Are Turkish pharmaceutical pricing strategies an access barrier to oncology medicines for Türkiye?

Objectives: Cancer diagnosis is increasing day by day all over the world. Deaths due to cancer are among the most common causes of death. Access to cancer drugs is a priority of health policies. The aim of this study is to evaluate access to cancer drugs through drug box sales data by modeling population growth, cancer incidence, and Fixed Euro Exchange (FEE) rate parameters used in drug pricing in Türkiye. Methods: Access to cancer drugs was evaluated by drug box sales figures obtained from IQVIA. Box sales data were classified according to diagnosis codes (ICD-10), reference, or generic status. Consumption of cancer drugs was examined over time with panel regression analysis, taking into account variables of population growth, cancer incidence, and the FEE rate in drug pricing in Türkiye. Results: The incidence of cancer in Türkiye was 215.1 in 2010 and 223.1 (per hundred thousand) in 2017. Whereas there was a 127.02% increase in the real euro exchange rate, there was an 89.6% increase in the FEE rate. With the regression approach, there is a negative relationship between the real and fixed exchange rate difference (RFED) and reference and generic drug consumption data. Medicine access is affected depending on diagnosis codes at different levels. Colorectal cancer medicine sales had negative correlations for each variable, namely, exchange rate, population growth, and cancer incidence. On the contrary, there was a positive correlation between non-small-cell lung cancer and relevant variables. Innovative medicine groups such as monoclonal antibodies and protein kinase inhibitor consumption showed a negative correlation. Conclusion: According to our results, pricing strategy may be an access barrier for oncology medicines in Türkiye. It should be reviewing the pricing policy that is beneficial for oncology medicine access in Türkiye.

Anti-inflammatory effects of oral and intraperitoneal administration of cerium oxide nanoparticles on experimental hepatic ischemia-reperfusion injury.

Objectives: Hepatic ischemia-reperfusion (IR) injury occurs in liver surgery, resection, and transplantation. Reactive oxygen species (ROS) produced following IR starts the cascade of cell damage, necrosis/apoptosis, and proinflammatory responses by activating intracellular signaling cascade to drive hepatocellular damage. Cerium oxide nanoparticles (CONPs) act as anti-inflammatory and antioxidant agents. Thus, we evaluated the protective effects of oral (o.g.) and intraperitoneal (i.p.) administration of CONPs on hepatic IR injury. Material and Methods: Mice were randomly divided into five groups: control, sham, IR protocol, CONP+IR (i.p.), and CONP+IR (o.g.). Mouse hepatic IR protocol was applied to the animals in the IR group. CONPs (300 µg/kg) were administered 24 hours before IR protocol. Blood and tissue samples were taken after the reperfusion period. Results: Hepatic IR injury markedly increased enzyme activities, tissue lipid peroxidation, myeloperoxidase (MPO), xanthine oxidase (XO), nitrite oxide (NO), and tissue nuclear factor kappa-B (NF-κB) p65 levels, plasma pro-inflammatory cytokines, chemokines, and adhesion molecules while decreasing antioxidant markers and caused pathological changes in hepatic tissue. The expression of tumor necrosis factor alpha (TNF-α), matrix metalloproteinase 2 (MMP-2), and 9 increased, and tissue inhibitor matrix metalloproteinase 1 (TIMP-1) expression decreased in the IR group. Pretreatment with CONPs o.g. and i.p. 24 hours before hepatic ischemia improved the biochemical parameters above and alleviated the histopathological findings. Conclusion: Results of the present study demonstrate a significant reduction in liver degeneration by administering CONPs via i.p. and o.g. route in an experimental liver IR model, suggesting that CONPs have the extensive potential to prevent hepatic IR injury.

The Cardiopulmonary Effects of the Calcitonin Gene-related Peptide Family.

Cardiopulmonary diseases are very common among the population. They are high-cost diseases and there are still no definitive treatments. The roles of members of the calcitonin-gene related-peptide (CGRP) family in treating cardiopulmonary diseases have been studied for many years and promising results obtained. Especially in recent years, two important members of the family, adrenomedullin and adrenomedullin2/intermedin, have been considered new treatment targets in cardiopulmonary diseases. In this review, the roles of CGRP family members in cardiopulmonary diseases are investigated based on the studies performed to date.

Mechanism of adrenomedullin 2/intermedin mediated vasorelaxation in rat main pulmonary artery.

Adrenomedullin 2/intermedin (AM2/IMD) is a member of calcitonin related gene peptide family and an important nitric oxide mediated vasorelaxant in various vascular beds. However, the mechanism of post receptor-interaction is not clear and may differ depending on tissue type and species. In this study, we aimed to investigate the exact mechanism and the role of BKCa and calcium channels on the vasorelaxant effect of AM2/IMD in rat PA. Changes in the AM2/IMD-mediated vasorelaxation were evaluated in the presence of various inhibitors. CGRP(8-37) (10-6 M), L-NAME (10-4 M), ODQ (10-5 M), SQ22536 (10-4 M), H89 (10-6 M), TEA (10-2 M), iberiotoxin (3 × 10-7 M), and verapamil (10-5 M), all partly or completely inhibited the vasorelaxation. The relaxation was also abolished by removal of the endothelium, or in KCl precontracted PAs. AM2/IMD did not elicit vasorelaxation in the Ca2+-free conditions. However, the vasorelaxation was not inhibited with AM(22-52) (10-6 M), 4-AP (3 × 10-3 M), glibenclamide (10-5 M), apamin (3 × 10-7 M), TRAM-34 (10-5 M), and La+3 (10-4 M). AM2/IMD -induced changes in intracellular calcium levels and isometric force were monitored simultaneously in fura-2-loaded, endothelium-intact PAs. The AM2/IMD-induced increase in intracellular Ca2+ concentration was inhibited in the presence of iberiotoxin and verapamil, whereas no change was observed with La3+ incubation. Our data suggest that the cAMP/PKA pathway is one of the important pathways AM2/IMD-induced vasorelaxation. AM2/IMD acts through activation of endothelial BKCa and subsequently causes hyperpolarization of the endothelial cell membrane. The hyperpolarization induces Ca2+ influx, which leads to NO production and subsequent vasorelaxation.

Effect of intermedin/adrenomedullin2 on the pulmonary vascular bed in hypoxia-induced pulmonary hypertensive rats.

AIMS: This study aimed to investigate the effect and mechanism of action of intermedin/adrenomedullin2 (IMD/AM2) on the pulmonary vascular bed in pulmonary hypertensive rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were exposed to hypobaric hypoxia for 3 weeks to induce pulmonary hypertension (PHT). The development of PHT was confirmed by histopathological analyses and measurement of hematocrit, basal perfusion pressure, and right ventricle hypertrophy. Subsequently, the effect of IMD/AM2 in pulmonary hypertensive rats was assessed with both, isolated organ bath and isolated lung perfusion studies. KEY FINDINGS: In the PHT group, the basal perfusion pressure and % hematocrit were increased, and right ventricle hypertrophy occurred after 3 weeks of hypoxia exposure. Increased medial wall thickness was also observed in the pulmonary artery with histopathological analysis. In the PHT, the nitric oxide-mediated vasodilation caused by IMD/AM2 in the pulmonary vascular bed and this was as potent as the control group. Acetylcholine responses were also protected in pulmonary hypertensive rats. SIGNIFICANCE: Our results showed for the first time in in vitro studies that IMD/AM2 administration causes potent, concentration-dependent vasodilation in the main and resistance pulmonary arteries of rats with PHT. Based on these results, IMD/AM2 might be considered as a future therapeutic target for PHT treatment.

Sodium nitrite provides angiogenic and proliferative effects in vivo and in vitro.

BACKGROUND Angiogenesis is the formation of new blood vessels from pre-existing vasculature. Many factors and substances may stimulate angiogenesis and exhibit proliferative effect. In this study, we aimed to investigate the angiogenic and proliferative effects of sodium nitrite. MATERIAL AND METHODS The angiogenic activity of sodium nitrite was examined in vivo in the chick chorioallantoic membrane (CAM) model and in vitro in tube formation assay of human umbilical vein endothelial cells (HUVECs). The proliferative activity of sodium nitrite was also determined through MTT assay on HUVECs. RESULTS In CAM assay, sodium nitrite had an angiogenic effect especially at high concentrations compared with the control group and this was statistically significant. There was a proliferative effect on HUVECs in the presence of sodium nitrite for 24 and 48 h, and this was statistically significant (p<0.05). Comparing the tube length/area ratio values, there was statistically significant increase in the sodium nitrite group compared to the control group (p<0.05). CONCLUSIONS The results provide evidence that sodium nitrite induces angiogenesis in vitro and in vivo.

Dispensing practice in the community pharmacies in the Turkish Republic of Northern Cyprus.

BACKGROUND: Good pharmacy practice is the process of supplying the accurate drug to the right patient for an adequate period of time with the lowest cost to the patient and the community. Pharmacist have a crucial role in promoting good pharmacy practice. OBJECTIVE: To assess the dispensing practice of the community pharmacists in the Turkish Republic of Northern Cyprus (TRNC) regarding RDU and to evaluate the quality of dispensing. Setting Community pharmacies in TRNC. Method The study consists of two parts: a face to face interview and a simulated patient visit to these pharmacies. MAIN OUTCOMES MEASURE: Rationality indicators (average dispensing time, stock availability and adequate labelling), presence of the pharmacist on the premises, dispenser characteristics, prescription checking, and the provided patient information. RESULTS: The majority of the prescriptions (73.3%) were dispensed by the pharmacists. None of the pharmacy employees had pharmacy based training. Eighty nine percent of the pharmacists believed that their employees could very well dispense drugs on their own. The declared average dispensing time for a prescription of a single drug was 233 s while the measured one was 149 s. Few dispensers in reality warned the patient about potential interactions. The difference between the average dispensing scores of the pharmacists and the non-pharmacist dispensers was not significant. CONCLUSIONS: The dispensing practice in the community pharmacies in the Turkish part of Cyprus seems inadequate in terms of GPP.

Sodium nitrite and cardioprotective effect in pig regional myocardial ischemia-reperfusion injury model.

OBJECTIVES: The present study was designed to investigate the cardioprotective effect of sodium nitrite (NaNO2) and sodium nitrate (NaNO3) against myocardial ischemia-reperfusion (I/R) injury in a pig regional ischemia model. MATERIAL AND METHODS: Eighteen pigs were randomly divided into three groups as control (Group 1), sodium nitrite (Group 2) and sodium nitrate (Group 3) groups. Before the exploration of the heart, blood samplings were taken for alanine aminotranspherase (ALT), aspartate aminotranspherase (AST), lactate dehydrogenase (LDH), creatinine kinase-muscle band (CK-MB), troponin-t, glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and nitrite/nitrate (NO2-/NO3-) in all groups (T0). Following sternotomy and stabilization, blood and tissue samples were repeated (T1). Then, intracoronary sodium nitrite and sodium nitrate were given (0.5µg/kg) in Groups 2 and 3. Five minutes later, the left anterior descending (LAD) artery was ligated for I/R experiments. Blood and tissue samplings were repeated after 60 minutes of ischemia (T2) and 180 minutes of reperfusion period (T3). Light and electron microscopic investigations were performed. RESULTS: There were statistically significant results in favor of Group 2 in all studied parameters. Hemodynamic parameters showed a decrease in mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI) and an increase in heart rate, mean pulmonary artery pressure (MPAP), left ventricle end-diastolic pressure (LVEDP), pulmonary capillary wedge pressure (PCWP) during ischemia. Following the ischemia these parameters returned to their near normal levels. This was prominent in group 2. Oxidative parameters showed protective increases in GPx, SOD, CAT and NO2-/NO3- levels and a decrease at MDA both in tissue and blood samples in group 2. There were statistical differences only in T3 for AST, troponin-t and CK-MB levels in favor of Group 2. Histological and electron microscopy examinations were also in favor of NO2- group. CONCLUSIONS: The results of the present study indicate that NaNO2 provides protection against myocardial I/R injury when compared to control and NaNO3 groups.

Tumor necrosis factor-alpha antagonist administration recovers skeletal muscle dysfunction in ovariectomized rats.

Skeletal muscles deteriorate after ovariectomy. Molecular pathway of this deterioration has not been defined. Tumor necrosis factor (TNF)-alpha activation is assumed to trigger muscle atrophy and administration of its antagonist is hypothesized to recover this atrophy in rats. Slow-twitch soleus and fast-twitch extensor digitorum longus muscle functions were investigated in intact, ovariectomized (OVX), and OVX plus 10 µg/g/week TNF-alpha antagonist administered female rats. Maximum isometric twitch and tetanic contraction responses were lower in the OVX groups. Maximum isometric twitch amplitudes recovered in the extensor digitorum longus but not in the soleus muscles after TNF-alpha antagonist administration. The decrease in responses to tetanic stimulations recovered in the OVX-TNF group at frequencies higher than 20 Hz in both muscle types. OVX animals body weight was 21% higher than intact animals. Muscle weight to body weight ratios of the OVX groups were higher than the control group which recovered after TNF-alpha antagonist administration. Findings suggest that the functional loss in OVX rat muscles is TNF-alpha pathway dependent. Skeletal muscle atrophy and function after OVX recovered by TNF-alpha antagonist administration.

Synthesis and studies on antidepressant and anticonvulsant activities of some 3-(2-thienyl)pyrazoline derivatives.

In this study, the synthesis of twelve 3-(2-thienyl)pyrazoline derivatives are described. The structures of all compounds were confirmed by UV, IR, (1)H-NMR, mass spectral data, and microanalyses. In the pharmacological studies, antidepressant and anticonvulsant activities of these compounds have been screened. The antidepressant activities of the compounds were investigated by Porsolt's behavioral despair test (forced swimming) on albino mice and compared with tranylcypromine. Among the compounds examined, the compounds 9 and 12 showed significant antidepressant activity. Anticonvulsant activities of the compounds were determined by maximal electroshock seizure (MES) and subcutaneous pentylenetetrazole (metrazol) (scMet.) tests, neurotoxicities were determined by rotarod toxicity test on albino mice. Compound 8 was found to be protective against MES in the range of 30-300 mg/kg dose levels at four hours. None of the synthesized compounds showed neurotoxicity at 30-300 mg/kg dose levels.

Ischemic and peroxynitrite preconditioning effects in chronic hypoxic rat lung.

Chronic hypoxic pulmonary hypertension is characterized by vasoconstriction and vascular remodeling and impaired endothelial nitric oxide (NO) production. Although ischemic preconditioning of the lung leads to protective effect against ischemic reperfusion injury, the mechanisms of this protection are not well documented in the lung. The aim of this study was to investigate the effects of chronic hypoxia on preconditioning induced by ischemia or peroxynitrite in isolated rat lungs. The isolated rat lung, from exposed to hypobaric hypoxia for 21 days, was mounted on a modified Langendorff perfusion apparatus. Lungs were preconditioned by either 5 minutes' ischemia and 5 minutes' reperfusion or 10 microM peroxynitrite prior to 2 hours of normothermic ischemia. Although ischemia-reperfusion or peroxynitrite preconditioning markedly reduced KCl responses on perfusion pressure, phenylephrine-induced responses were not significantly modified. Pretreatment of the hypoxic lungs with peroxynitrite scavenger, uric acid, or poly (ADP-ribose) synthase inhibitors (PARS), 3-aminobenzamide (3-AB) or nicotinamide, did not modify the KCl- and phenylephrine-induced responses in chronic hypoxic lungs. There were also no marked differences either in wet to dry weight ratio or malondialdehyde levels of chronic hypoxic lungs. These results imply that preconditioning does not occur in the chronic hypoxic rat lungs.

Intermedin/adrenomedullin-2 (IMD/AM2) relaxes rat main pulmonary arterial rings via cGMP-dependent pathway: role of nitric oxide and large conductance calcium-activated potassium channels (BK(Ca)).

The present study was designed to investigate the effects of rat intermedin/adrenomedullin2 (rIMD), an agonist for calcitonin-like calcitonin receptors (CRLR), on the isolated rat pulmonary arterial rings (PA). When PA were precontracted with 9,11-dideoxy-11alpha,9alpha-epoxymethanoprostaglandin F2alpha (U-46619), rIMD (10(-11) to 10(-6)M) induced concentration-dependent relaxation. The pulmonary vasorelaxant response (PVR) to rIMD in PA were completely inhibited by endothelium removal, NG-nitro-L-arginine-methyl-ester (L-NAME), l-N5-(1-iminoethyl)-ornithine hydrochloride (l-NIO) or 1H-[1,2,4] oxadiazolo[4,3-a]quinoxalin-1-one (ODQ). The PVR to rIMD were also significantly attenuated by a protein kinase inhibitor, Rp-8-bromo-beta-phenyl-1,N2-ethenoguanosine 3':5'-cyclic monophosphorothioate sodium salt hydrate (Rp-8-Br-PETcGMPs), cholera toxin and abolished by tetraethylammonium chloride (TEA), iberiotoxin and precontraction with KCl. The relaxant effect was not affected by 9-(tetrahydro-2-furanyl)-9H-purin-6-amine (SQ22536), (9S,10S,12R)-2,3,9,10,11,12-hexahydro-10-hydroxy-9-methyl-1-oxo-9,12-epoxy 1H diindolo [1,2,3fg:3',2',1'kl] pyrrolo [3,4-i] [1,6] benzodiazocine-10-carboxylic acid hexyl ester (KT5720), meclofenamate, glybenclamide or apamin. In parallel with SQ22536 and KT5720 results rolipram pretreatment did not alter the rIMD-induced PVR. The PVR to rIMD was potentialized either in the presence of zaprinast or sildenafil. Since the PVR to rIMD was also significantly reduced by rCGRP(8-37) and hADM(22-52) and rIMD(17-47), the present data suggest that rIMD produces PVR by acting in an indiscriminant manner on functional, and possibly different, endothelial CRLR. In conclusion, rIMD stimulates endothelial CRLR are coupled to release of nitric oxide, activation of guanylate cyclases, and promotion of hyperpolarization through large conductance calcium-activated K(+) channels in rat main PA.

Studies on 1,2,4-triazole derivatives as potential anti-inflammatory agents.

The reaction of acetic or propionic acid hydrazides with various aryl/alkyl isothiocyanates gave thiosemicarbazides which furnished the 1,2,4-triazoles by alkali cyclization. The 4-aryl/alkyl-5-(1-phenoxyethyl)-3-[N-(substituted)acetamido]thio-4H-1,2,4-triazole derivatives were synthesized by reacting the triazoles with 2-chloro-N-(substituted)acetamide. The chemical structures of the compounds were elucidated by IR, (1)H-NMR, FAB(+)-MS spectral data and elemental analysis. In the pharmacological studies, anti-inflammatory activities of these compounds have been screened and significant activities were observed.

Synthesis and studies on antidepressant and anticonvulsant activities of some 3-(2-furyl)-pyrazoline derivatives.

Twelve 1-phenyl-, 1-thiocarbamoyl- and 1-N-substituted thiocarbamoyl-3-(2-furyl)-5-phenyl/(2-furyl)-2-pyrazoline derivatives were synthesized. The chemical structures of the compounds were proved by IR, (1)H NMR, Mass spectrometric data and microanalyses. The antidepressant activities of the compounds were investigated by Porsolt's behavioural despair (forced swimming) test on albino mice. 1-N-Ethylthiocarbamoyl-3-(2-furyl)-5-phenyl-2-pyrazoline (6) and 1-N-allylthiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (11) reduced 33.80-31.42% duration of immobility times at 10 mg kg(-1) dose level. Anticonvulsant activities of the compounds were determined by maximal electroshock seizure (MES) and subcutaneous pentylenetetrazole (metrazol) (scMet.) tests, neurotoxicities were determined by rotarod toxicity test on albino mice. 1,5-Diphenyl-3-(2-furyl)-2-pyrazoline (2), 1-N-allylthiocarbamoyl-3-(2-furyl)-5-phenyl-2-pyrazoline (7), 1-N-allylthiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (11) and 1-N-phenylthiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (12) were active at 100-300 mg kg(-1) dose levels. 1-Thiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (4), 1-N-methylthiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (9) and 1-N-ethylthiocarbamoyl-3,5-di(2-furyl)-2-pyrazoline (10) were found protective against MES and scMet. at 30-300 mg kg(-1) dose levels.

Ischemic preconditioning modulates ischemia-reperfusion injury in the rat lung: role of adenosine receptors.

Recent studies have been focused on the protective role of ischemic preconditioning against ischemia-reperfusion injury of the lung occurring following cardiopulmonary by-pass surgery and lung or heart transplantation. The present study was undertaken to investigate the role of adenosine in ischemic preconditioning in the isolated buffer-perfused rat lung. Since the pulmonary perfusion flow rate and left atrial pressure were constant, changes in pulmonary arterial pressure directly reflect changes in pulmonary vascular resistance. When compared to control values, ischemia-reperfusion injury in the form of 2 h of normothermic ischemia significantly reduced the pulmonary vasoconstrictor response to phenylephrine and KCl, increased wet-to-dry lung weight ratios and increased malondialdehyde content of rat lungs. Ischemic preconditioning in the form of one cycle of 5 min of ischemia and reperfusion applied prior to ischemia-reperfusion, as well as, adenosine preconditioning in the form of adenosine infusion prior to ischemia-reperfusion independently prevented the reduction in pulmonary vasoconstrictor responses and the increases in pulmonary edema and malondialdehyde formation in response to ischemia-reperfusion injury. Pretreatment with adenosine receptor antagonists, theophylline or 8-cyclopentyl-1,3-dipropyl xanthine (DPCPX) prior to ischemic preconditioning or adenosine preconditioning abolished the protective effects of preconditioning by ischemic preconditioning and adenosine preconditioning. The present data demonstrate that ischemic preconditioning and adenosine preconditioning prevent the vascular and biochemical alterations studied in response to ischemia-reperfusion injury in the pulmonary vascular bed of the rat. Results of the present study suggest activation of adenosine A(1) receptors mediates the protective properties of ischemic preconditioning and adenosine preconditioning on ischemia-reperfusion injury in the lung. Moreover, the present data further suggest selective adenosine receptor agonists may be useful as pharmacologic preconditioning agents in preventing ischemia-reperfusion injury in lung transplantation and other forms of pulmonary vascular ischemia.

Effects of ischemic preconditioning on rat lung: role of nitric oxide.

Recent studies suggest that ischemic preconditioning (IP) of the lung may have a protective effect in ischemia-reperfusion (I/R) injury. The purpose of the present study was to investigate the preconditioning hypothesis in rat pulmonary vascular bed and to examine the role of nitric oxide (NO) in IP. Isolated rat lung was perfused with Krebs-Henseleit solution containing indomethacin at a constant flow rate and perfusion pressure changes was recorded by a pressure transducer. In rat pulmonary vascular bed, 2 hours of hypothermic ischemia significantly attenuated histamine-induced vasodilator responses without affecting sodium nitroprusside (SNP) vasodilation when compared to sham values. However, 2 cycles of 5 minutes of ischemia and reperfusion that were applied prior to 2 hours of ischemia (IP protocol) prevented the attenuation of histamine-induced vasodilation. On the other hand, IP failed to prevent pulmonary edema after ischemia. Histopathological examination of rat lungs demonstrated that IP was able to protect endothelial cells and type II pneumocytes in lung. Moreover, in IP group, malondialdehyde (MDA) contents of the lung tissue were significantly lower and tissue glutathione (GSH) contents were significantly higher than those in I/R group. Administration of NO synthase inhibitor, N(G)-nitro-L-arginine-methyl ester (L-NAME) prior to the IP protocol abolished the protective effects of IP, but not affected the tissue malondialdehyde and glutathione levels. These results suggest that I/R impaired endothelium-dependent vasodilatory response, whereas endothelium-independent SNP-induced responses were preserved in rat pulmonary vascular bed. IP prevented the impairment of pulmonary vascular endothelium-dependent responses, and these effects may be partially mediated by NO.

Oral administration of liposomal insulin.

There have been several attempts published in the literature related with orally effective insulin formulations, which are increasing in popularity. Some of the results indicate that it is possible to reduce blood glucose level by orally administered liposomal insulin formulations, but there is general need to understand the mechanism and effective components of the liposome formulations. In our study, liposomal insulin formulations were prepared using insulin (Humulin R) or protamine- containing insulin (Humulin N) with cholesterol, dipalmitoyl phosphatidylcholine (egg) (DPPC)-cholesterol mixture, and mucoadhesive agent (methyl cellulose, MC)-added DPPC-cholesterol mixture. A tablet formulation of insulin was also prepared. Formulations of liposomal insulin were introduced to mice and rats orally and reduced blood glucose levels were observed. The composition of phospholipid (DPPC, cholesterol and MC mixture) was found to be quite effective in reducing blood glucose levels. The pH of the solution and the presence of the protamine sulfate were found to be important. The application site was also found to be important because liposomal insulin formulations administered through the mouth or esophagus resulted in reduced blood glucose levels. Reduced blood glucose levels were also observed when tablet formulations of insulin were administered to rats orally.

Preconditioning modulates pulmonary endothelial dysfunction following ischemia-reperfusion injury in the rat lung: role of potassium channels.

Ischemic preconditioning (IP) may protect the lung from ischemia-reperfusion (I/R) injury following cardiopulmonary by-pass and lung or heart transplantation. The present study was undertaken to investigate the role of ATP-dependent potassium channels (K(ATP)) in IP in the isolated buffer-perfused rat lung (IBPR) under conditions of elevated pulmonary vasoconstrictor tone (PVT). Since pulmonary arterial perfusion flow and left atrial pressure were constant, changes in pulmonary arterial pressure (PAP) directly reflect changes in pulmonary vascular resistance (PVR). When compared to control value, the pulmonary vasodilator responses to histamine and acetylcholine (ACh) following 2 h of hypothermic ischemia were significantly attenuated, whereas the pulmonary vasodilator response to sodium nitroprusside (SNP) was not altered. IP in the form of two cycles of 5 min of ischemia and reperfusion applied prior to the two-hour interval of ischemia, prevented the decrease in the pulmonary vasodilator responses to histamine and ACh. Pretreatment with glybenclamide (GLB) or HMR-1098, but not 5-hydroxydecanoic acid (5-HD), prior to IP abolished the protective effect of IP. In contrast, GLB or 5-HD did not significantly alter the pulmonary vasodilator response to histamine without IP pretreatment. The present data demonstrate that IP prevents impairment of endothelium-dependent vasodilator responses in the rat pulmonary vascular bed. The present data further suggest that IP may alter the mediation of the pulmonary vasodilator response to histamine and thereby trigger a mechanism dependent on activation of sarcolemmal, and not mitochondrial, K(ATP) channels to preserve endothelial-dependent vasodilator responses and protect against I/R injury in the lung.

Hemopressin, a hemoglobin fragment, dilates the rat systemic vascular bed through release of nitric oxide.

The present study was undertaken to investigate the effects of intravenous (i.v.) administration of rat hemopressin (rHP), 30-1000 microg/kg, on systemic arterial pressure (SAP), cardiac output (CO) and systemic vascular resistance (SVR) in the anesthetized rat. Bolus i.v. injections of rHP produced mild decreases in SAP that were dose-dependent. Since CO was not altered, the decreases in SAP reflect reductions in SVR. The systemic vasodilator response to rHP was not subject to tachyphylaxis. The systemic vasodilator response to rHP was abolished by L-nitro-arginine methylester (L-NAME) but was not altered by meclofenamate. In addition, rHP lacked direct contractile and relaxant activity on isolated rat aortic rings (AA) and pulmonary arterial rings (PA). The present data suggest rHP dilates the rat systemic vascular bed through the endogenous release of nitric oxide (NO) independent of the formation of cyclooxygenase products including prostacyclin. It is possible rHP acts as an endogenous vasodilator substance to regulate local blood flow during clinical states of altered red cell turnover, microvascular disease and hemolysis.

Intermedin/adrenomedullin-2 dilates the rat pulmonary vascular bed: dependence on CGRP receptors and nitric oxide release.

Intermedin/adrenomedullin-2 (IMD/AM2) is a 47 amino acid peptide formed by enzymatic degradation of preprointermedin. The present study was undertaken to investigate the effects of rat IMD (rIMD) in the isolated buffer perfused rat lung (IBPR) under resting conditions and under conditions of elevated pulmonary vasoconstrictor tone (PVT). Under resting conditions in the IBPR, rIMD had little or no activity. When PVT was actively increased by infusion of U46619, bolus injection of IMD decreased pulmonary arterial pressure (PAP) in a dose-dependent manner. Since the pulmonary perfusion rate and left atrial pressure were constant, these reductions in PAP directly reflect reductions in pulmonary vascular resistance (PVR). The pulmonary vasodilator response to rIMD, when compared to calcitonin gene-related peptide (CGRP) on a molar basis, was greater at the lowest and midrange doses. The degree of inhibition by CGRP8-37 on pulmonary vasodilator response to rIMD was significantly less when compared to CGRP. Pretreatment with L-nitro-arginine-methyl ester (L-NAME), unlike meclofenamate and glybenclamide, significantly reduced the pulmonary vasodilator responses to rIMD. rIMD administration induced cross-tachyphylaxis to the pulmonary vasodilator response to CGRP whereas CGRP administration did not alter the ability of rIMD to dilate the IBPR. Pulmonary vasodilator responses to repeated injections of rIMD did not undergo tachyphylaxis. The present data demonstrate rIMD possesses direct vasodilator activity in the rat pulmonary vascular bed. The present data suggest activation of CGRP1 receptors and release of nitric oxide (NO*) mediate the pulmonary vasodilator response to rIMD whereas cyclooxygenase products and KATP channels do not contribute to the pulmonary vasodilator response to rIMD. The ability of rIMD to induce heterologous desensitization of CGRP1 receptor activation, to retain much of its pulmonary vasodilator activity after inhibition of CGRP1 receptors, and to lack homologous desensitization together suggests the pulmonary, unlike the systemic, vasodilator response to rIMD may depend on other vasodilator mechanisms including receptors in the calcitonin-receptor-like-receptor (CRLR) family.