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2.
Chem Sci ; 14(41): 11499-11506, 2023 Oct 25.
Article in English | MEDLINE | ID: mdl-37886087

ABSTRACT

Stapled peptides are regarded as the promising next-generation therapeutics because of their improved secondary structure, membrane permeability and metabolic stability as compared with the prototype linear peptides. Usually, stapled peptides are obtained by a hydrocarbon stapling technique, anchoring from paired olefin-terminated unnatural amino acids and the consequent ring-closing metathesis (RCM). To investigate the adaptability of the rigid cyclobutane structure in RCM and expand the chemical diversity of hydrocarbon peptide stapling, we herein described the rational design and efficient synthesis of cyclobutane-based conformationally constrained amino acids, termed (E)-1-amino-3-(but-3-en-1-yl)cyclobutane-1-carboxylic acid (E7) and (Z)-1-amino-3-(but-3-en-1-yl)cyclobutane-1-carboxylic acid (Z7). All four combinations including E7-E7, E7-Z7, Z7-Z7 and Z7-E7 were proven to be applicable in RCM-mediated peptide stapling to afford the corresponding geometry-specific stapled peptides. With the aid of the combined quantum and molecular mechanics, the E7-E7 combination was proven to be optimal in both the RCM reaction and helical stabilization. With the spike protein of SARS-CoV-2 as the target, a series of cyclobutane-bearing stapled peptides were obtained. Among them, E7-E7 geometry-specific stapled peptides indeed exhibit higher α-helicity and thus stronger biological activity than canonical hydrocarbon stapled peptides. We believe that this methodology possesses great potential to expand the scope of the existing peptide stapling strategy. These cyclobutane-bearing restricted anchoring residues served as effective supplements for the existing olefin-terminated unnatural amino acids and the resultant geometry-specific hydrocarbon peptide stapling provided more potential for peptide therapeutics.

3.
ACS Omega ; 8(6): 5901-5916, 2023 Feb 14.
Article in English | MEDLINE | ID: mdl-36816707

ABSTRACT

Approaches for predicting proteolysis targeting chimera (PROTAC) cell permeability are of major interest to reduce resource-demanding synthesis and testing of low-permeable PROTACs. We report a comprehensive investigation of the scope and limitations of machine learning-based binary classification models developed using 17 simple descriptors for large and structurally diverse sets of cereblon (CRBN) and von Hippel-Lindau (VHL) PROTACs. For the VHL PROTAC set, kappa nearest neighbor and random forest models performed best and predicted the permeability of a blinded test set with >80% accuracy (k ≥ 0.57). Models retrained by combining the original training and the blinded test set performed equally well for a second blinded VHL set. However, models for CRBN PROTACs were less successful, mainly due to the imbalanced nature of the CRBN datasets. All descriptors contributed to the models, but size and lipophilicity were the most important. We conclude that properly trained machine learning models can be integrated as effective filters in the PROTAC design process.

5.
J Med Chem ; 65(19): 13029-13040, 2022 10 13.
Article in English | MEDLINE | ID: mdl-36170570

ABSTRACT

Proteolysis-targeting chimeras (PROTACs) must be cell permeable to reach their target proteins. This is challenging as the bivalent structure of PROTACs puts them in chemical space at, or beyond, the outer limits of oral druggable space. We used NMR spectroscopy and molecular dynamics (MD) simulations independently to gain insights into the origin of the differences in cell permeability displayed by three flexible cereblon PROTACs having closely related structures. Both methods revealed that the propensity of the PROTACs to adopt folded conformations with a low solvent-accessible 3D polar surface area in an apolar environment is correlated to high cell permeability. The chemical nature and the flexibility of the linker were essential for the PROTACs to populate folded conformations stabilized by intramolecular hydrogen bonds, π-π interactions, and van der Waals interactions. We conclude that MD simulations may be used for the prospective ranking of cell permeability in the design of cereblon PROTACs.


Subject(s)
Cross-Linking Reagents , Ubiquitin-Protein Ligases , Permeability , Prospective Studies , Proteolysis , Solvents , Ubiquitin-Protein Ligases/metabolism , Cross-Linking Reagents/chemistry
6.
Conserv Biol ; 36(3): e13873, 2022 06.
Article in English | MEDLINE | ID: mdl-34865262

ABSTRACT

Tree diversity in Asia's tropical and subtropical forests is central to nature-based solutions. Species vulnerability to multiple threats, which affect provision of ecosystem services, is poorly understood. We conducted a region-wide, spatially explicit assessment of the vulnerability of 63 socioeconomically important tree species to overexploitation, fire, overgrazing, habitat conversion, and climate change. Trees were selected for assessment from national priority lists, and selections were validated by an expert network representing 20 countries. We used Maxent suitability modeling to predict species distribution ranges, freely accessible spatial data sets to map threat exposures, and functional traits to estimate threat sensitivities. Species-specific vulnerability maps were created as the product of exposure maps and sensitivity estimates. Based on vulnerability to current threats and climate change, we identified priority areas for conservation and restoration. Overall, 74% of the most important areas for conservation of these trees fell outside protected areas, and all species were severely threatened across an average of 47% of their native ranges. The most imminent threats were overexploitation and habitat conversion; populations were severely threatened by these factors in an average of 24% and 16% of their ranges, respectively. Our model predicted limited overall climate change impacts, although some study species were likely to lose over 15% of their habitat by 2050 due to climate change. We pinpointed specific natural areas in Borneo rain forests as hotspots for in situ conservation of forest genetic resources, more than 82% of which fell outside designated protected areas. We also identified degraded areas in Western Ghats, Indochina dry forests, and Sumatran rain forests as hotspots for restoration, where planting or assisted natural regeneration will help conserve these species, and croplands in southern India and Thailand as potentially important agroforestry options. Our results highlight the need for regionally coordinated action for effective conservation and restoration.


Especies de Árboles Valoradas y Amenazadas de Asia Tropical y Subtropical Resumen La diversidad de árboles en los bosques tropicales y subtropicales de Asia es un eje central para las soluciones basadas en la naturaleza. La vulnerabilidad de las especies ante las múltiples amenazas, las cuales afectan el suministro de servicios ambientales, es un tema poco comprendido. Realizamos una evaluación regional espacialmente explícita de la vulnerabilidad de 63 especies de árboles de importancia socioeconómica ante la sobreexplotación, incendios, sobrepastoreo, conversión del hábitat y cambio climático. Los árboles se seleccionaron para su evaluación a partir de listas nacionales de prioridades, y las selecciones fueron validadas por una red de expertos de 20 países. Usamos el modelado de idoneidad Maxent para predecir el rango de distribución de las especies, conjuntos de datos espaciales de libre acceso para mapear la exposición a las amenazas y rasgos funcionales para estimar la susceptibilidad a las amenazas. Con base en la vulnerabilidad a las amenazas actuales y al cambio climático, identificamos las áreas prioritarias para su conservación y restauración. En general, el 74% de las áreas más importantes para la conservación de estos árboles quedó fuera de las áreas protegidas y todas las especies estaban seriamente amenazadas en promedio en el 47% de su distribución nativa. Las amenazas más inminentes fueron la sobreexplotación y la conversión del hábitat; las poblaciones estuvieron seriamente amenazadas por estos factores en promedio en el 24% y 16% de su distribución, respectivamente. Nuestro modelo predijo un impacto general limitado del cambio climático, aunque algunas especies estudiadas tuvieron la probabilidad de perder más del 15% de su hábitat para el 2050 debido a este factor. Identificamos áreas naturales específicas en las selvas de Borneo como puntos calientes para la conservación in situ de los recursos genéticos forestales, más del 82% de los cuales estaban fuera de las áreas protegidas designadas. También identificamos áreas degradadas en los Ghats Occidentales, los bosques secos de Indochina y las selvas de Sumatra como puntos calientes para la restauración, en donde la siembra o la regeneración natural asistida ayudarán a conservar estas especies. Además, identificamos campos de cultivo al sur de India y Tailandia como potenciales opciones importantes de agrosilvicultura. Nuestros resultados resaltan la necesidad de acciones regionales coordinadas para la conservación y restauración efectivas.


Subject(s)
Ecosystem , Trees , Climate Change , Conservation of Natural Resources , Forests , Thailand
7.
J Neurointerv Surg ; 14(10): 1045, 2022 Oct.
Article in English | MEDLINE | ID: mdl-34819344

ABSTRACT

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm. neurintsurg;14/10/1045/V1F1V1Video 1.


Subject(s)
Catheterization , Stents , Humans , Israel , Microsurgery , Posterior Cerebral Artery
8.
Best Pract Res Clin Anaesthesiol ; 35(3): 405-414, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34511228

ABSTRACT

The current COVID-19 pandemic is testing political leaders and healthcare systems worldwide, exposing deficits in crisis communication, leadership, preparedness and flexibility. Extraordinary situations abound, with global supply chains suddenly failing, media communicating contradictory information, and politics playing an increasingly bigger role in shaping each country's response to the crisis. The pandemic threatens not just our health but also our economy, liberty, and privacy. It challenges the speed at which we work, the quality of our research, and the effectiveness of communication within the scientific community. It can impose ethical dilemmas and emotional stress on healthcare workers. Nevertheless, the pandemic also provides an opportunity for healthcare organizations, leaders, and researchers to learn from their mistakes and to place their countries and institutions in a better position to face future challenges.


Subject(s)
COVID-19/epidemiology , Crew Resource Management, Healthcare/standards , Health Personnel/standards , Leadership , COVID-19/therapy , Communication , Crew Resource Management, Healthcare/methods , Delivery of Health Care/methods , Delivery of Health Care/standards , Humans , Pandemics
10.
Resuscitation ; 156: 27-34, 2020 11.
Article in English | MEDLINE | ID: mdl-32866549

ABSTRACT

AIM: Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation (CPR) increases coronary and cerebral perfusion pressure, which might improve neurologically intact survival after refractory cardiac arrest. We investigated the feasibility of REBOA during CPR in the emergency department. METHODS: Patients in refractory cardiac arrest not qualifying for extracorporeal CPR were included in this pilot study. An introducer sheath was placed by ultrasound-guided puncture of the femoral artery, and a REBOA catheter was advanced to the thoracic aorta in 15 patients undergoing CPR. Primary outcome was correct placement within 10 min of skin disinfection. Secondary outcomes included perfusion markers (mean central arterial blood pressure, end-tidal CO2, non-invasively measured cerebral oxygenation) and procedural information (number and duration of attempts, complications, verification of correct position and occlusion). RESULTS: Successful catheter placement was achieved in 9 of the 15 patients (median 9 min 30 s). Median interval from dispatch to start of the procedure was 59 min. A small, albeit significant increase in non-invasively measured cerebral oxygenation was found, but none in blood pressure or end-tidal CO2. However, two patients with pulseless electrical activity of more than 20 min achieved return of spontaneous circulation immediately after REBOA. CONCLUSION: In this pilot trial, REBOA during CPR was successful in 60% of attempts. Long resuscitation times before start of the procedure might explain difficult insertion and missing effects. Nevertheless, insertion of REBOA in patients suffering from non-traumatic cardiac arrest is feasible and might increase coronary and cerebral perfusion pressures and perfusion.


Subject(s)
Balloon Occlusion , Cardiopulmonary Resuscitation , Endovascular Procedures , Heart Arrest , Aorta , Heart Arrest/therapy , Humans , Pilot Projects , Resuscitation
11.
J Nucl Cardiol ; 24(3): 862-871, 2017 06.
Article in English | MEDLINE | ID: mdl-27225517

ABSTRACT

BACKGROUND: Radioligands of 18-kDa translocator protein (TSPO) expressed on activated macrophages are a potential approach for imaging of inflammation in atherosclerosis. We evaluated a novel TSPO-targeted tracer 18F-FEMPA for the detection of atherosclerotic plaque inflammation in mice. METHODS AND RESULTS: The distribution kinetics of 18F-FEMPA was evaluated by in vivo PET/CT imaging. 18F-FEMPA uptake was compared in atherosclerotic (LDLR-/-ApoB100/100, n = 10) and healthy mice (C57BL/6 N, n = 7) ex vivo at twenty minutes post-injection. Biodistribution was analyzed from harvested tissue samples, and aortas were sectioned for autoradiography. Aortas of LDLR-/-ApoB100/100 mice showed large, macrophage-rich atherosclerotic plaques. In vivo, 18F-FEMPA showed rapid blood clearance but no difference in aortic uptake between atherosclerotic and healthy mice. In the mice studied ex vivo at 20 minutes post-injection, quantification of radioactivity in the whole aorta showed 1.3-fold higher 18F-FEMPA accumulation in atherosclerotic than healthy mice (P = .028). Autoradiography showed higher tracer uptake in plaque areas with high macrophage content as compared with areas of no macrophages (count densities 190 ± 54 vs 40 ± 13 PSL/mm2, P < .001), but the uptake in the plaques was not higher than in the normal vessel wall (230 ± 78 PSL/mm2). In vitro blocking showed specific accumulation in mouse and human atherosclerotic plaques. Immunohistochemistry confirmed co-localization of TSPO and macrophages. CONCLUSIONS: 18F-FEMPA shows rapid blood clearance and uptake in the mouse aorta. Uptake in atherosclerotic plaques correlated with the amount of macrophages, but did not exceed that in the normal vessel wall.


Subject(s)
Atherosclerosis/diagnostic imaging , Atherosclerosis/metabolism , Hydrocarbons, Fluorinated/pharmacokinetics , Pyridines/pharmacokinetics , Receptors, GABA/metabolism , Animals , Biomarkers/metabolism , Metabolic Clearance Rate , Mice , Mice, Inbred C57BL , Mice, Knockout , Organ Specificity , Radiopharmaceuticals/chemistry , Radiopharmaceuticals/pharmacokinetics , Reproducibility of Results , Sensitivity and Specificity , Tissue Distribution
12.
J Nucl Med ; 57(2): 315-20, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26585057

ABSTRACT

UNLABELLED: The aim of this study was to radiolabel a novel bis-deuterium substituted l-deprenyl analog (fluorodeprenyl-D2) with (18)F and to evaluate its potential to visualize and quantify monoamine oxidase (MAO) B activity in vivo. METHODS: The precursor compound ( 5A: + 5B: ) and reference standard ( 6: ) were synthesized in multistep syntheses. Recombinant human MAO-B and MAO-A enzyme preparations were used to determine inhibitory concentrations of 50%. Radiolabeling was accomplished by a nucleophilic substitution reaction. Whole-hemisphere autoradiography was performed with (18)F-fluorodeprenyl-D2. A PET study was performed on a cynomolgus monkey. Radiometabolites were measured in monkey plasma using high-performance liquid chromatography. RESULTS: The 50% inhibitory concentration of compound 6 for MAO-B was 227 ± 36.8 nM. Radiolabeling was accomplished with high radiochemical yield, purity, and specific radioactivity. The autoradiography binding density of (18)F-fluorodeprenyl-D2 was consistent with known MAO-B expression in the human brain. In vivo, (18)F-fluorodeprenyl-D2 showed favorable kinetic properties, with relatively fast washout from the brain. Regional time-activity curves were better described by the 2-tissue-compartment model. Administration of a 1 mg/kg dose of l-deprenyl yielded 70% inhibition of MAO-B in all regions. Radiometabolite studies demonstrated 20% unchanged radioligand at 120 min after injection. (18)F-fluorodeprenyl-D2 showed less irreversibility than did previously reported MAO-B radioligands. CONCLUSION: The results suggest that (18)F-fluorodeprenyl-D2 is a suitable PET radioligand for visualization of MAO-B activity in the human brain.


Subject(s)
Monoamine Oxidase Inhibitors/pharmacokinetics , Monoamine Oxidase , Radiopharmaceuticals/pharmacokinetics , Selegiline/analogs & derivatives , Animals , Autoradiography , Blood Proteins/metabolism , Carbon Radioisotopes , Fluorine Radioisotopes , Humans , Isotope Labeling , Macaca fascicularis , Male , Recombinant Proteins , Selegiline/pharmacokinetics
13.
Eur J Nucl Med Mol Imaging ; 42(3): 438-46, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25412766

ABSTRACT

PURPOSE: Imaging of the 18-kDa translocator protein (TSPO) is a potential tool for examining microglial activation and neuroinflammation in early Alzheimer's disease (AD). [(18)F]FEMPA is a novel high-affinity second-generation TSPO radioligand that has displayed suitable pharmacokinetic properties in preclinical studies. The aims of this study were to quantify the binding of [(18)F]FEMPA to TSPO in AD patients and controls and to investigate whether higher [(18)F]FEMPA binding in AD patients than in controls could be detected in vivo. METHODS: Ten AD patients (five men, five women; age 66.9 ± 7.3 years; MMSE score 25.5 ± 2.5) and seven controls (three men, four women; age 63.7 ± 7.2 years, MMSE score 29.3 ± 1.0) were studied using [(18)F]FEMPA at Turku (13 subjects) and at Karolinska Institutet (4 subjects). The in vitro binding affinity for TSPO was assessed using PBR28 in a competition assay with [(3)H]PK11195 in seven controls and eight AD patients. Cortical and subcortical regions of interest were examined. Quantification was performed using a two-tissue compartment model (2TCM) and Logan graphical analysis (GA). The outcome measure was the total distribution volume (V T). Repeated measures analysis of variance was used to assess the effect of group and TSPO binding status on V T. RESULTS: Five AD patients and four controls were high-affinity binders (HABs). Three AD patients and three controls were mixed-affinity binders. V T estimated with Logan GA was significantly correlated with V T estimated with the 2TCM in both controls (r = 0.97) and AD patients (r = 0.98) and was selected for the final analysis. Significantly higher V T was found in the medial temporal cortex in AD patients than in controls (p = 0.044) if the TSPO binding status was entered as a covariate. If only HABs were included, significantly higher V T was found in the medial and lateral temporal cortex, posterior cingulate, caudate, putamen, thalamus and cerebellum in AD patients than in controls (p < 0.05). CONCLUSION: [(18)F]FEMPA seems to be a suitable radioligand for detecting increased TSPO binding in AD patients if their binding status is taken into account.


Subject(s)
Alzheimer Disease/diagnostic imaging , Hydrocarbons, Fluorinated , Positron-Emission Tomography , Pyridines , Radiopharmaceuticals , Receptors, GABA/metabolism , Aged , Female , Humans , Hydrocarbons, Fluorinated/adverse effects , Hydrocarbons, Fluorinated/pharmacokinetics , Male , Middle Aged , Protein Binding , Pyridines/adverse effects , Pyridines/pharmacokinetics , Radiopharmaceuticals/adverse effects , Radiopharmaceuticals/pharmacokinetics
14.
J Clin Lab Anal ; 29(2): 122-8, 2015 Mar.
Article in English | MEDLINE | ID: mdl-24796889

ABSTRACT

BACKGROUND: Staphylococcus aureus has long been recognized as a major pathogen. Methicillin-resistant strains of S. aureus (MRSA) and methicillin-resistant strains of S. epidermidis (MRSE) are among the most prevalent multiresistant pathogens worldwide, frequently causing nosocomial and community-acquired infections. METHODS: In the present pilot study, we tested a polymerase chain reaction (PCR) method to quickly differentiate Staphylococci and identify the mecA gene in a clinical setting. RESULTS: Compared to the conventional microbiology testing the real-time PCR assay had a higher detection rate for both S. aureus and coagulase-negative Staphylococci (CoNS; 55 vs. 32 for S. aureus and 63 vs. 24 for CoNS). Hands-on time preparing DNA, carrying out the PCR, and evaluating results was less than 5 h. CONCLUSIONS: The assay is largely automated, easy to adapt, and has been shown to be rapid and reliable. Fast detection and differentiation of S. aureus, CoNS, and the mecA gene by means of this real-time PCR protocol may help expedite therapeutic decision-making and enable earlier adequate antibiotic treatment.


Subject(s)
Methicillin-Resistant Staphylococcus aureus/isolation & purification , Real-Time Polymerase Chain Reaction/methods , Staphylococcus aureus/classification , Staphylococcus aureus/genetics , Staphylococcus/classification , Staphylococcus/genetics , Bacterial Proteins/genetics , Bacteriological Techniques , DNA, Bacterial/analysis , Humans , Methicillin-Resistant Staphylococcus aureus/genetics , Penicillin-Binding Proteins
15.
J Labelled Comp Radiopharm ; 57(3): 164-71, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24453005

ABSTRACT

The radiosynthesis of [(18)F]fluoropyruvate was investigated using numerous precursors were synthesized from ethyl 2,2-diethoxy-3-hydroxypropanoate (5) containing different leaving groups: mesylate, tosylate, triflate, and nonaflate. These precursors were evaluated for [(18)F]fluoride incorporation with triflate being superior. The subsequent hydrolysis step was investigated, and an acidic hydrolysis was optimized. After establishing suitable purification and formulation methods, the [(18)F]fluoropyruvate could be isolated in ca. 50% d.c. yield. The [(18)F]fluoropyruvate was evaluated in vitro for its uptake into tumor cells using adenocarcinomic human alveolar basal epithelial cells (A549) and unfortunately showed an uptake of approximately 0.1% of the applied dose per 100,000 cells after 30 min. Initial pharmacokinetic properties were assessed in vivo using nude mice showed a high degree of bone uptake from defluorination, which will limit its potential as an imaging agent for metabolic processes.


Subject(s)
Fluorine Radioisotopes , Pyruvates/chemistry , Radiopharmaceuticals/chemistry , Animals , Cell Line, Tumor , Halogenation , Humans , Mice , Mice, Nude , Positron-Emission Tomography , Pyruvates/chemical synthesis , Radiochemistry , Radiopharmaceuticals/chemical synthesis , Tomography, X-Ray Computed
16.
Best Pract Res Clin Anaesthesiol ; 27(2): 279-88, 2013 Jun.
Article in English | MEDLINE | ID: mdl-24012238

ABSTRACT

In patients with sepsis, diagnosis of blood stream infection (BSI) is a key concern to the therapist. Direct verification of pathogens in the blood stream executed by blood cultures (BC) still is regarded as the gold standard up to date. The quickest possible initiation of an appropriate antimicrobial therapy is a cornerstone of an effective therapy. Moreover, in this view BC can also serve to identify antimicrobial agents to target the pathogen. However, when employing BC the time needed until microbiological results are available ranges from 24 up to 72 h. Moreover, infections caused by multiple pathogens often remain undetected and concurrent antibiotic therapy may lower the overall sensitivity. Alternative pathogen characterization can be performed by polymerase chain reaction (PCR) based amplification methods. Results using PCR can be obtained within 6-8 h. Therefore, the time delay until an appropriate therapy can be reduced enormously. Moreover, these methods have the potential to enhance the sensitivity in the diagnosis of blood stream infections. Therefore, PCR based methods might be a valuable adjunct to present procedures of diagnosing bacteraemia.


Subject(s)
Bacteremia/diagnosis , Bacteriological Techniques/methods , Polymerase Chain Reaction/methods , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Bacteria/isolation & purification , Humans , Sensitivity and Specificity , Time Factors
17.
PLoS One ; 8(3): e60239, 2013.
Article in English | MEDLINE | ID: mdl-23555934

ABSTRACT

BACKGROUND: The impact of polymorphic cytochrome P450 CYP2D6 enzyme on oxycodone's metabolism and clinical efficacy is currently being discussed. However, there are only spare data from postoperative settings. The hypothesis of this study is that genotype dependent CYP2D6 activity influences plasma concentrations of oxycodone and its metabolites and impacts analgesic consumption. METHODS: Patients received oxycodone 0.05 mg/kg before emerging from anesthesia and patient-controlled analgesia (PCA) for the subsequent 48 postoperative hours. Blood samples were drawn at 30, 90 and 180 minutes after the initial oxycodone dose. Plasma concentrations of oxycodone and its metabolites oxymorphone, noroxycodone and noroxymorphone were analyzed by liquid chromatography-mass spectrometry with electrospray ionization. CYP2D6 genotyping was performed and 121 patients were allocated to the following genotype groups: PM (poor metabolizer: no functionally active CYP2D6 allele), HZ/IM (heterozygous subjects, intermediate metabolizers with decreased CYP2D6 activity), EM (extensive metabolizers, normal CYP2D6 activity) and UM (ultrarapid metabolizers, increased CYP2D6 activity). Primary endpoint was the genotype dependent metabolite ratio of plasma concentrations oxymorphone/oxycodone. Secondary endpoint was the genotype dependent analgesic consumption with calculation of equianalgesic doses compared to the standard non-CYP dependent opioid piritramide. RESULTS: Metabolism differed between CYP2D6 genotypes. Mean (95%-CI) oxymophone/oxycodone ratios were 0.10 (0.02/0.19), 0.13 (0.11/0.16), 0.18 (0.16/0.20) and 0.28 (0.07/0.49) in PM, HZ/IM, EM and UM, respectively (p = 0.005). Oxycodone consumption up to the 12(th) hour was highest in PM (p = 0.005), resulting in lowest equianalgesic doses of piritramide versus oxycodone for PM (1.6 (1.4/1.8); EM and UM 2.2 (2.1/2.3); p<0.001). Pain scores did not differ between genotypes. CONCLUSIONS: In this postoperative setting, the number of functionally active CYP2D6 alleles had an impact on oxycodone metabolism. The genotype also impacted analgesic consumption, thereby causing variation of equianalgesic doses piritramide : oxycodone. Different analgesic needs by genotypes were met by PCA technology in this postoperative cohort.


Subject(s)
Analgesics, Opioid/metabolism , Cytochrome P-450 CYP2D6/genetics , Oxycodone/metabolism , Aged , Analgesics, Opioid/blood , Cytochrome P-450 CYP3A/genetics , Female , Genotype , Humans , Male , Middle Aged , Morphinans/blood , Morphinans/metabolism , Oxycodone/blood , Oxymorphone/blood , Oxymorphone/metabolism , Spectrometry, Mass, Electrospray Ionization
18.
PLoS One ; 8(1): e53045, 2013.
Article in English | MEDLINE | ID: mdl-23301018

ABSTRACT

OBJECTIVE: To investigate the suitability of blood granulocyte and monocyte sensitivity, as measured by the quantity of different agonists required to induce CD62L shedding, for assessment of perioperative immune changes in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Patients scheduled for aortocoronary bypass grafting or for valve surgery were included in this prospective observational study. Blood samples were drawn before anesthesia induction, directly after surgery and 48 hours after anesthesia induction. We determined the concentration of two different inflammatory stimuli--lipoteichoic acid (LTA) and tumor necrosis factor alpha (TNF)--required to induce shedding of 50% of surface CD62L from blood granulocytes and monocytes. In parallel monocyte surface human leukocyte antigen (HLA)-DR, and plasma interleukin (IL)-8, soluble (s)CD62L, soluble (s)Toll-like receptor (TLR)-2 and ADAM17 quantification were used to illustrate perioperative immunomodulation. RESULTS: 25 patients were enrolled. Blood granulocytes and monocytes showed decreased sensitivity to the TLR 2/6 agonist Staphylococcus aureus LTA immediately after surgery (p = 0.001 and p = 0.004 respectively). In contrast, granulocytes (p = 0.01), but not monocytes (p = 0.057) displayed a decreased postoperative sensitivity to TNF. We confirmed the presence of a systemic inflammatory response and a decreased immune sensitivity in the post-surgical period by measuring significant increases in the perioperative plasma concentration of IL-8 (p ≤ 0.001) and sTLR (p = 0.004), and decreases in monocyte HLA-DR (p<0.001), plasma sCD62L (p ≤ 0.001). In contrast, ADAM17 plasma levels did not show significant differences over the observation period (p = 0.401). CONCLUSIONS: Monitoring granulocyte and monocyte sensitivity using the "CD62L shedding assay" in the perioperative period in cardiac surgical patients treated with the use of cardiopulmonary bypass reveals common changes in sensitivity to TLR2/6 ligands and to TNF stimulus. Further long-term follow-up studies will address the predictive value of these observations for clinical purposes.


Subject(s)
Cardiopulmonary Bypass/methods , Heart Diseases/blood , Heart Diseases/immunology , L-Selectin/blood , ADAM Proteins/metabolism , ADAM17 Protein , Aged , Enzyme-Linked Immunosorbent Assay , Female , HLA-DR Antigens/metabolism , Humans , Inflammation , Interleukin-8/metabolism , Ligands , Lipopolysaccharides/pharmacology , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Staphylococcus aureus/metabolism , Teichoic Acids/pharmacology , Tumor Necrosis Factor-alpha/metabolism
19.
Beilstein J Org Chem ; 8: 1246-55, 2012.
Article in English | MEDLINE | ID: mdl-23019455

ABSTRACT

Starting from the enantiomers of limonene, all eight stereoisomers of trans-fused dihydronepetalactones were synthesized. Key compounds were pure stereoisomers of 1-acetoxymethyl-2-methyl-5-(2-hydroxy-1-methylethyl)-1-cyclopentene. The stereogenic center of limonene was retained at position 4a of the target compounds and used to stereoselectively control the introduction of the other chiral centers during the synthesis. Basically, this approach could also be used for the synthesis of enantiomerically pure trans-fused iridomyrmecins. Using synthetic reference samples, the combination of enantioselective gas chromatography and mass spectrometry revealed that volatiles released by the endohyperparasitoid wasp Alloxysta victrix contain the enantiomerically pure trans-fused (4R,4aR,7R,7aS)-dihydronepetalactone as a minor component, showing an unusual (R)-configured stereogenic center at position 7.

20.
Beilstein J Org Chem ; 8: 1256-64, 2012.
Article in English | MEDLINE | ID: mdl-23019456

ABSTRACT

Following our earlier approach to the synthesis of dihydronepetalactones, all eight stereoisomers of trans-fused iridomyrmecins were synthesized starting from the enantiomers of limonene. Combined gas chromatography and mass spectrometry including enantioselective gas chromatography revealed that volatiles released by the endohyperparasitoid wasp Alloxysta victrix contain (4S,4aR,7S,7aR)-iridomyrmecin of 95-97% ee and stereochemically pure (4S,4aS,7R,7aS)-iridomyrmecin as a minor component.

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