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1.
Mol Ther ; 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38569556

RESUMO

Carrier-free naked mRNA vaccines may reduce the reactogenicity associated with delivery carriers; however, their effectiveness against infectious diseases has been suboptimal. To boost efficacy, we targeted the skin layer rich in antigen-presenting cells (APCs) and utilized a jet injector. The jet injection efficiently introduced naked mRNA into skin cells, including APCs in mice. Further analyses indicated that APCs, after taking up antigen mRNA in the skin, migrated to the lymph nodes (LNs) for antigen presentation. Additionally, the jet injection provoked localized lymphocyte infiltration in the skin, serving as a physical adjuvant for vaccination. Without a delivery carrier, our approach confined mRNA distribution to the injection site, preventing systemic mRNA leakage and associated systemic proinflammatory reactions. In mouse vaccination, the naked mRNA jet injection elicited robust antigen-specific antibody production over 6 months, along with germinal center formation in LNs and the induction of both CD4- and CD8-positive T cells. By targeting the SARS-CoV-2 spike protein, this approach provided protection against viral challenge. Furthermore, our approach generated neutralizing antibodies against SARS-CoV-2 in non-human primates at levels comparable to those observed in mice. In conclusion, our approach offers a safe and effective option for mRNA vaccines targeting infectious diseases.

2.
Angew Chem Int Ed Engl ; : e202404972, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38651732

RESUMO

Controlling the end-groups of biocompatible polymers is crucial for enabling polymer-based therapeutics and nanomedicine. Typically, end-group diversification is a challenging and time-consuming endeavor, especially for polymers pre-pared via ionic polymerization mechanisms with limited functional group tolerance. In this study, we present a facile end-group diversification approach for poly(2-oxazoline)s (POx), enabling quick and reliable production of hetero-telechelic polymers to facilitate POxylation. The approach relies on the careful tuning of reaction parameters to establish differential reactivity of a pentafluorobenzyl initiator fragment and the living oxazolinium chain-end, allowing the selective introduction of N-, S-, O-nucleophiles via the termination of the polymerization, and a consecutive nucleophilic para-fluoro substitution. The value of this approach for the accelerated development of nanomedicine is demonstrated through the synthesis of well-defined lipid-polymer conjugates and POx-polypeptide block-copolymers, which are well-suited for drug and gene delivery. Furthermore, we investigated the application of a lipid-POx conjugate for the formulation and delivery of mRNA-loaded lipid nanoparticles for immunization against the SARS-COV-2 virus, underscoring the value of POx as a biocompatible polymer platform.

3.
RNA Biol ; 21(1): 1-27, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38528828

RESUMO

Adjuvanticity and delivery are crucial facets of mRNA vaccine design. In modern mRNA vaccines, adjuvant functions are integrated into mRNA vaccine nanoparticles, allowing the co-delivery of antigen mRNA and adjuvants in a unified, all-in-one formulation. In this formulation, many mRNA vaccines utilize the immunostimulating properties of mRNA and vaccine carrier components, including lipids and polymers, as adjuvants. However, careful design is necessary, as excessive adjuvanticity and activation of improper innate immune signalling can conversely hinder vaccination efficacy and trigger adverse effects. mRNA vaccines also require delivery systems to achieve antigen expression in antigen-presenting cells (APCs) within lymphoid organs. Some vaccines directly target APCs in the lymphoid organs, while others rely on APCs migration to the draining lymph nodes after taking up mRNA vaccines. This review explores the current mechanistic understanding of these processes and the ongoing efforts to improve vaccine safety and efficacy based on this understanding.


Assuntos
Vacinas , Vacinas de mRNA , Adjuvantes Imunológicos , Antígenos , RNA Mensageiro/genética
4.
Biomacromolecules ; 25(2): 1058-1067, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38181450

RESUMO

mRNA-based therapeutics are revolutionizing the landscape of medical interventions. However, the short half-life of mRNA and transient protein expression often limits its therapeutic potential, demanding high treatment doses or repeated administrations. Self-replicating RNA (RepRNA)-based treatments could offer enhanced protein production and reduce the required dosage. Here, we developed polymeric micelles based on flexible poly(ethylene glycol)-poly(glycerol) (PEG-PG) block copolymers modified with phenylalanine (Phe) moieties via biodegradable ester bonds for the efficient delivery of RepRNA. These polymers successfully encapsulated RepRNA into sub-100 nm micelles assisted by the hydrophobicity of the Phe moieties and their ability to π-π stack with the bases in RepRNA. The micelles made from Phe-modified PEG-PG (PEG-PG(Phe)) effectively maintained the integrity of the loaded RepRNA in RNase-rich serum conditions. Once taken up by cells, the micelles triggered a pH-responsive membrane disruption, promoted by the strong protonation of the amino groups at endosomal pH, thereby delivering the RepRNA to the cytosol. The system induced strong protein expression in vitro and outperformed commercial transfecting reagents in vivo, where it resulted in enhanced and long-lasting protein expression.


Assuntos
Micelas , Fenilalanina , RNA , Linhagem Celular Tumoral , Concentração de Íons de Hidrogênio , Polímeros/química , Polietilenoglicóis/química , RNA Mensageiro , Portadores de Fármacos/química
5.
ACS Omega ; 9(2): 3028-3034, 2024 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-38250351

RESUMO

In comparison to monolithic perovskite/perovskite double-junction solar cells, a four-terminal spectrum-splitting system is a simple method to obtain a higher power conversion efficiency (PCE) because it has no constraints of unifying the structures of the top and bottom cells. In this work, utilizing the fact that low-bandgap Sn-Pb bottom cells work the best in p-i-n while Pb-based wide-bandgap top cells work better in an n-i-p architecture, a wide-bandgap (Eg = 1.61 eV) perovskite solar cell with a mesoscopic structure and a narrow-bandgap (Eg = 1.27 eV) perovskite solar cell with an inverted structure were combined to fabricate a double-junction four-terminal spectral splitting solar cell. The double-junction solar cell with the 801 nm spectral splitting with an active area of 0.18 cm2 was found to work with a PCE of 25.3%, which is the highest reported so far for a 4-T all-perovskite double-junction spectral splitting solar cell.

6.
Bioconjug Chem ; 35(2): 125-131, 2024 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-38290165

RESUMO

Various cationic polymers are used to deliver polyplex-mediated antisense oligonucleotides (ASOs). However, few studies have investigated the structural determinants of polyplex functionalities in polymers. This study focused on the polymer hydrophobicity. A series of amphiphilic polyaspartamide derivatives possessing various hydrophobic (R) moieties together with cationic diethylenetriamine (DET) moieties in the side chain (PAsp(DET/R)s) were synthesized to optimize the R moieties (or hydrophobicity) for locked nucleic acid (LNA) gapmer ASO delivery. The gene knockdown efficiencies of PAsp(DET/R) polyplexes were plotted against a hydrophobicity parameter, logD7.3, of PAsp(DET/R), revealing that the gene knockdown efficiency was substantially improved by PAsp(DET/R) with logD7.3 higher than -2.4. This was explained by the increased polyplex stability and improved cellular uptake of ASO payloads. After intratracheal administration, the polyplex samples with a higher logD7.3 than -2.4 induced a significantly higher gene knockdown in the lung tissue compared with counterparts with lower hydrophobicity and naked ASO. These results demonstrate that the hydrophobicity of PAsp(DET/R) is crucial for efficient ASO delivery in vitro and in vivo.


Assuntos
Oligonucleotídeos Antissenso , Polímeros , Polímeros/química
7.
ACS Biomater Sci Eng ; 10(2): 890-896, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38159284

RESUMO

Cell-penetrating peptides (CPPs), for example, arginine (Arg) rich peptides, are used for the intracellular delivery of nucleic acids. In this study, oligosarcosine-conjugated Arg-rich peptides were designed as plasmid DNA (pDNA) carriers, and the physicochemical parameters and transfection efficiency of the peptide/pDNA complexes were evaluated. Oligosarcosine with different lengths were conjugated to a base sequence composed of arginine and α-aminoisobutyric acid (Aib) [(Aib-Arg-Arg)3]. Oligosarcosine conjugation inhibited the aggregation of the complexes after mixing with pDNA, shielded the positive charge of the complexes, and provided efficient pDNA transfection in cultured cells. The efficiency of the pDNA transfection was improved by varying the length of the oligosarcosine moiety (10-15 units were optimal). The cellular uptake efficiency and intracellular distribution of pDNA were the same regardless of oligosarcosine conjugation. These results implied that intracellular processes, including the decondensation of pDNA, contributed to the efficiency of the protein expression from pDNA. This study demonstrated the advantages of oligosarcosine conjugation to Arg-rich CPPs and provided valuable insight into the future design of CPPs.


Assuntos
Arginina , Peptídeos Penetradores de Células , Arginina/genética , DNA/química , DNA/genética , Plasmídeos/genética , Transfecção , Peptídeos Penetradores de Células/farmacologia , Peptídeos Penetradores de Células/química , Peptídeos Penetradores de Células/genética
8.
Artigo em Inglês | MEDLINE | ID: mdl-38083610

RESUMO

Fibrosis is a disease that causes abnormal accumulation of collagen and other extracellular matrix components. It can lead to organ failure and is responsible for one-third of all deaths worldwide. However, there is no cure for this disease, and the development of minimally invasive therapies is urgently needed. We have previously reported techniques for adjusting the shape and flexibility of fibrous tissue by traction while denaturing it with heat. However, studies comparing heat and traction on fibrous tissue are limited, so this paper examined that. Applying heat and traction to bovine Achilles tendon tissue has been shown to cause the denaturation of collagen molecules to accumulate in the tissue in response to these loads. Heat-induced collagen denaturation was nondirectional and omnidirectional, whereas mechanical stress-induced collagen denaturation was concentrated in the direction of traction. When both heat and traction were applied, collagen denaturation increased more than under a single load, indicating a synergistic effect.


Assuntos
Colágeno , Animais , Bovinos , Colágeno/fisiologia , Estresse Mecânico
9.
ACS Omega ; 8(45): 42711-42721, 2023 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-38024716

RESUMO

The influence of chloride integration on perovskite film deposition, encompassing both the structures of intermediate phases and the properties of the final films, was explored. Our methodology involved the fabrication of perovskite intermediate-phase films with varying concentrations of methylammonium chloride (MACl). Subsequently, we conducted an analysis employing X-ray diffraction and Rietveld refinement, incorporating the March-Dollase correction, to gain insights into how chloride-induced intermediate phases impact film morphology. Remarkably, a distinct preferred orientation was observed in the (020) lattice plane perpendicular to the substrate surface, and this orientation was found to be directly correlated to the MACl concentration. This distinctive arrangement of chloride-induced intermediate-phase complexes facilitated controlled crystallization, leading to highly oriented crystals and an improved film morphology. As a consequence, perovskite solar cell devices incorporating chloride-containing methylammonium lead iodide achieved a power conversion efficiency exceeding 20%. These findings suggest a crucial link between the preferred orientation observed in the final chlorine-derived perovskite films and the intermediate-phase structure formed during the initial stages of perovskite formation. These results suggest a profound impact of intermediate phase compositions and crystal structures on perovskite formation, emphasizing the importance of a comprehensive understanding of these factors to enable precise control over ideal structures and the subsequent transformation into high-quality perovskite films.

10.
Sci Rep ; 13(1): 16068, 2023 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-37752239

RESUMO

The effect of TiO2 interfacial morphology on perovskite crystallinity was investigated by modifying the micro and nanoscale surface roughness of compact TiO2. While surface treatments of the compact TiO2 layer are recognized as effective strategies to enhance the photovoltaic performance of perovskite solar cells, the discussion regarding the crystallinity of perovskite atop TiO2 has been limited. In this study, we explored the impact of micro and nano scale interface morphology on perovskite crystal formation and its subsequent effects on device performance. Surprisingly, despite the absence of noticeable voids at the interface between the compact TiO2 and perovskite layers, the perovskite crystal morphology exhibited significant improvement following either micro or nanoscale interfacial modification. This enhancement ultimately led to improved photoconversion efficiency and reduced I-V hysteresis. These results emphasize the importance of underlayer surface morphology in the perovskite crystallization and suggest that the presence of grain boundaries within the perovskite layer may also contribute to I-V hysteresis in perovskite solar cells.

11.
J Chem Phys ; 159(7)2023 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-37594068

RESUMO

This paper presents the molecular dynamics simulation of 1 mol kg-1 LiPF6 in a binary solvent of ethylene carbonate (EC) and dimethylcarbonate, which is a representative electrolyte solution for lithium-ion batteries. The simulation successfully reproduced the diffusion coefficient, ionic conductivity, and shear viscosity as functions of EC content at 300 K, which had been experimentally determined in our previous study. The Yukawa potential was adopted to model intercharge interactions to reduce computational costs, which consequently allowed us to precisely calculate the conductivity and viscosity by directly integrating time-correlation functions without explicitly modeling the molecular polarization. Breaking down microscopic current correlation functions into components revealed that, whereas the cation-anion attractive interaction dominantly impedes the conduction when the EC content is low, it is the cation-cation and anion-anion repulsive interactions that reduce the conductivity at a high EC content. An analysis of the pressure correlations revealed that all components positively contribute to the viscosity in the binary solvent without the electrolyte. On the other hand, negative terms are observed in five out of six cross correlations in the presence of the electrolyte, implying that these correlations negatively contribute to the shear stress and entropy production, both of which are net positive.

12.
JA Clin Rep ; 9(1): 42, 2023 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-37438473

RESUMO

BACKGROUND: Left atrial auricle (LAA) clipping is a common method of preventing cardiogenic thromboembolism. However, acute coronary syndrome (ACS) has been reported as a fatal complication of LAA clipping. We describe a case of ACS 2 months after LAA clipping. CASE PRESENTATION: A 33-year-old male with atrial fibrillation was scheduled LAA clipping during aortic valve replacement for congenital aortic bicuspid valve. The surgery went smoothly with no postoperative complications, but he suddenly went into cardiac arrest 2 months later. Emergency coronary angiography and intravascular ultrasonography revealed that compression by the clip of the left main coronary trunk had caused the ACS. Percutaneous coronary intervention with stents was performed, and the clip was removed under general anesthesia. CONCLUSION: Even in the remote timepoint of LAA clipping, compression of the coronary artery by the clip should be differentiated as a cause of ACS.

13.
Proc Natl Acad Sci U S A ; 120(29): e2214320120, 2023 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-37428918

RESUMO

Integrating antigen-encoding mRNA (Messenger RNA) and immunostimulatory adjuvant into a single formulation is a promising approach to potentiating the efficacy of mRNA vaccines. Here, we developed a scheme based on RNA engineering to integrate adjuvancy directly into antigen-encoding mRNA strands without hampering the ability to express antigen proteins. Short double-stranded RNA (dsRNA) was designed to target retinoic acid-inducible gene-I (RIG-I), an innate immune receptor, for effective cancer vaccination and then tethered onto the mRNA strand via hybridization. Tuning the dsRNA structure and microenvironment by changing its length and sequence enabled the determination of the structure of dsRNA-tethered mRNA efficiently stimulating RIG-I. Eventually, the formulation loaded with dsRNA-tethered mRNA of the optimal structure effectively activated mouse and human dendritic cells and drove them to secrete a broad spectrum of proinflammatory cytokines without increasing the secretion of anti-inflammatory cytokines. Notably, the immunostimulating intensity was tunable by modulating the number of dsRNA along the mRNA strand, which prevents excessive immunostimulation. Versatility in the applicable formulation is a practical advantage of the dsRNA-tethered mRNA. Its formulation with three existing systems, i.e., anionic lipoplex, ionizable lipid-based lipid nanoparticles, and polyplex micelles, induced appreciable cellular immunity in the mice model. Of particular interest, dsRNA-tethered mRNA encoding ovalbumin (OVA) formulated in anionic lipoplex used in clinical trials exerted a significant therapeutic effect in the mouse lymphoma (E.G7-OVA) model. In conclusion, the system developed here provides a simple and robust platform to supply the desired intensity of immunostimulation in various formulations of mRNA cancer vaccines.


Assuntos
Neoplasias , RNA de Cadeia Dupla , Humanos , Animais , Camundongos , RNA de Cadeia Dupla/genética , Adjuvantes Imunológicos/farmacologia , Antígenos , Imunidade Celular , Citocinas/genética , RNA Mensageiro/genética , Camundongos Endogâmicos C57BL , Neoplasias/terapia
14.
Adv Drug Deliv Rev ; 199: 114972, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37364611

RESUMO

Nanoparticle-based delivery systems have contributed to the recent clinical success of RNA therapeutics, including siRNA and mRNA. RNA delivery using polymers has several distinct properties, such as enabling RNA delivery into extra-hepatic organs, modulation of immune responses to RNA, and regulation of intracellular RNA release. However, delivery systems should overcome safety and stability issues to achieve widespread therapeutic applications. Safety concerns include direct damage to cellular components, innate and adaptive immune responses, complement activation, and interaction with surrounding molecules and cells in the blood circulation. The stability of the delivery systems should balance extracellular RNA protection and controlled intracellular RNA release, which requires optimization for each RNA species. Further, polymer designs for improving safety and stability often conflict with each other. This review covers advances in polymer-based approaches to address these issues over several years, focusing on biological understanding and design concepts for delivery systems rather than material chemistry.


Assuntos
Nanopartículas , Polímeros , Humanos , RNA Interferente Pequeno/uso terapêutico , Polímeros/química
15.
Nat Commun ; 14(1): 2657, 2023 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-37169757

RESUMO

Starting with the clinical application of two vaccines in 2020, mRNA therapeutics are currently being investigated for a variety of applications. Removing immunogenic uncapped mRNA from transcribed mRNA is critical in mRNA research and clinical applications. Commonly used capping methods provide maximum capping efficiency of around 80-90% for widely used Cap-0- and Cap-1-type mRNAs. However, uncapped and capped mRNA possesses almost identical physicochemical properties, posing challenges to their physical separation. In this work, we develop hydrophobic photocaged tag-modified cap analogs, which separate capped mRNA from uncapped mRNA by reversed-phase high-performance liquid chromatography. Subsequent photo-irradiation recovers footprint-free native capped mRNA. This approach provides 100% capping efficiency even in Cap-2-type mRNA with versatility applicable to 650 nt and 4,247 nt mRNA. We find that the Cap-2-type mRNA shows up to 3- to 4-fold higher translation activity in cultured cells and animals than the Cap-1-type mRNA prepared by the standard capping method.


Assuntos
Biossíntese de Proteínas , Capuzes de RNA , Animais , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Células Cultivadas , Capuzes de RNA/metabolismo
16.
Sci Technol Adv Mater ; 24(1): 2170164, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36950277

RESUMO

Messenger RNA (mRNA) therapeutics have recently demonstrated high clinical potential with the accelerated approval of SARS-CoV-2 vaccines. To fulfill the promise of unprecedented mRNA-based treatments, the development of safe and efficient carriers is still necessary to achieve effective delivery of mRNA. Herein, we prepared mRNA-loaded nanocarriers for enhanced in vivo delivery using biocompatible block copolymers having functional amino acid moieties for tunable interaction with mRNA. The block copolymers were based on flexible poly(ethylene glycol)-poly(glycerol) (PEG-PG) modified with glycine (Gly), leucine (Leu) or tyrosine (Tyr) via ester bonds to generate block catiomers. Moreover, the amino acids can be gradually detached from the block copolymers after ester bond hydrolyzation, avoiding cytotoxic effects. When mixed with mRNA, the block catiomers formed narrowly distributed polymeric micelles with high stability and enhanced delivery efficiency. Particularly, the micelles based on tyrosine-modified PEG-PG (PEG-PGTyr), which formed a polyion complex (PIC) and π-π stacking with mRNA, displayed excellent stability against polyanions and promoted mRNA integrity in serum. PEG-PGTyr-based micelles also increased the cellular uptake and the endosomal escape, promoting high protein expression both in vitro and in vivo. Furthermore, the PEG-PGTyr-based micelles significantly extended the half-life of the loaded mRNA after intravenous injection. Our results highlight the potential of PEG-PGTyr-based micelles as safe and effective carriers for mRNA, expediting the rational design of polymeric materials for enhanced mRNA delivery.

17.
Nat Commun ; 14(1): 1416, 2023 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-36932083

RESUMO

Naturally occurring peptides with high membrane permeability often have ester bonds on their backbones. However, the impact of amide-to-ester substitutions on the membrane permeability of peptides has not been directly evaluated. Here we report the effect of amide-to-ester substitutions on the membrane permeability and conformational ensemble of cyclic peptides related to membrane permeation. Amide-to-ester substitutions are shown to improve the membrane permeability of dipeptides and a model cyclic hexapeptide. NMR-based conformational analysis and enhanced sampling molecular dynamics simulations suggest that the conformational transition of the cyclic hexapeptide upon membrane permeation is differently influenced by an amide-to-ester substitution and an amide N-methylation. The effect of amide-to-ester substitution on membrane permeability of other cyclic hexapeptides, cyclic octapeptides, and a cyclic nonapeptide is also investigated to examine the scope of the substitution. Appropriate utilization of amide-to-ester substitution based on our results will facilitate the development of membrane-permeable peptides.


Assuntos
Amidas , Peptídeos Cíclicos , Peptídeos Cíclicos/química , Metilação , Ésteres , Permeabilidade da Membrana Celular , Peptídeos/química , Permeabilidade
18.
ACS Appl Mater Interfaces ; 15(18): 21974-21981, 2023 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-37000640

RESUMO

To develop a highly efficient solar cell using organometal halide perovskites, its microscale structure control is one of the most important factors because the microstructural defects inside the organometal halide perovskite are harmful to charge carrier flow and, thus, degrade device performance. In this study, we confirmed the existence of large physical gaps at the grain boundary in a methylammonium iodide (MAPbI3, MA = CH3NH3) perovskite with transmission electron microscopy (TEM) analysis and revealed that the physical gap prevents charge carrier flow in the MAPbI3 perovskite. To minimize the physical gap and its negative influences, the grain size of the MAPbI3 perovskite was optimized by increasing the portion of the cubic phase via microstructural phase control using liquid nitrogen (LN2). Through microstructural phase control of the MAPbI3 perovskite, its grain boundaries and physical gap were significantly decreased, and 20.23% power conversion efficiency (PCE) was achieved with a single cation MAPbI3 perovskite solar cell.

19.
Chem Pharm Bull (Tokyo) ; 71(3): 250-256, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36858531

RESUMO

Amphipathic peptides composed of cationic amino acids and hydrophobic amino acids have cell-penetrating ability and are often used as a delivery tool for membrane-impermeable compounds. Small interfering RNA (siRNAs) are one of the delivery targets for such cell-penetrating peptides (CPPs). Cationic CPPs can associate with anionic siRNAs by electrostatic interactions resulting in the formation of nano-sized complexes, which can deliver siRNAs intracellularly. CPPs containing unnatural amino acids offer promising tools to siRNA delivery. However, the detailed structure-activity relationship in siRNA delivery has been rarely studied. In the current study, we designed peptides containing dipropylglycine (Dpg) and explored the cellular uptake and cytotoxicity of peptide/siRNA complexes. The amphipathic structure of the peptides played a key role in complexation with siRNAs and intracellular siRNA delivery. In the amphipathic peptides, cellular uptake of siRNA increased with increasing peptide length, but cytotoxicity was reduced. A peptide containing four Dpg exhibited an effective gene-silencing effect with small amounts of peptides without cytotoxicity in medium containing serum. These findings will be helpful for the design of novel CPPs for siRNA delivery.


Assuntos
Peptídeos Penetradores de Células , Valina , RNA Interferente Pequeno , Aminoácidos
20.
JA Clin Rep ; 8(1): 99, 2022 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-36572840

RESUMO

BACKGROUND: Remimazolam is a new ultra-short-acting benzodiazepine, and its sedative effect is prolonged in patients with hepatic impairment. This is the first report of remimazolam anesthesia in a patient with Child-Pugh C liver cirrhosis. CASE PRESENTATION: A 52-year-old female was diagnosed with tongue cancer and scheduled for partial glossectomy. Preoperative examinations revealed Child-Pugh C liver cirrhosis, but the pathogenesis was unknown. We scheduled remimazolam anesthesia because it would stabilize her intraoperative circulation. We managed with a much lower-than-normal dose of remimazolam; even so, the patient required flumazenil to regain consciousness. She was admitted to the intensive care unit, but her consciousness remained clear even after the effect of flumazenil had worn off. CONCLUSION: We experienced anesthetic management with remimazolam in a patient with Child-Pugh C liver cirrhosis. Even conservative use of remimazolam in patients with severe hepatic dysfunction may result in emergence times that are delayed longer than expected.

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