Preoperative plasma fatty acid metabolites inform risk of prostate cancer progression and may be used for personalized patient stratification.

BACKGROUND: Little is known about the relationship between the metabolite profile of plasma from pre-operative prostate cancer (PCa) patients and the risk of PCa progression. In this study we investigated the association between pre-operative plasma metabolites and risk of biochemical-, local- and metastatic-recurrence, with the aim of improving patient stratification. METHODS: We conducted a case-control study within a cohort of PCa patients recruited between 1996 and 2015. The age-matched primary cases (n = 33) were stratified in low risk, high risk without progression and high risk with progression as defined by the National Comprehensive Cancer Network. These samples were compared to metastatic (n = 9) and healthy controls (n = 10). The pre-operative plasma from primary cases and the plasma from metastatic patients and controls were assessed with untargeted metabolomics by LC-MS. The association between risk of progression and metabolite abundance was calculated using multivariate Cox proportional-hazard regression and the relationship between metabolites and outcome was calculated using median cut-off normalized values of metabolite abundance by Log-Rank test using the Kaplan Meier method. RESULTS: Medium-chain acylcarnitines (C6-C12) were positively associated with the risk of PSA progression (p = 0.036, median cut-off) while long-chain acylcarnitines (C14-C16) were inversely associated with local (p = 0.034) and bone progression (p = 0.0033). In primary cases, medium-chain acylcarnitines were positively associated with suberic acid, which also correlated with the risk of PSA progression (p = 0.032, Log-Rank test). In the metastatic samples, this effect was consistent for hexanoylcarnitine, L.octanoylcarnitine and decanoylcarnitine. Medium-chain acylcarnitines and suberic acid displayed the same inverse association with tryptophan, while indoleacetic acid, a breakdown product of tryptophan metabolism was strongly associated with PSA (p = 0.0081, Log-Rank test) and lymph node progression (p = 0.025, Log-Rank test). These data were consistent with the increased expression of indoleamine 2,3 dioxygenase (IDO1) in metastatic versus primary samples (p = 0.014). Finally, functional experiments revealed a synergistic effect of long chain fatty acids in combination with dihydrotestosterone administration on the transcription of androgen responsive genes. CONCLUSIONS: This study strengthens the emerging link between fatty acid metabolism and PCa progression and suggests that measuring levels of medium- and long-chain acylcarnitines in pre-operative patient plasma may provide a basis for improving patient stratification.

Long-term sorption and desorption of sulfadiazine in soil: experiments and modeling.

Antibiotics, such as sulfadiazine (SDZ), may enter arable soil by spreading of manure of medicated husbandry or directly by the excrement of grazing animals. Knowledge of the fate of antibiotics in soils is crucial for assessing the environmental risk of these compounds, including possible transport to ground water. Kinetic sorption of (14)C-labeled SDZ (4-amino-N-pyrimidin-2-yl-benzenesulfonamide) was investigated using the batch technique. The batch sorption-desorption experiments were conducted at various concentration levels (0.044-13 mg L(-1) initial solute concentration) and time scales (0.75-272 d). Sorption of (14)C-SDZ in the investigated silty loam was time dependent and strongly nonlinear in the solution phase concentration. The time to reach an apparent sorption equilibrium was about 20 d. However, desorption was very slow, and 41 d were insufficient to reach the desorption equilibrium. An inverse modeling technique was used to identify relevant sorption processes of (14)C-SDZ during the batch experiments. Among the investigated two- and three-domain sorption models, adsorption and desorption of (14)C-SDZ were best described with a new model defining two sorption domains and four parameters. Whereas sorption in the first sorption domain was nonlinear and instantaneous, solute uptake in the second sorption domain was rate limited following first-order kinetics. Desorption followed the same rate law until an equilibrium distribution was reached. After that, desorption was assumed to be impossible due to partly irreversible sorption. Although the proposed model needs further validation, it contributes to the discussion on complex sorption processes of organic chemicals in soils.

Transport of sulfadiazine in soil columns: experiments and modelling approaches.

Antibiotics, such as sulfadiazine, reach agricultural soils directly through manure of grazing livestock or indirectly through the spreading of manure or sewage sludge on the field. Knowledge about the fate of antibiotics in soils is crucial for assessing the environmental risk of these compounds, including possible transport to the groundwater. Transport of (14)C-labelled sulfadiazine was investigated in disturbed soil columns at a constant flow rate of 0.26 cm h(-1) near saturation. Sulfadiazine was applied in different concentrations for either a short or a long pulse duration. Breakthrough curves of sulfadiazine and the non-reactive tracer chloride were measured. At the end of the leaching period the soil concentration profiles were determined. The peak maxima of the breakthrough curves were delayed by a factor of 2 to 5 compared to chloride and the decreasing limbs are characterized by an extended tailing. However, the maximum relative concentrations differed as well as the eluted mass fractions, ranging from 18 to 83% after 500 h of leaching. To identify relevant sorption processes, breakthrough curves of sulfadiazine were fitted with a convective-dispersive transport model, considering different sorption concepts with one, two and three sorption sites. Breakthrough curves can be fitted best with a three-site sorption model, which includes two reversible kinetic and one irreversible sorption site. However, the simulated soil concentration profiles did not match the observations for all of the used models. Despite this incomplete process description, the obtained results have implications for the transport behavior of sulfadiazine in the field. Its leaching may be enhanced if it is frequently applied at higher concentrations.

Environmental risk assessment of human pharmaceuticals in the European Union: A case study with the ß-blocker atenolol.

ß-Adrenergic receptor blockers (ß-blockers) are applied to treat high blood pressure, ischemic heart disease, and heart rhythm disturbances. Due to their widespread use and limited human metabolism, ß-blockers are widely detected in sewage effluents and surface waters. ß-Adrenergic receptors have been characterized in fish and other aquatic animals, so it can be expected that physiological processes regulated by these receptors in wild animals may be affected by the presence of ß-blockers. Because ecotoxicological data on ß-blockers are scarce, it was decided to choose the ß-blocker atenolol as a case study pharmaceutical within the project ERAPharm. A starting point for the assessment of potential environmental risks was the European guideline on the environmental risk assessment of medicinal products for human use. In Phase I of the risk assessment, the initial predicted environmental concentration (PEC) of atenolol in surface water (500 ng L−1) exceeded the action limit of 10 ng L−1. Thus, a Phase II risk assessment was conducted showing acceptable risks for surface water, for groundwater, and for aquatic microorganisms. Furthermore, atenolol showed a low potential for bioaccumulation as indicated by its low lipophilicity (log KOW = 0.16), a low potential for exposure of the terrestrial compartment via sludge (log KOC = 2.17), and a low affinity for sorption to the sediment. Thus, the risk assessment according to Phase II-Tier A did not reveal any unacceptable risk for atenolol. Beyond the requirements of the guideline, additional data on effects and fate were generated within ERAPharm. A 2-generation reproduction test with the waterflea Daphnia magna resulted in the most sensitive no-observed-effect concentration (NOEC) of 1.8 mg L−1. However, even with this NOEC, a risk quotient of 0.003 was calculated, which is still well below the risk threshold limit of 1. Additional studies confirm the outcome of the environmental risk assessment according to EMEA/CHMP (2006). However, atenolol should not be considered as representative for other ß-blockers, such as metoprolol, oxprenolol, and propranolol, some of which show significantly different physicochemical characteristics and varying toxicological profiles in mammalian studies.

Environmental risk assessment of ivermectin: A case study.

The veterinary parasiticide ivermectin was selected as a case study compound within the project ERAPharm (Environmental Risk Assessment of Pharmaceuticals). Based on experimental data generated within ERAPharm and additional literature data, an environmental risk assessment (ERA) was performed mainly according to international and European guidelines. For the environmental compartments surface water, sediment, and dung, a risk was indicated at all levels of the tiered assessment approach. Only for soil was no risk indicated after the lower tier assessment. However, the use of effects data from additional 2-species and multispecies studies resulted in a risk indication for collembolans. Although previously performed ERAs for ivermectin revealed no concern for the aquatic compartment, and transient effects on dung-insect populations were not considered as relevant, the present ERA clearly demonstrates unacceptable risks for all investigated environmental compartments and hence suggests the necessity of reassessing ivermectin-containing products. Based on this case study, several gaps in the existing guidelines for ERA of pharmaceuticals were shown and improvements have been suggested. The action limit at the start of the ERA, for example, is not protective for substances such as ivermectin when used on intensively reared animals. Furthermore, initial predicted environmental concentrations (PECs) of ivermectin in soil were estimated to be lower than refined PECs, indicating that the currently used tiered approach for exposure assessment is not appropriate for substances with potential for accumulation in soil. In addition, guidance is lacking for the assessment of effects at higher tiers of the ERA, e.g., for field studies or a tiered effects assessment in the dung compartment.