Initiation of Liver Transplant in Nepal: A Milestone.

Background: The incidence of chronic liver disease is increasing in the Nepalese population. Liver transplantation (LT) is the best option for patients with end-stage liver disease (ESLD). Nepal's first liver transplant was performed in 2016 in an international collaborative effort at Shahid Dharmabhakta National Transplant Centre (SDNTC), Bhaktapur, Nepal. We aim to report details of the first five patients who had undergone liver transplantation in SDNTC before the beginning of the COVID-19 outbreak in the history of transplantation in Nepal. Method: A descriptive analysis of the clinical data of five adult recipients of liver transplantation at SDNTC was done. We described the patient's demographics, length of stay, and survival of all the first five patients who had undergone four living donor liver transplantations and one brain-dead donor liver transplantation in SDNTC before the beginning of the COVID-19 outbreak. Results: Recipients were between 36 and 63 years old. The recipients of the four live donor liver transplants (LDLT) and one brain-dead donor liver transplant (DDLT) had alcoholic liver disease and cryptogenic liver disease, leading to end-stage liver disease. The model for end-stage liver disease (MELD) scores ranged from 23 to 34. Out of five, four recipients and four donors are doing well and relishing the prospect of a normal life, while the recipient of a brain-dead donor liver transplant passed away due to postoperative primary graft failure. Conclusion: Despite the small number of liver transplants that have been done, the success of these has created confidence in a sustainable liver transplantation program in Nepal.

Effect of the ET(B) receptor agonist, IRL-1620, on paclitaxel plasma pharmacokinetics of breast tumor rats.

Endothelin (ET)-B receptors are expressed in human breast carcinoma. We previously demonstrated that intravenous administration of the ET(B) receptor agonist, IRL-1620, to tumor-bearing rats, increased blood perfusion and enhanced delivery of paclitaxel to breast tumor tissue. The present study was conducted to determine whether IRL-1620 alters the pharmacokinetics of paclitaxel. Breast tumor-bearing rats were given 0.3 ml/kg saline or 3 nmol/kg IRL-1620 by intravenous (iv) administration. Fifteen minutes after saline or IRL-1620, 40 microCi/rat 3H-Paclitaxel was administered iv and serial plasma samples were collected until 24 hrs. 3H-Paclitaxel radioactivity in the plasma samples was measured by liquid scintillation counting. Data were fit to a three-compartment model and pharmacokinetic parameters were generated using WinNonlin software. IRL-1620 did not produce any change in the plasma paclitaxel pharmacokinetics of tumor-bearing rats. The AUC(0-infinity) (9.43 +/- 3.18 microg-hr/ml), clearance (0.69 +/- 0.17 l/hr/kg), volume of distribution (10.31 +/- 4.54 l/kg), and half-life (1.0 +/- 0.32 hrs) of paclitaxel were similar between rats treated with saline or IRL-1620. In conclusion, the ET(B) receptor agonist, IRL-1620, does not alter paclitaxel plasma pharmacokinetics and, therefore, could be used to augment the delivery of paclitaxel to the tumor tissue.

Endothelin B receptor agonist, IRL 1620, enhances the anti-tumor efficacy of paclitaxel in breast tumor rats.

Pharmacological agents that increase tumor blood flow could be utilized to promote the delivery of anti-cancer drugs. We have demonstrated that administration of endothelin-1 (ET-1) to breast tumor bearing rats transiently increased tumor blood flow by stimulating endothelin B (ET(B)) receptors. The present study evaluated the effect of ET(B) receptor agonist, IRL 1620, on breast tumor perfusion, concentration of [3H]paclitaxel in tumor and tissues, and efficacy of paclitaxel in N-methyl nitrosourea induced breast tumor bearing rats. Administration of IRL 1620 (3 and 9 nmol/kg) significantly increased (203 and 140%, respectively) breast tumor perfusion. BQ 788, an ET(B) receptor antagonist, pretreatment completely abolished IRL 1620 induced increase in tumor perfusion. Tumor [3H]paclitaxel concentration was increased by 308% when [3H]paclitaxel was administered 15 min after IRL 1620 (3 nmol/kg) compared to vehicle treated rats. However, IRL 1620 did not increase [3H]paclitaxel concentrations in other organs. Efficacy study showed that paclitaxel (5 mg/kg) administration on every third day for a total of five doses produced 60.0, 4.5 and 0% reduction in tumor volume, tumor progression and complete tumor remission, respectively, compared to saline treated rats. However, paclitaxel (5 mg/kg) when administered 15 min after IRL 1620 (3 nmol/kg) produced 268.9, 210.3 and 20% reduction in tumor volume, tumor progression and complete remission of tumors, respectively, compared to saline treated rats. In conclusion, IRL 1620 significantly enhanced delivery and effectiveness of paclitaxel in an animal model of breast cancer.

Disposition of morphine in plasma and cerebrospinal fluid varies during neonatal development in pigs.

The pharmacological effects of morphine are mediated via the central nervous system (CNS) but its clearance from the CNS in neonates has not been investigated. We have proposed that neonatal development of the blood-brain barrier affected CNS clearance mechanisms and CNS exposure to morphine. Male piglets (n = 5) aged one, three and six weeks were given morphine sulfate (0.5 mg kg(-1), i.v.). Serial blood and cerebrospinal fluid (CSF) samples were withdrawn over 360 min after morphine administration. Morphine concentration was measured by radioimmunoassay. A three-compartment model was fitted to individual data. Estimated parameters were reported as median and range. The peak morphine concentrations in plasma were not significantly different in the one-, three- or six-week-old piglets. Plasma clearance at one week (4.5, 3.8-8.6 mL min(-1) kg(-1)) was significantly lower than at three weeks (30.0, 19.1- 39.0 mL min(-1) kg(-1)) and six weeks (37.0, 29.7-82.8 mL min(-1) kg(-1)). The peak morphine concentration in CSF at one week (59.84, 31-67 ng mL(-1)) was higher than at three weeks (18.8, 17.7-25 ng mL(-1)) and six weeks (24.51, 16.5-84 ng mL(-1)), while CSF clearance was lower at one week (1.0, 0.18-9 mL min(-1) kg(-1)) compared with three weeks (6.2, 2.3-9.3 mL min(-1) kg(-1)) and six weeks (3.95, 1.3-85.7 mL min(-1) kg(-1)). Apparent plasma:CSF transfer ratio at one week was greater than at three and six weeks. The reduced plasma and CSF morphine clearance in early infancy resulted in elevated systemic and central morphine exposure in neonatal pigs.

ET(B) receptor agonist, IRL 1620, does not affect paclitaxel plasma pharmacokinetics in breast tumour bearing rats.

Endothelins are potent endogenous vasoactive substances. We have found that intravenous administration of endothelin (ET)B receptor agonist, IRL 1620 (N-suc-[Glu9, Ala(11,15)]ET-1 (8-21)) to tumour bearing rats increases blood perfusion and enhances delivery of chemotherapeutic agents to the tumour tissue. This study was conducted to determine whether IRL 1620, an ET(B) receptor selective agonist, alters pharmacokinetics of paclitaxel in breast tumour bearing rats. Breast tumours were induced in female Sprague-Dawley rats by N-methyl-n-nitrosourea (50 mg kg(-1), i.p). Saline (0.3 mL kg(-1), i.v.) or IRL 1620 (3 nmol kg(-1), i.v.), was administered to the tumour bearing rats via the tail vein. Paclitaxel (3 mg kg(-1), i.v.) was administered 15 min after saline or IRL 1620 injection. Serial plasma samples were collected up to 10 h after paclitaxel administration and analysed using an HPLC-UV assay. In a similar study [3H]-paclitaxel (40 microCi, i.v.) was administered after saline or IRL 1620 injection as described above and serial plasma samples were collected until 24 h. Data was fitted to a three-compartment model and pharmacokinetic parameters were generated using WinNonlin software. The AUC(0-infinity) (9.42 +/- 3.18 microg h mL(-1)), clearance (0.69 +/- 0.17 L h(-1) kg(-1)), volume of distribution (10.31 +/- 4.54 L kg(-1)) and half life (1.00 +/- 0.32 h) of [3H]-paclitaxel in tumour rats were similar in rats treated with IRL 1620 or vehicle. Tumour concentration of [3H]-paclitaxel was determined in rats treated with IRL 1620 or vehicle and there was a significant increase in tumour paclitaxel concentration (308.59 +/- 24.42%) in rats treated with IRL 1620 compared with vehicle. It is concluded that IRL 1620, an ET(B) receptor agonist, does not alter paclitaxel pharmacokinetics and can selectively augment the delivery of paclitaxel to the tumour tissue.

Endothelin ETA receptor antagonist did not affect development of tolerance to glyceryl trinitrate in rat.

Glyceryl trinitrate (GTN), extensively used for the treatment of cardiovascular disorders, is associated with rapid development of tolerance. The exact mechanism responsible for tolerance development to GTN is still not known. Recently, it has been demonstrated that GTN tolerance is associated with increased expression of endothelin (ET). This study was carried out to determine the effect of ET(A) receptor antagonist, BMS182874, on the development of tolerance to GTN in urethane-anaesthetized rats. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) were continuously recorded in vehicle- and BMS182874 (3 mg kg(-1), i.v.)-treated rats. GTN was infused at the rate of 10 microg min(-1), intravenously for 4 h. Tolerance to GTN was determined using challenge doses of GTN (10, 30 and 90 microg, i.v.). GTN produced a fall in DBP, SBP and an increase in HR. In vehicle-treated rats, the fall in SBP before induction of GTN tolerance was 28 +/- 2, 43 +/- 4 and 52 +/- 4 mmHg with 10, 30 and 90 microg GTN, respectively. However, following GTN infusion (10 microg min(-1), i.v. for 4 h) a rapid development of tolerance was observed and the fall in SBP was 1 +/- 1, 9 +/- 4 and 15 +/- 4 mmHg with 10, 30 and 90 microg GTN, respectively. Similarly, in BMS182874-treated rats the fall in SBP in non-tolerant rats was 28 +/- 4, 42 +/- 4 and 48 +/- 5 mmHg with 10, 30 and 90 microg GTN, respectively. In BMS182874-treated rats following GTN infusion (10 microg min(-1), i.v. for 4 h) a rapid development of tolerance was observed and the fall in SBP was 4 +/- 3, 10 +/- 2 and 13 +/- 4 mmHg with 10, 30 and 90 microg GTN, respectively. The decrease in DBP and SBP in vehicle- and BMS182874-treated GTN-tolerant rats was statistically similar. These results suggest that ET(A) receptor antagonist BMS182874 did not affect development of tolerance to GTN in rats.

Endothelin-1-induced vasodilatation in rat breast tumor is mediated through endothelin-B receptors.

Endothelin-1 (ET-1) causes vasodilatation via its endothelin-B receptors. ET-1, endothelin-3 and endothelin-B receptors are known to be overexpressed in breast carcinoma tissue. However, the functional role of ET-1 in tumor vasculature is still unknown. If ET-1 causes an increase in breast tumor perfusion, it could be used to increase delivery of chemotherapeutic agents to the tumor tissues. Female Sprague-Dawley rats (180-200 g) were treated with either saline or N-methyl, N-nitrosourea (50 mg/kg, intraperitoneally), a chemical carcinogen. Each group was treated with: (a) ET-1 (50 ng/kg/minute, 30 minute infusion) (n = 6); or (b) BQ788, an endothelin-B receptor antagonist (0.33 mg/kg/minute, 20 minute infusion) + ET-1 (50 ng/kg/minute, 30 minute infusion) (n = 5). Blood flow to tumor and normal breast tissue was measured using radioactive microspheres. Blood perfusion to the breast and tumor tissue was measured using laser Doppler flowmetry. Blood flow to tumor tissue increased (153%; P < 0.05) and vascular resistance decreased following ET-1 infusion. Blood flow to other organs was not affected. Laser Doppler flowmetry showed an increase (176%; P < 0.05) in breast tumor perfusion following ET-1 infusion. The increase in perfusion was attenuated (-25.2%; P < 0.05) with the administration of BQ788. Results indicate that ET-1 induced an increase in blood flow to tumors in tumor-bearing rats, which is mediated by endothelin-B receptors.

Evidence for the involvement of ET(B) receptors in ET-1-induced changes in blood flow to the rat breast tumor.

PURPOSE: Structure, growth, and function of the blood vessels in breast tumors are markedly different from those in normal breast tissue due to changes in the production of growth factors such as vascular endothelial growth factor (VEGF), vasoactive substances such as endothelin-1 (ET-1) and cytokines. The role of ET-1 in breast tumor angiogenesis is not adequately understood. Studies have shown that the expression of proET-1, proET-3, and ET(B) receptors is increased in breast tumor. However, it is unclear whether there are any changes in ET-1-induced vascular responses in breast tumor. Hence, in the present study we investigated systemic hemodynamics and regional circulatory effects of ET-1 in rats with breast tumors. METHODS: Female Sprague-Dawley rats weighing 180-200 g were divided into the following groups: (1) normal rats treated with saline ( n=6), (2) tumor-bearing rats treated with methylnitrosourea (MNU) ( n=6), (3) normal rats treated with saline plus the specific ET(B) receptor antagonist BQ 788 ( n=5), and (4) tumor-bearing rats treated with MNU plus BQ 788 ( n=5). Tumor development was monitored by regular palpation and measurement of tumor size. Once tumors had reached approximately 2-4 cm in diameter, the rats were anesthetized with urethane (1.5 g/kg i.p.) and their cardiovascular parameters were measured using a radioactive microsphere technique. Simultaneously, blood perfusion to the breast tissue was also measured using a laser Doppler technique. RESULTS: ET-1 produced a significant increase in mean arterial pressure in normal and tumor-bearing rats. Blood flow to the tumor tissue increased significantly in response to ET-1 as compared to breast tissue in normal rats. This response was accompanied by a concomitant decrease in vascular resistance in the tumor tissue. These results were confirmed by laser Doppler flowmetry, which showed a significant increase in blood perfusion to breast tumor compared to normal breast tissue. This increase in blood perfusion was attenuated by pretreatment with BQ 788, suggesting an ET(B) receptor-mediated vasodilator action of ET-1 in rat breast tumor. CONCLUSIONS: The results indicate that ET-1 induced an increase in blood flow to breast tumor tissue mediated through ET(B) receptors.