninergiques, la mirtazapine et de ses métabolites déméthylmirtazapine et 8-hydroxymirtazapine. Les données préliminaires obtenues dans les plasmas dosés suggèrent que les concentrations de R-(-)-mirtazapine sont plus élevées que celles de S-(+)-mirtazapine, à l'exception des patients qui auraient comme co-médication des inhibiteurs du CYP2D6, telle que la fluoxétine ou la thioridazine. Il y a une enantiosélectivité du métabolisme de la mirtazapine. En particulier pour la 8-hydroxymirtazapine qui est glucuroconjuguée et pour laquelle le ratio S/R varie considérablement. Cette méthode analytique présente l'avantage d'être utilisable pour le dosage stéréosélectif de la mirtazapine et de ses métabolites dans le plasma de patients ayant d'autres substances en co-médication. La glycoprotéine P fonctionne comme une pompe transmembranaire transportant les xénobiotiques depuis le milieu intracellulaire vers le milieu extracellulaire. Son induction et son inhibition, bien que moins étudiées que pour les cytochromes P-450, ont des implications cliniques importantes en termes d'efficacité de traitement et de toxicité. Cette glycoprotéine P a fait l'objet d'une recherche bibliographique. Nous avons étudié le métabolisme du citalopram, un antidépresseur de la classe des inhibiteurs spécifiques de la recapture de la sérotonine chez la souris et chez le chien. Cette substance subit un métabolisme complexe. La voie de métabolisation conduisant à la formation de l'acide propionique du citalopram, catalysée par les monoamines oxydases, a été étudiée in vitro dans les mitochondries cérébrales chez la souris déficiente du gène de la MAO-A (Tg8). La monoamine oxydase A catalyse la formation de l'énantiomère R-(-) et présente une plus grande affinité pour les amines tertiaires, tandis que la monoamine oxydase B favorise la formation de la forme S-(+) et a une affinité plus marquée pour les amines secondaires et primaires. L'étude du citalopram chez la souris Tg8 adulte a montré que la monoamine oxydase B compense la déficience de la monoamine oxydase A chez ces souris génétiquement modifiées. Une autre voie de métabolisation du citalopram conduisant à la formation de didéméthylcitalopram, catalysée par les cytochromes P-450, a été étudiée in vitro dans des microsomes hépatiques de chiens Beagle. Nos études ont montré que les cinétiques de N-déméthylation du citalopram sont biphasiques chez le chien. Les orthologues canins impliqués dans la première N-déméthylation semblent être identiques aux cytochromes P-450 humains. Par contre, dans la deuxième Ndéméthylation, un seul cytochrome P-450 semble être impliqué chez l'homme (CYP2D6), tandis qu'on retrouve jusqu'à cinq orthologues chez le chien. Le CYP2D15, orthologue canin du CYP2D6, est majoritairement impliqué. De plus, l'activité enzymatique, reflétée par les clairances intrinsèques, dans la première N-déméthylation est jusqu'à 45 fois plus élevée chez le chien comparé à l'homme. Ces différentes observations soutiennent l'hypothèse que des taux élevés de didéméthylcitalopram sont responsables de la toxicité du citalopram chez le chien. Nous pouvons conclure que plusieurs famille d'enzymes sont impliquées tant au niveau cérébral qu'hépatique dans la métabolisation de médicaments psychotropes. Sachant -que les enzymes peuvent être induits ou inhibés, il importe de pouvoir suivre au plus près les taux plasmatiques des différents psychotropes et de leurs métabolites. Summary Most of the drugs are metabolized in the organism. Substances issued from this metabolic activity do not always show a pharmacological activity. Therefore, it is necessary to monitor plasmatic levels of drugs and their metabolites, and establish the relationship with the clinical effect. This concept named therapeutic drug monitoring is very useful in psychiatry where lack of compliance is commonly observed. Antidepressants are mainly metabolized in the liver (cytochrome P-450) and sometimes in the brain (monoamine oxidase) like the citalopram, for exemple. A LC-MS method was developed, which allows the simultaneous analysis of R-(-) and S-(+) enantiomers of mirtazapine, an antidepressant acting specifically on noradrenergic and serotonergic receptors, and its metabolites demethylmirtazapine and 8-hydroxymirtazapine in plasma of mirtazapine treated patients. Preliminary data obtained suggested that R-(-) mirtazapine concentrations were higher than those of S-(+) mirtazapine, except in patients comedicated with CYP2D6 inhibitors such as fluoxetine or thioridazine. There is an enantioselectivity in the metabolism of mirtazapine. In particular for the 8-hydroxymirtazapine, which is glucuroconjugated and S/R ratio varies considerably. Therefore this method seems to be suitable for the stereoselective assay of mirtazapine and its metabolites in plasma of patients comedicated with mirtazapine and other drugs for routine and research purposes. P-glycoprotein is working as an efflux transporter of xenobiotics from intracellular to extracellular environment. Its induction or inhibition, although less studied than cytochrome P-450, has huge clinical implications in terms of treatment efficacy and toxicity. An extensive literature search on P-glycoprotein was performed as part of this thesis. The study of citalopram metabolism, an antidepressant belonging to the class of selective serotonin reuptake inhibitors. This substance undergoes a complex metabolism. First metabolization route leading to citalopram propionic acid, catalyzed by monoamine oxidase was studied in vitro in mice brain mitochondria. Monoamine oxidase A catalyzed the formation of R-(-) enantiomer and showed greater affinity for tertiary amines, whereas monoamine oxidase B triggered the formation of S-(+) enantiomer and demonstrated higher affinity for primary and secondary amines. citalopram evaluation in adult Tg8 mice showed that monoamine oxidase B compensated monoamine oxidase A deficiency in those genetically transformed mice. The second metabolization route of citalopram leading to didemethylcitalopram and catalyzed by cytochrome P-450 was studied in vitro in Beagle dog's livers. Our results showed that citalopram N-demethylation kinetics are biphasic in dogs. Canine orthologs involved in the first N-demethylation seemed to be identical to human cytochromes P-450. However, in the second N-demethylation only one cytochrome P-450 seemed to be involved in human (CYP2D6), whereas up to five canine orthologs were found in dogs. CYP2D15 canine ortholog of CYP2D6 was mainly involved. In addition, enzymatic activity reflected by intrinsic clearance in the first N-demethylation was up to 45 fold higher in dogs compared to humans. Those observations support the assumption that elevated rates of didemethylcitalopram are responsible for citalopram toxicity in dogs. We can conclude that several enzymes groups are involved in the brain, as well as in the liver, in antidepressant metabolization. Knowing that enzymes may be induced or inhibited, it makes sense to closely monitor plasmatic levels of antidepressants and their metabolites.

Sepsis: a roadmap for future research.

Sepsis is a common and lethal syndrome: although outcomes have improved, mortality remains high. No specific anti-sepsis treatments exist; as such, management of patients relies mainly on early recognition allowing correct therapeutic measures to be started rapidly, including administration of appropriate antibiotics, source control measures when necessary, and resuscitation with intravenous fluids and vasoactive drugs when needed. Although substantial developments have been made in the understanding of the basic pathogenesis of sepsis and the complex interplay of host, pathogen, and environment that affect the incidence and course of the disease, sepsis has stubbornly resisted all efforts to successfully develop and then deploy new and improved treatments. Existing models of clinical research seem increasingly unlikely to produce new therapies that will result in a step change in clinical outcomes. In this Commission, we set out our understanding of the clinical epidemiology and management of sepsis and then ask how the present approaches might be challenged to develop a new roadmap for future research.

Natural Products from Antarctic Colonial Ascidians of the Genera Aplidium and Synoicum: Variability and Defensive Role

Ascidians have developed multiple defensive strategies mostly related to physical, nutritional or chemical properties of the tunic. One of such is chemical defense based on secondary metabolites. We analyzed a series of colonial Antarctic ascidians from deep-water collections belonging to the genera Aplidium and Synoicum to evaluate the incidence of organic deterrents and their variability. The ether fractions from 15 samples including specimens of the species A. falklandicum, A. fuegiense, A. meridianum, A. millari and S. adareanum were subjected to feeding assays towards two relevant sympatric predators: the starfish Odontaster validus, and the amphipod Cheirimedon femoratus. All samples revealed repellency. Nonetheless, some colonies concentrated defensive chemicals in internal body-regions rather than in the tunic. Four ascidian-derived meroterpenoids, rossinones B and the three derivatives 2,3-epoxy-rossinone B, 3-epi-rossinone B, 5,6-epoxy-rossinone B, and the indole alkaloids meridianins A-G, along with other minoritary meridianin compounds were isolated from several samples. Some purified metabolites were tested in feeding assays exhibiting potent unpalatabilities, thus revealing their role in predation avoidance. Ascidian extracts and purified compound-fractions were further assessed in antibacterial tests against a marine Antarctic bacterium. Only the meridianins showed inhibition activity, demonstrating a multifunctional defensive role. According to their occurrence in nature and within our colonial specimens, the possible origin of both types of metabolites is discussed.

Predicting drug metabolism: experiment and/or computation?

Drug metabolism can produce metabolites with physicochemical and pharmacological properties that differ substantially from those of the parent drug, and consequently has important implications for both drug safety and efficacy. To reduce the risk of costly clinical-stage attrition due to the metabolic characteristics of drug candidates, there is a need for efficient and reliable ways to predict drug metabolism in vitro, in silico and in vivo. In this Perspective, we provide an overview of the state of the art of experimental and computational approaches for investigating drug metabolism. We highlight the scope and limitations of these methods, and indicate strategies to harvest the synergies that result from combining measurement and prediction of drug metabolism.

Absorption and pharmacokinetics of green tea catechins in beagles

The present study evaluates for the first time in dogs, the kinetics of green tea catechins and their metabolic forms in plasma and urine. Ten beagles were administered 173 mg (12·35 mg/kg body weight) of catechins as a green tea extract, in capsules. Blood samples were collected during 24 h after intake and urine samples were collected during the following periods of time: 0-2, 2-6, 6-8 and 8-24 h. Two catechins with a galloyl moiety and three conjugated metabolites were detected in plasma. Most of the detected forms in plasma reached their maximum plasma concentration (Cmax) at around 1 h. Median Cmax for (2)-epigallocatechin-3-gallate (EGCG), (2)-epicatechin-3-gallate (ECG), (2)-epigallocatechin glucuronide (EGCglucuronide), (2)-epicatechin glucuronide (EC-glucuronide), (2)-epicatechin sulphate (EC sulphate) were 0·3 (range 0·1-1·9), 0·1 (range 0-0·4), 0·8 (range 0·2-3·9), 0·2 (range 0·1 1·7) and 1 (range 0·3-3·4) mmol/l, respectively. The areas under the plasma concentration v. time curves (AUC0!24) were 427 (range 102-1185) mmol/l £ min for EGC-glucuronide, 112 (range 53-919) mmol/l £ min for EC-sulphate, 71 (range 26-306) mmol/l £ min for EGCG, 40 (range 12-258) mmol/l £ min for EC-glucuronide and 14 (range 0·1-124) mmol/l £ min for ECG. The values of mean residence time (MRT0!24) were 5 (range 2-16), 2 (range 1-11), 10 (range 2-13), 3 (range 2-16) and 2·4 (range 1-18) h for EGCG, ECG, EGC-glucuronide, EC-glucuronide and EC sulphate, respectively. In urine, catechins were present as conjugated forms, suggesting bile excretion of EGCG and ECG. Green tea catechins are absorbed following an oral administration and EGC-glucuronide is the metabolic form that remains in the organism for a longer period of time, suggesting that this compound could suffer an enterohepatic cycle.