Atazanavir modestly increases plasma levels of raltegravir in healthy subjects.

Raltegravir is an HIV integrase inhibitor that is metabolized through glucuronidation by uridine diphosphate glucuronosyltransferase 1A1, and its use is anticipated in combination with atazanavir (a uridine diphosphate glucuronosyltransferase 1A1 inhibitor). Two pharmacokinetic studies of healthy subjects assessed the effect of multiple-dose atazanavir or ritonavir-boosted atazanavir on raltegravir levels in plasma. Atazanavir and atazanavir plus ritonavir modestly increase plasma levels of raltegravir.

Effect of levetiracetam on cardiac repolarization in healthy subjects: a single-dose, randomized, placebo- and active-controlled, four-way crossover study.

BACKGROUND: Nonantiarrhythmic drugs may have the potential to prolong the QT interval, leading to potentially fatal ventricular tachycardias, including torsades de pointes. OBJECTIVE: This study evaluated the potential of the newer-generation, multiple-action antiepileptic drug levetiracetam, which binds to the synaptic vesicle protein SV2A, to affect cardiac repolarization, as detected by prolongation of the QT/corrected QT (QTc) interval. METHODS: This was a single-dose, randomized, placebo- and active-controlled, 4-way crossover study in healthy subjects. Subjects were randomly allocated to 1 of 4 different administration sequences. Each sequence included 3 double-blind treatments (levetirace-tam 1000 mg, levetiracetam 5000 mg, and placebo) and 1 open-label treatment (moxifloxacin 400 mg). Triplicate electrocardiograms (ECGs) were obtained at baseline and at various time points over 24 hours after each treatment using continuous Holter monitoring. ECGs were read centrally in a blinded manner. Blood samples for the determination of plasma concentrations of levetiracetam and moxifloxacin were collected before dosing and at 0.5, 1, 1.5, 2, 4, 6, 12, and 24 hours after dosing, within 5 minutes after the ECG recordings. The QT interval was corrected for heart rate using a sex- and study-specific correction (QTc(ss)) as the primary outcome measure and Fridericia's correction (QTc(F))as a secondary outcome measure. The primary analysis was performed on the time-matched, baseline-subtracted QTc(ss) (DeltaQTc(ss)). The maximum DeltaQTc(ss) difference between each active treatment and placebo (DeltaDeltaTc(ss)) was derived from a mixed-effect analysis of variance. Clinical laboratory tests, standard 12-lead ECGs, and vital signs were monitored at regular intervals. Spontaneously reported adverse events were recorded throughout the study. RESULTS: Fifty-two healthy, nonsmoking subjects (26 men, 26 women; 37 white, 9 black, 3 Hispanic, and 3 Asian/Pacific Islander) with a mean (SD) age of 28.4 (7.5) years (range, 18-45 years) and a mean weight of 71.5 (12.6) kg (range, 49-103 kg) participated in the study. Levetiracetam did not significantly prolong the QTc(ss). The upper bound of the 1-sided 95% CI for the maximum DeltaDeltaTc(ss) was 8.0 milliseconds for levetiracetam 1000 mg and 8.1 milliseconds for levetiracetam 5000 mg, with mean estimates of 4.0 and 4.1 milliseconds, respectively; similar results were obtained for the maximum DeltaDeltaQTc(F). Moxifloxacin significantly prolonged the QTc(ss), with a lower bound of the 1-sided 95% CI for the maximum DeltaDeltaQTc(ss) of 3.7 milliseconds and a mean estimate of 7.7 milliseconds. There was no statistically significant relationship between measured DeltaQTc(ss) and the levetiracetam plasma concentration, whereas a significant linear relationship was observed between measured DeltaQTc(ss) and the moxifloxacin plasma concentration (slope estimate: 4.4 milliseconds/[microg/mL]); 95% CI, 3.2-5.7; P < 0.001). No unexpected safety concerns arose based on reported adverse events, clinical laboratory evaluations, physical examinations, vital signs, or ECG monitoring during the course of the study. CONCLUSION: This randomized, placebo- and active-controlled study in healthy adult subjects found no clinically relevant changes in the QTc interval after a single levetiracetam dose of 1000 or 5000 mg.

Pharmacokinetics, disposition, and metabolism of bicifadine in humans.

Bicifadine [DOV 220,075; (+/-)-1-(4-methylphenyl)-3-azabicyclo-[3.1.0]hexane HCl)] is a non-narcotic analgesic that has proven to be effective for the treatment of acute pain in clinical studies. The pharmacokinetics, disposition, and metabolism of bicifadine were determined in eight healthy adult male subjects following a single oral dose of 200 mg of [(14)C]bicifadine in solution. The maximum concentration of total drug equivalents and bicifadine in plasma was at approximately 1 h; the elimination half-life was 2.6 and 1.6 h for radioactivity and bicifadine, respectively. Unchanged bicifadine represented 15% of the area under the concentration-time curve for total drug equivalents; the rest was due mainly to the lactam (M12), the acid (M3), and the lactam acid (M9). Total recovery of the dose was 92%, with most of the radioactivity recovered in the urine in the first 24 h; fecal excretion accounted for only 3.5% of the dose. Approximately 64% of the dose was metabolized to M9 and its acyl glucuronide; another 23% was recovered as M3 and its acyl glucuronide. Neither bicifadine nor M12 were detected in urine or feces. There were no reported serious or severe adverse events during the study.

Metabolism and hemoglobin adduct formation of acrylamide in humans.

Acrylamide (AM), used in the manufacture of polyacrylamide and grouting agents, is produced during the cooking of foods. Workplace exposure to AM can occur through the dermal and inhalation routes. The objectives of this study were to evaluate the metabolism of AM in humans following oral administration, to compare hemoglobin adduct formation on oral and dermal administration, and to measure hormone levels. The health of the people exposed under controlled conditions was continually monitored. Prior to conducting exposures in humans, a low-dose study was conducted in rats administered 3 mg/kg (1,2,3-13C3) AM by gavage. The study protocol was reviewed and approved by Institute Review Boards both at RTI, which performed the sample analysis, and the clinical research center conducting the study. (1,2,3-13C3) AM was administered in an aqueous solution orally (single dose of 0.5, 1.0, or 3.0 mg/kg) or dermally (three daily doses of 3.0 mg/kg) to sterile male volunteers. Urine samples (3 mg/kg oral dose) were analyzed for AM metabolites using 13C NMR spectroscopy. Approximately 86% of the urinary metabolites were derived from GSH conjugation and excreted as N-acetyl-S-(3-amino-3-oxopropyl)cysteine and its S-oxide. Glycidamide, glyceramide, and low levels of N-acetyl-S-(3-amino-2-hydroxy-3-oxopropyl)cysteine were detected in urine. On oral administration, a linear dose response was observed for N-(2-carbamoylethyl)valine (AAVal) and N-(2-carbamoyl-2-hydroxyethyl)valine (GAVal) in hemoglobin. Dermal administration resulted in lower levels of AAVal and GAVal. This study indicated that humans metabolize AM via glycidamide to a lesser extent than rodents, and dermal uptake was approximately 6.6% of that observed with oral uptake.

Non-surgical uterine flushing for the recovery of preimplantation embryos in rhesus monkeys: Lack of seasonal infertility.

A non-surgical uterine flushing technique was employed to recover rhesus monkey preimplantation embryos during April--September, a period thought to be associated with reduced fertility. A total of 22 females of proven fertility, maintained indoors under strict light and temperature control, were employed for the study in which 72 menstrual cycles were monitored. The average length of their menstrual cycle was 27.9 ± 3.8 days. The percentages of cycles that showed normal cyclic patterns of estrogen, LH, and sex-skin color were 84.7%, 91.7%, and 90.3%, respectively. Following natural mating, uterine flushing was performed on days 4-7 of pregnancy. Of 58 attempts, 27 (46.6%) resulted in the recovery of embryonic materials. Two recoveries produced unfertilized oocytes; 20 yielded embryos which were morphologically normal, and 7 yielded damaged and/or degenerate embryos. Luteal function in cycles involving uterine flushings was evaluated by examining ovaries by laparoscopy, ovulation being confirmed in 34 of 35 examinations. Serum progesterone was > 2 ng/ml in 39 of 45 cycles. The conception rate of 46.6% noted in this study was similar (P > 0.4) to those observed from other natural matings in our colony, either during the same period (49.3%; n = 67) or during October--March (46.9%; n = 113). These results show that rhesus monkeys, maintained under appropriate environmental conditions, can experience normal fertile menstrual cycles throughout the summer months, and extend previous observations to demonstrate, for the first time, that preimplantation embryos can be recovered from this species year-round. © 1993 Wiley-Liss, Inc.

The secretion of bioactive and immunoreactive follicle-stimulating hormone (FSH) and luteinizing hormone (LH) throughout the menstrual cycle of the rhesus monkey (Macaca mulatta).

The present study provides the first evaluation of related changes in serum levels of bioactive FSH (Bio FSH) and immunoreactive FSH (iFSH), and concurrent dynamics of LH and FSH bioactivity throughout the menstrual cycle of the rhesus monkey. Mean concentrations of Bio FSH were elevated on days 0 and 1 (n = 7; P < 0.05; day 0 = preovulatory LH surge). Data from individual animals revealed that an average (± SEM) of 1.43 ± 0.29 and 2.71 ± 0.61 discrete surges of Bio FSH occurred in each monkey's follicular and luteal phase, respectively. Analysis of the collective data indicated that periods of increased Bio FSH secretory activity spanned days -1 to 1 and 8 to 10 (P < 0.025). Increases in serum Bio FSH and iFSH concentrations were not precisely correlated on a daily basis (38.9%), although 72.2% of the peaks of Bio FSH and iFSH surges occurred within a day of one another. Similarly, only 36.1% of the Bio FSH surges were accompanied by elevations in bioactive LH (Bio LH). A significant rise in Bio LH, but not Bio FSH, occurred on day -1 (P < 0.01). Concentrations of Bio LH, but not Bio FSH, were elevated in the early luteal phase (P < 0.01). The bioactivity/immunoactivity ratios (Bio/I) of LH and FSH were maximal on the day of the preovulatory surge (P < 0.01). On day -1, LH Bio/I significantly increased (P < 0.05), but no change in FSH Bio/I was detected. The Bio/I of LH, but not FSH, remained elevated in the early luteal phase. In summary: the relative increase in Bio FSH exceeds iFSH during the preovulatory surge. Surges of Bio FSH occur during the follicular and luteal phases which potentially could support follicle selection/maturation. Divergencies between circulating LH and FSH biopotency may reflect a differential regulation of secretion and/or biosynthesis of these hormones. The prolonged early luteal elevation of LH Bio/I is consistent with the idea of a functional role of elevated LH biopotency in the maintenance of the corpus luteum.

Urinary and plasma gonadotropin concentrations in golden lion tamarins (Leontopithecus r. rosalia).

This paper describes the development and validation of a plasma and urinary gonadotropin immunoassay for golden lion tamarins (Leontopithecus rosalia), an endangered New World callitrichid primate. The assay is derived from a macaque chorionic gonadotropin assay and was validated for both plasma and urine samples in L. rosalia. Levels of immunoreactive LH/CG in lion tamarin urine were highly correlated (r = + 0.98) with gonadotropin bioactivity. Immunoreactive LH/CG levels were examined in two contexts: in the urine of adult females and in the plasma of adult males after administration of estrogen. Peaks of gonadotropin excretion were detected in samples collected from nonpregnant adult females. The peaks occurred immediately prior to cyclic elevations in urinary estrogen excretion. Plasma LH/CG concentration in males measured 24 and 48 hours after a single 50 µg injection of estradiol benzoate were significantly lower than levels at these time points measured after control treatment. Together, the results of this study point to the utility of the gonadotropin assay for monitoring reproductive function in both female and male lion tamarins.

Reproductive performance and excretion of urinary estrogens and gonadotropins in the female pygmy marmoset (Cebuella pygmaea).

By retrospective review of colony records and determinations of urinary hormones we have described the reproductive profile of the female pygmy marmoset (Cebuella pygmaea). The pygmy marmoset is a nonseasonal breeder and gives birth to twins 76% of the time with single births occurring 16% and triplet births 8% of the time. Interbirth intervals ranged from 149-746 days. First births occurred to females between 24-42 months of age and 5-27 months post pairing. We measured urinary estrone, estradiol and estrone conjugates along with immunoreactive luteinizing hormone/chorionic gonadotropin (LH/CG). The postpartum LH peak occurred a mean of 15.6 days following parturition. The conception rate was 69% following the postpartum ovulation. Levels of CG rose a mean of 19 days following the LH peak in conceptive cycles and remained elevated for a mean of 76 days. Gestational length was a mean of 141.9 days from the LH peak to parturition. Only one female of the five studied displayed ovarian cycles which were a mean of 27 days in length. Estradiol was the predominant urinary estrogen, however both estrone and estradiol were excreted in extremely high concentrations. LH peaks were discrete with urinary estrogens increasing at the time of the LH peak and remaining elevated throughout the luteal phase of the cycle.