Use of cyclophosphamide and other immunosuppressive drugs in the treatment of patients with lupus nephritis.

UNLABELLED: Systemic lupus erythematosus (SLE) is a chronic relapsing systemic autoimmune disease; one of the most serious complications is renal involvement, which is occurring in almost 50% of all patients at the beginning of the disease. The aim of the present study was to compare renal function, proteinuria, activity markers and treatment regimen of active and inactive SLE patients with renal involvement. We analyzed the correlation of serum blood urea nitrogen, creatinine level, glomerular filtration rate, urine total protein/serum creatinine (uTP/creat), CRP to classic activity markers of SLE (serum complement 3, -4 level, anti-dsDNA antibody). Moreover we analyzed the treatment modalities of patients with lupus nephritis (LN). Data of 418 SLE patients were analyzed, out of these patients 128 had biopsy proven lupus nephritis or had more than 3 + proteinuria by urine dipstick analysis (30% of all cases). RESULTS: Data of 128 patients with lupus nephritis were analyzed (mean age 32.18 +/- 11.48 year, time between the diagnosis of SLE and LN was 2.78 +/- 4.59 year). 48% of patients had diffuse proliferative glomerulonephritis, 75% of them received cyclic cyclophosphamide treatment. UTp (total protein)/creatinine level was significantly higher in active LN group (p = 0.03), and correlated to erythrocyte sedimentation rate (p = 0.002, R = 0.52). Mean anti-dsDNA level of patients with active LN was significantly higher (p < 0.001). CONCLUSIONS: Patients with active lupus nephritis are at higher risk of developing renal failure, activity markers and urine protein are elevated in these patients as compared to inactive patients, early aggressive immunosuppressive treatment needs to be started to prevent end-stage renal failure.

Binding characteristics of GYKI-46 903, a non-competitive ligand at 5-HT3 receptors.

GYKI-46903 [(+)-(5S,6R)-4-(4-fluorophenyl)-6-propionyloxy-1-aza-bicyclo[3.3.1]-non-3-ene-hydrochloride], a cognition enhancer identified as a non-competitive antagonist of 5-HT3receptors in isolated guinea-pig ileum, was investigated for allosteric action at 5-HT3 receptors in rat cortical membranes by using [3H]granisetron. Equilibrium and kinetic protocols were applied and the competitive antagonist granisetron was included as a negative control. In competition studies, both granisetron and GYKI-46 903 displaced the radioligand with K(i) values of 0.20 +/- 0.02 and 79.84 +/- 0.28 nM, respectively. The inhibition curve for GYKI-46 903 resulted in a Hill slope significantly greater than unity ( 1.37 +/- 0.11), whereas the slope for granisetron was 0.88 +/- 0.08, not different from unity. These results indicate non-competitive and competitive interactions, respectively. Scatchard analysis yielded a linear plot, suggesting a single population of binding sites with a Kd of 0.13 +/- 0.01 nM and a Bmax) of 13.15 +/- 0.34 fmol per mg of protein. Scatchard plots obtained in the absence and presence of granisetron (0.1-3 nM) or GYKI-46 903 (30-1000 nM) revealed a concentration-dependent increase in Kd values by either of these compounds. Granisetron left the Bmax unchanged, but there was a significant increase in the Bmax by GYKI-46 903, which could point to an atypical allosteric interaction. The Schild plot derived from the Kd shifts induced by granisetron was linear with a slope of 1.02, not different from unity, as expected from a competitive interaction. The Schild regression for GYKI-46 903 was linear with a slope of 1.20, deviating significantly from unity, which may also indicate an allosteric interaction. Both the association and dissociation curves of [3H]granisetron were monoexponential. The dissociation rate constant (K(-1)) and the association rate constant (K(+1)) were 0.32 +/- 0.01 min(-1) and 1.15 min(-1) x nM(-1), respectively. The dissociation driven by an excess concentration of ondansetron ( 1 microM) in the absence and presence of granisetron (0.1-3 nM) or GYKI-46 903 (30-10 000 nM) was not influenced by the compounds under study, as compared with the control, indicating the lack of an allosteric effect on the dissociation. Summing up, the binding profile of GYKI-46 903 may reflect a mixed type of action, including a negative allosteric interaction.

A new psychoactive 5H-2,3-benzodiazepine with a unique spectrum of activity.

The neuropharmacological effects of 1-(4-amino-phenyl)-4-methyl-7,8-dimethoxy-5H-2,3-benzodiazepine (GYKI 52 322) were investigated and compared with those of chlordiazepoxide and chlorpromazine. This novel 2,3-benzodiazepine displays neuroleptic activity in the apomorphine-climbing (ED50 = 1.15 mg/kg i.p.) and swim-induced grooming (ED50 = 6.9 mg/kg i.p.) tests in mice and it inhibits the conditioned avoidance response in rats (ED50 = 8.2 mg/kg i.p. and 9.8 mg/kg p.o.). However, it does not antagonize apomorphine-evoked vomiting in dogs; or stereotypy, hypermotility and turning in rats even at as high a dose as 50 mg/kg i.p. On the other hand it is active in the hole board test in mice (MED (minimal effective dose) = 0.5 mg/kg i.p.) and in the lick conflict assay in rats (MED = 5 mg/kg i.p.), indicating anxiolytic property. It shows antiaggressive effect in the fighting mice test (ED50 = 8.1 mg/kg p.o.) and the carbachol-rage procedure in cats (active at 10 mg/kg i.p.) According to the biochemical findings, this compound does not bind to the central dopamine receptors (IC50 greater than 10(-4) mol/l), but it shows affinity to the 5-HT1 receptors (IC50 = 7.1 x 10(-6) mol/l) and inhibits brain cAMP-phosphodiesterase (IC50 = 2.4 x 10(-5) mol/l). The substance causes no elevation of dopamine turnover and serum prolactin level suggesting fewer side effects. So the term "atypical neuroleptic agent" is proposed to characterize this molecule.