The Luxembourg Parkinson's Study: A Comprehensive Approach for Stratification and Early Diagnosis.

While genetic advances have successfully defined part of the complexity in Parkinson's disease (PD), the clinical characterization of phenotypes remains challenging. Therapeutic trials and cohort studies typically include patients with earlier disease stages and exclude comorbidities, thus ignoring a substantial part of the real-world PD population. To account for these limitations, we implemented the Luxembourg PD study as a comprehensive clinical, molecular and device-based approach including patients with typical PD and atypical parkinsonism, irrespective of their disease stage, age, comorbidities, or linguistic background. To provide a large, longitudinally followed, and deeply phenotyped set of patients and controls for clinical and fundamental research on PD, we implemented an open-source digital platform that can be harmonized with international PD cohort studies. Our interests also reflect Luxembourg-specific areas of PD research, including vision, gait, and cognition. This effort is flanked by comprehensive biosampling efforts assuring high quality and sustained availability of body liquids and tissue biopsies. We provide evidence for the feasibility of such a cohort program with deep phenotyping and high quality biosampling on parkinsonism in an environment with structural specificities and alert the international research community to our willingness to collaborate with other centers. The combination of advanced clinical phenotyping approaches including device-based assessment will create a comprehensive assessment of the disease and its variants, its interaction with comorbidities and its progression. We envision the Luxembourg Parkinson's study as an important research platform for defining early diagnosis and progression markers that translate into stratified treatment approaches.

A thermodynamically consistent phase diagram of a trimorphic pharmaceutical, l-tyrosine ethyl ester, based on limited experimental data.

Crystalline polymorphs possess different physical properties, and phase changes between those polymorphs may affect the properties of engineered materials such as drugs. This is very well illustrated by the large effort that is put into the capability to predict phase behaviour of pharmaceuticals to avoid the unexpected appearance of different crystal forms. Much progress has been made, but one of the remaining challenges is (the accuracy in) the prediction of phase behaviour as a function of temperature. Obviously, predictions should at a certain point be verified against experimental data; however, it may not always be easy to elucidate the phase behaviour of a given compound experimentally, because thermodynamically and kinetically controlled phenomena occur in a convoluted fashion in experimental data. The present paper discusses the trimorphism of l-tyrosine ethyl ester as an example case of how experimental data in combination with the thermodynamic tenets lead to a consistent phase diagram, which can be used as the basis for pharmaceutical formulations and for comparison with polymorph predictions by computer. The positions of the two-phase equilibria I-II, I-III, and I-L have been obtained experimentally. Using the Clapeyron equation and the alternation rule, it has been shown how the positions of the other equilibria II-L, III-L, and II-III can be deduced in combination with the stability rankings of the phases and the phase equilibria. The experimental data have been obtained by synchrotron X-ray diffraction, Raman spectroscopy, and thermal analysis as a function of pressure and temperature. Furthermore, laboratory X-ray diffraction as a function of temperature and differential scanning calorimetry have been used. At room temperature, form II is the most stable phase, which remains stable with increasing pressure, as it possesses the smallest specific volume. Form I becomes stable above 33 °C (306 K), but with increasing pressure it turns into form III. On thermodynamic grounds, form III is expected to have a stable domain at very low temperatures.

An Integrated View of the Influence of Temperature, Pressure, and Humidity on the Stability of Trimorphic Cysteamine Hydrochloride.

Understanding the phase behavior of pharmaceuticals is important for dosage form development and regulatory requirements, in particular after the incident with ritonavir. In the present paper, a comprehensive study of the solid-state phase behavior of cysteamine hydrochloride used in the treatment of nephropathic cystinosis and recently granted orphan designation by the European Commission is presented employing (high-pressure) calorimetry, water vapor sorption, and X-ray diffraction as a function of temperature. A new crystal form (I2/a, form III) has been discovered, and its structure has been solved by X-ray powder diffraction, while two other crystalline forms are already known. The relative thermodynamic stabilities of the commercial form I and of the newly discovered form III have been established; they possess an overall enantiotropic phase relationship, with form I stable at room temperature and form III stable above 37 °C. Its melting temperature was found at 67.3 ± 0.5 °C. Cysteamine hydrochloride is hygroscopic and immediately forms a concentrated saturated solution in water with a surprisingly high concentration of 47.5 mol % above a relative humidity of 35%. No hydrate has been observed. A temperature-composition phase diagram is presented that has been obtained with the unary pressure-temperature phase diagram, measurements, and calculations. For development, form I would be the best form to use in any solid dosage form, which should be thoroughly protected against humidity.

Liquid-liquid miscibility gaps in drug-water binary systems: crystal structure and thermodynamic properties of prilocaine and the temperature-composition phase diagram of the prilocaine-water system.

EMLA cream, a "eutectic mixture of local anesthetics", was developed in the early 1980s by Astra Pharmaceutical Production. The mixture of anesthetics containing lidocaine, prilocaine, and water is liquid at room temperature, which is partly due to the eutectic equilibrium between prilocaine and lidocaine at 293 K, as was clear from the start. However, the full thermodynamic background for the stability of the liquid and its emulsion-like appearance has never been elucidated. In the present study of the binary system prilocaine-water, a region of liquid-liquid demixing has been observed, linked to a monotectic equilibrium at 302.4 K. It results in a prilocaine-rich liquid containing approximately 0.7 mol fraction of anesthetic. Similar behavior has been reported for the binary system lidocaine-water (Céolin, R.; et al. J. Pharm. Sci. 2010, 99 (6), 2756-2765). In the ternary mixture, the combination of the monotectic equilibrium and the above-mentioned eutectic equilibrium between prilocaine and lidocaine results in an anesthetic-rich liquid that remains stable below room temperature. This liquid forms an emulsion-like mixture in the presence of an aqueous solution saturated with anesthetics. Physical properties and the crystal structure of prilocaine are also reported.

Crystal structure and solid-state studies of aged samples of tienoxolol, an API designed against hypertension.

Aging of drug molecules is generally studied following regulatory procedures, i.e. under forced conditions and for relatively limited storage time; therefore naturally aged samples are rare and provide scientific reference data beyond regulatory considerations. Tienoxolol was studied after 25 years of storage in the dark under ambient conditions. About 86% of the samples still consisted of tienoxolol and the main impurity (13%) was caused by the hydrolysis of the ester moiety. Protection from humidity is therefore important. Other sensitive groups containing nitrogen and sulfur appear to be quite stable with less than 0.8% conversion over 25 years. In addition, the crystal structure has been solved. Tienoxolol orange needles were found to crystallize in the orthorhombic non-centrosymmetric space group Iba2, indicating that the crystal is a racemic compound. The unit cell parameters at room temperature are a=10.069(5)Å, b=45.831(10)Å, and c=9.822(5)Å and the unit cell volume is 4533(3)Å(3) with Z=8.

Dimorphism of the prodrug L-tyrosine ethyl ester: pressure-temperature state diagram and crystal structure of phase II.

Polymorphism is important in the field of solid-state behavior of drug molecules because of the continuous drive for complete control over drug properties. By comparing different structures of a series of L-tyrosine alkyl esters, it became apparent that the ethyl ester possesses dimorphism. Its structure was determined by powder diffraction and verified by density functional theory calculations; it is orthorhombic, P2(1) 2(1) 2(1) with a = 12.8679(8) Å, b = 14.7345(7) Å, c = 5.8333 (4) Å, V = 1106.01(11) Å, and Z = 4. The density of phase II is in line with other tyrosine alkyl esters and its conformation is similar to that of l-tyrosine methyl ester. The hydrogen bonds exhibit similar geometries for phase I and phase II, but the H-bonds in phase I are stronger. The solid II-solid I transition temperature is heating-rate dependent; it levels off at heating rates below 0.5 K min(-1), leading to a transition temperature of 306 ± 4 K. Application of the Clapeyron equation in combination with calorimetric and X-ray data has led to a topological diagram providing the relative stabilities of the two solid phases as a function of pressure and temperature; phase II is stable under ambient conditions.

Solid-state studies of the triclinic (Z' = 2) antiprotozoal drug ternidazole.

The solid-state properties of antiprotozoal ternidazole (3-(2-methyl-5-nitroimidazol-1-yl)-propan-1-ol) have been studied. Crystals are triclinic in the temperature interval between 100 and 333 K (melting point) with two different molecular conformations present in the asymmetric unit (Z' = 2) and two of each conformer make up a tetramer held together by hydrogen bonding. Its melting enthalpy at 333 K is 25.65 (± 1.29) kJ · mol(-1). Linear plots were obtained for the melting temperature versus pressure (dP/dT = 5.67 (± 0.08) MPa · K(-1)] and the glass transition versus pressure [dP/dT = 7.73 (±1.76) MPa · K(-1)]. No crystalline polymorphism could be detected; thus, the single-crystal structure that has been found is most likely the stable one.

Overall monotropic behavior of a metastable phase of biclotymol, 2,2'-methylenebis(4-chloro-3-methyl-isopropylphenol), inferred from experimental and topological construction of the related P-T state diagram.

The melt from the usual monoclinic phase (Phase I) of biclotymol (T(fusI) = 400.5 +/- 1.0 K, Delta(fus)H(I) = 36.6 +/- 0.9 kJ mol(-1)) recrystallizes into another phase, Phase II, that melts at T(fusII) = 373.8 +/- 0.2 K (Delta(fus)H(II) = 28.8 +/- 1.0 kJ mol(-1)). The transformation of Phase II into Phase I is found to be exothermic upon heating either as a direct process at 363 K or through a melting-recrystallization process (II --> liquid --> I). The melting curves, obtained from differential thermal analyses at various pressures ranging from 0 to 85 MPa, diverge as the pressure increases ((dP/dT)(fusI) = 2.54 +/- 0.07 MPa K(-1), (dP/dT)(fusII) = 5.14 +/- 0.85 MPa K(-1)). A topological P-T diagram with no stable phase region for Phase II, and similar to the 4th case of the P-T state diagrams formerly published by Bakhuis Roozeboom, is drawn, thus illustrating the overall monotropic behavior of Phase II.