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1.
Phys Rev Lett ; 106(5): 052501, 2011 Feb 04.
Article in English | MEDLINE | ID: mdl-21405386

ABSTRACT

We measured with unprecedented precision the induced polarization P(y) in (4)He(e,e'p)(3)H at Q(2)=0.8 and 1.3 (GeV/c)(2). The induced polarization is indicative of reaction-mechanism effects beyond the impulse approximation. Our results are in agreement with a relativistic distorted-wave impulse approximation calculation but are overestimated by a calculation with strong charge-exchange effects. Our data are used to constrain the strength of the spin-independent charge-exchange term in the latter calculation.

2.
Lung ; 189(1): 73-9, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21240613

ABSTRACT

We postulate that most patients with chronic cough have a single discrete clinical entity: cough hypersensitivity syndrome. We constructed a questionnaire that elicits the major components of the syndrome. Here we describe the validation of this questionnaire. Following iterative development, the Hull Airway Reflux Questionnaire (HARQ) was administered to patients and normal volunteers. It is self-administered and comprises 14 items with a maximum score of 70. Unselected patients were recruited sequentially from the Hull Cough Clinic. Preclinic questionnaires were compared with those obtained at the clinic. Responsiveness was assessed 2 months after the clinic visit. One hundred eighty-five patients and 70 normal volunteers were included in this study. There was a marked difference in HARQ scores between patients with chronic cough and normal volunteers. The sensitivity (94%) and specificity (95%) of the HARQ was high, with an area under the ROC curve of 0.99. All items of the scale significantly correlated positively with others in the scale and with the total score. On repeatability testing using Cohen's kappa with quadratic weights, significant agreement was noted for all items. Good correlation was observed between the total scores (r = 0.78). The questionnaire was also responsive to treatment; the minimum clinically significant change was estimated to be 16 points. We have demonstrated the HARQ to have good construct and criterion validity. It is both reproducible and responsive to change. It can be used as a diagnostic instrument and demonstrates that chronic cough represents a single coherent entity: cough hypersensitivity syndrome.


Subject(s)
Cough/classification , Respiratory Hypersensitivity/classification , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Child , Chronic Disease , Cough/diagnosis , Cough/therapy , England , Female , Humans , Male , Middle Aged , Observer Variation , Patient Satisfaction , Predictive Value of Tests , Prospective Studies , Psychometrics , ROC Curve , Reproducibility of Results , Respiratory Hypersensitivity/diagnosis , Respiratory Hypersensitivity/therapy , Sensitivity and Specificity , Surveys and Questionnaires , Syndrome , Treatment Outcome , Young Adult
3.
Phys Rev Lett ; 105(7): 072001, 2010 Aug 13.
Article in English | MEDLINE | ID: mdl-20868031

ABSTRACT

Proton recoil polarization was measured in the quasielastic 4He(e,e'p)3H reaction at Q{2}=0.8 and 1.3 (GeV/c){2} with unprecedented precision. The polarization-transfer coefficients are found to differ from those of the 1H(e,e'p) reaction, contradicting a relativistic distorted-wave approximation and favoring either the inclusion of medium-modified proton form factors predicted by the quark-meson coupling model or a spin-dependent charge-exchange final-state interaction. For the first time, the polarization-transfer ratio is studied as a function of the virtuality of the proton.

4.
Int J Obes (Lond) ; 32(3): 443-50, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18059406

ABSTRACT

BACKGROUND: Evidence suggests that people who are more responsive to psychological stress are at an increased risk of developing obesity. However, the biological mechanisms underlying this phenomenon are poorly understood. The cytokines leptin, interleukin-1 receptor antagonist (IL-1Ra) and interleukin-6 (IL-6) play a key role in fat metabolism and abnormal circulating levels of these proteins have been reported in obese people and in individuals subject to stress. OBJECTIVE: This study investigated whether cytokine responses to acute mental stress are associated with adiposity in healthy young women. DESIGN AND SUBJECTS: A laboratory study of 67 women, aged 18-25 years, recruited from University College London. MEASUREMENTS: Height, weight and waist circumference were measured and body fat mass was estimated by bioelectrical impedance body composition analysis. Laboratory mental stress testing was carried out and blood pressure and heart rate were recorded at baseline, during two moderately challenging tasks (Stroop and speech) and during recovery 40-45 min post-stress. Blood samples taken at baseline, immediately post-stress and 45 min post-stress, were used for assessment of circulating cytokines. Saliva samples taken throughout the session were assessed for cortisol. RESULTS: Women who had larger cytokine responses to stress were more abdominally obese than women with smaller cytokine stress responses. Specifically, there was a positive correlation between waist circumference and stress-induced increases in plasma levels of leptin (r=0.35, P<0.05) and IL-1Ra responses (r=0.29, P<0.05). There was also a significant positive correlation between prolonged diastolic blood pressure responses to stress and measures of total and abdominal obesity (r=0.28-0.33, P<0.05). CONCLUSION: Increased cytokine production could be a mechanism linking stress and abdominal obesity.


Subject(s)
Adiposity , Body Composition , Cytokines/metabolism , Obesity/psychology , Stress, Psychological/metabolism , Adolescent , Adult , Body Mass Index , Enzyme-Linked Immunosorbent Assay , Female , Heart Rate , Humans , Hydrocortisone/metabolism , Interleukin 1 Receptor Antagonist Protein/blood , Interleukin-6/blood , Leptin/blood , Obesity/metabolism , Obesity/physiopathology , Saliva/chemistry
5.
Placenta ; 29(3): 255-65, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18272217

ABSTRACT

In normal pregnancy, the fetal membranes become increasingly distended towards term and in multifetal gestations they become over-distended. Apoptosis of the amniotic epithelium increases with advancing gestation and may contribute to fetal membrane weakening and rupture. The effects of chronic static stretching for 36h have been investigated using primary amniotic epithelial cells. Pre-B cell colony-enhancing factor (PBEF) is a stretch-responsive cytokine and expression of its gene, intracellular and secreted protein were all significantly increased by 4h and its secretion sustained over 36h, contrasting with the rapid increase and decline in expression of IL-8. Increased expression of SIRT1 and decreased p53 paralleled the changes in PBEF, are known to be responsive to PBEF, and contribute to cell survival. Distension had no effects on proliferation or necrosis but protected the cells from apoptosis, knocking-down PBEF with antisense probes abrogated this protective effect. There was increased immunostaining of PBEF in the compact layer of the amnion in multifetal tissues and significantly fewer apoptotic amniotic epithelial cells. These results show that chronic stretching of the amniotic epithelial cells increases PBEF expression, which protects them from apoptosis.


Subject(s)
Amnion/physiology , Apoptosis/genetics , Cytokines/genetics , Epithelial Cells/metabolism , Epithelial Cells/physiology , Nicotinamide Phosphoribosyltransferase/genetics , Amnion/growth & development , Amnion/metabolism , Cells, Cultured , Cytokines/metabolism , Cytoprotection/genetics , Elasticity , Female , Gene Expression Regulation , Humans , Nicotinamide Phosphoribosyltransferase/metabolism , Pregnancy , Pregnancy, Multiple/genetics , Pregnancy, Multiple/metabolism , Sirtuin 1 , Sirtuins/metabolism , Stress, Mechanical , Tensile Strength/physiology , Triplets , Tumor Suppressor Protein p53/metabolism , Twins
6.
Diabetes Res Clin Pract ; 76(2): 207-14, 2007 May.
Article in English | MEDLINE | ID: mdl-17023087

ABSTRACT

BACKGROUND: Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. METHODS: Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. RESULTS: Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P<0.0001) and insulin therapy by just -9 U/day (P<0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers' interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. CONCLUSIONS: Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.


Subject(s)
Blood Glucose/analysis , Diabetes Mellitus/prevention & control , Hypoglycemia/prevention & control , Insulin/therapeutic use , Adolescent , Adult , Aged , Diabetes Mellitus/blood , Female , Follow-Up Studies , Humans , Hypoglycemia/blood , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Insulin/adverse effects , Male , Middle Aged , Predictive Value of Tests , Prognosis , Time Factors
7.
Biochim Biophys Acta ; 969(3): 242-8, 1988 May 13.
Article in English | MEDLINE | ID: mdl-3370223

ABSTRACT

13C-NMR with 13C-enriched taurine [( 13C]taurine) has been utilized to study the formation and reactions of N-chlorotaurine in solution and in human cells. Taurine reacts instantaneously with HOCl at pH 7.0 to form N-chlorotaurine, which is stable in solution by itself. In the presence of alpha-amino acids, a chlorine transfer reaction taken place to produce N-chloroamino acids, which quickly convert to the corresponding aldehydes. [13C]Taurine was incubated with human neutrophils and with cultured human lymphoblastoid cells and 13C-NMR spectra of the whole cell mixtures were acquired in order to examine the formation of N-chlorotaurine from reaction between taurine and the endogenous HOCl produced by myeloperoxidase-catalyzed reactions (Zgliczynski, J.M., et al. (1968) Eur. J. Biochem. 4, 540; Weiss, S.J., et al. (1982) J. Clin. Invest. 70, 598). The presence of N-chlorotaurine in the cells was not detected on the 13C-NMR spectra. On the other hand, N-chloro[13C]taurine incubated with the cells was found to be converted to taurine, which must have been produced by a chlorine transfer reaction of the N-chlorotaurine to other cellular components such as amino acids, peptides or proteins. A 13C-NMR study of taurine uptake in human lymphoblastoid cells indicated that taurine is incorporated into a freely mobile intracellular pool. These results suggest that the presence of abundant taurine in a freely mobile intracellular pool may serve as a buffer in preventing oxidative damage to the cells from attacks by HOCl or other oxidants.


Subject(s)
Lymphocytes/metabolism , Taurine/analogs & derivatives , Taurine/metabolism , Biological Transport , Cells, Cultured , Humans , In Vitro Techniques , Magnetic Resonance Spectroscopy
8.
J Mol Biol ; 224(1): 283-4, 1992 Mar 05.
Article in English | MEDLINE | ID: mdl-1548709

ABSTRACT

Crystals of the C2-subunit of crustacyanin have been grown from solutions containing ammonium sulphate and 2-methyl-2,4-pentanediol as co-precipitants. The crystals belong to space group P2(1)2(1)2(1) (a = 42.0 A, b = 80.9 A, c = 110.8 A) with two subunits per asymmetric unit and diffract beyond 2.2 A resolution.


Subject(s)
Pigments, Biological/chemistry , Proteins/chemistry , Carrier Proteins , Crystallization , X-Ray Diffraction
9.
J Mol Biol ; 218(4): 699-701, 1991 Apr 20.
Article in English | MEDLINE | ID: mdl-1708830

ABSTRACT

Crystals of the mouse major urinary protein (MUP) and rat alpha-2u globulin (AMG) have been grown from solutions of polyethylene glycol 3350 and CdCl2, respectively. The crystals differ both in their morphologies and space groups but have very similar unit cell sizes. AMG crystallized in P2(1) (a = 56.6 A, b = 103.8 A, c = 62.7 A, beta = 95.1 degrees) with four subunits/asymmetric unit, while MUP gave crystals in P4(1)2(1)2 or P4(3)2(1)2 (a = 57.3 A, c = 109.9 A) with one subunit/asymmetric unit. Both crystal forms diffract beyond 2.8 A resolution.


Subject(s)
Alpha-Globulins/chemistry , Proteins/chemistry , Animals , Mice , Protein Conformation , Rats , X-Ray Diffraction
10.
Psychoneuroendocrinology ; 30(9): 826-38, 2005 Oct.
Article in English | MEDLINE | ID: mdl-15975730

ABSTRACT

Cognitive decline in old age is not universal or inevitable. Associations have been observed with neuroendocrine function, but the relevance of other physiological processes is unclear. We predicted that impairment of memory in an ageing population would be related to the dysregulation of neuroendocrine and cardiovascular responses. One hundred and thirty-nine participants (65-80 years) were recruited from general practice in London. Two standardised verbal paired-associates recall tasks were administered in order to determine declarative memory performance, and a fluid intelligence task (matrix reasoning) was also performed. Salivary cortisol samples were collected every 10 min, while blood pressure and heart rate were measured before, during and after each task. Illness history and medication use were obtained from medical records. Multiple linear regression analysis, adjusted for age, gender, education, chronic illness, and medication use, revealed that cortisol responses were inversely related to memory performance. Additionally, superior memory was associated with more effective post-task recovery of heart rate (in both men and women) and diastolic blood pressure recovery in men. Cardiovascular recovery effects were independent of covariates, and of levels of heart rate and blood pressure measured during tasks themselves. These associations were also independent of subjective ratings of stress and perceived performance. Neither neuroendocrine nor cardiovascular responses were related to performance of the reasoning task. We conclude that memory in the elderly is associated both with hypothalamic-pituitary-adrenocortical function and cardiovascular regulation. Disturbances of neuroendocrine and hemodynamic function may be related to greater vulnerability to cognitive decline.


Subject(s)
Aging/physiology , Blood Pressure/physiology , Cognition/physiology , Hydrocortisone/metabolism , Stress, Psychological/metabolism , Verbal Learning/physiology , Aged , Aged, 80 and over , Female , Heart Rate/physiology , Humans , Hypothalamo-Hypophyseal System/physiology , Linear Models , Male , Memory/physiology , Pituitary-Adrenal System/physiology , Saliva/metabolism
11.
J Leukoc Biol ; 54(2): 119-24, 1993 Aug.
Article in English | MEDLINE | ID: mdl-7689627

ABSTRACT

Taurine is present in high concentrations in most mammalian tissues, including those that prodigiously produce oxidants. Taurine protects against bronchiolar damage induced by NO2, ozone, bleomycin, and amiodarone. Taurine is chlorinated to form taurine chloramine (Tau-Cl) by the halide-dependent myeloperoxidase system and, under physiological conditions, reduces HOCl toxicity. Although NO and its metabolites, NO2- and NO3-, are thought to be major mediators of tissue damage resulting from oxidant exposure, cytokines, including tumor necrosis factor (TNF), are also involved. We examined the effects of Tau-Cl on NO production and TNF release by using RAW 264.7 cells activated with recombinant interferon-gamma (rIFN-gamma; 50 U/ml) and lipopolysaccharide (LPS; 10 micrograms/ml). NO was measured spectrophotometrically as NO2- after reaction with Griess reagent and TNF was measured by ELISA. Tau-Cl (0.5 mM) inhibits NO and TNF released into the medium by 47% and 43%, respectively. Tau-Cl is actively transported into RAW 264.7 cells by an uptake system that is energy, temperature, and Na+ dependent. Competition experiments demonstrate that the uptake system for Tau-Cl is distinct from that for taurine. In addition, the NO synthase activity of cytosolic preparations from activated RAW 264.7 cells is irreversibly inhibited by pretreatment with Tau-Cl. We demonstrate that Tau-Cl inhibits production of NO and TNF by activated macrophages and suggest a mechanism through which taurine supplementation may protect against oxidant-induced tissue damage.


Subject(s)
Amino Acid Oxidoreductases/antagonists & inhibitors , Macrophage Activation/physiology , Nitric Oxide/metabolism , Taurine/analogs & derivatives , Tumor Necrosis Factor-alpha/metabolism , Animals , Biological Transport , Cell Line , Inflammation/metabolism , Interferon-gamma/pharmacology , Lipopolysaccharides/pharmacology , Mice , Nitric Oxide Synthase , Recombinant Proteins , Taurine/metabolism , Taurine/physiology
12.
Cardiovasc Res ; 26(1): 48-57, 1992 Jan.
Article in English | MEDLINE | ID: mdl-1516112

ABSTRACT

OBJECTIVE: The aim was to investigate the effects of NG-monomethyl-L-arginine (L-NMMA), an inhibitor of both the constitutive (Ca2+ dependent) and inducible (Ca2+ independent) nitric oxide (NO) synthases, or of pretreatment with the glucocorticoid dexamethasone, an inhibitor of the induction of the Ca2+ independent NO synthase, on lipopolysaccharide induced shock in the anaesthetised rabbit. METHODS: Mean arterial blood pressure, and blood flow in the portal vein, hepatic artery, and hindquarter vascular beds were measured in 49 halothane anaesthetised New Zealand White rabbits given lipopolysaccharide (Salmonella minnesota, 500 micrograms.kg-1 intravenously). The effects of pre- or post-lipopolysaccharide treatment with L-NMMA (300 mg.kg-1 intravenously) and of pretreatment with dexamethasone (3 mg.kg-1 intravenously) were determined. The effect of the NO donor S-nitroso-N-acetyl-penicillamine (SNAP, 300 micrograms.kg-1.h-1 intravenously) in animals treated with lipopolysaccharide and L-NMMA was also studied. RESULTS: Lipopolysaccharide elicited an initial transient fall in mean arterial pressure and decreases in blood flow in the vascular beds, followed by a progressive fall in mean arterial pressure. L-NMMA when given either before or after lipopolysaccharide markedly exacerbated its effects and resulted in severe hypotension, intense vasoconstriction, and increased mortality. Pretreatment with dexamethasone had no effect on the initial haemodynamic changes following lipopolysaccharide, but prevented the subsequent fall in mean arterial pressure observed in animals treated with lipopolysaccharide alone. Dexamethasone failed, however, to protect animals also treated with L-NMMA before lipopolysaccharide. Animals pretreated with L-NMMA and SNAP showed reduced haemodynamic changes when compared with controls (lipopolysaccharide only) or lipopolysaccharide and L-NMMA treated animals. CONCLUSIONS: Inhibition of both constitutive and inducible NO synthases during endotoxaemia is deleterious. This can be overcome by replacing NO intravenously with a donor of NO. Selective inhibition of the inducible NO synthase may, however, be beneficial in shock.


Subject(s)
Arginine/analogs & derivatives , Dexamethasone/pharmacology , Nitric Oxide/metabolism , Shock, Septic/metabolism , Animals , Arginine/pharmacology , Blood Pressure/drug effects , Disease Models, Animal , Heart Rate/drug effects , Male , Penicillamine/analogs & derivatives , Penicillamine/pharmacology , Rabbits , Regional Blood Flow/drug effects , S-Nitroso-N-Acetylpenicillamine , omega-N-Methylarginine
13.
Hypertension ; 8(5): 361-71, 1986 May.
Article in English | MEDLINE | ID: mdl-3699879

ABSTRACT

Vasodilator substances act either directly on vascular smooth muscle (e.g., adenosine) or indirectly (e.g., acetylcholine) on endothelial cells that respond by releasing an unknown powerful, short-lived relaxing factor. To determine whether chronic hypertension or hypercholesterolemia or both would alter the release of the endothelium-derived relaxing factor, experiments were performed in hypertensive rabbits (5-week cellophane wrap perinephritis; mean blood pressure, 134.7 mm Hg) and normotensive rabbits (mean blood pressure, 80 mm Hg) with a Doppler flow transducer and perivascular balloon implanted on the lower abdominal aorta. Rabbits were fed either 1% cholesterol or control diet for 4 weeks before the experiment. On the day of the experiment, resting hindlimb vascular resistance was greatest in hypertensive rabbits fed 1% cholesterol diet, followed (in descending order) by hypertensive rabbits, normotensive rabbits fed 1% cholesterol diet, and normotensive rabbits. Pharmacological autonomic reflex blockade was induced, and steady state intravenous infusion curves to acetylcholine, serotonin, and adenosine were constructed. Sensitivity (location of effective dose, 50%) to the three vasodilator agents was altered less than twofold from the values in normotensive rabbits for any treatment group. The maximum vasodilator response to acetylcholine, but not to adenosine or serotonin, infusion was reduced significantly in the treated rabbits compared with that in normal rabbits. Reactive hyperemic responses to 5 to 80 seconds of ischemia were not significantly different among the treatment groups. These results indicate that hypertension with or without hypercholesterolemia does not greatly alter the responsiveness of the hindlimb resistance vasculature to these three vasodilator agents or to ischemia.


Subject(s)
Hypercholesterolemia/physiopathology , Hypertension/physiopathology , Vasodilation , Acetylcholine/pharmacology , Adenosine/pharmacology , Analysis of Variance , Animals , Body Weight , Female , Guanethidine/pharmacology , Heart Rate/drug effects , Male , N-Methylscopolamine , Phentolamine/pharmacology , Propranolol/pharmacology , Rabbits , Regional Blood Flow/drug effects , Scopolamine Derivatives/pharmacology , Serotonin/pharmacology , Vascular Resistance/drug effects , Vasodilation/drug effects
14.
Hypertension ; 9(2): 122-31, 1987 Feb.
Article in English | MEDLINE | ID: mdl-3818010

ABSTRACT

The local responses of the resistance vessels of the hindquarters of conscious, renal hypertensive (cellophane wrap) and sham-operated normotensive rabbits were studied during infusions of constrictor (norepinephrine, methoxamine, angiotensin II) and dilator (acetylcholine, adenosine, serotonin) drugs. The rabbits had implanted Doppler ultrasonic flow probes on the lower aorta and an indwelling catheter for intra-arterial infusion of drugs. Autonomic blockade with mecamylamine and propranolol was used to determine local vascular effects of each drug uncomplicated by reflex changes. Logistic dose-vascular response curves were characterized by their range from resting to maximum response, their 50% effective dose (i.e., sensitivity or dose at middle of the response range), and the average slope about the 50% effective dose. At maximum dilatation the vascular resistance was about 70% greater in hypertensive rabbits than in normotensive rabbits. There were no significant differences in 50% effective dose values between curves for hypertensive and normotensive rabbits for constrictor or dilator drugs. However, with all drugs the hypertensive rabbits showed about twice the change in vascular resistance per unit dose compared with the normotensive rabbits. These results suggest that hypertrophy of the muscles of the precapillary vessels makes them a nonspecific amplifier of vascular resistance changes evoked by constrictor and dilator stimuli. They do not support previous claims of specific changes in "sensitivity" or claims that local amplifier action is unimportant in hypertension.


Subject(s)
Hypertension, Renovascular/physiopathology , Vascular Resistance/drug effects , Vasoconstrictor Agents/pharmacology , Vasodilator Agents/pharmacology , Animals , Female , Male , Muscle, Smooth, Vascular/drug effects , Muscle, Smooth, Vascular/physiopathology , Rabbits
15.
Clin Pharmacol Ther ; 34(5): 707-10, 1983 Nov.
Article in English | MEDLINE | ID: mdl-6627831

ABSTRACT

We evaluated kinetics of ibuprofen and acetaminophen taken concurrently by 20 healthy adults in a randomized crossover design. Steady-state blood levels of ibuprofen and acetaminophen were measured by gas-liquid chromatography and HPLC. There were no significant differences in any of the ibuprofen serum concentrations, but there were differences in acetaminophen serum concentrations in 5 of 19 sampling times. When bioavailability and kinetic parameters for both drugs were compared, there were no significant differences. Our data demonstrate that steady-state kinetics of ibuprofen and acetaminophen are not changed when taken concurrently.


Subject(s)
Acetaminophen/metabolism , Ibuprofen/metabolism , Absorption , Adult , Biological Availability , Drug Interactions , Female , Humans , Kinetics , Male
16.
Clin Pharmacol Ther ; 64(3): 237-47, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9757147

ABSTRACT

BACKGROUND: Kinetic and dynamic consequences of metabolic inhibition were evaluated in a study of the interaction of ketoconazole, a P4503A inhibitor, with alprazolam and triazolam, two 3A substrate drugs with different kinetic profiles. METHODS: In a double-blind, 5-way crossover study, healthy volunteers received (A) ketoconazole placebo plus 1.0 mg alprazolam orally, (B) 200 mg ketoconazole twice a day plus 1.0 mg alprazolam, (C) ketoconazole placebo plus 0.25 mg triazolam orally, (D) 200 mg ketoconazole twice a day plus 0.25 mg triazolam, and (E) 200 mg ketoconazole twice a day plus benzodiazepine placebo. Plasma concentrations and pharmacodynamic parameters were measured after each dose. RESULTS: For trial B versus trial A, alprazolam clearance was reduced (27 versus 86 mL/min; P < .002) and apparent elimination half-life (t1/2) prolonged (59 versus 15 hours; P < .03), whereas peak plasma concentration (Cmax) was only slightly increased (16.1 versus 14.7 ng/mL). The 8-hour pharmacodynamic effect areas for electroencephalographic (EEG) beta activity were increased by a factor of 1.35, and those for digit-symbol substitution test (DSST) decrement were increased by 2.29 for trial B versus trial A. For trial D versus trial C, triazolam clearance was reduced (40 versus 444 mL/min; P < .002), t1/2 was prolonged (18.3 versus 3.0 hours; P < .01), and Cmax was increased (2.6 versus 5.4 ng/mL; P < .001). The 8-hour effect area for EEG was increased by a factor of 2.51, and that for DSST decrement was increased by 4.33. Observed in vivo clearance decrements due to ketoconazole were consistent with those anticipated on the basis of an in vitro model, together with in vivo plasma concentrations of ketoconazole. CONCLUSION: For triazolam, an intermediate-extraction compound, impaired clearance by ketoconazole has more profound clinical consequences than those for alprazolam, a low extraction compound.


Subject(s)
Alprazolam/pharmacokinetics , Antifungal Agents/pharmacology , Hypnotics and Sedatives/pharmacokinetics , Ketoconazole/pharmacology , Triazolam/pharmacokinetics , Administration, Oral , Adult , Alprazolam/blood , Antifungal Agents/blood , Area Under Curve , Cross-Over Studies , Double-Blind Method , Electroencephalography/drug effects , Humans , Hypnotics and Sedatives/blood , Ketoconazole/blood , Male , Reference Values , Time Factors , Triazolam/blood
17.
Clin Pharmacol Ther ; 64(3): 278-85, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9757151

ABSTRACT

BACKGROUND: Macrolide antimicrobial agents may impair hepatic clearance of drugs metabolized by cytochrome P4503A isoforms. Potential interactions of triazolam, a substrate metabolized almost entirely by cytochrome P4503A in humans, with 3 commonly prescribed macrolides were identified using an in vitro metabolic model. The actual interactions, and their pharmacodynamic consequences, were verified in a controlled clinical study. METHODS: In an in vitro model using human liver microsomes, 250 mumol/L triazolam was incubated with ascending concentrations (0 to 250 mumol/L of troleandomycin, azithromycin, erythromycin, and clarithromycin. In a randomized, double-blind, 5-trial clinical pharmacokinetic-pharmacodynamic study, 12 volunteers received 0.125 mg triazolam orally, together with placebo, azithromycin, erythromycin, or clarithromycin. In a fifth trial they received placebo plus placebo. RESULTS: Mean 50% inhibitory concentrations versus 4-hydroxytriazolam formation in vitro were as follows: 3.3 mumol/L troleandomycin, 27.3 mumol/L erythromycin, 25.2 mumol/L clarithromycin, and greater than 250 mumol/L azithromycin. Apparent oral clearance of triazolam when given with placebo or azithromycin was nearly identical (413 and 416 mL/min), as were peak plasma concentrations (1.25 and 1.32 ng/mL) and elimination half-life (2.7 and 2.6 hours). Apparent oral clearance was significantly reduced (P < .05) during erythromycin and clarithromycin trials (146 and 95 mL/min). Peak plasma concentration was correspondingly increased, and elimination half-life was prolonged. The effects of triazolam on dynamic measures were nearly identical when triazolam was given with placebo or azithromycin, but benzodiazepine agonist effects were enhanced during erythromycin and clarithromycin trials. CONCLUSION: The in vitro model identifies macrolides that may impair triazolam clearance. Anticipated interactions, and their pharmacodynamic consequences in volunteer subjects, were verified in vivo.


Subject(s)
Anti-Bacterial Agents/pharmacology , Aryl Hydrocarbon Hydroxylases , Cytochrome P-450 Enzyme System/drug effects , Hypnotics and Sedatives/pharmacokinetics , Microsomes, Liver/drug effects , Microsomes, Liver/metabolism , Oxidoreductases, N-Demethylating/drug effects , Triazolam/pharmacokinetics , Administration, Oral , Azithromycin/pharmacology , Clarithromycin/pharmacology , Cytochrome P-450 CYP3A , Cytochrome P-450 Enzyme System/metabolism , Double-Blind Method , Erythromycin/pharmacology , Humans , Hypnotics and Sedatives/metabolism , In Vitro Techniques , Microsomes, Liver/enzymology , Oxidoreductases, N-Demethylating/metabolism , Time Factors , Triazolam/metabolism , Troleandomycin/pharmacology
18.
Am J Psychiatry ; 155(9): 1178-83, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9734539

ABSTRACT

OBJECTIVE: This study was undertaken to clarify earlier inconsistent findings in brain metabolic topography in panic disorder patients at rest. METHOD: Positron emission tomography (PET) with [18F]fluorodeoxyglucose was used to determine cerebral metabolic activity in six female patients with a DSM-III-R diagnosis of panic disorder and in six healthy female volunteers. All patients with panic disorder were medication free and were sensitive to lactate infusion. RESULTS: A significant increase in glucose metabolism was found in the left hippocampus and parahippocampal area of the panic disorder subjects in comparison with that found in the healthy subjects. In addition, a significant decrease in metabolism was found in the right inferior parietal and right superior temporal brain regions of the panic disorder subjects in comparison with that of the normal subjects. There was no significant correlation between scores for the severity of panic disorder or for the severity of lactate-induced panic attack and the quantified PET abnormality. CONCLUSIONS: These data provide further support for the hypothesis of an abnormal brain metabolism in the hippocampal and parahippocampal area in individuals with panic disorder and also suggest other areas of aberrant brain metabolism in this disorder.


Subject(s)
Glucose/metabolism , Panic Disorder/diagnostic imaging , Panic Disorder/metabolism , Adult , Brain/diagnostic imaging , Brain/metabolism , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/metabolism , Female , Fluorodeoxyglucose F18 , Hippocampus/diagnostic imaging , Hippocampus/metabolism , Humans , Middle Aged , Tomography, Emission-Computed
19.
J Hypertens ; 1(2): 183-90, 1983 Aug.
Article in English | MEDLINE | ID: mdl-6681038

ABSTRACT

The role of alpha 1-adrenoceptors in the hypotensive response to ketanserin was studied in conscious normotensive (sham-operated) and Page hypertensive (two-kidney, two wrapped) rabbits. Ketanserin (0.01, 0.1 and 1 mg/kg i.v.) was administered at 30 min intervals on four experimental days: no pretreatment; after prazosin 1 mg/kg and infusion; after pharmacological 'total' autonomic effector block (TAB) and with repeated three point methoxamine dose-response lines. Only the highest dose (1 mg/kg) of ketanserin lowered blood pressure and dilated the iliac vascular bed (Doppler flowmeter) in both wrap and sham-operated rabbits. Prazosin pretreatment and TAB prevented these effects. Ketanserin (1 mg/kg) also caused significant alpha 1-adrenoceptor antagonism as measured by a 2.5-fold shift in the methoxamine dose-response lines. In separate experiments prazosin (0.01-0.1 mg/kg i.v. bolus) caused similar falls in blood pressure and alpha 1-adrenoceptor block as ketanserin 0.3 and 1 mg/kg. The only difference observed between prazosin and ketanserin was the substantial reflex tachycardia to prazosin that was absent after ketanserin. These results suggest that in normotensive rabbits and in rabbits with Page hypertension the hypotensive response to ketanserin can be explained by alpha 1-adrenoceptor antagonism.


Subject(s)
Hemodynamics/drug effects , Hypertension/physiopathology , Piperidines/pharmacology , Prazosin/pharmacology , Quinazolines/pharmacology , Serotonin Antagonists/pharmacology , Animals , Blood Pressure/drug effects , Dose-Response Relationship, Drug , Heart Rate/drug effects , Ketanserin , Male , Methoxamine/pharmacology , Piperidines/blood , Rabbits , Receptors, Serotonin/drug effects
20.
J Hypertens ; 17(12 Pt 1): 1687-96, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10658934

ABSTRACT

BACKGROUND: Increases in vascular resistance (or the reciprocal, vascular conductance) in response to constrictor drugs are amplified (or attenuated) in the hindquarter vascular bed of hypertensive rats and rabbits. However, such changes have not been observed for the total peripheral circulation. OBJECTIVE: To assess whether the vascular amplifier applies to the total peripheral circulation in conscious hypertensive rabbits. METHODS: Rabbits were implanted with a flow probe for measuring cardiac output, a left atrial catheter for infusing dilator (adenosine) and constrictor (methoxamine) drugs, and ear artery and vein catheters for measuring mean arterial pressure (MAP) and for giving ganglion blockade. Data from full dose-total peripheral resistance (TPR) or total peripheral conductance (TPC) response curves to adenosine and methoxamine were combined into a logistic function extending from near full dilatation to near maximum constriction. RESULTS: Changes in MAP induced by methoxamine and adenosine were markedly greater in the 'wrap' rabbits (those with renal cellophane wrapping) compared with the sham animals. In the 'wrap' rabbits, the slopes and ranges of the adenosine-TPR response curve and the methoxamine-TPC response curve were 200% and 60%, respectively, of sham values. These data show that TPR changes are amplified, and TPC changes attenuated, to dilator and constrictor stimuli. The relationship between dose-average vascular radius (r; based on Poiseuille's law) over the full range of vascular tone showed that r was narrower in hypertension, but, in contrast to TPR, the degree of narrowing was almost the same between maximum dilatation and constriction. CONCLUSION: The total peripheral circulation in experimental hypertension is a TPR amplifier, or TPC attenuator, in the rabbit, consistent with well-established data in the major vascular beds.


Subject(s)
Hypertension/physiopathology , Models, Cardiovascular , Vascular Resistance/physiology , Adenosine/pharmacology , Animals , Blood Pressure/drug effects , Blood Pressure/physiology , Cardiac Output/drug effects , Cardiac Output/physiology , Cellophane , Dose-Response Relationship, Drug , Female , Male , Methoxamine/pharmacology , Rabbits , Vascular Resistance/drug effects , Vasoconstrictor Agents/pharmacology , Vasodilator Agents/pharmacology
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