Levodopa-based device-aided therapies for the treatment of advanced Parkinson's disease: a social return on investment analysis.

Introduction: Parkinson's disease (PD) is an incurable, progressive, neurodegenerative disorder. As PD advances and symptoms progress, patients become increasingly dependent on family and carers. Traditional cost-effectiveness analyses (CEA) only consider patient and payer-related outcomes, failing to acknowledge impacts on families, carers, and broader society. This novel Social Return on Investment (SROI) analysis aimed to evaluate the broader impact created by improving access to levodopa (LD) device-aided therapies (DATs) for people living with advanced PD (aPD) in Australia. Methods: A forecast SROI analysis over a three-year time horizon was conducted. People living with aPD and their families were recruited for qualitative interviews or a quantitative survey. Secondary research and clinical trial data was used to supplement the primary research. Outcomes were valued and assessed in a SROI value map in Microsoft Excel™. Financial proxies were assigned to each final outcome based on willingness-to-pay, economic valuation, and replacement value. Treatment cost inputs were sourced from Pharmaceutical Benefits Schedule (PBS) and Medicare Benefits Scheme (MBS) published prices. Results: Twenty-four interviews were conducted, and 55 survey responses were received. For every $1 invested in access to LD-based DATs in Australia, an estimated $1.79 of social value is created. Over 3 years, it was estimated $277.16 million will be invested and $406.77 million of social return will be created. This value is shared between people living with aPD (27%), their partners (22%), children (36%), and the Australian Government (15%). Most of the value created is social and emotional in nature, including reduced worry, increased connection to family and friends, and increased hope for the future. Discussion: Investment in LD-based DATs is expected to generate a positive social return. Over 50% of the value is created for the partners and children of people living with aPD. This value would not be captured in traditional CEA. The SROI methodology highlights the importance of investing in aPD treatment, capturing the social value created by improved access to LD-based DATs.

Luminescent cyclometalated Rh(III), Ir(III), and (DIP)2Ru(II) complexes with carboxylated bipyridyl ligands: synthesis, X-ray molecular structure, and photophysical properties.

Luminescent cyclometalated rhodium(III) and iridium(III) complexes of the general formula [M(ppy) 2(N (wedge)N)][PF 6], with N (wedge)N = Hcmbpy = 4-carboxy-4'-methyl-2,2'-bipyridine and M = Rh ( 1), Ir ( 2) and N (wedge)N = H 2dcbpy = 4,4'-dicarboxy-2,2'-bipyridine and M = Rh ( 3), Ir ( 4), were prepared in high yields and fully characterized. The X-ray molecular structure of the monocarboxylic iridium complex [Ir(ppy) 2(Hcmbpy)][PF 6] ( 2) was also determined. The photophysical properties of these compounds were studied and showed that the photoluminescence of rhodium complexes 1 and 3 and iridium complexes 2 and 4 originates from intraligand charge-transfer (ILCT) and metal-to-ligand charge-transfer/ligand-centered MLCT/LC excited states, respectively. For comparison purposes, the mono- and dicarboxylic acid ruthenium complexes [Ru(DIP) 2(Hcmbpy)][Cl] 2 ( 5) and [Ru(DIP) 2(H 2dcbpy)][Cl] 2 ( 6), where DIP = 4,7-diphenyl-1,10-phenanthroline, were also prepared, whose emission is MLCT in nature. Comparison of the photophysical behavior of these rhodium(III), iridium(III), and ruthenium(II) complexes reveals the influence of the carboxylic groups that affect in different ways the ILCT, MLCT, and LC states.

cis-trans photoisomerization in [Ru(DIP)2(MeOH)2][OTf]2: synthesis, NMR, X-ray structure of the trans-isomer and photophysical properties.

The first trans-ruthenium complex trans-[Ru(DIP)2(MeOH)2][OTf]2 (1b, where DIP = 4,7-diphenyl-1,10-phenanthroline) incorporating a pi-extended ligand was prepared via two methods: either photolysis of cis-[Ru(DIP)2(OTf)2] in MeOH-Et(2)O or via crystallization from MeOH-Et(2)O in direct sunlight. The X-ray molecular structure of is reported and confirmed the trans geometry of the title compound. The cis-trans isomerization process was monitored by 1H-NMR and showed that 1b reverts back to cis-[Ru(DIP)2(MeOH)2][OTf]2 (1a) in methanol-d4 after 15 h at 55 degrees C or several days at room temperature. The absorption spectra recorded in MeOH showed a bathochromic shift of the MLCT band of the trans-isomer 1b relative to that of the cis complex 1a. Interestingly at 77 K the emission spectrum of 1b is red shifted compared to the cis analog 1a. A rational explanation in terms of the energy of the excited states in the cis- and trans-isomers is proposed to explain this behavior.

A new family of mono- and dicarboxylic ruthenium complexes [Ru(DIP)2(L2)]2+ (DIP = 4,7-diphenyl-1,10-phenanthroline): synthesis, solution behavior, and X-ray molecular structure of trans-[Ru(DIP)2(MeOH)2][OTf]2.

A new family of ruthenium complexes of general formula [Ru(DIP)2(L2)]2+, where DIP = 4,7-diphenyl-1,10-phenanthroline, a bidentate ligand with an extended aromatic system, was prepared and fully characterized. When L is a monodentate ligand, the following complexes were obtained: L = CF3SO3(-1) (2), CH3CN (3), and MeOH (4). When L2 is a bidentate ligand, the compounds [Ru(DIP)2(Hcmbpy)][Cl]2 (5) and [Ru(DIP)2(H2dcbpy)][Cl]2 (6) were prepared (Hcmbpy = 4-carboxy-4'-methyl-2,2-bipyridine, H2dcbpy = 4,4'-dicarboxy-2,2'-bipyridine). Complex [Ru(DIP)2(MeOH)2][OTf]2 (4) displayed a trans configuration of the DIP ligands, which is rare for octahedral complexes featuring DIP bidentate ligands. DFT calculations carried out on 4 showed that the cis isomer is more stable by 12.2 kcal/mol relative to the trans species. The solution behaviors of monocarboxylic complex [Ru(DIP)2(Hcmbpy)][Cl]2 (5) and dicarboxylic complex [Ru(DIP)2(H2dcbpy)][Cl]2 (6) were investigated by 1H NMR spectroscopy. VT-NMR, concentration dependence, and reaction with NaOD allowed us to suggest that aggregation of the cationic species in solution, especially for 6, originates mainly from hydrogen bonding interactions.

Intracellular mapping of the distribution of metals derived from the antitumor metallocenes.

The intracellular distribution of transition metals in V79 Chinese hamster lung cells treated with subtoxic doses of the organometallic anticancer complexes Cp(2)MCl(2), where Cp is eta (5) -cyclopentadienyl and M is Mo, Nb, Ti, or V, has been studied by synchrotron-based X-ray fluorescence (XRF). While significantly higher concentrations of Mo and Nb were found in treated cells compared with control cells, distinct differences in the cellular distribution of each metal were observed. Analysis of thin sections of cells was consistent with some localization of Mo in the nucleus. Studies with a noncytotoxic thiol derivative of molybdocene dichloride showed an uneven distribution of Mo in the cells. For comparison, the low levels of Ti and V in cells treated with the more toxic titanocene and vanadocene complexes, respectively, resulted in metal concentrations at the detection limit of XRF. The results agree with independent chemical studies that have concluded that the biological chemistry of each of the metallocene dihalides is unique.

Organometallic anticancer agents: cellular uptake and cytotoxicity studies on thiol derivatives of the antitumor agent molybdocene dichloride.

The effect of aqueous solubility, charge, and lability of four thiol derivatives of the antitumor metallocene molybdocene dichloride (Cp(2)MoCl(2)) on the cell uptake and cytotoxicity against V79 Chinese hamster lung cells has been determined. Addition of 4-thiol-2,3,5,6-tetrafluorobenzoic acid, 1-thio-beta-d-glucose, and 1-thio-2,3,4,5-tetraacetyl-beta-d-glucose to aqueous solutions of molybdocene dichloride afforded the corresponding metallocenes in which the deprotonated thiols are coordinated to the metal center. These metallocenes were studied, along with the previously reported glutathione derivative Cp(2)Mo(GS)(2), which has been proposed to be formed from molybdocene dichloride in blood plasma. In contrast to Cp(2)MoCl(2) which rapidly loses the chloride ligands to form a positively charged aquated complex at pH 7, the thiol derivatives are stable to ligand hydrolysis in 50 mM salt at 37 degrees C for 24 h. Cytotoxicity values determined by a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay gave an IC(50) value of 350 microM for molybdocene dichloride with V79 cells, with similar values obtained with human breast MCF-7 (620 microM) and ovarian 2008 (700 microM) cell lines. The water-soluble thiol derivatives were not cytotoxic, while the acetylated sugar derivative was insoluble in water or aqueous dimethyl sulfoxide. Cell uptake experiments in which the molybdenum content in cells treated with each metallocene for 24 h was measured by graphite furnace atomic absorption spectroscopy showed that the fluorinated aromatic derivative was most efficiently transported into cells, followed by molybdocene dichloride, with the lowest uptake observed for Cp(2)Mo(GS)(2) and the glucose derivative. The cell uptake results do not correlate with overall charge of the complexes or the measured IC(50) values. The distinct cytotoxicity and cell uptake profiles of Cp(2)MoCl(2) compared with Cp(2)Mo(GS)(2) show that while rapid coordination of Cp(2)MoCl(2) to glutathione occurs in water at pH 7, significant deactivation of molybdocene dichloride by conversion to Cp(2)Mo(GS)(2) does not occur in cells.

Coordination chemistry of the antitumor metallocene molybdocene dichloride with biological ligands.

The relative affinity of molybdocene dichloride (Cp(2)MoCl(2)) for the thiol, amino, carboxylate, phosphate(O) and heterocyclic(N) donor ligands present in amino acids and nucleotides, has been studied in aqueous solutions at pH 2-7, using (1)H, (13)C and (31)P NMR spectroscopy. Molybdocene dichloride forms the highly water soluble, air-stable complexes Cp(2)Mo(Cys)(2) and Cp(2)Mo(GS)(2) with cysteine and glutathione respectively, via coordination of the deprotonated thiol groups. While coordination to the imidazole nitrogen in histidine was observed, no evidence for coordination of the amino or carboxylate groups in the amino acids cysteine, histidine, alanine or lysine to Cp(2)MoCl(2) was detected. Competition experiments with dAMP, ribose monophosphate and histidine showed preferential coordination to the cysteine thiol over the phosphate(O) and heterocyclic(N) groups. Cp(2)Mo(Cys)(2) is stable in the presence of excess dAMP or ribose monophosphate and Cys displaces coordinated histidine, dAMP or ribose monophosphate to give Cp(2)Mo(Cys)(2). These results provide further evidence against interaction with DNA as the key interaction that is related to the antitumor activity of molybdocene dichloride. The implications of these results for the biological activity of the antitumor metallocene and the likely species formed in vivo are discussed.