[Ischemia reperfusion: an unavoidable phase of transplant procedures]. / L'ischémie reperfusion: un passage obligatoire de la transplantation.

Transplanted organs are inevitably exposed to ischemia-reperfusion injury. Cold preservation is also used to reduced metabolic processes during ex vivo transport but triggers a complex pathophysiological syndrome which is responsible for delayed graft function after reperfusion. Ischemia-reperfusion injury is also associated with chronic graft dysfunction.

Amyloidosis and neurodegenerative diseases: current treatments and new pharmacological options.

Most neurodegenerative diseases share several clinical, genetic and pathophysiological features, and an irreversible evolution as well. They are characterized by an endogenous production of abnormal proteins called amyloid proteins (AP), which are not hydrosoluble, form depots, and are only partly cleared by autophagy and the ubiquitin-protease system. Despite their different structures, they are probably generated by a common pathological pathway, a misfolding process. This hypothesis suggests a common pharmacological approach, which can consist of either the blockade of the misfolding process, the elimination of AP or both. The currently validated treatments are mostly palliative ones, trying to supplant the function of destroyed neurons. New trends involve the regulation of the cerebral cholesterol metabolism and the preservation of neuron mitochondrial functions. Special attention is given to already marketed drugs used for other indications, which are also able to act on neurodegeneration.

[French national health insurance. The current situation]. / Assurance maladie. Un état des lieux.

An audit of the French national health insurance system would be justified by economic considerations alone, but this would risk overlooking the notions of solidarity and freedom to which the French are rightly attached. European comparisons suggest, however, that our system could be made more efficient without undermining public health. The national health insurance system allows each member of the population to receive high-quality medical care. Practitioners have near-total freedom of prescription and practice. Medical care contributes to the ongoing increase in life expectancy, which is currently 73 years and second only to Japan. Healthcare is also a source of a million jobs. Macro-economic spending controls have failed, owing to medical progress and population aging, and also to medical consumerism favored by an unprecedented range of examinations and treatments, the increasing reimbursement of medical care, and the extension of direct payment by the insurer. Many ineffective measures have been implemented, such as tarification according to activity, and hospital certification. Health spending is also increased unnecessarily by bureaucratisation of healthcare spending and the transfer of professionals to posts for which they are not qualified. Some controversial medical prescriptions are not adequately controlled by the health service. Many reforms are based on over-optimistic economic predictions that fail to take related overheads into account. Lobbying by special interests groups undermines reform and the public interest. Too many independent administrative bodies have been created, and many are less efficient than the public structures they replaced. In sum, the French national health insurance system has become less and less efficient over the years.

Concentration-dependent plasma protein binding of the novel dipeptidyl peptidase 4 inhibitor BI 1356 due to saturable binding to its target in plasma of mice, rats and humans.

OBJECTIVES: The purpose of this study was to characterise the plasma protein binding of BI 1356. METHODS: BI 1356 (proposed trade name ONDERO) is a novel dipeptidyl peptidase 4 (DPP-4) inhibitor, which is under clinical development for the treatment of type 2 diabetes. DPP-4 is expressed in various tissues but soluble DPP-4 is also present in plasma. Therefore, binding to soluble DPP-4 may influence the pharmacokinetics of BI 1356. Plasma protein binding of BI 1356 was determined in vitro for wild type mice and rats and the results compared with those for DPP-4 knockout mice and DPP-4 deficient Fischer rats. In addition, protein binding of BI 1356 was examined in plasma from healthy human volunteers and renal excretion of the compound in the DPP-4 knockout mice was compared with that occurring in wild type mice. KEY FINDINGS: The results showed that BI 1356 exhibited a prominent concentration-dependent plasma protein binding due to a saturable high affinity binding to the DPP-4 target in plasma. Differences in renal excretion of BI 1356 between DPP-4 knockout mice and wild type mice suggested that saturable binding of BI 1356 to DPP-4 in the body also influenced elimination. CONCLUSIONS: High affinity, but readily saturable binding of BI 1356 to its target DPP-4 accounted primarily for the concentration-dependent plasma protein binding at therapeutic plasma concentrations of BI 1356.

Protection of cellular and mitochondrial functions against liver ischemia by N-benzyl-N'-(2-hydroxy-3,4-dimethoxybenzyl)-piperazine (BHDP), a sigma1 ligand.

We investigated the antiischemic properties of a new compound N-benzyl-N'-(2-hydroxy-3,4-dimethoxybenzyl)-piperazine (BHDP), having high affinity and selectivity for the sigma(1) receptor, in two different models of ischemia. The first was an experimental model of rat liver normothermic ischemia-reperfusion. Rats were pretreated with different doses of BHDP (0.5, 2.5 or 10 mg/kg/day, or solvent alone) and subjected to 90 min normothermic ischemia followed by either 30 or 120 min reperfusion. The second model was a hypothermic model of ischemia in which livers were incubated for 24 h at 4 degrees C in a preservation solution in the absence or presence of increasing BHDP concentrations (0.5, 2.5 or 10 microg/ml). These different ischemic conditions induced huge alterations in hepatocyte functions (membrane leakage of alanine aminotransferase and aspartate aminotransferase, decreased metabolic capacities evaluated by the ability of the liver to transform lidocaine, alterations of mitochondrial functions characterized by a decrease in ATP synthesis and the appearance of histological damages). Pretreatment of rats with BHDP alleviated these deleterious ischemia-reperfusion effects in a dose-dependent manner at both the cellular and mitochondrial levels. The protection of mitochondrial functions was almost complete at a dosage of 10 mg/kg/day during normothermic ischemia and 10 microg/ml in the preservation liquid during hypothermic ischemia. In addition, BHDP significantly reduced the histological damage. These data demonstrate that BHDP protects liver against the deleterious effects of ischemia-reperfusion and suggest that sigma(1) receptors play an important role in the protective effect.

[Self-medication and safety]. / Automédication et sécurité.

Most drugs used for self-medication act on pain, diarrhea, constipation, gastric acid hypersecretion, or allergic diseases. They are generally well-tolerated, provided the recommended dose regimen is respected. Most adverse effects result from misuse (wrong indication, overdose, interactions, etc.). Self-medication can also be harmful by masking an underlying disease. Most of these untoward effects are avoidable. Severe adverse effects requiring hospital admission are easy to identify, but some milder reactions may only be discovered by chance. We discuss how to improve the safety of self-medication, particularly by involving public health stakeholders such as general practitioners, pharmacists and pharmaceutical firms, both through personal contact with self-medication users and through the mass media.

Effect of the mitochondrial transition pore inhibitor, S-15176, on rat liver mitochondria: ATP synthase modulation and mitochondrial uncoupling induction.

S-15176 is a new inhibitor of the permeability transition pore (PTP) which has been shown to display anti-ischemic properties. We show here that S-15176 prevented PTP, cytochrome c release and maintained mitochondrial membrane potential when low concentrations of S-15176 were used (not exceeding 50 nmol/mg protein). For higher concentrations S-15176 is able to collapse mitochondrial potential. This effect was reversed by the recoupling agent 6-ketocholestanol (6-KCh) suggesting that S-15176 has uncoupling properties. In addition, S-15176 is able to inhibit ATP synthase activity and to stimulate the hydrolytic activity of the enzyme but none of these effects appears to be related to its PTP inhibiting property. These data demonstrate that S-15176 interacts with several targets in mitochondria and these pharmacological properties should be considered in the examination of its health benefits as well as its potential cytotoxicity.

[Drug binding to blood proteins: characteristics, roles and pathophysiological changes]. / Liaisons des médicaments aux protéines circulantes: caractéristiques, rôles et modifications physio-pathologiques.

HSA and AGP are the only plasma proteins capable of binding drugs through specific sites with high affinity. As such, they can limit drug distribution and, sometimes, drug elimination. Such binding is called restrictive. Low binding capacities are said to be permissive, as they do not lead to drug retention. Modifications of restrictive binding can influence other pharmacokinetic parameters and also have clinical implications.

Resveratrol protects against cold ischemia-warm reoxygenation-induced damages to mitochondria and cells in rat liver.

Ischemia-reperfusion is a critical event in the development of primary graft dysfunctions after liver transplantations. Ischemia-reperfusion causes cell injuries which are related to the successive cold preservation-warm reperfusion (CPWR) periods required by the graft. Recent evidences suggest that oxidative stress plays an important role in the development of these injuries and that mitochondrial dysfunctions are involved. The purpose of this study was to investigate the effect of the natural phytoalexin resveratrol on the prevention of liver injuries induced by 40-h cold preservation followed by a warm reperfusion. CPWR induced liver mitochondrial and cellular damages as attested by the increase in lipid peroxidation of liver membranes, the alteration of oxidative phosphorylation parameters, mitochondrial swelling and the activation of the cellular markers of necrosis and apoptosis, i.e., lactate dehydrogenase (LDH) leakage, mitochondrial cytochrome c release and caspase activation. Resveratrol inhibits lipid peroxidation and protects mitochondrial functions. It improves respiratory chain activity and prevents opening of the permeability transition pore, allowing better recovery of ATP energetic charge. Resveratrol also limits the activation of the cellular markers of necrosis and apoptosis. These protective effects could be related to the antioxidant properties of the drug but also to its membrane-stabilizing activity. Indeed, further experiments demonstrate that resveratrol is able to prevent the release of cytochrome c caused by oxygen deprivation in isolated liver mitochondria. These data demonstrate that resveratrol ameliorates the liver injury induced by CPWR and appears as a promising drug to improve the primary function of the grafted liver after transplantation.

Effect of ethanol and red wine on ochratoxin a-induced experimental acute nephrotoxicity.

Ochratoxin A (OTA), is a nephrotoxic mycotoxin present in wine, which is nephrotoxic in humans. Our working hypothesis is that natural substances in wine may counteract OTA toxicity. Thirty-six rats were randomized to OTA dissolved in saline, red wine, or 13.5% ethanol or to OTA-free wine, ethanol, or saline. OTA (289 microg/kg of body weight/48 h) was administered by gastric gavage for 2 weeks. Serum creatinine, tubular enzymuria, renal lipohydroperoxides (LOOH), reduced (GSH) and oxidized (GSSG) glutathione, and renal superoxide dismutase activity (SOD) were determined in renal tissue. OTA alone produced significant increases in renal lipoperoxides and significant decreases in SOD and GSH/GSSG ratio. In red wine or ethanol, OTA was less nephrotoxic, reducing oxidative damage as revealed by LOOH. In OTA-wine and OTA-ethanol groups, SOD activity was higher than in the OTA-treated one, suggesting that both ethanol and nonalcoholic fractions may preserve antioxidant reserve. GSH/GSSG ratio was significantly preserved only in the OTA-wine group and not in OTA-ethanol. Red wine may exert a protective effect against OTA nephrotoxicity by limiting oxidative damage. The ostensible protection afforded by ethanol deserves further investigation.

Effects of curcumin and curcumin derivatives on mitochondrial permeability transition pore.

Curcumin (1,7-bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione) is a natural compound with antiproliferative properties. Recent studies suggest that these properties might be due to the ability of curcumin to induce apoptosis in tumor cells by increasing the permeability of the mitochondrial membrane. In the present study, we confirm these observations and provide a molecular mechanism for the action of curcumin in rat liver mitochondria. Curcumin induced mitochondrial swelling, the collapse of Deltapsi, and the release of cytochrome C, events associated with the opening of the permeability transition pore (PTP). Experiments were performed with chemically substituted curcumin derivatives. Some derivatives were obtained by modification of groups on the terminal aromatic rings, and others were obtained by substitution of the diketone function with the cyclohexanone function. They demonstrated that phenol and methoxy groups were essential to promote PTP opening. Curcumin and curcumin derivatives that open the PTP were able to oxidize thiol groups. In addition, PTP opening was abolished in medium devoid of O2 and decreased in the presence of catalase, ferrozine, o-phenanthroline, mannitol, or N-ethylmaleimide. These data suggest that the mechanism by which curcumin promotes PTP opening involves the reduction of Fe3+ to Fe2+, inducing hydroxyl radical (HO*) production and oxidation of thiol groups in the membrane, leading to pore opening.

[3H]BHDP as a novel and selective ligand for sigma1 receptors in liver mitochondria and brain synaptosomes of the rat.

The binding profile of [(3)H]BHDP ([(3)H]N-benzyl-N'-(2-hydroxy-3,4-dimethoxybenzyl)-piperazine) was evaluated. [(3)H]BHDP labelled a single class of binding sites with high affinity (K(d)=2-3 nM) in rat liver mitochondria and synaptic membranes. The pharmacological characterization of these sites using sigma reference compounds revealed that these sites are sigma receptors and, more particularly, sigma1 receptors. Indeed, BHDP inhibited [(3)H]pentazocine binding, a marker for sigma1 receptors, with high affinity in a competitive manner. BHDP is selective for sigma1 receptors since it did not show any relevant affinity for most of the other receptors, ion channels or transporters tested. Moreover, in an in vitro model of cellular hypoxia, BHDP prevented the fall in adenosine triphosphate (ATP) levels caused by 24 h hypoxia in cultured astrocytes. Taken together, these results demonstrate that [(3)H]BHDP is a potent and selective ligand for sigma1 receptors showing cytoprotective effects in astrocytes.

Fluoride curcumin derivatives: new mitochondrial uncoupling agents.

The mitochondrial effects of two fluoride curcumin derivatives were studied. They induced the collapse of mitochondrial membrane potential (DeltaPsi), increased mitochondrial respiration, and decreased O(2)*- production and promoted Ca(2+) release. These effects were reversed by the recoupling agent 6-Ketocholestanol, but not by cyclosporin A, an inhibitor of the permeability transition pore (PTP), suggesting that these compounds act as uncoupling agents. This idea was reinforced by the analysis of the physico-chemical properties of the compounds indicating, that they are mainly in the anionic form in the mitochondrial membrane. Moreover, they are able to induce PTP opening by promoting the oxidation of thiol groups and the release of cytochrome c, making these two molecules potential candidates for induction of apoptosis.

Tacrolimus and sirolimus decrease oxidative phosphorylation of isolated rat kidney mitochondria.

1. Tacrolimus and sirolimus are potent immunosuppressors used in transplantation. Tacrolimus has been suspected to alter mitochondrial respiration of different tissues but sirolimus has not been evaluated. 2. We evaluated the in vitro effect of tacrolimus and sirolimus on oxidative phosphorylation of isolated rat kidney mitochondria. 3. Oxygen consumption was measured with a Clark-type electrode. Tacrolimus and sirolimus increased the resting rate (state 4) and had no significant effect on ADP-stimulated respiration (state 3). The decrease of respiratory control ratio was concentration-dependent with a biphasic curve for tacrolimus. The EC(50)s were 3.4 x 10(-11) M and 2.3 x 10(-8) M for tacrolimus and 4.4 x 10(-10) M for sirolimus. The maximal inhibition was 20 and 14% for tacrolimus and sirolimus, respectively. 4. Tacrolimus and sirolimus had an uncoupling effect on oxidative phosphorylation related to a decrease of the inner membrane fluidity. At the opposite of cyclosporin A, no effect on swelling or Ca(2+) fluxes was observed. 5. All events occurred at therapeutic concentrations and then could appear during long-term treatment. Cellular consequences such as chronic nephrotoxicity with tacrolimus are suggested. The risk of cyclosporin A nephrotoxicity potentiation by sirolimus is discussed.

Evidence for sigma-1-like receptors in isolated rat liver mitochondrial membranes.

1. Sigma (sigma) receptors have generated a great deal of interest on the basis of their possible roles in various pathologies, including cytoprotection. Although the exact function of sigma-1 (sigma(1)) receptors is not yet known, their role in the regulation of intracellular Ca(2+) levels and sterol biosynthesis, functions that could be assigned to mitochondria, are the only mechanisms described. 2. Using preparations of purified rat liver and brain mitochondria we demonstrate herein the presence of sigma-like binding sites. [(3)H](+)-pentazocine, a sigma(1) radioligand was used to label these sites. 3. In the liver, [(3)H](+)-pentazocine labelled one class of binding sites with high affinity (K(d)=3 nM), similar to that observed in liver microsomes and synaptic membranes. These sites were located on the outer mitochondrial membranes and displayed high affinity for other sigma(1) ligands namely, haloperidol, ifenprodil, carbetapentane or 1,3-di(2-tolyl)guanidine (DTG). 4. The presence of sigma(1) receptors on liver mitochondria was confirmed using double fluorescence immunostaining. 5. [(3)H](+)-pentazocine binding sites were also found on brain mitochondria but they appeared pharmacologically distinct to the liver ones as [(3)H](+)-pentazocine and typical sigma(1) ligands displayed lower affinities for these sites. Nevertheless, [(3)H](+)-pentazocine binding on both liver and brain mitochondria was modulated by progesterone, a putative endogenous ligand for sigma receptors. 6. Our data demonstrates the presence of [(3)H](+)-pentazocine binding sites with pharmacological characteristics identical to sigma(1) receptors on rat liver mitochondrial membranes. The pharmacological significance of these sites and their role on mitochondrial function remain unknown.

Compared pharmacological characteristics in humans of racemic cetirizine and levocetirizine, two histamine H1-receptor antagonists.

The potent histamine H(1)-receptor antagonist cetirizine (Zyrtec) is a racemic mixture of levocetirizine (now available under the trademark Xyzal and dextrocetirizine. In this Commentary, we examine some biological properties of cetirizine and levocetirizine, namely enantioselectivity in pharmacological activity and pharmacokinetic properties, with emphasis on the possibility of racemization, the compared behavior of the two enantiomers, and the potential for interactions with other drugs. Recent data demonstrate that the antihistaminergic activity of the racemate is primarily due to levocetirizine. Levocetirizine is rapidly and extensively absorbed, poorly metabolized, and not subject to racemization. Its pharmacokinetic characteristics are comparable after administration alone or in the racemate. Its apparent volume of distribution is smaller than that of dextrocetirizine (0.41 L kg(-1) vs. 0.60 L kg(-1)). Moreover, the non-renal (mostly hepatic) clearance of levocetirizine is also significantly lower than that of dextrocetirizine (11.8 mL min(-1) vs. 29.2 mL min(-1)). Our conclusion is that levocetirizine is indeed the eutomer of cetirizine. The evidence reviewed here confirms preclinical findings and offers a rationale for the chiral switch from the racemate to levocetirizine.

Role of the permeability transition pore in cytochrome C release from mitochondria during ischemia-reperfusion in rat liver.

Ischemia and reperfusion cause mitochondrial dysfunctions that initiate the mitochondrial apoptosis pathway. They involve the release of cytochrome C and the activation of the caspase cascade but the mechanism(s) leading to cytochrome C release is(are) poorly understood. The aim of this study was to analyse the relation between cytochrome C release and the opening of the permeability transition pore (PTP) during in situ liver ischemia and reperfusion. Liver ischemia was induced for 30, 60 and 120 min and blood re-flow was subsequently restored for 30 and 180 min. Ischemia hugely altered mitochondrial functions, i.e., oxidative phosphorylation and membrane potential, and was accompanied by a time-dependent mitochondrial release of cytochrome C into the cytosol and by activations of caspases-3 and -9. PTP opening was not observed during ischemia, as demonstrated by the absence of effect of an in vivo pre-treatment of rats with cyclosporin A (CsA), a potent PTP inhibitor. Cytochrome C release was due neither to a direct effect of caspases onto mitochondria nor to an interaction of Bax or Bid with the mitochondrial membrane but could be related to a direct effect of oxygen deprivation. In contrast, during reperfusion, CsA pre-treatment inhibits cytochrome C release, PTP opening and caspase activation. At this step, cytochrome C release is likely to occur as a consequence of PTP opening. In conclusion, our study reveals that cytochrome C release, and thus the induction of the mitochondrial cell death pathway, occur successively independently and dependent on PTP opening during liver ischemia and reperfusion, respectively.

Dual effect of ebselen on mitochondrial permeability transition.

This study reports an investigation on the effect of the seleno-organic compound ebselen on rat liver mitochondria. We show that low concentrations of ebselen induced an increase in rat liver mitochondrial membrane permeability, resulting in swelling and loss of membrane potential. These effects were mediated by the opening of the permeability transition pore. They required Ca(2+), were independent of pyridine nucleotide oxidation, and involved the oxidation of thiol groups. Ebselen pore induction is apparently promoted by the glutathione peroxidase mimicking activity of the drug. Opposite effects, that is, inhibition of both pore opening and thiol oxidation, were observed when concentrations higher than 20 micro M were used. These data demonstrate that ebselen is able to modulate the opening of the permeability transition pore and that it might be a critical event for both the proapoptotic and cytoprotective activities of the drug.

Recognition forces involved in mitochondrial binding to a low-affinity trimetazidine binding site related to anti-ischemic activity.

A number of heterogeneous drugs previously shown to bind to trimetazidine (TMZ) binding sites on mitochondria and to inhibit mitochondrial swelling (Morin et al., Br J Pharmacol 1998;123:1385-94) were investigated here for their physicochemical properties. The molecular parameters measured were the partition coefficients of the neutral and monocationic forms in the n-octanol/water and dichloroethane/water systems, their distribution coefficients at pH 7.4 in these two solvent systems, as well as their distribution coefficients at pH 7.4 in a phosphatidylcholine (PhC) liposomes/water system (log D(lip)(7.4)). Most of these properties were not correlated with affinity to mitochondria or inhibition of mitochondrial swelling. In contrast, log D(lip)(7.4) showed a modest correlation with binding to the low-affinity site (r(2)=0.52) and a better correlation with anti-swelling activity (r(2)=0.69), itself well correlated with binding to the low-affinity sites (r(2)=0.83). Thus, these sites have recognition properties much like those of membranes, as they depend on lipophilicity-hydrophobicity (core binding) and ionic bonds (surface interactions).