Pharmacokinetics of quinupristin-dalfopristin in continuous ambulatory peritoneal dialysis patients.

Quinupristin-dalfopristin may be useful for treatment of organisms causing peritoneal dialysis-related peritonitis, including methicillin-resistant coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The pharmacokinetic profiles of single intravenous doses of this combination streptogramin antibiotic of 7.5 mg/kg of body weight were characterized for eight noninfected patients receiving continuous ambulatory peritoneal dialysis. Comparison was made to pharmacokinetic profiles determined for eight healthy volunteers matched by age, sex, and race. Drug was measured in dialysate up to 6 h following the dose. Plasma and dialysate were assayed for parent compounds and metabolites. Mean pharmacokinetic parameters were compared between groups. No statistically significant differences were observed between groups for maximal concentrations in plasma, times to maximal concentration, areas under the curve, distribution volumes, rates of total body clearance, or half-lives in plasma for quinupristin and dalfopristin. No statistically significant differences were observed in maximal concentrations in plasma, times to maximal concentration, areas under the curve, or half-lives for cysteine, the glutathione conjugates of quinupristin, or the pristinamycin IIA metabolite of dalfopristin. The measurements in dialysate of the parent and most metabolites were below the expected MICs. Dialysis clearance was insignificant. Quinupristin-dalfopristin was well tolerated in both groups, causing only mild adverse events that resolved prior to discharge from the study. The disposition of quinupristin, dalfopristin, or their primary metabolites following a single dose was unaltered in patients receiving peritoneal dialysis. Intravenous dosing of this antibiotic combination is unlikely to be adequate for the treatment of peritonitis associated with peritoneal dialysis.

Steady-state and dynamic MR angiography with MS-325: initial experience in humans.

PURPOSE: To evaluate the imaging performance and patient tolerance of a blood-pool contrast agent (MS-325) for magnetic resonance (MR) angiography. MATERIALS AND METHODS: Imaging of peripheral and carotid vessels was performed in seven healthy volunteers in a phase I clinical trial of the gadolinium chelate MS-325. Each volunteer received an intravenous injection of 0.05 mmol/kg MS-325 over 30 seconds. Dynamic (arterial phase) and steady-state (arterial-venous phase) three-dimensional gradient-echo MR angiograms were acquired during, immediately after, and approximately 50 minutes after injection. Images were ranked (1 [poor] to 5 [excellent]) for overall image quality, and signal-to-noise ratio (S/N) and contrast-to-noise ratio (C/N) were measured by using standard techniques. RESULTS: All volunteers tolerated the procedure well. The MS-325-enhanced studies demonstrated intense vascular signal. Mean peripheral arterial C/N was 12.9 +/- 4.8 (standard deviation), 78.8 +/- 29.4, 46.1 +/- 10.9, and 41.9 +/- 14.1 for the two-dimensional (2D) time-of-flight (TOF) and the contrast material-enhanced dynamic, early steady-state, and late steady-state images, respectively. Image quality of steady-state postcontrast images was statistically significantly (P < .02) higher than that of 2D TOF images. Image quality of early and late postcontrast images was similar, but a small (10%) decrease in C/N was noted from early to late images. CONCLUSION: MS-325 provides excellent vascular and selective arterial enhancement during dynamic MR angiography. The long blood residence time also allows acquisition of steady-state images of the arteries and veins with excellent spatial resolution.

Increase in follicle stimulating hormone content occurs in cultured human fetal pituitary cells exposed to gonadotropin-releasing hormone.

To investigate the mechanisms by which GnRH regulates FSH production in the human fetus, dispersed pituitary cells from second trimester human fetuses were cultured on surface-modified plates. Exposure of cells to GnRH [(10(-8) and 10(-7) mol/L), study I] or [D-Ala6]des-Gly10-GnRH ethylamide (DALA) [(10(-11) to 10(-7) mol/L), study II] for 48 h resulted in an elevation of total FSH which correlated with an increase in releasable, but not nonreleasable, FSH. When pituitary cells were incubated for 24, 48 and 72 h with and without 10(-8) mol/L GnRH (study III), total FSH was significantly increased in cells cultured for 48-72 h without GnRH compared to cells lysed at the beginning of the incubation (p less than 0.001). At all intervals, GnRH significantly enhanced total FSH compared to respective controls (p less than 0.05).

Regulation of the biopotency of primate luteinizing hormone by gonadotropin-releasing hormone in vitro and in vivo.

Gonadotropin biological/immunological (B/I) ratios have proven to be valuable indicators of the biopotencies of LH and FSH. Observations of rapidly changing LH B/I have been made which suggest the existence of a readily mobilized pool of highly bioactive pituitary gonadotropins. To test this hypothesis, we have examined the role of GnRH in the regulation of LH B/I in vivo and in vitro. The rhesus monkey was used as a model due to its many physiological similarities with the human. A rapid elevation in circulating LH B/I was observed following GnRH administration to male monkeys that was sustained for at least 2 h (15 min; p less than 0.05). The administration of 1 or 10 nM GnRH to cultured pituitary cells was found to significantly increase the B/I of secreted, but not intracellular, LH (p less than 0.05). In unstimulated controls, the B/I of intracellular LH was higher than that of secreted LH (p less than 0.05). These findings are consistent with the notion that a pool of highly active LH exists within the gonadotrophs in primates. One way that GnRH may regulate the bioactivity of circulating LH is by rapidly mobilizing this gonadotropin pool.

Urinary excretion of oestrone conjugates and gonadotrophins during pregnancy in the Goeldi's monkey (Callimico goeldii).

Oestrone conjugate and LH/CG were measured in the urine of 4 Goeldi's monkeys during 6 pregnancies. The gestational length was a mean of 148.8 days from the post-partum LH/CG peak to parturition. CG was first detected a mean of 18.8 days after the LH/CG peak and values remained elevated for a mean of 44.8 days. Three different gonadotrophin assays were used to detect LH/CG: the mouse in-vitro interstitial cell bioassay, a mixed heterologous LH RIA, and a monkey CG RIA. The mouse in-vitro interstitial cell bioassay was useful for measuring both the LH peak which occurred post partum and the CG concentrations during pregnancy. However, both immunoassays were inconsistent in measuring LH due to poor cross-reactivity or lack of specificity; CG concentrations were measurable. Oestrone conjugates became elevated at the time of the LH/CG peak and concentrations continued to increase throughout pregnancy, reaching peak levels before parturition. The postpartum interval, pregnancy and parturition can therefore be monitored in the Goeldi's monkey by the use of urinary assays: those for bioactive LH and immunoreactive oestrone conjugates to determine the post-partum LH peak and those for immunoreactive LH/CG and immunoreactive oestrone conjugates to follow pregnancy and parturition.

Ovarian cyclicity, hormones, and behavior as markers of aging in female pigtailed macaques (Macaca nemestrina).

Age-related differences in reproductive function were studied to identify variables suitable for a battery of noninvasive tests used to measure aging rate. Twenty-seven adult female pigtailed macaques, ranging in age from 8 to 31 years, were studied in a cross-sectional design. Perineal tumescence, menses, and activity in the home environment were recorded daily. Sexual behavior, when paired with unfamiliar males of three age groups, was observed six times in the early follicular phase of two ovarian cycles. Estradiol, LH, and FSH were measured twice during the same time period. Of the behavioral measures, mount, present, and activity were found to be lower in old than in young females. Of the physiological measures, ovarian cyclicity was less regular, estradiol was lower, and FSH and LH were higher in old compared to young females. Correlations between measures suggested two dimensions of reproductive function, a behavioral dimension and a physiological dimension.

Pulsatile luteinizing hormone (LH) release during the progesterone-induced LH surge in the female rhesus monkey.

LH pulses during the progesterone (P)-induced LH surge were examined in ovariectomized and estrogen-treated female monkeys. Animals received a 2.5-mg P or oil injection 24 h after administration of 30 micrograms estradiol benzoate. The animals were fitted with jugular catheters connected to a tether-swivel system. Blood samples were collected at 10-min intervals starting 3-4 h before and ending 12-20 h after P or oil injection. Plasma LH was measured by both bioassay and RIA. LH pulses were determined by the PULSAR program. P administration induced a BIA-LH surge with a latency of 71 +/- 10 min in all seven animals. The P-induced bioassayable LH (BIA-LH) surge consisted of an ascending phase (204 +/- 24 min), a plateau period (174 +/- 32 min), and a descending phase (376 +/- 60 min). Oil injection did not cause a LH surge (n = 4). BIA-LH release before P and that during the P-induced LH surge were pulsatile. Pulse intervals of BIA-LH before P treatment (57.1 +/- 5.2 min) were not different from those before (55.0 +/- 11.7 min) and after (62.9 +/- 16.3 min) oil injection. In contrast, pulse intervals during the ascending phase (35.0 +/- 4.0 min), plateau period (34.6 +/- 2.6 min), and descending phase (45.0 +/- 3.1 min) were significantly shorter (P less than 0.02) than those before P. Pulse amplitudes of BIA-LH during the ascending phase (125.3 +/- 28.7 ng/ml) and plateau period (253.9 +/- 27.0 ng/ml) were significantly (P less than 0.001) higher than those (44.7 +/- 12.6 ng/ml) before P and during the descending phase (66.9 +/- 11.1 ng/ml). Radioimmunoassayable LH results were quite similar to those for BIA-LH, except that amplitude changes in radioimmunoassayable LH after P treatment were smaller than those in BIA-LH. It was concluded, therefore, that both the frequency and amplitude of pulsatile LH release increase during the P-induced LH surge, especially during the ascending phase and plateau period, in female rhesus monkeys. Furthermore, the present results support our previous conclusion that P facilitates pulsatile LHRH release with increases in frequency and amplitude in ovariectomized and estrogen-treated monkeys.

Urinary gonadotropin and estrogen excretion during the postpartum estrus, conception, and pregnancy in the cotton-top tamarin (Saguinus oedipus oedipus).

Hormonal profiles during postpartum estrus, time of conception, and pregnancy were determined in urine samples from six cotton-top tamarins (Saguinus oedipus oedipus). Noninvasive collection techniques permitted daily sampling throughout lactation and pregnancy. Urinary estrone (E1), estradiol (E2), and both bioactive and immunoreactive luteinizing hormone/chorionic gonadotropin (LH/CG) measures revealed an interval of 19 ± 2.07 (S E M) days between parturition and the postpartum ovulatory LH peak. An increase in both E1 and E2 was seen prior to the LH peak; however, E1 and E2 continued to increase to their highest concentrations after the LH peak. Since postpartum ovulations resulted in pregnancy, neither postpartum estrus nor conception was suppressed by lactation. The length of gestation (measured from the LH peak to parturition) was 183.7 ± 1.14 (S E M) days, which is at least 30 days longer than that previously reported for other callitrichid species. Both E1 and E2 reached their maximum levels during midpregnancy but showed a rapid decline at parturition. Gestational levels of CG were first detectable approximately 20 days after the LH peak and continued to be elevated for approximately 80 days. The Sub-Human Primate Tube Test (SHPTT) for pregnancy did not detect the LH Peak and was less sensitive than other methods in detecting CG. Two RIA methods and a bioassay technique could not distinguish between LH and CG. We concluded that monitoring both estrogen and LH concentration was needed to determine when ovulation occurs in the cotton-top tamarin, since peak values of estrogen are seen after the ovulatory LH peak. Also, these tamarins were pregnant the majority of the time, indicating an unusually high fertility rate in contrast to most noncallitrichid primate species.

Developmental changes in the luteinizing hormone secretory pattern in peripubertal female rhesus monkeys: comparisons between gonadally intact and ovariectomized animals.

Developmental changes in LH release patterns were observed longitudinally in female rhesus monkeys at 10-65 months of age. The average ages of menarche and first ovulation in this experiment (n = 14) were 31.1 +/- 2.6 and 47.0 +/- 2.6 months (mean +/- SE), respectively. To assess the ovarian influence on developmental changes in LH, data were simultaneously obtained from neonatally ovariectomized animals at similar ages. The estimation of circulating LH was made with RIA as well as biological assay. During the prepubertal period (10-20 months of age), basal LH was very low, and there was no circadian fluctuation of LH in gonadally intact monkeys. During the early pubertal stage (20-30 months of age), before menarche, basal LH levels started to increase, and a circadian LH rhythm (nocturnal increases) appeared. At the midpubertal stage (30-50 months of age), a period between menarche and first ovulation, basal LH levels further increased, and the circadian LH rhythm was maximal. At the late pubertal stage (50-60 months of age), a period after the first ovulation during which the animals were not able to reproduce fully as adults, basal LH declined, and the circadian rhythm diminished. Similar but more exaggerated developmental changes in basal LH and the circadian fluctuation of LH were observed in females ovariectomized neonatally. Basal LH levels at 10-20 months were as low as those in intact animals with no circadian rhythm present. During the early pubertal period, a circadian fluctuation appeared at the time when a slight increase in the basal LH level occurred. Furthermore, the amplitude of circadian fluctuation (the difference between morning and evening LH values) increased linearly with the increase in basal LH during the midpubertal stage. These LH parameters in ovariectomized animals reached their peaks at 40-44 months, an age before the first ovulation in intact animals. As basal LH levels declined during the late pubertal stage to postpubertal stage, circadian fluctuation disappeared. The results suggest that the increase in LH output and concomitant circadian fluctuations occur in close association with the pubertal process, and this change in LH release is not dependent on the presence of the ovary. Therefore, we suggest that alteration of the LHRH release pattern during maturation, as reflected by LH release, rather than resetting of the gonadostat, is the key factor involved in the mechanism of the onset of puberty.

Serum progesterone and corpus luteum function in pregnant pigtailed monkeys (Macaca nemestrina).

Corpus luteum (CL) function and control during pregnancy and early lactation in the pigtailed macaque was investigated. Peripheral concentrations of progesterone (P) on day 10 of pregnancy were 12.98 +/- 2.21 ng/ml and decreased progressively to 7.96 +/- 1.27 ng/ml by day 21 of pregnancy. The concentration of P increased around day 27 of gestation and reached peak levels of 18.48 +/- 2.45 ng/ml on day 37, thereafter gradually decreasing to a nadir at about midgestation. Ten days before parturition P concentrations increased again (P < 0.05). Concentrations of P decreased from 6.62 +/- 1.48 ng/ml on the day of delivery to 2.16 +/- 0.43 ng/ml on day 2 of lactation and remained low thereafter. Ovariectomy on day 35 did not affect the normal course of gestation or the patterns of P secretion during pregnancy. However, in these ovariectomized animals, in spite of suckling, P was not detectable after parturition. In intact monkeys, serum concentrations of P in the utero-ovarian vein at days 80 and 159 of pregnancy were higher relative to the uterine vein. Incubation studies utilizing 3H-cholesterol as a substrate revealed that the CL were capable of synthesizing P on days 35 and 159 of gestation. Histologically, the CL contained active luteal cells at late pregnancy. Low serum concentrations of chorionic gonadotropin were detected on day 10 of gestation; concentrations of this hormone reached high levels between days 18 and 24 and the titers were nondetectable after day 40 of pregnancy. Luteinizing hormone was present in constant amounts in the circulation during pregnancy and lactation. These data suggest that the CL of pregnancy in the pigtailed monkey is functional or capable of functioning during various stages of pregnancy. However, the fetoplacental unit is the primary source of P during the latter 4.5 months of gestation. As in other primates, a functional CL is not required for maintenance of pregnancy after implantation nor for lactation. Thus, the physiological significance of CL function during pregnancy is unclear.

Effects of discrete lesions of preoptic and suprachiasmatic structures in the female rat. Alterations in the feedback regulation of gonadotropin secretion.

The purpose of this study was to determine which specific structures within the medial preoptic-anterior hypothalamic area are necessary to maintain cyclic ovulation in the rat, and to define the deifcit(s) in the feedback regulation of gonadotropin secretion associated with lesions that result in anovulation. Large (approximately 1.1 mm dia.) or small (approximately 0.7 mm dia.) electrolytic lesions were placed in several loci within preoptic, anterior hyopthalamic and suprachiasmatic areas in regularly cycling adult female rats. Large lesions which included the suprachiasmatic nuclei (SCN) induced an anovulatory condition characterized by persistent vaginal cornification and polyfollicular ovaries (persistent estrus). Large or small lesions which included the medial preoptic nucleus (MPN), a small periventricular column of cells located immediately caudal to the organum vasculosum of the lamina terminalis (OVLT), also induced persistent estrus. Lesions placed elsewhere within the medial preoptic-anterior hypothalamic area never induced persistent estrus but were frequently associated with repeated periods of prolonged diestrus separated by brief periods of vaginal cornification. These prolonged diestrous intervals appeared to be related to spontaneous luteal activation following ovulation rather than impaired folliculogenesis. LH and FSH surges induced by sequential administration of estradiol benzoate and progesterone (P) were completely abolished only by lesions which included the MPN. Small lesions involving only the MPN and OVLT or the MPN and caudally adjacent loci in the suprachiasmatic region were as effective in this respect as larger lesions encompassing most of the preoptic-suprachiasmatic region from the diagonal band of Broca to the rostral pole of the SCN. On the other hand, P-induced gonadotropin surges were never completely blocked by SCN lesions, although the magnitude of the surge was highly variable and frequently attenuated compared to controls. It is concluded that both the MPN and SCN are required for the long-term maintenance of spontaneous cyclic ovulation in the rat. However, the characteristically dissimilar deficits in P-induced gonadotropin release associated with lesions of one or the other of these structures indicate that these nuclei may play different roles in the regulation of gonadotropin surges. It is suggested that neural elements indispensable for phasic gonadotropin release are located within and/or immediately adjacent to the MPN. The SCN may influence phasic gonadotropin release indirectly, by regulating circadian rhythms which govern the responsiveness of other neural elements to hormonal stimuli.