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1.
Toxicol Sci ; 186(2): 298-308, 2022 03 28.
Artículo en Inglés | MEDLINE | ID: mdl-35134235

RESUMEN

The nonclinical safety profile of GS-8873, a hepatitis B virus RNA transcript inhibitor was evaluated in rat and monkey 13-week toxicity studies with 8-week recovery phases. Vehicle or GS-8873 was dosed orally for 13 weeks at 2, 6, 20, and 60 mg/kg/day to Wistar Han rats and at 0.5, 1.5, 3, and 6 mg/kg/day to cynomolgus monkeys. In vitro and in vivo screening results from an analog discovered prior to GS-8873 informed the 13-week toxicology study designs. Neuroelectrophysiology and neurobehavioral evaluations were included at weeks 4 and 13 of the dosing and recovery phases for GS-8873. No adverse neurobehavioral effects were observed. Significant nerve conduction velocity (NCV) decreases and latency increases occurred at the high doses after 4 weeks of dosing. By week 13, dose-responsive NCV reductions and latency increases worsened across all dose groups compared with controls. Some reversal occurred 8 weeks after the last dose administered, but not to vehicle control levels. A minimal, axonal degeneration was observed in rat spinal and peripheral nerves across dose groups compared with controls. No monkey nervous system microscopic findings were observed. No-observed-adverse-effect-levels could not be determined for either species due to the neuroelectrophysiology findings and development was halted in the interest of safety. A retrospective risk assessment approach utilizing benchmark dose (BMD) modeling contributed 13-week NCV BMDL estimates (lower limits of the 95% confidence interval) in lieu of no-observed-adverse-effect-levels. The best-fitted models extrapolated NCV BMDLs for the rat caudal and monkey sural nerve at 0.3 and 0.1 mg/kg/day, respectively.


Asunto(s)
Antivirales , Virus de la Hepatitis B , Administración Oral , Animales , Antivirales/farmacología , Antivirales/toxicidad , Haplorrinos , Virus de la Hepatitis B/efectos de los fármacos , Ratas , Ratas Wistar , Estudios Retrospectivos
2.
Toxicol Pathol ; 48(1): 71-77, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31530138

RESUMEN

The peripheral nervous system (PNS) is subject to a wide range of structural and functional insults including direct damage to axons, loss of myelin, and progressive deficits in saltatory conduction. Drugs that damage the PNS often result in neuropathies that impact the structure and function of targeted nerves. In most cases, both sensory and motor neurons are affected with damage initially evident in the distal extremities. Drug-induced neuropathies are potentially reversible following cessation of treatment, but early stages of neuropathy can be subclinical and asymptomatic making diagnosis difficult. Nerve biopsy is highly validated and provides definitive evidence of nerve injury and corresponding severity; however, it is limited in some respects and electrophysiological measures can complement histopathological assessments and provide a functional measure of potential toxicity. In a drug development setting, nerve conduction assessments are valuable to monitor nerve function longitudinally if nerve damage is suspected or confirmed, and importantly, can be used to monitor progression and/or recovery of a drug-induced neuropathy. This review will summarize the methodology used in nerve conduction assessments as well as discuss data interpretation and considerations for use in nonclinical species. Finally, the use of nerve conduction assessments in nonclinical drug development is discussed.


Asunto(s)
Conducción Nerviosa/fisiología , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Humanos , Modelos Animales , Preparaciones Farmacéuticas
3.
PLoS Biol ; 16(3): e2002988, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29534062

RESUMEN

How asymmetries in motor behavior become established normally or atypically in mammals remains unclear. An established model for motor asymmetry that is conserved across mammals can be obtained by experimentally inducing asymmetric striatal dopamine activity. However, the factors that can cause motor asymmetries in the absence of experimental manipulations to the brain remain unknown. Here, we show that mice with inner ear dysfunction display a robust left or right rotational preference, and this motor preference reflects an atypical asymmetry in cortico-striatal neurotransmission. By unilaterally targeting striatal activity with an antagonist of extracellular signal-regulated kinase (ERK), a downstream integrator of striatal neurotransmitter signaling, we can reverse or exaggerate rotational preference in these mice. By surgically biasing vestibular failure to one ear, we can dictate the direction of motor preference, illustrating the influence of uneven vestibular failure in establishing the outward asymmetries in motor preference. The inner ear-induced striatal asymmetries identified here intersect with non-ear-induced asymmetries previously linked to lateralized motor behavior across species and suggest that aspects of left-right brain function in mammals can be ontogenetically influenced by inner ear input. Consistent with inner ear input contributing to motor asymmetry, we also show that, in humans with normal ear function, the motor-dominant hemisphere, measured as handedness, is ipsilateral to the ear with weaker vestibular input.


Asunto(s)
Lateralidad Funcional , Enfermedades del Laberinto/complicaciones , Actividad Motora/fisiología , Animales , Conducta Animal , Humanos , Ratones , Transmisión Sináptica/fisiología , Vestíbulo del Laberinto/fisiología , Vestíbulo del Laberinto/fisiopatología
4.
Sci Transl Med ; 8(365): 365ra159, 2016 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-27856798

RESUMEN

Microtubule-targeting agents (MTAs) are widely used anticancer agents, but toxicities such as neuropathy limit their clinical use. MTAs bind to and alter the stability of microtubules, causing cell death in mitosis. We describe DZ-2384, a preclinical compound that exhibits potent antitumor activity in models of multiple cancer types. It has an unusually high safety margin and lacks neurotoxicity in rats at effective plasma concentrations. DZ-2384 binds the vinca domain of tubulin in a distinct way, imparting structurally and functionally different effects on microtubule dynamics compared to other vinca-binding compounds. X-ray crystallography and electron microscopy studies demonstrate that DZ-2384 causes straightening of curved protofilaments, an effect proposed to favor polymerization of tubulin. Both DZ-2384 and the vinca alkaloid vinorelbine inhibit microtubule growth rate; however, DZ-2384 increases the rescue frequency and preserves the microtubule network in nonmitotic cells and in primary neurons. This differential modulation of tubulin results in a potent MTA therapeutic with enhanced safety.


Asunto(s)
Antineoplásicos/farmacología , Lactamas Macrocíclicas/farmacología , Microtúbulos/efectos de los fármacos , Neuronas/efectos de los fármacos , Oxazoles/farmacología , Alcaloides de la Vinca/farmacología , Animales , Antineoplásicos/química , Línea Celular Tumoral , Cristalografía por Rayos X , Dimerización , Genómica , Humanos , Lactamas Macrocíclicas/química , Ratones , Microscopía Electrónica , Mitosis , Trasplante de Neoplasias , Oxazoles/química , Tubulina (Proteína)/química , Vinblastina/análogos & derivados , Vinblastina/química , Vinblastina/farmacología , Alcaloides de la Vinca/química , Vinorelbina
5.
Diabetes Care ; 39(4): 596-602, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26884473

RESUMEN

OBJECTIVE: Lack of C-peptide in type 1 diabetes may be an important contributing factor in the development of microvascular complications. Replacement of native C-peptide has been shown to exert a beneficial influence on peripheral nerve function in type 1 diabetes. The aim of this study was to evaluate the efficacy and safety of a long-acting C-peptide in subjects with type 1 diabetes and mild to moderate peripheral neuropathy. RESEARCH DESIGN AND METHODS: A total of 250 patients with type 1 diabetes and peripheral neuropathy received long-acting (pegylated) C-peptide in weekly dosages of 0.8 mg (n = 71) or 2.4 mg (n = 73) or placebo (n = 106) for 52 weeks. Bilateral sural nerve conduction velocity (SNCV) and vibration perception threshold (VPT) on the great toe were measured on two occasions at baseline, at 26 weeks, and at 52 weeks. The modified Toronto Clinical Neuropathy Score (mTCNS) was used to grade the peripheral neuropathy. RESULTS: Plasma C-peptide rose during the study to 1.8-2.2 nmol/L (low dose) and to 5.6-6.8 nmol/L (high dose). After 52 weeks, SNCV had increased by 1.0 ± 0.24 m/s (P < 0.001 within group) in patients receiving C-peptide (combined groups), but the corresponding value for the placebo group was 1.2 ± 0.29 m/s. Compared with basal, VPT had improved by 25% after 52 weeks of C-peptide therapy (Δ for combined C-peptide groups: -4.5 ± 1.0 µm, placebo group: -0.1 ± 0.9 µm; P < 0.001). mTCNS was unchanged during the study. CONCLUSIONS: Once-weekly subcutaneous administration of long-acting C-peptide for 52 weeks did not improve SNCV, other electrophysiological variables, or mTCNS but resulted in marked improvement of VPT compared with placebo.


Asunto(s)
Péptido C/administración & dosificación , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Neuropatías Diabéticas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Glucemia/metabolismo , Índice de Masa Corporal , Péptido C/sangre , Diabetes Mellitus Tipo 1/sangre , Neuropatías Diabéticas/sangre , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Nervios Periféricos/metabolismo , Análisis de Regresión , Adulto Joven
6.
J Pain ; 15(12): 1366-76, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25283471

RESUMEN

UNLABELLED: Complex regional pain syndrome (CRPS) is a potentially debilitating chronic pain syndrome with a poorly understood but likely neuroimmune/multifactorial pathophysiology associated with axonal injury. Based on the potential contribution of proinflammatory cytokines to CRPS pathogenesis and prior research with thalidomide, we investigated lenalidomide, a thalidomide derivative, for CRPS treatment. We conducted a phase II, randomized, double-blind, placebo-controlled study to evaluate the efficacy of oral lenalidomide 10 mg once daily in consenting patients with unilateral or bilateral CRPS type 1. The study comprised 12 weeks of treatment followed by a long-term extension. The primary efficacy outcome was reduced pain in the index limb, defined as ≥30% improvement from baseline using an 11-point numeric rating scale. One hundred eighty-four subjects enrolled. The primary endpoint was not met because equal proportions of treated (16.1%) and control (16.1%) subjects achieved the outcome; however, lenalidomide was well tolerated, with no evidence of neuropathy or major adverse effects. This study is the largest controlled, blinded clinical trial in subjects with chronic CRPS using the Budapest research criteria. It demonstrates the feasibility of conducting high-quality clinical trials in CRPS type 1 and provides considerations for designing future trials. PERSPECTIVE: This article reports an adequately powered, controlled clinical trial in subjects with CRPS. Treatment and placebo were equally effective, but the study demonstrated that lenalidomide treatment is feasible in this population. The study provides examples to consider in designing future CRPS trials.


Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Distrofia Simpática Refleja/tratamiento farmacológico , Talidomida/análogos & derivados , Anciano , Analgésicos no Narcóticos/efectos adversos , Enfermedad Crónica , Método Doble Ciego , Femenino , Humanos , Lenalidomida , Masculino , Persona de Mediana Edad , Distrofia Simpática Refleja/fisiopatología , Talidomida/efectos adversos , Talidomida/uso terapéutico , Resultado del Tratamiento
7.
Science ; 341(6150): 1120-3, 2013 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-24009395

RESUMEN

There is a high prevalence of behavioral disorders that feature hyperactivity in individuals with severe inner ear dysfunction. What remains unknown is whether inner ear dysfunction can alter the brain to promote pathological behavior. Using molecular and behavioral assessments of mice that carry null or tissue-specific mutations of Slc12a2, we found that inner ear dysfunction causes motor hyperactivity by increasing in the nucleus accumbens the levels of phosphorylated adenosine 3',5'-monophosphate response element-binding protein (pCREB) and phosphorylated extracellular signal-regulated kinase (pERK), key mediators of neurotransmitter signaling and plasticity. Hyperactivity was remedied by local administration of the pERK inhibitor SL327. These findings reveal that a sensory impairment, such as inner ear dysfunction, can induce specific molecular changes in the brain that cause maladaptive behaviors, such as hyperactivity, that have been traditionally considered exclusively of cerebral origin.


Asunto(s)
Cuerpo Estriado/fisiopatología , Oído Interno/fisiopatología , Hipercinesia/fisiopatología , Enfermedades del Laberinto/fisiopatología , Trastornos Mentales/fisiopatología , Núcleo Accumbens/fisiopatología , Aminoacetonitrilo/análogos & derivados , Aminoacetonitrilo/farmacología , Animales , Cuerpo Estriado/patología , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/metabolismo , Oído Interno/patología , Quinasas MAP Reguladas por Señal Extracelular/antagonistas & inhibidores , Quinasas MAP Reguladas por Señal Extracelular/metabolismo , Hipercinesia/genética , Enfermedades del Laberinto/genética , Enfermedades del Laberinto/patología , Trastornos Mentales/genética , Ratones , Ratones Noqueados , Actividad Motora/genética , Plasticidad Neuronal/efectos de los fármacos , Plasticidad Neuronal/genética , Plasticidad Neuronal/fisiología , Órgano Espiral/patología , Órgano Espiral/fisiopatología , Simportadores de Cloruro de Sodio-Potasio/genética , Miembro 2 de la Familia de Transportadores de Soluto 12
8.
Handb Clin Neurol ; 115: 265-78, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23931786

RESUMEN

The assessment of changes in sensory-motor function in clinical research presents a unique set of difficulties. Clinimetrics is the science of measurement as related to the identification of a clinical disorder, the tracing of the progression of the condition under study, and calculation of its impact. The selection of appropriate measures for clinical studies of sensory-motor function must consider validity, sensitivity, specificity, responsiveness, reliability, and feasibility. Reasonable measures of motor function in clinical research include manual examination of muscle strength, electrophysiology, functional scales, patient-reported outcomes (e.g., quality of life), and for severe conditions such as ALS, survival. The assessment of sensory function includes targeted electrophysiology and QOL, as well as more focused measures such as quantitative sensory testing and the scoring of positive symptoms. Each individual measure and each combination of endpoints has its strengths and limitations.


Asunto(s)
Investigación Biomédica , Movimiento , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Sensación , Humanos , Evaluación de Resultado en la Atención de Salud , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
9.
Physiol J ; 20132013.
Artículo en Inglés | MEDLINE | ID: mdl-23580940

RESUMEN

A novel non-invasive technique was applied to measure velocity within slow conducting axons in the distal extreme of the sciatic nerve (i.e., digital nerve) in a rat model. The technique is based on the extraction of rectified multiple unit activity (MUA) from in vivo whole nerve compound responses. This method reliably identifies compound action potentials in thinly myelinated fibers conducting at a range of 9-18 m/s (Aδ axons), as well as in a subgroup of unmylinated C fibers conducting at approximately 1-2 m/s. The sensitivity of the method to C-fiber conduction was confirmed by the progressive decrement of the responses in the 1-2 m/s range over a 20-day period following the topical application of capsaicin (ANOVA p<0.03). Increasing the frequency of applied repetitive stimulation over a range of 0.75 Hz to 6.0 Hz produced slowing of conduction and a significant decrease in the magnitude of the compound C-fiber response (ANOVA p<0.01). This technique offers a unique opportunity for the non-invasive, repeatable, and quantitative assessment of velocity in the subsets of Aδ and C fibers in parallel with evaluation of fast nerve conduction.

10.
Diabetes Metab Res Rev ; 27(7): 620-8, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21695763

RESUMEN

Prior to a joint meeting of the Neurodiab Association and International Symposium on Diabetic Neuropathy held in Toronto, Ontario, Canada, 13-18 October 2009, Solomon Tesfaye, Sheffield, UK, convened a panel of neuromuscular experts to provide an update on polyneuropathies associated with diabetes (Toronto Consensus Panels on DPNs, 2009). Herein, we provide definitions of typical and atypical diabetic polyneuropathies (DPNs), diagnostic criteria, and approaches to diagnose sensorimotor polyneuropathy as well as to estimate severity. Diabetic sensorimotor polyneuropathy (DSPN), or typical DPN, usually develops on long-standing hyperglycaemia, consequent metabolic derangements and microvessel alterations. It is frequently associated with microvessel retinal and kidney disease-but other causes must be excluded. By contrast, atypical DPNs are intercurrent painful and autonomic small-fibre polyneuropathies. Recognizing that there is a need to detect and estimate severity of DSPN validly and reproducibly, we define subclinical DSPN using nerve conduction criteria and define possible, probable, and confirmed clinical levels of DSPN. For conduct of epidemiologic surveys and randomized controlled trials, it is necessary to pre-specify which attributes of nerve conduction are to be used, the criterion for diagnosis, reference values, correction for applicable variables, and the specific criterion for DSPN. Herein, we provide the performance characteristics of several criteria for the diagnosis of sensorimotor polyneuropathy in healthy subject- and diabetic subject cohorts. Also outlined here are staged and continuous approaches to estimate severity of DSPN.


Asunto(s)
Neuropatías Diabéticas/diagnóstico , Conducción Nerviosa/fisiología , Neuropatías Diabéticas/clasificación , Neuropatías Diabéticas/fisiopatología , Electrodiagnóstico , Humanos , Investigación , Índice de Severidad de la Enfermedad
11.
Prostate ; 71(5): 480-8, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20878947

RESUMEN

BACKGROUND: Androgen receptor (AR) antagonists are part of the standard of care for prostate cancer. Despite the almost inevitable development of resistance in prostate tumors to AR antagonists, no new AR antagonists have been approved for over a decade. Treatment failure is due in part to mutations that increase activity of AR in response to lower ligand concentrations as well as to mutations that result in AR response to a broader range of ligands. The failure to discover new AR antagonists has occurred in the face of continued research; to enable progress, a clear understanding of the reasons for failure is required. METHODS: Non-clinical drug safety studies and safety pharmacology assays were performed on previously approved AR antagonists (bicalutamide, flutamide, nilutamide), next generation antagonists in clinical testing (MDV3100, BMS-641988), and a pre-clinical drug candidate (BMS-501949). In addition, non-clinical studies with AR mutant mice, and EEG recordings in rats were performed. Non-clinical findings are compared to disclosures of clinical trial results. RESULTS: As a drug class, AR antagonists cause seizure in animals by an off-target mechanism and are found in vitro to inhibit GABA-A currents. Clinical trials of candidate next generation AR antagonists identify seizure as a clinical safety risk. CONCLUSIONS: Non-clinical drug safety profiles of the AR antagonist drug class create a significant barrier to the identification of next generation AR antagonists. GABA-A inhibition is a common off-target activity of approved and next generation AR antagonists potentially explaining some side effects and safety hazards of this class of drugs.


Asunto(s)
Antagonistas de Andrógenos/farmacología , Antagonistas de Andrógenos/toxicidad , Neoplasias de la Próstata/tratamiento farmacológico , Receptores Androgénicos/metabolismo , Antagonistas de Andrógenos/farmacocinética , Animales , Perros , Descubrimiento de Drogas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Noqueados , Neoplasias de la Próstata/metabolismo , Ratas , Ratas Sprague-Dawley
12.
Toxicol Pathol ; 39(1): 46-51, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21119050

RESUMEN

The evaluation of neurotoxic damage involves a unique set of challenges. Vulnerable structures, such as neocortex, hippocampus, spinal cord, and peripheral nerve are complex and sharply differentiated; deficits can result from insults to one or more element(s) in the system (e.g., myelin, axon, soma, synapse, or glia). In-life assessment of neurotoxic damage is complicated by the relative inaccessibility of structures in the brain and spinal cord, and recovery is severely limited. Histopathology and electrophysiology represent two of the most commonly used and valuable techniques in this field. This review outlines the strengths and limitations of these procedures and focuses on circumstances in which findings from these measures are dissociated. Electrophysiology is noninvasive and affords a longitudinal view of onset and progression of deficits; however, measures are generally weighted to large-diameter myelinated axons and to regions of primary sensory and motor processing. Histology is a highly validated biomarker, but it is restricted by sampling issues and is insensitive to some elements of neurotoxicity (e.g., altered channel function) associated with profound functional consequences. The central tenet of the discussion is that histology and electrophysiology offer complementary views of neurotoxic damage and, whenever possible, they should be used in concert.


Asunto(s)
Electrofisiología/métodos , Síndromes de Neurotoxicidad/patología , Enfermedades del Sistema Nervioso Periférico/patología , Médula Espinal/patología , Animales , Axones/patología , Biomarcadores , Fenómenos Electrofisiológicos , Modelos Animales , Vaina de Mielina/patología , Conducción Nerviosa , Nervios Periféricos/patología
13.
Diabetes Care ; 33(12): 2648-53, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20823346

RESUMEN

OBJECTIVE: Slow nerve conduction velocity and reduction in response amplitude are objective hallmarks of diabetic sensorimotor polyneuropathy. Because subjective or clinical indicators of neuropathy do not always match well with the presence of abnormal nerve physiology tests, we evaluated associations to nerve conduction in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: Nerve conduction studies were performed in the distal sural and ulnar sensory nerves and the peroneal motor nerve in 456 individuals with type 1 diabetes who participated in the follow-up visit of the EURODIAB Prospective Complications Study (EPCS). We used multivariate regression models to describe associations to decreased nerve conduction measures. RESULTS: In addition to an effect of duration of diabetes and A1C, which were both associated with low nerve conduction velocity and response amplitude, we found that the presence of nephropathy, retinopathy, or a clinical diagnosis of neuropathy was associated with low nerve conduction velocity and amplitude. In the case of nonproliferative retinopathy, the odds ratio (OR) for being in lowest tertile was 2.30 (95% CI 1.13-4.67) for nerve conduction velocity. A similar OR was found for each 2% difference in A1C (2.39 [1.68-3.41]). CONCLUSIONS: We show that the presence of other microvascular diabetes complications, together with diabetes duration and A1C, are associated with low nerve conduction velocity and amplitude response and that cardiovascular disease or risk factors do not seem to be associated with these measures.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/fisiopatología , Conducción Nerviosa/fisiología , Nervios Periféricos/fisiopatología , Adulto , Diabetes Mellitus Tipo 1/metabolismo , Neuropatías Diabéticas/fisiopatología , Retinopatía Diabética/fisiopatología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Adulto Joven
14.
Toxicon ; 54(5): 690-6, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19286001

RESUMEN

This review outlines factors that differentiate botulinum toxin serotypes and focuses on the unique features of the commercially available form of BoNT-B (i.e., Myobloc/NeuroBloc). A series of preclinical studies in Cynomolgus monkeys are reviewed. Each of these studies used electrophysiologic measures of changes in the compound muscle action potential (CMAP) following supramaximal nerve stimulation to evaluate the direct effects of the toxin in the injected muscle, as well as the spread of the effects to non-injected muscles. The results of 14 studies were summarized, including several that compared the effects of equivalent doses of BoNT-A and BoNT-B injected into muscles on the opposite side of the same monkey. There is clear evidence that when equivalent doses of BoNT-A and BoNT-B are assessed, there is greater spread to both nearby and remote non-injected muscles associated with BoNT-A. Similar studies in the mouse model demonstrated that high, but non-lethal, doses of BoNT-A unilaterally injected into the foot resulted in spread of the effects across the midline to the opposite non-treated foot, while there was no evidence of bilateral effects with equivalent unilateral injections of BoNT-B. Finally, this review summarizes a series of studies in the trapezius and gastrocnemius muscles of monkeys demonstrating that when doses producing equivalent initial effects of BoNT-A and BoNT-B are compared, the duration of effects and the time course of recovery are almost identical across toxins.


Asunto(s)
Potenciales de Acción/efectos de los fármacos , Toxinas Botulínicas/farmacología , Músculo Esquelético/efectos de los fármacos , Fármacos Neuromusculares/farmacología , Animales , Toxinas Botulínicas/clasificación , Toxinas Botulínicas Tipo A , Lateralidad Funcional , Macaca fascicularis , Serotipificación
15.
BMC Neurol ; 8: 33, 2008 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-18796160

RESUMEN

BACKGROUND: Recent consensus guidelines recommend pregabalin as a first-tier treatment for painful diabetic peripheral neuropathy (DPN). We evaluated the efficacy of pregabalin 600 mg/d (300 mg dosed BID) versus placebo for relieving DPN-associated neuropathic pain, and assessed its safety using objective measures of nerve conduction (NC). METHODS: In this randomized, double-blind, placebo-controlled trial, the primary efficacy measure was endpoint mean pain score (MPS) from daily pain diaries (11-point scale). NC velocity and sensory and motor amplitudes were assessed at baseline, endpoint, and end of follow-up (2 weeks post-treatment). At each timepoint, the median-motor, median-sensory, ulnar-sensory, and peroneal-motor nerves were evaluated. Secondary efficacy measures included weekly MPS and proportion of responders (patients achieving >or=50% reduction in MPS from baseline to endpoint). After 1-weeks' dosage escalation, pregabalin-treated patients received 300 mg BID for 12 weeks. RESULTS: Eighty-two patients received pregabalin and 85 placebo. Mean durations were 10 years for diabetes and approximately 5 years for painful DPN. Pregabalin-treated patients had lower MPS than controls (mean difference, -1.28; p <.001). For all four nerves, 95% CIs for median differences in amplitude and velocity from baseline to endpoint and baseline to follow-up included 0 (ie, no significant difference vs. placebo). Significant pain improvement among pregabalin-treated patients was evident at week 1 and sustained at every weekly timepoint. More pregabalin-treated patients (49%) than controls (23%) were responders (p <.001). CONCLUSION: Pregabalin 600 mg/d (300 mg BID) effectively reduced pain, was well tolerated, and had no statistically significant or clinically meaningful effect on NC in patients with painful DPN.


Asunto(s)
Neuropatías Diabéticas/tratamiento farmacológico , Dolor/tratamiento farmacológico , Ácido gamma-Aminobutírico/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Analgésicos/uso terapéutico , Neuropatías Diabéticas/fisiopatología , Método Doble Ciego , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nervio Mediano/efectos de los fármacos , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa/efectos de los fármacos , Dolor/fisiopatología , Dimensión del Dolor/métodos , Nervio Peroneo/efectos de los fármacos , Nervio Peroneo/fisiopatología , Placebos , Pregabalina , Resultado del Tratamiento , Nervio Cubital/efectos de los fármacos , Nervio Cubital/fisiopatología , Ácido gamma-Aminobutírico/administración & dosificación , Ácido gamma-Aminobutírico/efectos adversos , Ácido gamma-Aminobutírico/uso terapéutico
16.
Exp Neurol ; 213(2): 439-47, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18687329

RESUMEN

The present study explored parallel changes in the physiology and structure of myelinated (Adelta) and unmyelinated (C) small diameter axons in the cavernous nerve of rats associated with streptozotocin-induced hyperglycemia. Damage to these axons is thought to play a key role in diabetic autonomic neuropathy and erectile dysfunction, but their pathophysiology has been poorly studied. Velocities in slow conducting fibers were measured by applying multiple unit procedures; histopathology was evaluated with both light and electron microscopy. To our knowledge, these are the initial studies of slow nerve conduction velocities in the distal segments of the cavernous nerve. We report that hyperglycemia is associated with a substantial reduction in the amplitude of the slow conducting response, as well as a slowing of velocities within this very slow range (< 2.5 m/s). Even with prolonged hyperglycemia (> 4 months), histopathological abnormalities were mild and limited to the distal segments of the cavernous nerve. Structural findings included dystrophic changes in nerve terminals, abnormal accumulations of glycogen granules in unmyelinated and preterminal axons, and necrosis of scattered smooth muscle fibers. The onset of slowing of velocity in the distal cavernous nerve occurred subsequent to slowing in somatic nerves in the same rats. The functional changes in the cavernous nerve anticipated and exceeded the axonal degeneration detected by morphology. The physiologic techniques outlined in these studies are feasible in most electrophysiologic laboratories and could substantially enhance our sensitivity to the onset and progression of small fiber diabetic neuropathy.


Asunto(s)
Axones/fisiología , Axones/ultraestructura , Hiperglucemia/patología , Tejido Nervioso/fisiología , Tejido Nervioso/ultraestructura , Pene/inervación , Animales , Hiperglucemia/fisiopatología , Masculino , Ratas , Ratas Endogámicas F344 , Ratas Sprague-Dawley
17.
Clin Adv Hematol Oncol ; 6(6): 455-67, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18567992

RESUMEN

Microtubule inhibitor (MTI)-based chemotherapies used in the treatment of breast cancer--including vinca alkaloids, taxanes, and epothilones--are known to be associated with peripheral neuropathy. The incidence and severity of neuropathy, most frequently sensory in nature, depend on the agent used, absolute and cumulative drug dose, administration schedule, and presence of comorbidities. Although some first-generation vinca alkaloids, such as vincristine, were associated with severe mixed sensory/motor neuropathy, the deficits associated with newer agents in this class (eg, vinflunine) are generally milder and limited to distal sensory signs and symptoms. Among the taxanes, sensory neuropathy is reported more often with administration of paclitaxel and albumin-bound paclitaxel and less frequently with docetaxel. Epothilones, a new class of MTI, may be associated with grade 3/4 peripheral neuropathy; however, the neuropathy associated with ixabepilone, a novel epothilone B analog, is generally mild to moderate and reversible to baseline or grade 1 levels. The neuropathy induced by MTI therapy is best managed with dose adjustments and/or treatment delay. This article provides an overview of the incidence, characteristics, and management of MTI-associated neurotoxicities for known vinca alkaloids and taxanes, as well as newer agents, such as vinflunine and ixabepilone.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Polineuropatías/etiología , Moduladores de Tubulina/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Moduladores de Tubulina/clasificación
18.
Toxicol Pathol ; 36(4): 608-19, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18467682

RESUMEN

Zoniporide, an inhibitor of the Na+-H+ exchanger-1, was administered by continuous intravenous infusion to rats and dogs for up to 1 month. In 1-month studies, histological and functional changes were observed in select portions of the peripheral nervous system; however, these findings were not detected in 2-week studies at similar or higher doses. In the 1-month rat study, there was dose-dependent, minimal, focal, or multifocal nerve fiber (axonal) degeneration in the spinal cord and/or sciatic nerve. In a follow-up rat study, findings included slowing of caudal nerve conduction velocity and axonal degeneration in the spinal cord (dorsal funiculus), dorsal roots, dorsal root ganglia (DRG), radial, sciatic, and tibial nerves. In the 1-month dog study, there was impairment of the patellar reflex and associated postural reaction changes, minimal to marked proximal nerve fiber degeneration in the DRG, and minimal nerve fiber degeneration in the dorsal roots and funiculi of the spinal cord. Minimal nerve fiber degeneration of equivocal significance was noted in various peripheral nerves. Taken together, these findings were consistent with a specific effect on peripheral sensory nerve fibers. These studies demonstrated that zoniporide produces clinical, electrophysiologic, and microscopic evidence of peripheral sensory axonopathy and establishes the importance of careful preclinical evaluation of neurological function.


Asunto(s)
Guanidinas/toxicidad , Degeneración Nerviosa/etiología , Fibras Nerviosas , Síndromes de Neurotoxicidad/etiología , Pirazoles/toxicidad , Intercambiadores de Sodio-Hidrógeno/antagonistas & inhibidores , Animales , Perros , Electrofisiología , Femenino , Guanidinas/sangre , Guanidinas/química , Guanidinas/farmacocinética , Infusiones Intravenosas , Masculino , Microscopía Electrónica de Transmisión , Estructura Molecular , Degeneración Nerviosa/metabolismo , Degeneración Nerviosa/patología , Fibras Nerviosas/efectos de los fármacos , Fibras Nerviosas/metabolismo , Fibras Nerviosas/ultraestructura , Síndromes de Neurotoxicidad/metabolismo , Síndromes de Neurotoxicidad/patología , Pirazoles/sangre , Pirazoles/química , Pirazoles/farmacocinética , Ratas , Ratas Sprague-Dawley , Factores de Tiempo
19.
Cereb Cortex ; 18(3): 610-25, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17586604

RESUMEN

Electroencephalography is increasingly being used to probe the functional organization of auditory cortex. Modulation of the electroencephalographic (EEG) signal by tones was examined in primary auditory cortex (A1) of awake monkeys. EEG data were measured at 4 laminar depths defined by current source density profiles evoked by best frequency (BF) tones. Midlaminar multiunit activity was used to define the tuning characteristics of A1 sites. Presentation of BF tones increased EEG power across the range of frequencies examined (4-290 Hz), with maximal effects evident within the first 100 ms after stimulus onset. The largest relative increases in EEG power generally occurred at very high gamma frequency bands (130-210 Hz). Increases in EEG power for frequencies less than 70 Hz primarily represented changes in phase-locked activity, whereas increases at higher frequencies primarily represented changes in non-phase-locked activity. Power increases in higher gamma bands were better correlated with the A1 tonotopic organization than power increases in lower frequency bands. Results were similar across the 4 laminar depths examined. These findings highlight the value of examining high-frequency EEG components in exploring the functional organization of auditory cortex and may enhance interpretation of related studies in humans.


Asunto(s)
Estimulación Acústica/métodos , Corteza Auditiva/fisiología , Electroencefalografía/métodos , Potenciales Evocados Auditivos/fisiología , Vigilia/fisiología , Animales , Haplorrinos , Macaca fascicularis , Masculino , Factores de Tiempo
20.
Cutan Ocul Toxicol ; 26(2): 83-105, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17612977

RESUMEN

Monkey studies were conducted for the preclinical safety assessment of SCH 412499, an adenovirus encoding p21, administered by subconjunctival injection prior to trabeculectomy for postoperative maintenance of the surgical opening. Biodistribution of SCH 412499 was minimal and there was no systemic toxicity. Findings included swollen, partially closed or shut eye(s) and transient congestion in the conjunctiva. A mononuclear cell infiltrate was present in the conjunctiva, choroid and other ocular tissues, but completely or partially resolved over time. Electroretinograms and visual evoked potentials revealed no adverse findings. Thus, the findings are not expected to preclude the clinical investigation of SCH 412499.


Asunto(s)
Adenoviridae/genética , Inhibidor p21 de las Quinasas Dependientes de la Ciclina/genética , Terapia Genética , Implantes de Drenaje de Glaucoma , Anestesia , Animales , Presión Sanguínea/fisiología , Conjuntiva , Conjuntivitis/patología , Electrorretinografía , Ensayo de Inmunoadsorción Enzimática , Potenciales Evocados Visuales/fisiología , Ojo/patología , Femenino , Frecuencia Cardíaca/fisiología , Inyecciones , Macaca fascicularis , Masculino , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Distribución Tisular , Malla Trabecular , Cicatrización de Heridas
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