ABSTRACT
Sevelamer hydrochloride is an ionic exchange resin with high affinity for phosphate. This phosphate-binding agent has few serious adverse reactions with the advantage of reducing total and low density lipoprotein (LDL) cholesterol levels. However, it is controversial as to whether sevelamer hydrochloride can modulate the inflammatory response via endotoxin reduction. Therefore, a single-center, open-label, prospective and randomized study was performed to compare the clinical efficacy, safety and anti-inflammatory activity of two sevelamer hydrochloride tablet forms a branded tablet form, Renagel (Genzyme manufacturer) and its generic equivalent (EMS manufacturer). Twenty-eight chronic kidney disease volunteer patients at stage 5 (CDK 5D), on chronic low-flux hemodialysis carried out in 4-hour sessions, three times a week, were studied. The serum phosphorus, ionic calcium, total cholesterol and fractions, bicarbonate, blood pH, interleukin (IL)-6, IL-10, IL-1 beta and tumor necrosis factor-alpha (TNF-alpha) levels were collected prior to dialysis at mid-week. The incidence of gastrointestinal adverse effects were determined at the end of the phosphate-binder washout period as well as at the end of the fourth and eighth weeks of use of both tablet forms. The same magnitude of reduction in serum phosphorus was observed with both sevelamer tablet forms. Only the Renagel group showed lower total cholesterol and lower LDL cholesterol levels at the fourth and eighth week versus baseline. No significant differences in serum cytokine levels were identified in either drug group. However, the incidence of intestinal obstipation was higher among patients who used the generic equivalent form. In conclusion, Renagel and its EMS generic equivalent tablet forms have a similar clinical efficacy in reducing phosphorus in CKD 5D patients on low-flux hemodialysis and a similar safety profile.
Subject(s)
Chelating Agents , Drugs, Generic , Phosphorus/blood , Polyamines , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic , C-Reactive Protein/analysis , C-Reactive Protein/immunology , Chelating Agents/adverse effects , Chelating Agents/pharmacology , Chelating Agents/therapeutic use , Cholesterol/blood , Cytokines/blood , Cytokines/immunology , Drugs, Generic/adverse effects , Drugs, Generic/pharmacology , Drugs, Generic/therapeutic use , Female , Humans , Male , Middle Aged , Polyamines/adverse effects , Polyamines/pharmacology , Polyamines/therapeutic use , Prospective Studies , Renal Dialysis/methods , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/immunology , Sevelamer , Treatment Outcome , Tumor Necrosis Factor-alpha/blood , Tumor Necrosis Factor-alpha/immunologyABSTRACT
O provável fator de início de tradução 5A (eIF5A) é uma proteína abundante e altamente conservada em todos os organismos eucarióticos observados e também está presente em arquebactérias. eIF5A é essencial para aviabilidade celular e esse fator é a única proteína descrita que contém o resíduo de aminoácido hipusina. Em Saccharomyces cerevisiae, eIF5A é expressa em condições aeróbicas pelo gene TIF51A. Apesar de eIF5A ser conhecida há quase 30 anos, a sua função biológica ainda é obscura. Este artigo revisa os estudos de caracterização funcional de eIF5A, evidenciando como esse fator foi envolvido com diferentes etapas do metabolismo de RNA mensageiro (mRNA), como o início de tradução, o transporte nucleocitoplasmático e o decaimento de RNA mensageiro. Ainda, estudos que evidenciaram o envolvimento de eIF5A com a proliferação celular e progressão no ciclo celular também foram abordados. Finalmente, esse artigo apresenta os resultados recentes dos experimentos que colocam eIF5A novamente no cenário da tradução. Novos experimentos serão necessários para definir o papel desempenhado por eIF5A na maquinaria de tradução.
