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2.
Phys Rev Lett ; 119(25): 256404, 2017 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-29303315

RESUMO

Upon reduction of the film thickness we observe a metal-insulator transition in epitaxially stabilized, spin-orbit-coupled SrIrO_{3} ultrathin films. By comparison of the experimental electronic dispersions with density functional theory at various levels of complexity we identify the leading microscopic mechanisms, i.e., a dimensionality-induced readjustment of octahedral rotations, magnetism, and electronic correlations. The astonishing resemblance of the band structure in the two-dimensional limit to that of bulk Sr_{2}IrO_{4} opens new avenues to unconventional superconductivity by "clean" electron doping through electric field gating.

3.
J Transl Med ; 14: 273, 2016 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-27650038

RESUMO

The fifth "Melanoma Bridge Meeting" took place in Naples, December 1-5th, 2015. The main topics discussed at this meeting were: Molecular and Immuno advances, Immunotherapies and Combination Therapies, Tumor Microenvironment and Biomarkers and Immunoscore. The natural history of cancer involves interactions between the tumor and the immune system of the host. The immune infiltration at the tumor site may be indicative of host response. Significant correlations were shown between the levels of immune cell infiltration in tumors and patient's clinical outcome. Moreover, incredible progress comes from the discovery of mutation-encoded tumor neoantigens. In fact, as tumors grow, they acquire mutations that are able to influence the response of patients to immune checkpoint inhibitors. It has been demonstrated that sensitivity to PD-1 and CTLA-4 blockade in patients with advanced NSCLC and melanoma was enhanced in tumors enriched for clonal neoantigens. The road ahead is still very long, but the knowledge of the mechanisms of immune escape, the study of tumor neo-antigens as well as of tumor microenvironment and the development of new immunotherapy strategies, will make cancer a more and more treatable disease.


Assuntos
Imunoterapia , Melanoma/imunologia , Humanos
4.
Phys Rev Lett ; 117(17): 176401, 2016 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-27824473

RESUMO

Mott insulators are "unsuccessful metals" in which Coulomb repulsion prevents charge conduction despite a metal-like concentration of conduction electrons. The possibility to unlock the frozen carriers with an electric field offers tantalizing prospects of realizing new Mott-based microelectronic devices. Here we unveil how such unlocking happens in a simple model that shows the coexistence of a stable Mott insulator and a metastable metal. Considering a slab subject to a linear potential drop, we find, by means of the dynamical mean-field theory, that the electric breakdown of the Mott insulator occurs via a first-order insulator-to-metal transition characterized by an abrupt gap collapse in sharp contrast to the standard Zener breakdown. The switch on of conduction is due to the field-driven stabilization of the metastable metallic phase. Outside the region of insulator-metal coexistence, the electric breakdown occurs through a more conventional quantum tunneling across the Hubbard bands tilted by the field. Our findings rationalize recent experimental observations and may offer a guideline for future technological research.

5.
Br J Cancer ; 112(4): 745-54, 2015 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-25647013

RESUMO

BACKGROUND: Cancer is a multifactorial disease not only restricted to transformed epithelium, but also involving cells of the immune system and cells of mesenchymal origin, particularly mesenchymal stem cells (MSCs). Mesenchymal stem cells contribute to blood- and lymph- neoangiogenesis, generate myofibroblasts, with pro-invasive activity and may suppress anti-tumour immunity. METHODS: In this paper, we evaluated the presence and features of MSCs isolated from human head neck squamous cell carcinoma (HNSCC). RESULTS: Fresh specimens of HNSCC showed higher proportions of CD90+ cells compared with normal tissue; these cells co-expressed CD29, CD105, and CD73, but not CD31, CD45, CD133, and human epithelial antigen similarly to bone marrow-derived MSCs (BM-MSCs). Adherent stromal cells isolated from tumour shared also differentiation potential with BM-MSCs, thus we named them as tumour-MSCs. Interestingly, tumour-MSCs showed a clear immunosuppressive activity on in vitro stimulated T lymphocytes, mainly mediated by indoelamine 2,3 dioxygenase activity, like BM-MSCs. To evaluate their possible role in tumour growth in vivo, we correlated tumour-MSC proportions with neoplasm size. Tumour-MSCs frequency directly correlated with tumour volume and inversely with the frequency of tumour-infiltrating leukocytes. CONCLUSIONS: These data support the concept that tumour-MSCs may favour tumour growth not only through their effect on stromal development, but also by inhibiting the anti-tumour immune response.


Assuntos
Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Proliferação de Células , Neoplasias de Cabeça e Pescoço/imunologia , Neoplasias de Cabeça e Pescoço/patologia , Células-Tronco Mesenquimais/patologia , Linfócitos T/fisiologia , Carga Tumoral , Idoso , Estudos de Casos e Controles , Contagem de Células , Regulação para Baixo , Feminino , Humanos , Masculino , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Carcinoma de Células Escamosas de Cabeça e Pescoço , Antígenos Thy-1/metabolismo
6.
Phys Rev Lett ; 114(18): 185701, 2015 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-26001010

RESUMO

Topological quantum phase transitions are characterized by changes in global topological invariants. These invariants classify many-body systems beyond the conventional paradigm of local order parameters describing spontaneous symmetry breaking. For noninteracting electrons, it is well understood that such transitions are continuous and always accompanied by a gap closing in the energy spectrum, given that the symmetries protecting the topological phase are maintained. Here, we demonstrate that a sufficiently strong electron-electron interaction can fundamentally change the situation: we discover a topological quantum phase transition of first-order character in the genuine thermodynamic sense that occurs without a gap closing. Our theoretical study reveals the existence of a quantum critical endpoint associated with an orbital instability on the transition line between a 2D topological insulator and a trivial band insulator. Remarkably, this phenomenon entails unambiguous signatures related to the orbital occupations that can be detected experimentally.

7.
Phys Rev Lett ; 109(16): 166404, 2012 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-23215100

RESUMO

Cs(3)C(60) in the A15 structure is an antiferromagnet at ambient pressure in contrast with other superconducting trivalent fullerides. Superconductivity is recovered under pressure and reaches the highest critical temperature of the family. Comparing density-functional calculations with generalized gradient approximation to the hybrid functional of Heyd, Scuseria, and Ernzerhof, which includes a suitable component of exchange, we establish that the antiferromagnetic state of Cs(3)C(60) is not due to a Slater mechanism, and it is stabilized by electron correlation. Pressure reduces the stability of the antiferromagnetic state. Our findings corroborate previous analyses suggesting that the properties of this compound can be understood as the result of the interplay between electron correlations and Jahn-Teller electron-phonon interaction.

8.
Phys Rev Lett ; 105(7): 077002, 2010 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-20868070

RESUMO

The optical conductivity σ(ω) and the spectral weight W(T) of two superconducting cuprates at optimum doping, Bi2Sr2-xLaxCuO6 and Bi2Sr2CaCu2O8, have been first measured up to 500 K. Above 300 K, W(T) deviates from the usual T2 behavior in both compounds, even though σ(ω→0) remains larger than the Ioffe-Regel limit. The deviation is surprisingly well described by the T4 term of the Sommerfeld expansion, but its coefficients are enhanced by strong correlation, as shown by the good agreement with dynamical mean field calculations.

9.
J Phys Condens Matter ; 30(3): 035402, 2018 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-29265008

RESUMO

The structural and magnetic properties of LaCo0.9Mn0.1O3 have been studied as a function of pressure by neutron powder diffraction and DC magnetometry. The material is confirmed to exhibit rhombohedral R [Formula: see text] c symmetry between ambient pressure and 6 GPa. We have determined the bulk modulus B 0 of the sample using a second-order Birch-Murnaghan equation of state which yielded: B 0 = 140(9) GPa and V [Formula: see text]. We report a non-linear increase of the Curie temperature T C from an ambient pressure value of 224.7 K to ∼236 K at a pressure of 4 GPa. Finally, we confirm the glassy-like nature of the magnetism in LaCo0.9Mn0.1O3, which is maintained throughout the pressure range explored.

11.
Mol Cell Biol ; 15(6): 3217-26, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7760817

RESUMO

Immunoglobulin and T-cell receptor gene transcriptional enhancers encompass sequences which stimulate V(D)J recombination of associated variable gene segments. To address the question of whether enhancer-mediated transcriptional activation and recombinational activation depend on the same cis-regulatory sequences, we have produced transgenic mice by using recombination substrates containing various mutations in the immunoglobulin heavy-chain intronic enhancer (E mu). Analysis of substrate rearrangements indicated that specific compound elements including E-box transcriptional motifs are crucial for the recombinational activity of E mu in the developing B and T lymphocytes. In most cases, a faithful correlation between the levels of substrate germ line transcription and recombination was observed. However, some of the E mu mutants which were able to activate transcription of the unrearranged substrate were inefficient in stimulating transgene recombination, implying that the latter function depends on molecular events other than the mere activation of transcription and that both activities can be mediated through distinct regulatory sequences. Together, these results support a model in which lymphoid gene enhancers, in addition to providing docking sites for factors that dictate transcriptional accessibility, must have some specific function(s) for activating V(D)J recombination.


Assuntos
Cadeias Pesadas de Imunoglobulinas/genética , Receptores de Antígenos de Linfócitos T/genética , Animais , Linfócitos B/metabolismo , Sequência de Bases , Elementos Facilitadores Genéticos , Cadeias Pesadas de Imunoglobulinas/metabolismo , Camundongos , Camundongos Transgênicos , Dados de Sequência Molecular , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Recombinação Genética , Linfócitos T/metabolismo , Transcrição Gênica
12.
Nat Phys ; 13(8): 806-811, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28781605

RESUMO

The influence of the Mott physics on the doping-temperature phase diagram of copper oxides represents a major issue that is subject of intense theoretical and experimental effort. Here, we investigate the ultrafast electron dynamics in prototypical single-layer Bi-based cuprates at the energy scale of the O-2p→Cu-3d charge-transfer (CT) process. We demonstrate a clear evolution of the CT excitations from incoherent and localized, as in a Mott insulator, to coherent and delocalized, as in a conventional metal. This reorganization of the high-energy degrees of freedom occurs at the critical doping pcr ≈0.16 irrespective of the temperature, and it can be well described by dynamical mean field theory calculations. We argue that the onset of the low-temperature charge instabilities is the low-energy manifestation of the underlying Mottness that characterizes the p < pcr region of the phase diagram. This discovery sets a new framework for theories of charge order and low-temperature phases in underdoped copper oxides.

13.
Artigo em Inglês | MEDLINE | ID: mdl-15626589

RESUMO

Aspirin may reduce the risk of colorectal neoplasia at doses similar to those recommended for the prevention of cardiovascular disease. Thus, we aimed to address whether enhanced platelet activation, as assessed by the measurement of the urinary excretion of 11-dehydro-TXB(2) (a major enzymatic metabolite of TXB(2)), occurs in patients with colorectal cancer. In 10 patients with colorectal cancer, the urinary excretion of 11-dehydro-TXB(2) was significantly higher than in 10 controls, matched for sex, age and cardiovascular risk factors [1001(205-5571) versus 409(113-984) pg/mg creatinine, respectively, median (range), P<0.05]. The administration of aspirin 50 mg daily for 5 consecutive days to colorectal cancer patients caused a cumulative inhibition of platelet cyclooxygenase (COX)-1 activity either ex vivo, as assessed by the measurement of serum TXB(2) levels, or in vivo, as assessed by urinary 11-dehydro-TXB(2) excretion. In conclusion, enhanced platelet activation occurs in colorectal cancer patients. Permanent inactivation of platelet COX-1 by low-dose aspirin might restore anti-tumor reactivity.


Assuntos
Aspirina/administração & dosagem , Neoplasias Colorretais/sangue , Ativação Plaquetária/efeitos dos fármacos , Tromboxano B2/análogos & derivados , Tromboxano B2/urina , Idoso , Aspirina/farmacologia , Biomarcadores/urina , Neoplasias Colorretais/tratamento farmacológico , Ciclo-Oxigenase 1 , Inibidores de Ciclo-Oxigenase/administração & dosagem , Inibidores de Ciclo-Oxigenase/farmacologia , Feminino , Humanos , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/farmacologia , Prostaglandina-Endoperóxido Sintases/efeitos dos fármacos
14.
Sci Rep ; 5: 15240, 2015 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-26468959

RESUMO

Cs3C60 is an antiferromagnetic insulator that under pressure (P) becomes metallic and superconducting below Tc = 38 K. The superconducting dome present in the T - P phase diagram close to a magnetic state reminds what found in superconducting cuprates and pnictides, strongly suggesting that superconductivity is not of the conventional Bardeen-Cooper-Schrieffer (BCS) type We investigate the insulator to metal transition induced by pressure in Cs3C60 by means of infrared spectroscopy supplemented by Dynamical Mean-Field Theory calculations. The insulating compound is driven towards a metallic-like behaviour, while strong correlations survive in the investigated pressure range. The metallization process is accompanied by an enhancement of the Jahn-Teller effect. This shows that electronic correlations are crucial in determining the insulating behaviour at ambient pressure and the bad metallic nature for increasing pressure. On the other hand, the relevance of the Jahn-Teller coupling in the metallic state confirms that phonon coupling survives in the presence of strong correlations.

15.
Clin Pharmacol Ther ; 70(5): 475-83, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11719735

RESUMO

BACKGROUND: We studied the concentration dependence of the inhibitory effects of cortisol, 6-methylprednisolone, and dexamethasone on cyclooxygenase-2 (COX-2) expression and activity in human monocytes in response to lipopolysaccharide (LPS) in vitro. Moreover, we characterized the time and dose dependence of the inhibitory effects of 6-methylprednisolone, administered to healthy subjects, on LPS-inducible prostaglandin E2 (PGE2) biosynthesis in whole blood ex vivo. METHODS: Heparinized whole-blood samples obtained from healthy subjects and patients with rheumatoid arthritis were incubated with LPS (10 microg/ml) for 24 hours at 37 degrees C, and PGE2 was measured in plasma as an index of monocyte COX-2 activity. Comparative experiments were performed in LPS-stimulated isolated monocytes. The levels of COX-2-like immunoreactivity in monocyte lysates were measured by a specific Western blot technique. PGE2 was evaluated by radioimmunoassay. RESULTS: Nanomolar concentrations of cortisol, 6-methylprednisolone, and dexamethasone suppressed LPS-induced PGE2 biosynthesis both in whole blood and in isolated monocytes in vitro with relative potencies similar to those reported for their anti-inflammatory effects in vivo. The administration of single oral doses (4, 8, or 16 mg) of 6-methylprednisolone caused a dose- and time-dependent inhibition of whole-blood COX-2 activity. Whole-blood samples obtained from patients with rheumatoid arthritis treated with comparable maintenance doses of glucocorticoids produced significantly lower levels of LPS-inducible PGE2 than were found in untreated patients. CONCLUSIONS: Therapeutic plasma levels of synthetic glucocorticoids down-regulate inducible prostanoid biosynthesis in circulating monocytes. This effect may represent a readily measurable surrogate marker of their clinical efficacy for dose-finding studies.


Assuntos
Inibidores de Ciclo-Oxigenase/farmacologia , Glucocorticoides/farmacologia , Hidrocortisona/farmacologia , Isoenzimas/sangue , Monócitos/enzimologia , Prostaglandina-Endoperóxido Sintases/sangue , Artrite Reumatoide/enzimologia , Ciclo-Oxigenase 1 , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Dexametasona/farmacologia , Dinoprostona/biossíntese , Humanos , Hidrocortisona/sangue , Lipopolissacarídeos/farmacologia , Proteínas de Membrana , Metilprednisolona/farmacologia
16.
Curr Pharm Des ; 10(6): 589-601, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-14965322

RESUMO

Novel coxibs (i.e. etoricoxib, valdecoxib, parecoxib and lumiracoxib) with enhanced biochemical cyclooxygenase (COX)-2 selectivity over that of rofecoxib and celecoxib have been recently developed. They have the potential advantage to spare COX-1 activity, thus reducing gastrointestinal toxicity, even when administered at high doses to improve efficacy. They are characterized by different pharmacodynamic and pharmacokinetics features. The higher biochemical selectivity of valdecoxib than celecoxib, evidenced in vitro, may be clinically relevant leading to an improved gastrointestinal safety. Interestingly, parecoxib, a pro-drug of valdecoxib, is the only injectable coxib. Etoricoxib shows only a slightly improved COX-2 selectivity than rofecoxib, a highly selective COX-2 inhibitor that has been reported to halve the incidence of serious gastrointestinal toxicity compared to nonselective nonsteroidal antiinflammatory drugs (NSAIDs). Lumiracoxib, the most selective COX-2 inhibitor in vitro, is the only acidic coxib. The hypothesis that this chemical property may lead to an increased and persistent drug accumulation in inflammatory sites and consequently to an improved clinical efficacy, however, remains to be verified. Several randomized clinical studies suggest that the novel coxibs have comparable efficacy to nonselective NSAIDs in the treatment of osteoarthritis, rheumatoid arthritis and acute pain, but they share similar renal side-effects. The apparent dose-dependence of renal toxicity may limit the use of higher doses of the novel coxibs for improved efficacy. Large-size randomized clinical trials are ongoing to define the gastrointestinal and cardiovascular safety of the novel coxibs.


Assuntos
Inibidores de Ciclo-Oxigenase/farmacologia , Isoenzimas/antagonistas & inibidores , Ciclo-Oxigenase 1 , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase/efeitos adversos , Inibidores de Ciclo-Oxigenase/uso terapêutico , Humanos , Isoenzimas/metabolismo , Proteínas de Membrana , Prostaglandina-Endoperóxido Sintases/metabolismo , Prostaglandinas/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Biomaterials ; 24(2): 337-46, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12419636

RESUMO

Loss of bone near joint prostheses is thought to be caused by activation of recruited osteoclasts by osteolytic mediators induced by wear particles. It is proposed that particles inhibit osteogenesis during bone remodelling causing a reduction in the levels of peri-implant bone. This study explores whether prosthetic particles modulate bone formation by affecting osteoblastic bone-related mRNAs (alkaline phosphatase, pro-collagen Ialpha1, osteopontin, osteonectin, osteocalcin, bone sialoprotein and thrombospondin) or their translated proteins using titanium alloy, commercially pure titanium, and cobalt-chrome particles. The direct effect of the particles revealed no change to the expression of the bone-related mRNAs in human bone-derived cells (HBDC) at the time points investigated; although non-collagenous translated proteins expressed by these HBDC were significantly effected (p<0.05). Different patterns of expression for bone-related proteins were induced by the different particles both directly and indirectly. Inflammatory mediators (interleukin-1beta, tumor necrosis factor alpha, interleukin-6, and prostaglandin E2) had similar effects on HBDC to the media obtained from monocytes incubated with particles. This study shows that prosthetic wear particles can significantly modify the expression of bone-related proteins by osteogenic cells in vitro. These alterations in osteogenic activity at the interface of the implant and bone may be an important factor in the failure of many orthopaedic implants.


Assuntos
Osso e Ossos/metabolismo , Prótese Articular , Osteoblastos/metabolismo , Proteínas/metabolismo , Osso e Ossos/citologia , Humanos , Hibridização In Situ , Técnicas In Vitro , Osteoblastos/citologia , Osteogênese , Proteínas/genética , RNA Mensageiro/genética
18.
Biomaterials ; 25(4): 565-73, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14607494

RESUMO

Aseptic bone loss adjacent to orthopedic joint implants is a common cause of joint implant failure in humans. This study investigates the expression of key regulators of osteoclast formation, receptor activator NFkappaB (RANK), Receptor activator of NFkappaB ligand (RANKL) and osteoprotegerin (OPG), in the peri-implant tissues of patients with osteolysis compared with levels in synovial tissues from osteoarthritic and healthy subjects. Immunohistochemical studies demonstrated that significantly higher levels of RANKL protein (p<0.05) were found in the peri-implant tissues of patients with implant failure than in similar tissues from osteoarthritic and healthy subjects. In contrast, OPG protein levels were similar in all tissues. RANKL, expressed as mRNA and protein, was predominantly associated with cells containing wear particles. Dual labeling studies showed that the cells expressing RANKL protein were macrophages. In situ hybridization studies confirmed that mRNA encoding for these proteins is also expressed by cells in the peri-implant tissues. In addition, RANK mRNA was expressed in cells that contained wear particles. These findings show that abnormally high levels of RANKL are expressed in peri-implant tissues of patients with prosthetic loosening and that these abnormal levels of RANKL may significantly contribute to aseptic implant loosening.


Assuntos
Proteínas de Transporte/metabolismo , Glicoproteínas/metabolismo , Glicoproteínas de Membrana/metabolismo , NF-kappa B/metabolismo , Osteoartrite/metabolismo , Osteoclastos/metabolismo , Osteólise/metabolismo , Falha de Prótese , Infecções Relacionadas à Prótese/metabolismo , Receptores Citoplasmáticos e Nucleares/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/metabolismo , Reação a Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/patologia , Osteoclastos/patologia , Osteólise/etiologia , Osteólise/patologia , Osteonecrose/etiologia , Osteonecrose/metabolismo , Osteonecrose/patologia , Osteoprotegerina , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/patologia , Ligante RANK , Receptor Ativador de Fator Nuclear kappa-B , Receptores do Fator de Necrose Tumoral
19.
Int J Impot Res ; 8(2): 87-9, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8858397

RESUMO

OBJECTIVE: Antibiotic prophylaxis in prosthetic surgery was administered prospectively according an original protocol. Routine pre-operative preparation included also scrupulous, repeated disinfection of the skin of the genital and perineal region. METHODS: Vancomycin 500 mg i.v. every 6 h on the day of surgery and gentamicin 1 mg/kg i.v. every 8 h on the day of surgery and for the following 48 h were administered to 75 consecutive patients. Overall 87 prosthetic devices were implanted. The patients were evaluated at 6 weeks and at 6 months after surgery. RESULTS: No infection was observed. CONCLUSION: Support from this study to antibiotic prophylaxis in penile prosthetic surgery is uncertain. The importance of scrupulous routine pre-operative preparation is probably underestimated.


Assuntos
Antibacterianos/uso terapêutico , Gentamicinas/uso terapêutico , Prótese de Pênis , Pênis/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Vancomicina/uso terapêutico , Estudos de Avaliação como Assunto , Humanos , Masculino , Estudos Prospectivos
20.
Int J Immunopathol Pharmacol ; 16(2 Suppl): 49-58, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14552704

RESUMO

The discovery of cyclooxygenase (COX)-2 has provided the rationale for the development of a new class of nonsteroidal antiinflammatory drugs (NSAIDs), the selective COX-2 inhibitors (denominated coxibs), with the aim of reducing the gastrointestinal (GI) toxicity associated with the administration of NSAIDs by virtue of COX-1 sparing. Rofecoxib and celecoxib are the first selective COX-2 inhibitors approved by the FDA and EMEA for the treatment of rheumatoid arthritis (RA), osteoarthritis (OA) and for relief of acute pain. Rofecoxib has been shown to spare COX-1 activity ex vivo, in platelets and gastric mucosa, when administered at therapeutic doses or above. In a large clinical trial, COX-2 inhibitors have been demonstrated to halve the incidence of serious upper GI events vs a nonselective NSAID. Recently, other selective COX-2 inhibitors with different COX-1/COX-2 selectivity and pharmacokinetic features have been developed, i.e. valdecoxib, parecoxib, etoricoxib and lumiracoxib. The improved biochemical selectivity of valdecoxib vs celecoxib in vitro (COX-1/COX-2 ratio: 60 vs 30, respectively) may be clinically relevant leading to an improved GI safety. Interestingly, parecoxib, a pro-drug of valdecoxib, is the only injectable coxib. Etoricoxib, showing only a slightly higher COX-2 selectivity than rofecoxib in vitro (COX-1/COX-2 ratio: 344 vs 272, respectively), has been reported to cause a similar specific COX-2 inhibition ex vivo that should translate into comparable GI safety. Lumiracoxib, the most selective COX-2 inhibitor in vitro (COX-1/COX-2 ratio: 400), is the only acidic coxib. It has been hypothesized that this pecular chemical feature may lead to an enhanced concentration in inflammatory sites that may translate into an improved clinical efficacy. The results of clinical trials have shown that coxibs have a comparable clinical efficacy and renal toxicity and an improved GI safety vs nonselective NSAIDs. Whether the different pharmacodynamic and pharmacokinetics features of the various coxibs will produce detectable differences in efficacy and toxicity remains to be evaluated in appropriate comparative randomized clinical studies.


Assuntos
Inibidores de Ciclo-Oxigenase/farmacologia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Isoenzimas/antagonistas & inibidores , Animais , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Ensaios Clínicos como Assunto/estatística & dados numéricos , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase/química , Humanos , Isoenzimas/metabolismo , Proteínas de Membrana , Prostaglandina-Endoperóxido Sintases/metabolismo
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