Genetic Polymorphism of CYP2D6 and Clomiphene Concentrations in Infertile Patients with Ovulatory Dysfunction Treated with Clomiphene Citrate

CYP2D6 is primarily responsible for the metabolism of clomiphene citrate (CC). The purpose of the present study was to investigate the relationship between CYP2D6 genotypes, concentrations of CC and its major metabolites and drug response in infertility patients. We studied 42 patients with ovulatory dysfunction treated with only CC. Patients received a dose of 100 mg/day CC on days 3-7 of the menstrual cycle. CYP2D6 genotyping and measurement of CC and the major metabolite concentrations were performed. Patients were categorized into CC responders or non-responders according to one cycle response for the ovulation. Thirty-two patients were CC responders and 10 patients were non-responders with 1 cycle treatment. The CC concentrations were highly variable within the same group, but non-responders revealed significantly lower (E)-clomiphene concentration and a trend of decreased concentrations of active metabolites compared to the responders. Nine patients with intermediate metabolizer phenotype were all responders. We confirmed that the CC and the metabolite concentrations were different according to the ovulation status. However, our results do not provide evidence for the contribution of CYP2D6 polymorphism to either drug response or CC concentrations.

Evaluation of anti-estrogenic or estrogenic activities of aqueous root extracts of Gunnera manicata L / Avaliação das atividades anti-estrogênicos ou estrogênica de raiz aquosa extraida de Gunnera manicata L

Gunnera perpensa (Gunneraceae) is an African plant widely used in traditional medicine. This species is known for its activity involving the female reproductive system, such as inducing or increasing labor, treating female infertility, expelling the placenta and/or preventing post-partum hemorrhage. These properties are probably due to (z)-venusol, a majoritary compound, and its action in conjunction with substances in the whole extract and other natural products. In southern Brazil, a native species Gunnera manicata L. that also belongs to Gunneraceae can be found. In spite of the traditional use of G. perpensa, there is no pharmacological and phytochemical information regarding the South American Gunnera species. Therefore, the aim of this study was to investigate the activity of Brazilian G. manicata aqueous extracts on the reproductive system of immature female Wistar rats through a uterotrophic assay and to verify the presence of (z)-venusol by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Data were analyzed by analysis of variance (ANOVA) and Bonferroni´s post-hoc test (p< 0.01). Results obtained shown that G. manicata extracts did not present in vivo anti or estrogenic activity. Furthermore, (z)-venusol compound was not found. This study represents the first preliminary screening done on the South American G. manicata species.

Gunnera perpensa (Gunneraceae) é uma planta de origem africana extensamente utilizada na medicina tradicional do país. Esta espécie é conhecida por suas atividades no sistema reprodutor feminino, como indução ou aumento do trabalho de parto, tratamento da infertilidade em mulheres, expulsão da placenta e/ou impedimento de hemorragia pós-parto. Tais atividades devem-se, provavelmente, ao sinergismo existente entre o (z)-venusol, composto majoritário, e outros compostos presentes na planta. No sul do Brasil, encontra-se uma espécie nativa, Gunnera manicata L., pertencente à família Gunneraceae. Apesar do uso tradicional de G. perpensa, não há informações farmacológicas e fitoquímicas a respeito da espécie sul Americana de Gunnera. Assim, o objetivo deste estudo foi investigar a atividade de extratos aquosos da espécie brasileira G. manicata no sistema reprodutor de ratas Wistar imaturas através de ensaio uterotrófico e verificar a presença do composto (z)-venusol utilizando-se cromatografia líquida acoplada a espectrômetro de massas em tandem (CL-EM/EM). Para a análise estatística, utilizou-se ANOVA/Bonferroni (p<0,01). Os resultados obtidos demonstraram que os extratos de G. manicata testados não apresentaram atividade anti ou estrogênica in vivo. Na análise química não foi verificada a presença do composto (z)-venusol. Este estudo representa o primeiro screening realizado com a espécie sul-americana G. manicata.

Hormones, nevi, and melanoma: an approach to the patient

For many years, clinicians have been concerned about a potential adverse effect of pregnancy-associated hormones and exogenous hormones on melanocytic nevi and malignant melanoma. Today, these issues are more significant as women have delayed childbearing into their 30's and 40's, and the likelihood of diagnosis with melanoma during pregnancy is enhanced. More recent clinical, epidemiologic, and laboratory studies have shed some light on the relationship among hormones, nevi, and melanoma in pregnancy.