Paritaprevir/ritonavir/ombitasvir+dasabuvir plus ribavirin therapy and inhibition of the anticoagulant effect of warfarin: a case report.

WHAT IS KNOWN AND OBJECTIVE: Paritaprevir/ritonavir/ombitasvir+dasabuvir (PrOD) is a direct-acting antiviral (DAA) approved for the treatment of chronic hepatitis C virus. We report on a probable interaction between PrOD with ribavirin and warfarin. CASE DESCRIPTION: Two weeks after the start of PrOD with ribavirin, the patient's international normalized ratio (INR) became subtherapeutic. Eleven weeks into therapy and following a 125% total increase in the weekly warfarin dose, therapeutic INR was achieved. Thirteen days after DAA therapy was completed and discontinued, the patient's INR became critically supratherapeutic. WHAT IS NEW AND CONCLUSION: Patients on PrOD plus ribavirin with warfarin should have INR followed closely upon initiation and discontinuation of therapy due to a probable drug interaction.

Lurbinectedin for the treatment of small cell lung cancer.

Small cell lung cancer (SCLC) is a rapidly progressive, aggressive metastatic and lethal subtype of lung cancer. Unfortunately, there has been little progress regarding the development of novel treatments for SCLC. However, lurbinectedin, a transcriptional inhibitor, has emerged as a potential novel treatment for cancer. It produces antitumor efficacy by inhibiting oncogenic transcription activity, inducing the accumulation of DNA double-strand breaks and modulating the tumor microenvironment (TME). Data from phase I/II trials indicates that lurbinectedin has significant antitumor efficacy and tolerable adverse effects in SCLC patients. Furthermore, lurbinectedin is efficacious in platinum-sensitive and platinum-resistant SCLC patients and in those with SCLC relapse after second-line treatment. In 2020, the U.S. Food and Drug Administration (FDA) approved lurbinectedin for the treatment of adult patients with metastatic SCLC or for patients that have received platinum-based chemotherapy. In this review, we discuss the molecular profile and the preclinical and clinical studies of lurbinectedin in the treatment of SCLC patients.

Pralsetinib for the treatment of non-small cell lung cancer.

The identification of oncogenic drivers and the subsequent development of targeted therapies have been established as biomarker-based care for metastatic non-small cell lung cancer (NSCLC) patients. Rearranged during transfection (RET) events have been reported to be oncogenic drivers in NSCLC and were more common in patients who i) were young; ii) had adenocarcinoma histology; and iii) had never smoked. Phase II studies indicated the limited efficacy of multi-targeted tyrosine kinase inhibitors in patients with NSCLC that have a confirmed RET event. Consequently, there has been ongoing research to develop more potent and specific RET tyrosine kinase inhibitors. Recently, a novel and specific RET inhibitor, pralsetinib (BLU-667), has been reported to have excellent efficacy and low off-target toxicity in RET cancer patients. In this review, we summarize the clinical data regarding the use of pralsetinib in NSCLC patients.

Heterogeneity of the mesotelencephalic dopamine fibers: physiology and pharmacology.

The mesotelencephalic dopamine (DA) system is heterogeneous with respect to nuclei, terminal loci, DA receptor subtypes, electrophysiological characteristics and response patterns, and neuropharmacological response to a range of agents. The majority of mesocortical and mesolimbic DA neurons originate in the ventral tegmental area. Mesostriatal DA neurons originate in substantia nigra pars compacta. DA neurons originating from the retrorubal field primarily innervate subcortical limbic and neostriatal loci. Mesostriatal terminal loci have relatively low densities of D3 and D4 receptors, compared to mesolimbic and mesocortical loci. The D1 and D2 receptors appear more homogeneously distributed. Electrophysiologically, mesostriatal DA neurons show more regularity in firing pattern (fewer bursting events), and a lower basal firing rate than mesolimbic or mesocortical neurons. Neuropharmacologically, mesocortical DA neurons are less responsive to intravenous d-amphetamine, (+)apomorphine, and chronic antipsychotic drug treatment. Mesocortical DA neurons are also relatively insensitive to iontophoretically applied DA, a finding congruent with their reported relative lack of somatodendritic autoreceptors. Neurochemically, mesoaccumbens DA neurons are more sensitive to systemic administration of drugs with addictive liability.

Alteration of platelet serotonergic mechanisms and monoamine oxidase activity in premenstrual syndrome.

Platelet uptake and content of 5-hydroxytryptamine (5-HT), platelet monoamine oxidase (MAO) activity, and plasma free and total tryptophan levels were determined in patients diagnosed with premenstrual syndrome (PMS) and in control subjects. The Vmax of 5-HT uptake and 5-HT content in platelets of PMS patients were significantly decreased during the premenstrual phase (cycle days -9 to -1) compared to control subjects. Platelet MAO activity was significantly lower postmenstrually (cycle days 5-9) in PMS patients compared to the premenstrual phase. There were no differences in plasma free and total tryptophan levels between PMS patients and control subjects during either interval. As platelets are believed to be a peripheral model for central serotonergic neurons, the results suggest that PMS symptomatology may be related to alterations in serotonergic neuronal mechanisms.

Gamma vinyl-GABA differentially modulates NMDA antagonist-induced increases in mesocortical versus mesolimbic DA transmission.

To explore the role of endogenous GABA in NMDA antagonist induced dopamine (DA) release, we used in vivo microdialysis to study the effects of pretreatment with gamma-vinyl GABA (GVG) on phencyclidine (PCP)-induced DA release in terminal regions of midbrain DA neurons. GVG, an irreversible inhibitor of the GABA catabolizing enzyme GABA-AT, significantly reduced the DA response to PCP (7.0 mg/kg) in freely moving animals. Preferential increases in PCP-induced DA release in the PFC (four-fold those of NAcc) were dose-dependently inhibited by acute pretreatment with GVG at doses of 150 (51% inhibition), 300 (68% inhibition), and 500 (82% inhibition) mg/kg, whereas NAcc PCP-induced DA activity was unresponsive to 150 mg/kg and only partially inhibited by 300 and 500 mg/kg. Subchronic treatment with GVG did not enhance the inhibitory capacity of the GABAergic system. While GVG evidently modulates PCP-induced increases in mesocorticolimbic DA transmission, the character of this modulation is regionally specific, with cortical NMDA-antagonist induced increases appearing more sensitive to inhibition by endogenous GABA than subcortical areas.

(+/-)-1-(2,5-Dimethoxy-4-iodophenyl)-2-aminopropane(DOI) and alpha-methyl-5-HT: 5-HT2 receptor agonistic action on phosphatidylinositol metabolism in the rat fronto-cingulate and entorhinal cortex.

In the present study, the effects of 5-HT and two 5-HT1c/5-HT2 receptor agonists, (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and alpha-methyl-serotonin (alpha-Me-5-HT) on phosphoinositide hydrolysis were compared, to determine whether DOI and alpha-Me-5-HT were full agonists. Consistent with the results obtained from previous studies, both (+/-)-DOI and alpha-Me-5-HT stimulated turnover of phosphoinositide in a concentration-dependent manner. However, the response obtained with these 5-HT1c/5-HT2 receptor agonists was only 30-40% of that of 5-HT. The stimulation of hydrolysis of phosphoinositide, produced by both 5-HT2 receptor agonists, was potently antagonized by ritanserin (a 5-HT1c/5-HT2 receptor antagonist) and alpha-phenyl-1-(2-phenylethyl)-4-piperine methanol [(+)-MDL 11,939, a 5-HT2 receptor antagonist] but not by granisetron (BRL a 5-HT3 receptor antagonist), suggesting that the action of DOI and alpha-Me-5-HT was primarily mediated by 5-HT2 receptors. When the effect of increasing the concentration of 5-HT on turnover of phosphoinositide was measured in the presence of a 1 microM concentration of the 5-HT3 receptor antagonist granisetron, the response obtained was similar to the response produced by the 5-HT2 receptor agonists, DOI and alpha-Me-5-HT. These results confirm the previous finding that 5-HT stimulates hydrolysis of phosphoinositide by interacting with 5-HT1c/5-HT2 and 5-HT3 receptors. Moreover, they suggest that DOI and alpha-Me-5-HT are full agonists at the 5-HT2 receptor, coupled to hydrolysis of phosphoinositide in the cortex of the rat.

The induction of serotonin3-like receptor supersensitivity and dopamine receptor subsensitivity in the rat medial prefrontal cortex after the intraventricular administration of the neurotoxin 5,7-dihydroxytryptamine: a microiontophoretic study.

This study examines the effect of intraventricular administration of the neurotoxin 5,7-dihydroxytryptamine on serotonin1A, serotonin2 and serotonin3 receptors in the rat medial prefrontal cortex using in vivo extracellular single cell recording and iontophoresis. Iontophoresis of the serotonin1A, serotonin1C,2 and serotonin3 receptor agonists (+-)-8-hydroxy-(di-n-propyl)aminotetralin, (+-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane and 2-methylserotonin, respectively, produces a current-dependent (5-80 nA) suppression of the basal firing rate of medial prefrontal cortical cells in sham- and 5,7-dihydroxytryptamine-lesioned rats. The suppression produced by 2-methylserotonin and serotonin was significantly greater in 5,7-dihydroxytryptamine-lesioned rats than in control rats. No significant difference in the spontaneous activity of medial prefrontal cortex cells was observed between experimental and control rats after iontophoresis of (+-)-8-hydroxy-(di-n-propyl)aminotetralin or (+-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane. There was no significant difference between the groups regarding the response of medial prefrontal cortex cells to the iontophoresis of GABA, whereas the response of medial prefrontal cortex cells to the iontophoresis of dopamine was significantly attenuated in animals pretreated with 5,7-dihydroxytryptamine compared to controls. Our results indicate that 5,7-dihydroxytryptamine-induced denervation selectively enhances the sensitivity of serotonin3-like receptors in the medial prefrontal cortex, which could, at least partially, account for the serotonin denervation supersensitivity. Moreover, the finding that the response of medial prefrontal cortical cells to the iontophoresis of dopamine is attenuated in 5,7-dihydroxytryptamine pretreated rats is consistent with the view that the inhibitory action of dopamine in the medial prefrontal cortex is dependent upon serotonin tone.

The role of 5-HT3-like receptors in the action of clozapine.

The serotonin3 (5-HT3)-like receptors play an important role in modulating the inhibitory action of dopamine in the mesocorticolimbic regions. The atypical antipsychotic drugs clozapine and RMI 81,582, but not other antipsychotic drugs, blocked the suppressant action produced by the 5-HT3 receptor agonist 2-methyl-5-HT on the firing rate of medial prefrontal cortical cells. Since the localization of 5-HT3 receptors overlaps with the mesocorticolimbic but not the nigrostriatal dopamine system, it is hypothesized that the preferential action of clozapine on the mesocorticolimbic dopamine system is the result of the drug's interaction with the 5-HT3-like receptors. Furthermore, the antagonizing effect of clozapine to 5-HT3-like receptors may contribute to its increased antipsychotic efficacy.

Evidence for genetically mediated dysfunction of the central dopaminergic system in the stargazer rat.

The stargazer rat is an autosomal recessive mutant (homozygous stg/stg) that displays abnormal behavior, characterized by stereotypic head-movement, circling, and a high level of ambulatory activity. Heterozygous (stg/+) littermates display normal spontaneous behaviors. In this study, stargazers and their unaffected littermates were compared in their behavioral responses to both stimulation and inhibition of dopamine D2/D3 receptors, using quinpirole and haloperidol. Stargazers were observed to yawn a significantly fewer number of times than littermates in response to (--)-quinpirole (50 mu g/kg, IP). Haloperidol (HAL 0.1 mg/kg and 0.3 mg/kg, SC) caused a decrease in stereotypic head-movement in the mutants that was both time- and dose-dependent. In normal littermates, HAL inhibited locomotor activity and produced catalepsy in a time- and dose-dependent manner. In stargazers, both doses of HAL inhibited locomotor activity to a similar degree as in the littermates. However, no catalepsy was detectable in the mutants using 0.1 mg/kg of HAL. A dose of 0.3 mg/kg HAL was only weakly cataleptogenic. Overall, the spectrum of abnormal behaviors expressed by the stargazers and the present evidence of D2/D3 receptor subsensitivity suggest that stargazers possess a genetically mediated dysfunction of the central dopaminergic system.

Biochemical characterization of phosphoinositide hydrolysis stimulated by 5-HT3 receptor agonists.

Serotonin (5-HT) stimulates phosphoinositide (PI) turnover in rat fronto-cingulate cortical slices and is probably mediated through the activation of both 5-HT2 and 5-HT3 receptors. We have extended these findings and have assessed whether the increased stimulation of PI turnover is secondary to 5-HT stimulated arachidonate metabolism or to the release of another neurotransmitter. Incubation of the cortical slices by the two 5-HT3 receptor agonists, 2-methyl-serotonin (2-Me-5-HT) and phenylbiguanide (PBG), significantly decreases serotonin-stimulated phosphoinositide turnover, indicating that activation of 5-HT3, receptors by 2-Me-5-HT and PBG caused the desensitized PI hydrolysis to 5-HT. Indomethacin did not affect the increased PI hydrolysis induced by 5-HT, 2-Me-5-HT and PBG, suggesting that neither cyclooxygenase nor lipoxgenase activity is required for the PI response and that it is independent of arachidonic acid metabolism. The stimulation in PI turnover induced by 5-HT and the 5-HT3 receptor agonists was not potentiated by proteinase inhibitors suggesting that the release of a peptide neurotransmitter is not involved in the PI response. In addition, the effects of 5-HT, 2-Me-5-HT and PBG on PI turnover are additive to the effect of KCl and veratrine. In conclusion, our results indicate that the action of 2-Me-5-HT and PBG on PI turnover is direct.

Modulation of the A10 dopamine system: electrophysiological studies of the role of 5-HT3-like receptors.

The distribution of 5-HT3-like receptors is primarily in the mesocorticolimbic structures. We have previously demonstrated that the atypical antipsychotic drug clozapine and a structurally related compound RMI 81,582 differ from other typical antipsychotic drugs in that they are effective 5-HT3 receptor antagonists. Our experimental results suggest that 5-HT3-like receptors play a permissive role in regulating or gating the inhibitory action of dopamine in the mesocorticolimbic areas. We hypothesize that the ability of clozapine to antagonize both 5-HT3-like and dopamine receptors may account for its preferential interaction with the mesocorticolimbic dopamine system and the higher efficacy in treating the schizophrenic symptoms.

Effects of antipsychotic drugs on 5-HT2 receptors in the medial prefrontal cortex: microiontophoretic studies.

Microiontophoretic application (10-80 nA) of the relatively selective serotonin 2 (5-HT2) agonist, 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane [+/-)-DOI), suppressed medial prefrontal cortical (mPFc) cell's firing rate in a dose-dependent manner. This effect was antagonized by the antipsychotic drugs (APDs) clozapine (CLOZ) and spiperone (SPIP), with CLOZ displaying a greater potency in blocking DOI's action in the mPFc. In contrast, the typical APDs haloperidol (HAL) and L-sulpiride (SUL) failed to block DOI's effect. These results suggest that certain APDs interact with 5-HT2 receptors. Although 5-HT2 antagonism alone may not distinguish typical versus atypical APDs, it is possible that their 5-HT2/dopamine 2 (D2) binding ratio is important.

The CCK-A receptor antagonist devazepide but not the CCK-B receptor antagonist L-365,260 reverses the effects of chronic clozapine and haloperidol on midbrain dopamine neurons.

In this study, we examined the effects of the cholecystokinin-A (CCK-A) antagonist devazepide (MK 329) and the CCK-B antagonist L-365,260 to reverse the decrease in the number of spontaneously active dopamine (DA) cells in the ventral tegmental area and substantia nigra pars compacta after chronic haloperidol (HAL) or clozapine (CLOZ) treatment. The intravenous administration of devazepide (2 micrograms/kg) but not L-365,260 (2 micrograms/kg) reversed the reduction in the number of spontaneously active A9 and A10 DA cells produced by chronic HAL. Furthermore, devazepide also reversed the decrease in the number of spontaneously active A10 DA cells produced by chronic CLOZ administration. Overall, these results suggest that CCK-A but not CCK-B receptors play an important role in mediating or maintaining the chronic antipsychotic drug-induced effect on midbrain DA cells.

The effect of typical and atypical antipsychotic drugs on the stimulation of phosphoinositide hydrolysis produced by the 5-HT3 receptor agonist 2-methyl-serotonin.

The atypical antipsychotic drug clozapine (CLOZ) and a structurally related compound RMI 81,582 (RMI) dose-dependently inhibited the stimulation of phosphoinositide hydrolysis induced by the 5-HT3 receptor agonist 2-methyl-serotonin in the rat fronto-cingulate and entorhinal cortices. The antagonism of 2-methyl-serotonin's stimulation of phosphoinositide hydrolysis by CLOZ and RMI was comparable to that observed with 5-HT3 antagonists such as granisetron, ondansetron, ICS 205-930 and zacopride. By contrast, the typical antipsychotic drugs haloperidol (HAL) and chlorpromazine (CPZ) did not antagonize the stimulation of phosphoinositide hydrolysis induced by 2-methyl-serotonin. The 5-HT3 receptor antagonizing effect of CLOZ and RMI may contribute to the 'atypical' pharmacological profile of these antipsychotic drugs.

Further characterization of 5-HT- and 5-HT3 receptor agonists'-stimulated phosphoinositol phosphates accumulation.

The calcium requirement for serotonin (5-HT)- and the 5-HT3 receptor agonists, 2-Me-5-HT- and PBG-dependent breakdown of phosphatidyl inositol has been examined in the rat fronto-cingulate cortex. The omission of added Ca2+ from the Kreb's incubation medium reduced the [3H]inositol phosphate accumulation from pre-labelled phospholipids. Removal of Ca2+ by pre-incubation with EGTA (0.5 mM), as well as the addition of the calcium channel blocker, lanthanum (10 microM), abolished the 5-HT- and the 5-HT3 receptor agonists'-stimulated phosphoinositide (PI) response. By contrast, the calcium ionophores, A 23187 and Ionomycin (both at 30 microM) stimulated PI hydrolysis, and this effect was additive to the increased PI turnover induced by 5-HT, 2-Me-5-HT and PBG. The increase in phosphoinositide hydrolysis induced by 5-HT and 2-Me-5-HT was significantly inhibited by phorbol dibutyrate (PDBu) and phorbol myristate acetate, indicating that the activation of protein kinase C (PKC) may provide negative feedback to the PI response induced by 5-HT and 2-Me-5-HT-stimulated PI metabolism was reversed by the PKC inhibitors, staurosporine, calphostin C and chelerythrine (all at 10 microM), however, Pertussis toxin (0.5 and 1 microgram) had no effect on either 5-HT's or 2-Me-5-HT's increased stimulation of PI hydrolysis, suggesting that this response is not associated to a Gi GTP binding protein.

5-HT3-like receptors in the rat medial prefrontal cortex: an electrophysiological study.

In this study, we have identified and characterized 5-HT3-like receptors in the rat medial prefrontal cortex (mPFc), an area with a moderate density of 5-HT3 binding sites, using the techniques of single unit recording and microiontophoresis. The microiontophoresis of the 5-HT3 receptor agonist 2-methylserotonin (2-Me-5HT), similar to the action of 5-HT, produced a current-dependent (10-80 nA) suppression of the firing rate of both spontaneously active and glutamate (GLU)-activated (quiescent) mPFc cells. Phenylbiguanide (PBG), another 5-HT3 receptor agonist, suppressed the firing rate of mPFc cells but was less effective compared to 2-Me-5HT. The continuous iontophoresis (10-20 min) of 1 M magnesium chloride markedly attenuated the suppressant effect produced by electrical stimulation of the ascending 5-HT pathway, but did not alter 2-Me-5HT's action, suggesting that the action of 2-Me-5HT is a direct one. The suppressant action of 2-Me-5HT on mPFc cells was blocked by a number of structurally diverse and selective 5-HT3 antagonists, with a rank order of effectiveness as follows: ICS 205930 = (+/-)-zacopride greater than granisetron = ondansetron = LY 278584 greater than MDL 72222. Furthermore, the intravenous administration of (+/-)-zacopride antagonized the action of 2-Me-5HT and PBG on mPFc cells. In contrast to the effects of the 5-HT3 receptors antagonists, other receptor antagonists such as metergoline (5-HT1A,1B,1C.2), (+/-)-pindolol (5-HT1A,1B, beta), SCH 23390 (5-HT1C.2, D1), l-sulpiride (D2) or SR 95103 (GABAA) failed to block 2-Me-5HT's action. These results combined suggest that 2-Me-5HT's suppressive action on mPFc cells is mediated directly by 5-HT3-like receptors.

Effects of (+/-)-DOI on medial prefrontal cortical cells: a microiontophoretic study.

The relatively selective 5-HT2 receptor agonist, 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane [+/-)-DOI) ejected by microiontophoresis at low currents potentiates glutamate (GLU)-induced excitation and at higher currents (greater than 20 nA) invariably inhibits both spontaneous and GLU-induced activity of cells in the medial prefrontal cortex (mPFc). The inhibitory action of DOI is blocked by the 5-HT2 antagonists, ritanserin, metergoline and spiperone, but not other receptor antagonists. Microiontophoresis of 1 M Mg2+ for 5-20 min did not alter DOI's inhibitory effect suggesting that DOI's action is a direct one. These results show that DOI predominantly inhibits mPFc neuronal activity and this inhibitory action is mediated by 5-HT2 receptors.

One year treatment with haloperidol or clozapine fails to alter neostriatal D1- and D2-dopamine receptor sensitivity in the rat.

Rats were treated continuously with either haloperidol (HAL), clozapine (CLOZ) or tap water for one year. There were no differences between age-matched control and antipsychotic drug (APD) treated groups regarding the effects of the D1-agonist (+)-SKF 38393 or the D2-agonist quinpirole on striatal cAMP content. However, the combination of SKF (10 microM) and quinpirole (1 microM) produced a marked synergistic response in HAL-treated animals as compared to controls. Our data fail to support the hypothesis that APD produce their neurological side effects by inducing D2-receptor hypersensitivity in the basal ganglia. However, the results do suggest that chronic APD treatment alters the interaction between D1- and D2-neostriatal receptors.

The effect of intraventricular administration of the 5-HT3 receptor agonist 2-methylserotonin on the release of dopamine in the nucleus accumbens: an in vivo chronocoulometric study.

In the present study we have examined the effects of the serotonin3 (5-HT3) agonist 2-methylserotonin (2-Me-5HT) on the dopamine (DA) release in the nucleus accumbens (NAc) of rats using in vivo chronocoulometric recording. The intraventricular (i.c.v.) administration of 2-Me-5HT dose-dependently increased the DA release in the NAc. This effect was blocked by the selective 5-HT3 antagonist BRL-43694 (granisetron), but not by the 5-HT1/5-HT2 antagonist metergoline. The i.c.v. injection of 8-hydroxydipropylaminotetraline (8-OHDPAT, a selective 5-HT1a agonist) or (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI, a 5-HT2/5-HT1c agonist) failed to alter the DA release in the NAc. The increase in the DA release produced by 2-Me-5HT was abolished in animals that had received acute bilateral injections of 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle. Our results suggest that the 2-Me-5HT-induced DA release in the NAc is mediated by 5-HT3 receptors. In addition, 2-Me-5HT induced effect is dependent upon the impulse flow of DA cells.