Clinical safety of SonoVue, a new contrast agent for ultrasound imaging, in healthy volunteers and in patients with chronic obstructive pulmonary disease.

RATIONALE AND OBJECTIVES: To evaluate the safety profile of SonoVue, a new echo-contrast agent based on stabilized sulfur hexafluoride (SF6) microbubbles, in healthy volunteers and in patients with chronic obstructive pulmonary disease (COPD). METHODS: Safety and tolerability of SonoVue were evaluated in 66 healthy volunteers during two placebo-controlled phase I studies (a single intravenous ascending-dose study in 36 volunteers given SonoVue doses of 0.003 to 0.12 mL/kg and a multiple-dose study in 30 subjects given cumulative doses of 0.15 to 0.6 mL/kg) and in 12 patients with COPD of various degrees of clinical severity, who were given SonoVue at a dosage of 4 mL (corresponding to 0.057 mL/kg in a 70-kg patient). Adverse events were monitored up to 48 to 72 hours after administration. All volunteers underwent extensive safety assessments (monitoring of vital signs, electrocardiogram, blood oxygen saturation, laboratory assessments, and Mini-Mental test) up to 24 to 72 hours after administration. In addition, patients with COPD underwent specific lung function tests, such as forced expiratory volume, forced vital capacity, and forced midexpiratory flow. RESULTS: No serious adverse events occurred throughout the study. All nonserious adverse events were minor, mild, and rapidly self-resolving. No difference in the incidence of adverse events was observed among the various dosages of SonoVue and between SonoVue and placebo. There were no clinically significant changes in any of the safety assessments. No statistically significant differences between SonoVue and placebo were observed in mean forced expiratory volume, forced vital capacity, or forced midexpiratory flow levels. No substantial changes from baseline in blood oxygen saturation were observed for either study agent at any postinjection time point. CONCLUSIONS: SonoVue showed a good safety profile both in healthy subjects and in patients with COPD.

Safety and pharmacokinetics of a new liposomal liver-specific contrast agent for CT: results of clinical testing in nonpatient volunteers.

RATIONALE AND OBJECTIVES: To evaluate the safety and pharmacokinetics of BR21, a liposome-encapsulated iomeprol formulation, in nonpatient volunteers. METHODS: This was a single-blind, placebo-controlled, ascending dose study in 30 adult, male nonpatient volunteers, randomized to receive a single intravenous bolus (2 mL/s) of BR21 (0.5, 1.0, 1.5, 2.0, and 2.5 mL/kg, four volunteers per dose level) or matched volumes of placebo (0.9% saline, 10 volunteers). The safety controls performed consisted of preand postdose complete physical examinations, measurement of vital signs, electrocardiographic controls, clinical laboratory investigations (hematology, serum chemistry, and urinalysis), and monitoring of adverse events. The safety controls and monitoring of subjects for adverse events continued up to 7 days after the dose. For pharmacokinetic analysis, the determination of total iomeprol content was performed by a high-performance liquid chromatography assay procedure in blood, urine, and fecal samples collected before the dose and serially after the dose, up to 120 hours. RESULTS: No serious adverse events occurred throughout the study. All nonserious adverse events were minor and mild in intensity and rapidly resolved without treatment. No difference in the incidence of adverse events was observed among the various doses of BR21 and between BR21 and placebo. There were no clinically significant changes in vital signs, electrocardiographic parameters, or clinical laboratory findings. Iomeprol blood level decay can be described by a three-exponential function, consistent with a distribution phase (range, t1/2 0.12-0.21 hours), a fast elimination phase (range, t1/2 1.2-1.5 hours), and a slow elimination phase from a deep compartment (range, t1/2 3.3-4.5 hours). There was an apparent linearity in the relation between the area under the curve and the dose. Urinary elimination of unchanged iomeprol accounted for 89% to 90% of injected dose within 24 hours. CONCLUSIONS: BR21 appeared to be safe and well tolerated in nonpatient subjects. Its pharmacokinetic profile was compatible with nonspecific distribution into the extracellular fluid space and specific distribution into a deep compartment.

General pharmacology in experimental animals of gadobenate dimeglumine (MultiHance), a new magnetic resonance imaging contrast agent.

OBJECTIVES: To assess in animals the pharmacological tolerability for intravascular gadobenate dimeglumine. RESULTS: Cardiovascular effects: In healthy animals no relevant effects were observed apart from slight and transient increases in cardiac output and decreases in systemic vascular resistance. In pigs with myocardial ischemia: doses up to 3.0 mmol/kg caused dose-dependent decreases in heart rate, systemic vascular resistance and mean arterial blood pressure along with transient increases in cardiac output. In vitro: Myocardial contractility was slightly depressed after direct exposure to a 30 mM solution. Respiratory effects in healthy pigs: no effects after 1.0 mmol/kg i.v. Effects on the central nervous system: In healthy animals: gadobenate dimeglumine, 1.0 mmol/kg i.v, did not penetrate nor impair the blood-brain barrier in rats and did not affect behavior, motor coordination or EEG. In pathological models: even in the presence of an osmotically disrupted blood-brain barrier, brain penetration of gadobenate was poor and no signs of epileptogenic potential were evident. Effects on blood: No hemolytic potential was observed. Plasma coagulation was slightly affected in vitro but not in vivo. Effects on kidney and liver function: Transient increases in diuresis, without effects on blood and urine enzymes were observed at doses of 1.25 and 2.5 mmol/kg. CONCLUSIONS: The clinical use of gadobenate dimeglumine as an intravascular magnetic resonance imaging contrast agent is strongly supported by the good tolerability of the product in healthy and pathological animal models.

Brain penetration and neurological effects of gadobenate dimeglumine in the rat.

PURPOSE: The study aimed at measuring the amount of the gadobenate ion that crosses an experimentally disrupted blood-brain barrier (BBB) in rats following i.v. administration of gadobenate dimeglumine (GD). The intention was also to compare this amount with the minimally effective intrathecal dose that alters the cerebral function. METHODS: Sprague Dawley rats with an osmotically disrupted BBB received 0.3 mmol/kg of (153Gd) GD, i.v. Radioactivity was measured in plasma and brain parenchyma. The effect on the cerebral function was evaluated by means of a standard motor coordination test (Rota-rod test). RESULTS: Brain levels of the gadobenate ion were approximately 60 nmol/g tissue after i.v. injection of GD. In rats with an intact BBB, the lowest dose of GD able to slightly impair motor coordination was 0.01 mmol/kg following intracisternal injection. CONCLUSION: I.v. administration of GD to rats with a disrupted BBB results in brain levels of the gadobenate ion that are more than 20 times lower than those reached following intrathecal administration of the minimal effective dose, as determined by the Rota-rod test.

Neurotolerability of nonionic X-ray contrast media. The role of chemotoxicity.

RATIONALE AND OBJECTIVES: Because small quantities of x-ray contrast agents can cross the blood-brain barrier, the authors evaluate the properties that contribute to neurotoxicity. METHODS: The acute toxicity of various monomer and dimer contrast media was assessed after intracerebroventricular (ICV) injection to mice and intracisternal (ICI) injection to rats. RESULTS: In mice, median lethal dose (LD50) values for monomer contrast media apart from iohexol were higher than those for dimer contrast media. In rats, iopentol and iopromide were more neurotoxic than all other contrast media. The signs of toxicity for all contrast media included convulsions, dyspnea, hypoactivity, and sedation. Hypertonic D-mannitol solution was tolerated as well as artificial cerebrospinal fluid. Neither the hydrophilicity of the molecules nor the physicochemical properties of their solutions explain the toxicities satisfactorily. CONCLUSIONS: Neurotoxicity of monomer or dimer contrast media depends more on chemical structure characteristics other than hydrophilicity than on the physicochemical characteristics of their solutions.

Hepatic transport of the magnetic resonance imaging contrast agent gadobenate dimeglumine in the rat.

RATIONALE AND OBJECTIVES: Gadobenate dimeglumine is a new octadentate gadolinium (III) complex salified with meglumine. The compound is currently under evaluation as an intravenously administered paramagnetic contrast agent for magnetic resonance (MR) imaging. We investigated the mechanisms involved in the biliary excretion of gadobenate ion, the contrast-effective ion in gadobenate dimeglumine. METHODS: Biliary and urinary excretion of gadobenate ion injected intravenously to rats at 0.25 mmol/kg was studied following pretreatment with bromosulfophthalein (BSP) disodium salt, sodium taurocholate (TC), or oxyphenonium bromide (OP) and at various times after common bile duct ligation. Gadobenate ion was assayed by high-pressure liquid chromatography in bile and urine. Plasma bilirubin levels after duct ligation were measured by colorimetric assay. RESULTS: The 90-min excretion of gadobenate ion into bile accounted for 35.5 +/- 3.7% and excretion into urine for 45.7 +/- 3.5% of the injected dose (mean +/- SD). Pretreatment with BSP reduced recovery of the compound in bile to less than 1% and increased urinary excretion to 65.6 +/- 4.7%. Gadobenate dimeglumine had a substantial choleretic effect that was completely abolished by pretreatment with BSP. Pretreatment with TC and OP did not change the biliary or urinary excretion of gadobenate ion. Surgical cholestasis led to a massive increase in plasma bilirubin levels from 3.9 +/- 2.2 (day of surgery) to 129 +/- 37 mumol/L (4 days after common bile duct ligature) and decreased 6-hr cumulative biliary excretion of gadobenate ion from 45 +/- 16% to 5.3 +/- 4.2% of the injected dose. Urinary excretion increased correspondingly from 49 +/- 15% to 83 +/- 12%. CONCLUSION: The transport of gadobenate ion from plasma to bile occurs in the rat mainly through the BSP/bilirubin transport systems.

Toxicological safety assessment of iomeprol, a new X-ray contrast agent.

The toxicology of pharmaceutical formulations of iomeprol, a new nonionic iodinated radiographic contrast agent, was studied in rodents (mice, rats and guinea-pigs) and non-rodents (rabbits and dogs). When injected intravascularly the acute toxicity of iomeprol, both in terms of median lethal dose and symptoms, was comparable to that of analogous triiodinated nonionic contrast media (CM). Intravenous daily dosing for 4 weeks showed that iomeprol was well tolerated at doses as high as the maximum dose anticipated for clinical use. Moreover, the compound did not possess reproductive, developmental, or genetic toxicity. Tissue tolerability was completely superimposable on those of reference CM such as iopamidol and iohexol. Finally, no antigenic potential was detected either in mice or guinea-pigs. These favourable toxicological characteristics bode well for iomeprol as an intravascular radiographic contrast agent.

Pharmacokinetics and tissue distribution of iomeprol in animals.

The pharmacokinetics of iomeprol, a new triiodinated nonionic radiographic contrast agent, has been studied in rats, rabbits and dogs. Following intravenous administration, iomeprol did not bind measurably to plasma proteins and was rapidly excreted in unchanged form, mostly through the kidneys. The compound was rapidly distributed to the plasma and thence to the extracellular spaces. Iomeprol did not accumulate in specific organs or tissues except for those involved in its elimination, i.e. the kidneys and the liver. However, 24 h after administration, less than 1% of the injected dose remained in the tissues. The overall profile was very similar to the published profiles of other radiographic contrast agents used in uroangiography.

Preclinical safety assessment of iomeprol for injection as contrast medium for myelography.

A series of pharmaco-toxicological investigations were carried out in animals in order to assess the neurotolerance of iomeprol, a new nonionic iodinated contrast medium. After intrathecal administration iomeprol was completely eliminated from the cerebrospinal fluid, rapidly cleared from the plasma and excreted unchanged through the kidneys. When administrated intrathecally, iomeprol did not significantly alter the behavioural functions or the physiological activities of the brain. Unlike other contrast media, iomeprol was devoid of any epileptogenic activity. The acute neurotoxicity of iomeprol was comparable with that of iopamidol, but less than that of iohexol, iotrolan and iodixanol. Iomeprol was well tolerated in both rats and dogs following weekly intrathecal administrations for four weeks of doses up to three times higher than those foreseen for clinical use. High neurotolerance in animals and favourable physico-chemical characteristics make iomeprol particularly suitable as a contrast medium for both myelography and cerebral ventriculography.

Pharmacodynamic effects of iomeprol for injection in experimental animals.

Iomeprol for injection is a new nonionic triiodinated contrast medium for diagnostic radiology, which combines low osmolality with low viscosity. The effects of iomeprol for injection on the cardiovascular system, blood parameters, renal function and the central nervous system were studied after intravascular administration to several animal species of doses at least as high as the highest presumed clinical doses. The following observations were made with respect to the central circulatory system: moderate and short-lasting increases of left ventricular end-diastolic pressure and cardiac output, no significant effects on heart rate either in vitro or in vivo, some episodes of arrhythmia and ventricular fibrillations only at doses far higher than the highest presumed clinical ones, no significant increases in diastolic and systolic coronary flow. The following observations were made with respect to peripheral circulation: no significant changes on blood pressure, moderate and short-lasting increases in renal and pulmonary arterial flow, together with a decrease in peripheral vascular resistance, no crossing of the blood-brain barrier in healthy animals. Cardiovascular and haemodynamic changes were all significantly milder than those induced by ionic contrast media (CM) and were similar to effects caused by some other nonionic contrast media. When injected into the femoral artery of rats, iomeprol was shown to be less algogenic than iopamidol and iohexol. In comparison with the same reference CM, iomeprol affected to a lesser extent the filterability of red blood cells in vitro and showed a less marked effect on their deformability. When administered intravenously at very high dosages, iomeprol had no effect on the glomerular filtration rate, but increased both renal blood flow and diuresis. Proteinuria and enzymuria were also increased, albeit more transiently. The neurotolerance of iomeprol for injection after intravenous administration was higher than or at worst equal to that of iopamidol and iohexol. Iomeprol is therefore a promising new contrast agent particularly suitable for intravascular use in humans.

Effect of a terpenoid, (-)-6-hydroxy-4-(1-hydroxy-1-methylethyl)-1-cyclohexene-1-ethanol, on drug-metabolizing enzymes and glutathione content in rat liver and lung.

1. Chronic treatment of Sprague-Dawley rats with the new terpenoid mucoregulating drug (I) did not modify activities of the drug-metabolizing enzymes (phase I and phase II) of liver and lung. 2. Acute treatment of rats with I did not affect the GSH content of liver and lung, but administration of the corresponding alpha, beta-unsaturated ketone (II) produced considerable GSH depletion in both tissues, the original GSH levels being restored after a few hours. 3. The results are discussed in comparison with those previously obtained with the structurally related drug trans-sobrerol (III).

Effects of trans-sobrerol on drug metabolizing enzymes in the rat.

1. Metabolism of 14C-trans-sobrerol (I) by Sprague-Dawley rat liver microsomes did not result in covalent binding to proteins, lipid peroxidation or cytochrome P-450 destruction. 2. Subacute and chronic treatment of Sprague-Dawley rats with (I) resulted only in an increase in liver cytosolic GSH-S-transferase. 3. Acute treatment of rats with trans-sobrerol or its metabolite, 8-hydroxycarvotanacetone (II) produced considerable GSH depletion, faster in the case of II, in both liver and lung; the original GSH levels were restored within 24 h. No significant increase in lipid peroxidation was found even when GSH was at its lowest level. 4. UDP-glucuronyltransferase and GSH-S-transferase conjugation occurred with trans-sobrerol and some of its metabolites although at low rates.

Esaprazole, a new antiulcer agent, stimulates gastric mucus output in the rat.

The effect of esaprazole, a new antiulcer compound endowed with gastro-protective properties, on rat gastric mucus was investigated after acute oral administration. Both soluble (luminal) and insoluble (parietal) mucus were examined for their content of: acidic and neutral glycoproteins; N-acetylneuraminic acid by colorimetric techniques; and fucose by HPLC methods. One hour after dosing (50-200 mg/kg) a 2-15-fold increase in soluble mucus and a 2-4-fold increase in insoluble mucus output were observed. Under the same experimental conditions, carbenoxolone (200 mg/kg, p.o.) caused a similar increase in gastric mucus output. These results demonstrate that quantitative changes in both luminal and parietal mucus occurred after orally dosed esaprazole: it is tempting to speculate that this effect might be responsible, at least in part, for the gastro-protective action of the drug.

Benzodiazepine receptor ligands. Synthesis and preliminary pharmacological evaluation of 2-aminoalkyl-8-chloro- and 2-aryl-1,2,4-triazolo[3,4-a]phthalazine-3(2H)-ones.

Some 2-aminoalkyl-8-chloro- and 2-aryl-1,2,4-triazolo[3,4-a]-phthalazine-3-(2H)-ones were synthesized and preliminarily tested in vitro and in vivo as potential benzodiazepine-receptor (BZRs) ligands. 2-Aryl-1,2,4-triazolo[3,4-a]-phthalazine-3(2H)-ones displaced in vitro 3H-diazepam (3H-DZ) from rat brain specific binding sites with Ki (nM) comparable to DZ and chlordiazepoxide used as reference compounds. The specific binding of the triazolones of this study was not enhanced in vitro by 4-aminobutyric acid (GABA) and in vivo they did not show any activity in counteracting the pentylenetetrazole (PTZ) induced convulsions (mice). One of these compounds (IV a) antagonized the effects of DZ in the bicuculline (BIC) induced convulsions test (mice) and the DZ induced muscle relaxant effects in the horizontal wire test.

6-(Alkylamino)-3-aryl-1,2,4-triazolo[3,4-a]phthalazines. A new class of benzodiazepine receptor ligands.

Some 6-(alkylamino)-3-aryl-1,2,4-triazolo[3,4-a]phthalazines have been shown to displace diazepam from rat brain specific binding sites, in vitro, with Ki (nM) values comparable to those of reference benzodiazepines and to have anticonvulsant (pentylenetetrazole test, mice) and anticonflict activity (Vogel test, rat) in vivo. Separation between the doses causing anticonflict effects (Vogel test, rat) and those impairing motor coordination (rotarod test, rat) has been shown for N,N-bis(2-methoxyethyl)-3-(4-methoxyphenyl)-1,2,4-triazolo[3,4-a] phthalazin-6-amine (80). This compound, unlike diazepam, was inactive in counteracting the strychnine (mouse) and maximal electroshock (mouse) induced convulsions and in the "aggressive monkey" model. These differences from the classical benzodiazepines in the animal tests indicate that 80 may have some selective anxiolytic activity.

Benzodiazepine receptor ligands. Synthesis and preliminary pharmacological evaluation of some 3-aryl-6-thioalkyl-, 3-aryl-6-alkylsulphinyl-, 3-aryl-6-alkylsulphonyl-, and 3-aryl-6-alkoxy-1,2,4-triazolo[3,4-a]phthalazines.

A series of 3-aryl-6-alkoxy- and some 3-aryl-6-thioalkyl-, 3-aryl-6-alkylsulphinyl-, and 3-aryl-6-alkylsulphonyl-1,2,4-triazolo[3,4-a]phthalazines were synthesised and tested for inhibition of the in vitro binding of 3H-Diazepam to benzodiazepine receptors in membranes isolated from rat brain synaptosomes. 6-Alkoxy-3-(4'-methoxy)phenyl-1,2,4-triazolo[3,4-a]phthalazines were more active than or as active as diazepam in the binding assay (Ki nM) but unlike diazepam their binding to the benzodiazepine receptors was not enhanced by 4-aminobutyric acid. These compounds did not antagonize pentylenetetrazole induced convulsions and were inactive in modifying the conditioned behaviour of rats. Compound (II a) counteracted the muscle relaxant effects of diazepam (traction test). These results suggest that (II a) may be a benzodiazepine receptor antagonist.

A rapid and highly predictive in vitro assay for non-steroidal anti-inflammatory agents.

The inhibition of the production of malonyldialdehyde (MDA) in guinea-pig lung homogenates, incubated in the presence of 50 microM arachidonic acid and 1.4 mM adrenaline, has been exploited as a simple and reliable assay to test in vitro non-steroidal anti-inflammatory agents (NSAIA). The inhibitory potencies of a series of reference NSAIA, which correlated fairly well with in vivo anti-inflammatory activity as determined by carrageenin oedema, are herewith reported. The specificity of the assay was also evaluated by testing up to forty miscellaneous drugs: none of these significantly reduced the MDA production.

Heterocyclic GABA analogues. Displacement of radiolabelled 3H-GABA from rat brain membrane preparations.

2,5-Dimethyl-1H-pyrrol-1-yl-butanoic acid (I) and 2,5-diethyl-1H-pyrrol-1-yl-butanoic acid (V) were synthesised as non basic analogues of 4-aminobutanoic acid (GABA) to investigate the influence of the pKa of the 4-nitrogen on the in vitro binding to GABA receptors. (I) displaced 3H-GABA from specific binding sites of synaptosomal membrane preparations from rat cerebellum with an IC50 of 0.5 microM and (V) with an IC50 of 0.4 microM. (I) was inactive in vivo in the bicuculline anticonvulsant test (mice i.p.). The authors conclude that a basic nitrogen is not necessary for the binding to the GABAergic receptors although the ensuing complex is likely to be pharmacologically ineffective.