Correlations between imatinib pharmacokinetics, pharmacodynamics, adherence, and clinical response in advanced metastatic gastrointestinal stromal tumor (GIST): An emerging role for drug blood level testing?

Imatinib is the standard of care for patients with advanced metastatic gastrointestinal stromal tumors (GIST), and is also approved for adjuvant treatment in patients at substantial risk of relapse. Studies have shown that maximizing benefit from imatinib depends on long-term administration at recommended doses. Pharmacokinetic (PK) and pharmacodynamic factors, adherence, and drug-drug interactions can affect exposure to imatinib and impact clinical outcomes. This article reviews the relevance of these factors to imatinib's clinical activity and response in the context of what has been demonstrated in chronic myelogenous leukemia (CML), and in light of new data correlating imatinib exposure to response in patients with GIST. Because of the wide inter-patient variability in drug exposure with imatinib in both CML and GIST, blood level testing (BLT) may play a role in investigating instances of suboptimal response, unusually severe toxicities, drug-drug interactions, and suspected non-adherence. Published clinical data in CML and in GIST were considered, including data from a PK substudy of the B2222 trial correlating imatinib blood levels with clinical responses in patients with GIST. Imatinib trough plasma levels <1100ng/mL were associated with lower rates of objective response and faster development of progressive disease in patients with GIST. These findings have been supported by other analyses correlating free imatinib (unbound) levels with response. These results suggest a future application for imatinib BLT in predicting and optimizing therapeutic response. Nevertheless, early estimates of threshold imatinib blood levels must be confirmed prospectively in future studies and elaborated for different patient subgroups.

Optimum zinc supplementation level in Nile tilapia Oreochromis niloticus juveniles diets

The present study was designed to determine the optimum dietary zinc supplementation to Nile tilapia juveniles (13.3 +/- 1.13 g), by using vegetable-based diets supplemented with increasing levels of zinc from commercial-grade zinc sulfate monohydrate, a previously determined zinc source of higher bioavailability. The basal diet was supplemented with 25, 50, 100, 150, 200, 300, or 400 mg/kg Zn. The experiment was conducted in forty 250-l tanks arranged in a recirculating water system. The experimental period was divided in two phases. For the first 10-week experimental phase, fish were fed satiation diets supplemented with increasing levels of zinc. For the second 5-week experimental phase, fish that were fed diets supplemented with 0-300 mg/kg Zn during the first phase were fed the 400 mg/kg Zn-supplemented diet; fish fed the diet supplemented with 400 mg/kg Zn (first phase) were fed the nonzinc-supplemented diet (second phase). Broken-line analysis showed that the optimum dietary zinc supplementation ((ZnSO4H2O)-H-.) to Nile tilapia juveniles, using weight gain and bone zinc saturation as response criteria, was 44.50 and 79.51 mg/kg Zn, respectively. When challenged by a zinc-deficient diet, tilapia mobilized stored bone zinc to preserve its zinc status. By considering that bone zinc saturation is a more accurate response criterion than weight gain, it was concluded that the optimum dietary zinc supplementation ((ZnSO4H2O)-H-.) in vegetable-based diets to Nile tilapia juveniles is 79.51 mg/kg Zn. (C) 2004 Elsevier B.V. All rights reserved.

Lack of inhibitory effect of zinc on prolactin secretion induced by cimetidine

The dopaminergic, serotoninergic and GABA-ergic systems are closely involved in PRL secretion, as well as thyrotropin-releasing hormone. There is some evidence that zinc interacts with some of these neuroamines and neuropeptides. The histamine H2-receptor cimetidine stimulates PRL secretion rapidly following an intravenous injection in man. In this sense, we investigated probable inhibitory effect of zinc on prolactin secretion following cimetidine injection (300 mg). Therefore, we studied five healthy adult men, before and after oral zinc administration (25 mg elemental zinc) during three consecutive months. The results did not demonstrate any inhibitory effect of zinc on prolactin secretion. So, we originally concluded that zinc did not interact with dopamine, serotonine, gamma-aminobutyric acid and the thyrotropin-releasing hormone in humans. In addition, the intravenous administration of cimetidine did not change the serum zinc profile. © 2005 Dustri-Vertag Dr. K. Feistle.

Lack of protective effects of zinc gluconate against rat colon carcinogenesis

Zinc has been proposed as a promising chemopreventive candidate against colon cancer. However, few studies on the potential beneficial effects of this trace element on cancer chemoprevention are available. The present study was designed to investigate the potential modifying influence of zinc gluconate (ZnGly) on the initiation step of colon carcinogenesis induced by 1,2-dimethylhydrazine (DMH). Male Wistar rats received orally ZnGly (15 mg elemental zinc/kg, 3 times per wk) 2 wk before and during DMH treatment (3 × 40 mg/kg, once a wk). The animals were euthanized at the end of 4th and 16th wk. Colons were analyzed for aberrant crypt foci (ACF) and tumor development. Blood and colon zinc levels, cell proliferation, and apoptosis indexes in colonic crypts were analyzed 24 h after the last DMH administration. Oral treatment with ZnGly did neither alter the number of ACF nor the indexes of cell proliferation and apoptosis in the colonic mucosa. The incidence and multiplicity of colon tumors induced by DMH and their histopathological patterns were not modified by previous treatment with ZnGly. These findings indicate a lack of chemopreventive action of zinc gluconate supplementation on the initiation step of rat colon carcinogenesis induced by DMH. © 2013 Copyright Taylor and Francis Group, LLC.

BDNF Val66Met polymorphism influence on striatal blood-level-dependent response to monetary feedback depends on valence and agency

Animal work implicates the brain-derived neurotrophic factor (BDNF) in function of the ventral striatum (VS), a region known for its role in processing valenced feedback. Recent evidence in humans shows that BDNF Val66Met polymorphism modulates VS activity in anticipation of monetary feedback. However, it remains unclear whether the polymorphism impacts the processing of self-attributed feedback differently from feedback attributed to an external agent. In this study, we emphasize the importance of the feedback attribution because agency is central to computational accounts of the striatum and cognitive accounts of valence processing. We used functional magnetic resonance imaging and a task, in which financial gains/losses are either attributable to performance (self-attributed, SA) or chance (externally-attributed, EA) to ask whether BDNF Val66Met polymorphism predicts VS activity. We found that BDNF Val66Met polymorphism influenced how feedback valence and agency information were combined in the VS and in the right inferior frontal junction (IFJ). Specifically, Met carriers' VS response to valenced feedback depended on agency information, while Val/Val carriers' VS response did not. This context-specific modulation of valence effectively amplified VS responses to SA losses in Met carriers. The IFJ response to SA losses also differentiated Val/Val from Met carriers. These results may point to a reduced allocation of attention and altered motivational salience to SA losses in Val/Val compared to Met carriers. Implications for major depressive disorder are discussed.

ESTUDO DO ZINCO PLASMATICO E HEMATICO NA DESNUTRICAO PROTEICO CALORICA EXPERIMENTAL

Plasma and red cell zinc was assayed by atomic absorption spectrophotometry in three groups of male rats, 58 days old, weaned in the 30th day of life. Control group (20 rats) was fed with normal lab diet while the kwashiorkor group (20 rats) received a protein-free diet and the marasmic group (15 rats) received a protein calorie deficient diet. The clinical and biochemical data obtained in the different groups agreed with the nutritional state. A lower and similar concentration of Zinc in plasma and red cells was observed among both malnourished groups. In this paper the authors discuss the results and present a review of the literature concerning the role of zinc in nutrition.

Papel da eritropoetina recombinante humana sobre o metabolismo dos carboidratos, paratormônio, cálcio iônico, zinco, prolactina e níveis pressóricos em renais crônicos tratados com hemodiálise

Objective: To evaluate the influence of recombinant human erythropoietin (Epho) on carbohydrate metabolism, parathyroid hormone, calcium ionic, zinc, prolactin and blood pressure (BP) in chronic renal failure treated by hemodialysis. Methods: Ten patients in hemodialysis were followed during 24 weeks in two phases: 12 weeks pre-Epho (BP was measured pre and post hemodialysis sessions) and 12 weeks post-Epho (BP was measured as above and also the blood levels of glucose, insulin, parathyroid hormone, calcium ionic, prolactin, and zinc). Results: Patients were 39.8±8.5 y, 50% males. Hematocrit and hemoglobin presented a significant increase four weeks after Epho (22.3±2.3 to 28.1±2.6% and 7.4±0.8 to 9.4±0.9 g/dL, p<0.05). BP (mmHg) and weight pre-Epho: 158±99 and 59±13 (before hemodialysis), 147±96 and 55±13 (after hemo) and post-Epho: 161±100 and 59±13 (before hemo) 155±101 and 56±12 (after hemo) were all not statistically different in any moment. There are also no difference pre and post-Epho in fast glucose (91.8±6.5 and 90.8±6.1 mg/dL, p>0.05), parathyroid hormone (341.4±249.3 and 515.7±310 pg/ mL), calcium ionic (3,66±0.63 and 3.76±0.45 mmol/L), prolactin (males: 327±144.1 and 298.1 ±145.2 μg/mL; females: 666.2±426.6 and 659±395.3 μg/mL) and zinc (median of 0.73 and 0.71 μg\L). Basal insulin was lower after Epho (median of 9.1 to 3.8 μg/mL, p<0.05). Conclusion: These data suggest that recombinant human erythropoietin was effective to improve the anemia and the carbohydrate metabolism in patients with chronic renal failure treated by hemodialysis. © Copyright Moreira Jr. Editors. Todos os direitos reservados.

Renal excretion of zinc in normal individuals during zinc tolerance test and glucose tolerance test

The urinary excretion, renal clearance, and tubular reabsorption of zinc were investigated in 30 adult healthy subjects under basal conditions and during the zinc and glucose tolerance tests. After a 12h overnight fast, each subject was submitted to renal clearance of zinc. The procedures were performed between 8.00 and 12.00 a.m., after emptying the bladder and ingestion of 4 ml deionized water/kg body weight at 8.00 a.m. The first urine sample was collected at 10.00 a.m., and the second at 12.00 a.m. A dose of 110 mg ZnSO47H2O was administered orally to each subject, diluted in 20 ml deionized water, at time 0 min. Blood samples were collected from an antecubital vein at times -30, 0, and 30 min and at 30 min intervals up to 240 min. Glucose was administered intravenously (0.5 ml 50%/kg body weight) during the first 3 min of the test, and blood samples were collected from an unconstricted, contralateral, antecubital vein at times -30, 0, 3, 5, 10, 20, 30, 45, 60, and 90 min. The results showed that urinary zinc excretion, and renal zinc clearance were significantly higher during the zinc and glucose tolerance tests than in the control condition. On the other hand, renal zinc clearance was more elevated during tile glucose tolerance test than during the zinc tolerance test. Variations in zinc tubular reabsorption and glomerular filtration rate were not detected. The results suggest that urinary excretion and renal clearance of zinc in healthy subjects increase during acute zinc ingestion and glucose infusion, Although zinc ingestion raised urinary zinc excretion, glucose infusion was more effective in increasing renal zinc clearance. These normal parameters are important in the investigation of diabetic patients with serum and urine zinc changes.

Possible mechanism by which zinc protects the testicular function of rats exposed to cigarette smoke

Background: The aim of this study was to evaluate the changes in testicular function of rats due to cigarette smoke exposure and the possible mechanism by which zinc protects against these alterations. Methods: MaleWistar rats (60 days old) were randomly divided into 3 groups: control (G1, n = 10); exposed to cigarette smoke (G2, n = 10; 20 cigarettes/day/9 weeks) and exposed to cigarette smoke and supplemented with zinc (G3, n = 8; 20 cigarettes/day/9 weeks; 20 mg/kg zinc chloride daily for 9 weeks, by gavage). After the treatment period, the animals were euthanized, and materials were collected for analyses. Results: G2 rats showed a reduction in body mass; impaired sperm concentration, motility, morphology and vitality; and increased malonaldehyde and thiol group levels and superoxide dismutase activity as compared to G1. Zinc prevented the reduction of sperm concentration and the excessive increase of lipid peroxidation and induced an increase in plasma testosterone levels, wet weight of testis and thiol group concentration. Conclusions: Exposure to cigarette smoke led to harmful effects on testicular function at least partially due to the exacerbation of oxidative stress. Supplementary zinc had an important modulator/protector effect on certain parameters. The mechanism of zinc protection can be through an increase of SH concentration. Thus, zinc supplementation may be a promising addition to conventional treatments for male infertility related to smoking. Copyright © 2012 by Institute of Pharmacology Polish Academy of Sciences.

Health consequences of exposure to e-waste : a systematic review

Background The population exposed to potentially hazardous substances through inappropriate and unsafe management practices related to disposal and recycling of end-of-life electrical and electronic equipment, collectively known as e-waste, is increasing. We aimed to summarise the evidence for the association between such exposures and adverse health outcomes. Methods We systematically searched five electronic databases (PubMed, Embase, Web of Science, PsycNET, and CINAHL) for studies assessing the association between exposure to e-waste and outcomes related to mental health and neurodevelopment, physical health, education, and violence and criminal behaviour, from Jan 1, 1965, to Dec 17, 2012, and yielded 2274 records. Of the 165 full-text articles assessed for eligibility, we excluded a further 142, resulting in the inclusion of 23 published epidemiological studies that met the predetermined criteria. All studies were from southeast China. We assessed evidence of a causal association between exposure to e-waste and health outcomes within the Bradford Hill framework. Findings We recorded plausible outcomes associated with exposure to e-waste including change in thyroid function, changes in cellular expression and function, adverse neonatal outcomes, changes in temperament and behaviour, and decreased lung function. Boys aged 8–9 years living in an e-waste recycling town had a lower forced vital capacity than did those living in a control town. Significant negative correlations between blood chromium concentrations and forced vital capacity in children aged 11 and 13 years were also reported. Findings from most studies showed increases in spontaneous abortions, stillbirths, and premature births, and reduced birthweights and birth lengths associated with exposure to e-waste. People living in e-waste recycling towns or working in e-waste recycling had evidence of greater DNA damage than did those living in control towns. Studies of the effects of exposure to e-waste on thyroid function were not consistent. One study related exposure to e-waste and waste electrical and electronic equipment to educational outcomes. Interpretation Although data suggest that exposure to e-waste is harmful to health, more well designed epidemiological investigations in vulnerable populations, especially pregnant women and children, are needed to confirm these associations. Funding Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Australia.

The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation

To evaluate malnutrition in chronic liver disease, and its relationship to nutrient deficiencies and hepatic dysfunction. 27 children with end-stage liver disease were studied. Mean protein-energy intakes were 70% of recommended daily intakes. The patients were underweight and stunted with reduced mean triceps and subscapular skinfold thicknesses and midupper arm circumference. Mean total body potassium was only 63 ± 18% of that expected for age and sex. Deficiency of essential fatty acids (32%), and low concentrations of fat-soluble vitamins (A, 92%; E, 32%), iron (32%), zinc (42%), and selenium (13%) were common. Serum ammonia concentrations were raised in all patients, and increased methionine, tyrosine, and glutamic acid, and reduced glutamine concentrations were noted. There was no correlation between the degree of malnutrition and the degree of liver synthetic function, the degree of cholestasis, or the degree of liver injury. We suggest that potentially correctable factors in addition to liver failure (eg, inadequate absorbed intake) were important determinants of malnutrition in these patients.

Genome-wide association study identifies novel genetic variants contributing to variation in blood metabolite levels

Metabolites are small molecules involved in cellular metabolism, which can be detected in biological samples using metabolomic techniques. Here we present the results of genome-wide association and meta-analyses for variation in the blood serum levels of 129 metabolites as measured by the Biocrates metabolomic platform. In a discovery sample of 7,478 individuals of European descent, we find 4,068 genome- and metabolome-wide significant (Z-test, P<1.09 × 10−9) associations between single-nucleotide polymorphisms (SNPs) and metabolites, involving 59 independent SNPs and 85 metabolites. Five of the fifty-nine independent SNPs are new for serum metabolite levels, and were followed-up for replication in an independent sample (N=1,182). The novel SNPs are located in or near genes encoding metabolite transporter proteins or enzymes (SLC22A16, ARG1, AGPS and ACSL1) that have demonstrated biomedical or pharmaceutical importance. The further characterization of genetic influences on metabolic phenotypes is important for progress in biological and medical research.

Effects of dietary calcium levels and limestone particicle size on the performance, tibia and blood of laying hens

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