RESUMEN
BACKGROUND: Despite the recognized benefits of physical activity (PA), the extent of its recognition and applications as a medical disability (MD) prevention program by practitioners working in Ethiopian health-care settings is unknown. OBJECTIVE: The objective of the study was to explore health-care professionals' knowledge base and characteristics on the utilization of the frequency, intensity, time (duration), and type principle (FITT) of PA as an MD prevention program in the Ethiopian public health-care system. METHODS: A mixed-method research design was used with data collected from 13 public referral hospitals in Ethiopia. In Phase I, quantitative data were collected from 312 health professionals (99 physicians and 213 nurses) using a survey. In Phase II, qualitative data were collected by interviewing health officers (n = 13 physician-hospital managers) and conducting one focus group discussion (n = 6 national health bureau officers). RESULTS: A quarter (28%) of practitioners working in referral hospitals are using PA as an MD prevention program. Higher specialization (adjusted odds ratio [AOR] = 20.203, P < 0.001), many service years (AOR = 0.041, P = 0.014), young age (AOR = 19.871, P < 0.001), and being male (AOR = 0.269, P < 0.001) were associated with using PA as a MDs prevention program. CONCLUSION: Applying the FITT principle of PA for the prevention of MD among practitioners was very poor. Training of health-care professionals to use PA as a program for MDs prevention is required at the undergraduate level as well as specialized courses on qualification.
Asunto(s)
Personas con Discapacidad , Ejercicio Físico , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Adulto , Factores de Edad , Etiopía , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Especialización , Factores de TiempoRESUMEN
Peatlands are a major carbon (C) sink globally. Organic matter quality influence greenhouse gases production. However, little is known about how organic matter from different vegetation types, influences C composition and resultant greenhouse gases production in subtropical peatland. Anoxic incubation experiments were conducted using two types of peats with different botanical origin to assess C composition, CO2 and CH4 production. First peat had cypress dominance and the second knotted spikerush and water lily (spike + lily). Solid-state CPMAS 13C NMR determined C chemical stability, MESTA determined C thermal stability, stable isotopes for C source and gas chromatograph for carbon dioxide (CO2) and methane (CH4). The results indicated dominance of autochthonous C as indicated by δ13C signatures. Low thermal stable C (LTSC) dominated in litter, FL (fermentation layer) and spike + lily sediment, high thermal stable C was dominant in cypress peat. O-alkyl C strongly correlated with LTSC whereas aromatic C correlated negatively with R400 (LTSC:total C ratio). Generally, O-alkyl decreased and alkyl increased along litter-FL-peat continuum. Spike + lily peat exhibited initial stage of decomposition. Indicated by increased alkyl C, aromatic C and aromatic:O-alkyl ratio with increasing peat depth. Also, exhibited 3 times more CH4 and CO2 production compared to cypress peat that dominantly exhibited second stage of decomposition. O-alkyl C exhibited positive relationship with CH4 (P = 0.012, r2 = 0.57) and CO2 (P = 0.047, r2 = 0.41) production whereas R400 related positively with CH4 (P = 0.05, r2 = 0.40). Organic matter thermal and chemical composition varied between the peat types and thermally and chemically labile C influenced CO2 and CH4 production.
RESUMEN
The antimalarial peroxide, dispiro-1,2,4,5-tetraoxane WR 148999, was synergistic with chloroquine, quinine, mefloquine, and artemisinin against both D6 and W2 clones of Plasmodium falciparum. In consideration of the contrasting antagonism between artemisinin and chloroquine, these drug combination data imply that WR 148999 and artemisinin may not share a common mechanism of action. For Plasmodium berghei-infected mice given oral, subcutaneous, and intraperitoneal doses of WR 148999 ranging from 2 to 1024 mg/kg in the Thompson test, median survival times were 8.8, 11.8, and 27.5 days, respectively, compared to 8 days for control animals. Using subcutaneous administration, WR 148999 had a considerably longer duration of action than did artemisinin against P. berghei. WR 148999 did not significantly inhibit cytochrome P450 isozymes CYP 2C9, 2C19, 2D6, 2E1, or 3A4 (IC50 >500 microM) but did inhibit CYP 1A2 with an IC50 value of 36 microM, suggesting that WR 148999 may be metabolized by the latter CYP isozyme. These results combined with previous observations that formulation strategies and incorporation of polar functional groups in a series of WR 148999 analogs both failed to enhance tetraoxane oral antimalarial activity suggest that oral bioavailability of tetraoxane WR 148999 is more likely a function of extensive first-pass metabolism rather than solubility-limited dissolution.
Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas , Malaria/tratamiento farmacológico , Plasmodium berghei/efectos de los fármacos , Plasmodium falciparum/efectos de los fármacos , Compuestos de Espiro/uso terapéutico , Tetraoxanos , Animales , Antimaláricos/farmacología , Cloroquina/farmacología , Cloroquina/uso terapéutico , Inhibidores Enzimáticos del Citocromo P-450 , Interacciones Farmacológicas , Resistencia a Medicamentos , Quimioterapia Combinada , Eritrocitos/efectos de los fármacos , Eritrocitos/parasitología , Humanos , Lactonas/uso terapéutico , Malaria/parasitología , Malaria Falciparum/parasitología , Ratones , Sesquiterpenos/uso terapéutico , Compuestos de Espiro/administración & dosificación , Compuestos de Espiro/farmacologíaRESUMEN
Products of the reaction of 4-hydroxy-2-nonenal (4HNE) with native and heat-denatured Leuconostoc mesenteroides glucose-6-phosphate dehydrogenase (G6PDH) were analyzed to determine the structure and position of the protein modifications. Matrix assisted laser desorption time-of-flight mass spectrometry was used to measure molecular weights of the modified proteins and determine mass maps of peptides formed by digestion with cyanogen bromide. The molecular weight data show that one to two 4HNE molecules add to each subunit of native enzyme while approximately nineteen 4HNE molecules add to each subunit of heat-denatured enzyme. Peptides are observed in the cyanogen bromide mass map of modified native G6PDH that are consistent with selective modification of two segments of the amino acid sequence. One modified segment contains Lysine-182 that has been found to be part of the enzyme active site. Peptides are observed in the cyanogen bromide mass map of modified heat-denatured enzyme that are consistent with extensive modification of several segments of the amino acid sequence. The magnitude of the mass differences between modified and unmodified peptides were approximately 156 Da, consistent with a 1,4-addition of 4HNE. These results support the conclusion that 4HNE inactivates G6PDH by selectively modifying only two or three sites in the protein by a 1,4-addition reaction and that some aspect of the tertiary structure of the enzyme directs those modification reactions.
Asunto(s)
Aldehídos/química , Glucosafosfato Deshidrogenasa/química , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Aldehídos/metabolismo , Sitios de Unión , Bromuro de Cianógeno/química , Glucosafosfato Deshidrogenasa/metabolismo , Calor , Rayos Láser , Peso Molecular , Fragmentos de Péptidos/química , Conformación Proteica , Desnaturalización Proteica , Factores de TiempoRESUMEN
Metabolism and disposition of most drugs used to treat malaria are substantially altered in malaria infection. Few data are available that specify effects of malaria infection on drug metabolism pathways in humans or animal model systems. In this report, studies were undertaken to determine the effect of Plasmodium berghei infection on cytochrome P-450 (CYP450) 2E1 and 3A2-mediated metabolism and enzyme expression in rat liver microsomes. Malaria infection (MAL) resulted in significant decreases in total cytochrome P-450 content (56%, P < 0.05) and NADPH cytochrome P-450 reductase activity (32%, P < 0.05) as compared to control (CON) rats. Chlorzoxazone 4-hydroxylase activity (CYP2E1-mediated) showed no significant difference between CON and MAL microsomes while testosterone 6-beta-hydroxylase activity (CYP3A2-mediated) was reduced by 41% (P < 0.05) in MAL. Enzyme kinetic studies and immunoblot analysis indicate that the loss of activity for CYP3A2 in malaria infection is due to significantly decreased CYP3A2 protein expression. The altered expression of CYP450s in malaria infection should be taken into account when treating patients with malaria in order to minimize drug-drug interactions or toxicity.
Asunto(s)
Sistema Enzimático del Citocromo P-450/metabolismo , Hígado/metabolismo , Malaria/metabolismo , Microsomas Hepáticos/metabolismo , NADPH-Ferrihemoproteína Reductasa/metabolismo , Plasmodium berghei , Animales , Clorzoxazona/análisis , Citocromo P-450 CYP2E1/genética , Citocromo P-450 CYP2E1/metabolismo , Sistema Enzimático del Citocromo P-450/genética , Densitometría , Immunoblotting , Técnicas In Vitro , Hígado/enzimología , Malaria/enzimología , Masculino , Microsomas Hepáticos/enzimología , Oxigenasas de Función Mixta/genética , Oxigenasas de Función Mixta/metabolismo , NADPH-Ferrihemoproteína Reductasa/genética , Plasmodium berghei/fisiología , Ratas , Ratas Sprague-Dawley , Esteroide Hidroxilasas/genética , Esteroide Hidroxilasas/metabolismo , Testosterona/análisisRESUMEN
Debrisoquine 4-hydroxylase is a unique cytochrome P450 that effects oxidation of protonated substrates at sites distal from the basic nitrogen. A basic tenet of the several models that have been proposed for the active site of P450 2D6 is that oxidation occurs at distances of approximately 5 or approximately 7 A from the protonated site. In this study, the metabolism of both stereoisomers of deprenyl, a therapeutically valuable monoamine oxidase B inhibitor, was shown to produce N-demethylation and N-depropargylation of the sole basic nitrogen in the molecule by recombinant cytochrome P450 2D6. N-Demethylation of L-(-)-deprenyl leading to nordeprenyl was favored by approximately 13:1 over N-depropargylation which produced methamphetamine. The Km and kcat values for formation of methamphetamine, the minor metabolite, were 56 +/- 5 microM and 0.63 +/- 0.063 nmol of methamphetamine min-1 (nmol of P450)-1, respectively; the kcat for nordeprenyl formation was approximately 8.2 nmol of nordeprenyl min-1 (nmol of P450)-1. Although these pathways would be the anticipated processes for monoamine oxidases and most cytochrome P450s, this mode of biotransformation is not predicted by current active site models and represents a novel pathway for P450 2D6. Statistical analysis indicates that the therapeutically important L-(-)-isomer was preferentially metabolized [kcat/Km (-)/(+) ratio = 2.66]. Competitive inhibition of deprenyl metabolism by both quinidine and quinine with an approximate 10(3) differential confirms that this metabolic pathway is P450 2D6 mediated.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Sistema Enzimático del Citocromo P-450/metabolismo , Oxigenasas de Función Mixta/metabolismo , Selegilina/metabolismo , Animales , Cromatografía Líquida de Alta Presión , Citocromo P-450 CYP2D6 , Cromatografía de Gases y Espectrometría de Masas , Humanos , Técnicas In Vitro , Masculino , Microsomas Hepáticos/efectos de los fármacos , Microsomas Hepáticos/enzimología , Modelos Moleculares , Fenobarbital/farmacología , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes/metabolismo , Selegilina/farmacocinética , EstereoisomerismoRESUMEN
1. Artelinic acid (AL), a water-soluble artemisinin analogue for treatment of multidrug resistant malaria, is metabolized to the active metabolite dihydroqinghaosu (DQHS) solely by CYP3A4/5. Although AL is not metabolized by CYP2C9, it does inhibit diclofenac 4-hydroxylase activity with an IC50 = 115 microM. Interestingly, AL activates CYP2D6-mediated bufuralol metabolism in human liver microsomes but not recombinant CYP2D6-Val by approximately 30% at AL concentrations up to 100 microM. 2. In human liver microsomes, AL is metabolized to DQHS with a Km = 157 +/- 44 microM and Vmax = 0.77 +/- 0.56 nmol DQHS/min/mg protein. Human recombinant CYP3A4 catalysed the conversion of AL to DQHS with a Km = 102 +/- 23 microM and a Vmax = 1.96 +/- 0.38 nmol DQHS/min/nmol P450. The kinetic parameters (Km and Vmax) for DQHS formation from CYP3A5 were 189 +/- 19 microM and 3.60 +/- 0.42 nmol DQHS/min/nmol P450 respectively. 3. Inhibition studies suggest that azole antifungals and calcium channel blockers may present clinically significant drug drug interactions. In human liver microsomes, ketoconazole and miconazole were potent competitive inhibitors of DQHS formation with a Ki = 0.028 and 0.124 microM respectively. Verapamil is a non-competitive inhibitor of DQHS formation in human liver microsomes with a Ki = 15 microM.
Asunto(s)
Antimaláricos/metabolismo , Artemisininas , Hidrocarburo de Aril Hidroxilasas , Sistema Enzimático del Citocromo P-450/metabolismo , Hígado/metabolismo , Oxidorreductasas N-Desmetilantes/metabolismo , Sesquiterpenos/metabolismo , Adulto , Anciano , Antifúngicos/farmacología , Citocromo P-450 CYP2D6/inmunología , Citocromo P-450 CYP2D6/metabolismo , Citocromo P-450 CYP2D6/farmacología , Citocromo P-450 CYP3A , Sistema Enzimático del Citocromo P-450/efectos de los fármacos , Combinación de Medicamentos , Interacciones Farmacológicas , Medicamentos Herbarios Chinos/farmacología , Inhibidores Enzimáticos/farmacología , Femenino , Glycyrrhiza , Humanos , Inactivación Metabólica , Concentración 50 Inhibidora , Isoenzimas/efectos de los fármacos , Isoenzimas/metabolismo , Cetoconazol/farmacología , Hígado/efectos de los fármacos , Masculino , Miconazol/farmacología , Microsomas Hepáticos/efectos de los fármacos , Microsomas Hepáticos/metabolismo , Persona de Mediana Edad , Oxidorreductasas N-Desmetilantes/efectos de los fármacos , Paeonia , Quinidina/farmacología , Proteínas Recombinantes/farmacología , Sulfafenazol/farmacología , Troleandomicina/farmacología , Vasodilatadores/farmacología , Verapamilo/farmacologíaRESUMEN
PURPOSE: To study the reaction of artelinic acid with chemical model systems of cytochrome P-450 as a means of obtaining authentic samples of the putative metabolites necessary for identification of the mammalian metabolites of artelinic acid. METHODS: Artelinic acid was reacted with different organic complexes of iron(II). The reaction products were isolated and characterized by NMR and thermospray mass spectroscopy. RESULTS: Five compounds which are putative metabolites of artelinic acid were isolated from these reactions and unambiguously identified, while the identity of two other compounds await final confirmation. CONCLUSIONS: Standards of possible metabolites of artelinic acid can be produced by the reaction of the compound with ferrous complexes that may simulate cytochrome P-450 catalyzed metabolism of xenobiotics. This approach may provide a simple and versatile method for the formation of metabolites of artemisinin compounds which is more advantageous than previous approaches with fungal-based systems.
Asunto(s)
Antimaláricos/metabolismo , Artemisininas , Sistema Enzimático del Citocromo P-450/metabolismo , Sesquiterpenos/metabolismo , Antimaláricos/química , Benzoatos/química , Cromatografía Líquida de Alta Presión , Compuestos Ferrosos/química , Hemina/química , Espectrometría de Masas , Oxiquinolina/química , Sesquiterpenos/química , Compuestos de Sulfhidrilo/química , TimerosalRESUMEN
Mitonafide (4-nitro-benzoisoquinolinedione) and a number of structural analogs were synthesized and studied in order to determine the structural requirements for inhibition of leishmanial nuclear and kinetoplast topoisomerase II and human topoisomerase II. The structure-activity relationship studies with the mitonafide analogs demonstrated that there was selective targeting of leishmanial nuclear topoisomerase II and human topoisomerase II and differential targeting of kinetoplast over nuclear topoisomerase II in the parasite. Mitonafide analogs appeared to have multiple mechanisms of action leading to death of leishmanias, but several compounds that affected kinetoplast but not nuclear topoisomerase II were not cytotoxic as determined by short-term assays. These studies provide new insight into the differential sensitivities of leishmanial nuclear and kinetoplast topoisomerase II to topoisomerase II-targeting drugs.
Asunto(s)
Inhibidores Enzimáticos/farmacología , Imidas/farmacología , Sustancias Intercalantes/farmacología , Isoquinolinas/farmacología , Leishmania infantum/enzimología , Inhibidores de Topoisomerasa II , Animales , Núcleo Celular/efectos de los fármacos , Núcleo Celular/metabolismo , Daño del ADN , ADN de Helmintos/metabolismo , ADN de Cinetoplasto/metabolismo , Electroforesis en Gel de Poliacrilamida , Leishmania infantum/efectos de los fármacos , Leishmania infantum/metabolismo , Naftalimidas , Relación Estructura-ActividadRESUMEN
beta-Arteether (AE) is an endoperoxide sesquiterpene lactone derivative currently being developed for the treatment of severe, complicated malaria caused by multidrug-resistant Plasmodium falciparum. Studies were undertaken to determine which form(s) of human cytochrome P-450 catalyze the conversion of beta-arteether to its deethylated metabolite, dihydroqinghaosu (DQHS), itself a potent antimalarial compound. In human liver microsomes, AE was metabolized to DQHS with a Km of 53.7 +/- 29.5 microM and a Vmax of 1.64 +/- 1. 78 nmol DQHS/min/mg protein. AE biotransformation to DQHS was inhibited by ketoconazole and troleandomycin. Ketoconazole was a competitive inhibitor, with an apparent Ki of 0.33 +/- 0.11 microM. Because AE is being developed for patients who fail primary treatment, it is possible that AE may be involved in life-threatening drug-drug interactions, such as the associated cardiotoxicity of mefloquine and quinidine. Coincubation of AE with other antimalarials showed mefloquine and quinidine to be competitive inhibitors with a mean Ki of 41 and 111 microM, respectively. Metabolism of AE using human recombinant P450s provided evidence that cytochrome P450s 2B6, 3A4, and 3A5 were the primary isozymes responsible for its deethylation. CYP3A4 metabolized AE to dihydroqinghaosu at a rate approximately 10 times that of CYP2B6 and approximately 4.5-fold greater than that of CYP3A5. These results demonstrate that CYP3A4 is the primary isozyme involved in the metabolism of AE to its active metabolite, DQHS, with secondary contributions by CYP2B6 and -3A5.
Asunto(s)
Antimaláricos/metabolismo , Artemisininas , Sistema Enzimático del Citocromo P-450/metabolismo , Microsomas Hepáticos/metabolismo , Sesquiterpenos/metabolismo , HumanosRESUMEN
Arteether (AE) is primarily deethylated to dihydroqinghaosu (DQHS) in rats and humans. Conversion of AE to DQHS was impaired in microsomes from rats infected with Plasmodium berghei. The Km for AE was 175.1 +/- 49.1 and 124.4 +/- 115.1 mumol/l, and Vmax was 2.24 +/- 0.45 and 1.22 +/- 0.67 nmol AE formed/mg protein/min in control and infected microsomes (p < 0.05), respectively. Calculated intrinsic clearance (CLint = initial Vmax/Km) for AE was only 4% lower in infected microsomes. Apparent pharmacokinetic parameter estimates for AE using the isolated perfused rat liver demonstrated no differences (p > 0.05) in volume of distribution, clearance, and half-life between normal and infected animals. Malaria infection resulted in decreased biliary excretion of free AE and DQHS. The majority of AE is eliminated via biliary excretion of conjugated DQHS, which is approximately 500-fold higher than free DQHS and 75-fold higher than free AE on a molar basis.