RESUMO
A number of issues have remained unanswered in the design of "thorough QT"(TQT) studies. In this randomized, placebo-controlled, two-period crossover study in 20 healthy subjects, replicate electrocardiograms (ECGs) were recorded on a digital 12-lead Holter recorder, extracted in a core ECG laboratory, and interpreted manually by a cardiologist. The observed within-subject variability was slightly greater when time-matched baselines were employed than when predose baselines were employed, whereas the magnitude of the increase in QTc was similar for both. Moxifloxacin 400 mg was associated with an observed 7.5-12.5 ms increase in the mean placebo- and baseline-corrected QTc interval. A PK-QTc model estimated a 3.9 ms increase in the QTc interval for every 1,000 ng/ml increase in moxifloxacin concentration. The QTc increases associated with moxifloxacin support the appropriateness of its use as a positive control in TQT studies. This crossover study failed to justify the use of time-matched baselines rather than the less resource-intensive predose definition of baseline.
Assuntos
Anti-Infecciosos/efeitos adversos , Compostos Aza/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Quinolinas/efeitos adversos , Projetos de Pesquisa , Adulto , Anti-Infecciosos/administração & dosagem , Compostos Aza/administração & dosagem , Estudos Cross-Over , Relação Dose-Resposta a Droga , Eletrocardiografia , Feminino , Fluoroquinolonas , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Moxifloxacina , Projetos Piloto , Quinolinas/administração & dosagemRESUMO
Raltegravir is a novel HIV-1 integrase inhibitor with potent in vitro activity (IC(95) = 31 nM in 50% human serum). A double-blind, randomized, placebo-controlled, double-dummy, 3-period, single-dose crossover study was conducted; subjects received single oral doses of 1600 mg raltegravir, 400 mg moxifloxacin, and placebo. The upper limit of the 2-sided 90% confidence interval for the QTcF interval placebo-adjusted mean change from baseline of raltegravir was less than 10 ms at every time point. For the raltegravir and placebo groups, there were no QTcF values >450 ms or change from baseline values >30 ms. A mean C(max) of approximately 20 muM raltegravir was attained, approximately 4-fold higher than the C(max) at the clinical dose. Moxifloxacin demonstrated an increase in QTcF at the 2-, 3-, and 4-hour time points. Administration of a single supratherapeutic dose of raltegravir does not prolong the QTcF interval. A single supratherapeutic dose design may be appropriate for crossover thorough QTc studies.
Assuntos
Eletrocardiografia , Inibidores de Integrase de HIV/efeitos adversos , Pirrolidinonas/efeitos adversos , Adulto , Anti-Infecciosos/efeitos adversos , Compostos Aza/efeitos adversos , Estudos Cross-Over , Método Duplo-Cego , Feminino , Fluoroquinolonas , Inibidores de Integrase de HIV/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Moxifloxacina , Pirrolidinonas/farmacocinética , Quinolinas/efeitos adversos , Raltegravir Potássico , Fatores de TempoRESUMO
Niacin (nicotinic acid) reduces cardiovascular events in patients with dyslipidemia. However, symptoms associated with niacin-induced vasodilation (e.g., flushing) have limited its use. Laropiprant is a selective antagonist of the prostaglandin D(2) receptor subtype 1 (DP1), which may mediate niacin-induced vasodilation. The aim of this proof-of-concept study was to evaluate the effects of laropiprant (vs placebo) on niacin-induced cutaneous vasodilation. Coadministration of laropiprant 30, 100, and 300 mg with extended-release (ER) niacin significantly lowered flushing symptom scores (by approximately 50% or more) and also significantly reduced malar skin blood flow measured by laser Doppler perfusion imaging. Laropiprant was effective after multiple doses in reducing symptoms of flushing and attenuating the increased malar skin blood flow induced by ER niacin. In conclusion, the DP1 receptor antagonist laropiprant was effective in suppressing both subjective and objective manifestations of niacin-induced vasodilation.
Assuntos
Indóis/uso terapêutico , Niacina/efeitos adversos , Receptores Imunológicos/antagonistas & inibidores , Receptores de Prostaglandina/antagonistas & inibidores , Vasodilatação/efeitos dos fármacos , Vasodilatadores/efeitos adversos , Adolescente , Adulto , Aspirina/farmacologia , Estudos Cross-Over , Preparações de Ação Retardada , Relação Dose-Resposta a Droga , Feminino , Humanos , Indóis/administração & dosagem , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Niacina/administração & dosagem , Fluxo Sanguíneo Regional , Pele/irrigação sanguínea , Vasodilatadores/administração & dosagemRESUMO
African trypanosomes evade the humoral immune response by periodically changing the antigenic identity of their variant cell-surface glycoprotein (VSG) coat. Antigenic variation relies on DNA rearrangement events that can translocate a silent VSG gene to a telomerically located VSG gene expression site. Antigenic switches can also be brought about by the differential transcriptional control of the expression sites, only one of which is transcribed at any time.
Assuntos
Variação Antigênica/genética , Antígenos de Protozoários/genética , Antígenos de Superfície/genética , Rearranjo Gênico , Proteínas de Protozoários/genética , Trypanosoma/genética , Animais , Conversão Gênica , Regulação da Expressão Gênica , Proteínas de Protozoários/imunologia , Telômero/fisiologia , Transcrição Gênica , Trypanosoma/imunologiaRESUMO
The expressed variant cell surface glycoprotein (VSG) gene of the protozoan parasite Trypanosoma brucei is invariably found at one of several telomeric VSG gene expression sites (ESs). The active ES in variant 118 clone 1 is found on a 1.5-Mb chromosome, and the promoter region is located more than 45 kb upstream of the VSG gene. We had previously shown that DNA rearrangement events occurred in the promoter region, specifically at inactivation of this ES (K. M. Gottesdiener, H.-M. Chung, S. L. Brown, M. G.-S. Lee, and L. H. T. Van der Ploeg, Mol. Cell. Biol. 11:2467-2477, 1991). In this report, we describe the cloning of the entire 17-kb promoter region, which revealed the presence of two identical 2.15-kb tandem promoter repeats separated by 13 kb of DNA. The two virtually identical promoter repeats both function efficiently in directing transcription in transient transfection assays in insect-form trypanosomes. We characterized the DNA rearrangement events that occur at ES inactivation, and by studying both of the reciprocal products of this recombination event, we infer that these result from direct (promoter) repeat recombination, formation of heteroduplex DNA, and a reciprocal exchange event that releases a circular DNA as a side product of the reaction. The finding of DNA recombinational events in a region of the VSG gene ES that encodes the promoter(s), and their relatively frequent occurrence at ES inactivation, suggests a possible role in ES control.
Assuntos
Rearranjo Gênico , Regiões Promotoras Genéticas , Glicoproteínas Variantes de Superfície de Trypanosoma/genética , Sequência de Bases , Southern Blotting , DNA de Protozoário , Eletroforese em Gel de Campo Pulsado , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Sequências Repetitivas de Ácido Nucleico , Mapeamento por Restrição , Homologia de Sequência , Glicoproteínas Variantes de Superfície de Trypanosoma/metabolismoRESUMO
The genome of the protozoan Trypanosoma brucei is known to be diploid. Karyotype analysis has, however, failed to identify homologous chromosomes. Having refined the technique for separating trypanosome chromosomes (L. H. T. Van der Ploeg, C. L. Smith, R. I. Polvere, and K. Gottesdiener, Nucleic Acids Res. 17:3217-3227, 1989), we can now provide evidence for the presence of homologous chromosomes. By determining the chromosomal location of different genetic markers, most of the chromosomes (14, excluding the minichromosomes), could be organized into seven chromosome pairs. In most instances, the putative homologs of a pair differed in size by about 20%. Restriction enzyme analysis of chromosome-sized DNA showed that these chromosome pairs contained large stretches of homologous DNA sequences. From these data, we infer that the chromosome pairs represent homologs. The identification of homologous chromosomes gives valuable insight into the organization of the trypanosome genome, will facilitate the genetic analysis of T. brucei, and suggests the presence of haploid gametes.
Assuntos
Mapeamento Cromossômico , Trypanosoma brucei brucei/genética , Animais , Bandeamento Cromossômico , Marcadores Genéticos , Gliceraldeído-3-Fosfato Desidrogenases/genética , Mapeamento por Restrição , Homologia de Sequência do Ácido NucleicoRESUMO
The expressed variant cell surface glycoprotein (VSG) gene of Trypanosoma brucei is located at the 3' end of a large, telomeric, polycistronic transcription unit or expression site. We show that the region 45 kb upstream of the VSG gene, in the expression site on a 1.5-Mb chromosome, contains at least two promoters that are arranged in tandem, directing the transcription of the expression site. DNA rearrangement events occur specifically, at inactivation of the expression site, and these events delete the most upstream transcribed region and replace it with a large array of simple-sequence DNA, leaving the downstream promoter intact. Because of the placement of simple-sequence DNA, the remaining downstream promoter now becomes structurally identical to previously described VSG promoters. The downstream promoter is repetitive in the genome, since it is present at several different expression sites. Restriction fragment length polymorphism mapping allows grouping of the expression sites into two families, those with and those without an upstream transcription unit, and the DNA rearrangement events convert the expression sites from one type to the other. Deletion of the upstream transcription unit also leads to the loss of several steady-state RNAs. The findings may indicate a role for promoter-associated DNA rearrangement events, and/or interactions between tandemly arranged promoters, in expression site transcriptional control.
Assuntos
Rearranjo Gênico , Genes , Regiões Promotoras Genéticas , Trypanosoma brucei brucei/genética , Glicoproteínas Variantes de Superfície de Trypanosoma/genética , Animais , Sequência de Bases , Northern Blotting , Southern Blotting , Clonagem Molecular , DNA/genética , DNA/isolamento & purificação , Biblioteca Gênica , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , RNA/genética , RNA/isolamento & purificação , Coelhos , Mapeamento por Restrição , Homologia de Sequência do Ácido Nucleico , Transcrição Gênica , Trypanosoma brucei brucei/imunologiaRESUMO
The human 4F2 cell surface antigen is a 120-kilodalton (kDa) disulfide-linked heterodimer which is composed of an 80- to 90-kDa glycosylated heavy chain (4F2HC) and a 35- to 40-kDa nonglycosylated light chain (4F2LC). 4F2 belongs to a family of inducible cell surface molecules which are involved in T-lymphocyte activation and growth. To better understand the molecular mechanism(s) that controls 4F2HC gene expression in both resting and activated T cells, a 4F2HC human genomic clone was isolated and structurally characterized. The 4F2HC gene spans 8 kilobases of chromosome 11 and is composed of nine exons. The 5' upstream region of the gene displays several properties which are characteristic of housekeeping genes. It is G+C rich and hypomethylated in peripheral blood lymphocyte DNA and contains multiple binding sites for the Sp1 transcription factor while lacking TATA or CCAAT sequences. This region of the gene also displays sequence homologies with several other inducible T-cell genes, including the interleukin-2, interleukin-2 receptor alpha chain, dihydrofolate reductase, thymidine kinase, and transferrin receptor genes. A 255-base-pair fragment of the 4F2HC gene which contains 154 base pairs of the 5' flanking sequence was able to efficiently promote expression of the bacterial chloramphenicol acetyltransferase gene in human Jurkat T cells, indicating that it contains promoter or enhancer (or both) sequences. Analyses of chromatin structure in resting and lectin-activated T cells revealed the presence of stable DNase I-hypersensitive sites within both the 5' flanking and intron 1 regions of the 4F2HC gene. Although the 4F2HC gene displayed many of the structural features characteristic of a constitutively expressed gene, lectin-mediated activation of resting peripheral blood T lymphocytes resulted in a dramatic increase in steady-state levels of 4F2HC mRNA.
Assuntos
Antígenos de Superfície/genética , Genes , Ativação Linfocitária , Linfócitos T/imunologia , Sequência de Aminoácidos , Sequência de Bases , Northern Blotting , Southern Blotting , Células Cultivadas , DNA/sangue , DNA/genética , DNA/isolamento & purificação , Proteína-1 Reguladora de Fusão , Humanos , Substâncias Macromoleculares , Dados de Sequência Molecular , Mapeamento de Nucleotídeos , Transcrição GênicaRESUMO
OBJECTIVE: To assess the bioequivalence of an ezetimibe/simvastatin (EZE/SIMVA) combination tablet compared to the coadministration of ezetimibe and simvastatin as separate tablets (EZE + SIMVA). METHODS: In this open-label, randomized, 2-part, 2-period crossover study, 96 healthy subjects were randomly assigned to participate in each part of the study (Part I or II), with each part consisting of 2 single-dose treatment periods separated by a 14-day washout. Part I consisted of Treatments A (EZE 10 mg + SIMVA 10 mg) and B (EZE/SIMVA 10/10 mg/mg) and Part II consisted of Treatments C (EZE 10 mg + SIMVA 80 mg) and D (EZE/SIMVA 10/80 mg/mg). Blood samples were collected up to 96 hours post-dose for determination of ezetimibe, total ezetimibe (ezetimibe + ezetimibe glucuronide), simvastatin and simvastatin acid (the most prevalent active metabolite of simvastatin) concentrations. Ezetimibe and simvastatin acid AUC(0-last) were predefined as primary endpoints and ezetimibe and simvastatin acid Cmax were secondary endpoints. Bioequivalence was achieved if 90% confidence intervals (CI) for the geometric mean ratios (GMR) (single tablet/coadministration) of AUC(0-last) and Cmax fell within prespecified bounds of (0.80, 1.25). RESULTS: The GMRs of the AUC(0-last) and Cmax for ezetimibe and simvastatin acid fell within the bioequivalence limits (0.80, 1.25). EZE/ SIMVA and EZE + SIMVA were generally well tolerated. CONCLUSIONS: The lowest and highest dosage strengths of EZE/SIMVA tablet were bioequivalent to the individual drug components administered together. Given the exact weight multiples of the EZE/SIMVA tablet and linear pharmacokinetics of simvastatin across the marketed dose range, bioequivalence of the intermediate tablet strengths (EZE/SIMVA 10/20 mg/mg and EZE/SIMVA 10/40 mg/mg) was inferred, although these dosages were not tested directly. These results indicate that the safety and efficacy profile of EZE + SIMVA coadministration therapy can be applied to treatment with the EZE/SIMVA tablet across the clinical dose range.
Assuntos
Anticolesterolemiantes/farmacocinética , Azetidinas/farmacocinética , Sinvastatina/farmacocinética , Adolescente , Adulto , Análise de Variância , Anticolesterolemiantes/administração & dosagem , Anticolesterolemiantes/efeitos adversos , Área Sob a Curva , Azetidinas/administração & dosagem , Azetidinas/efeitos adversos , Estudos Cross-Over , Combinação de Medicamentos , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Sinvastatina/administração & dosagem , Sinvastatina/efeitos adversos , Comprimidos , Equivalência Terapêutica , Fatores de Tempo , Resultado do TratamentoRESUMO
The alphaVbeta3 integrin (vitronectin receptor) plays a pivotal role in bone resorption. We hypothesized that L-000845704, an alphaVbeta3 integrin antagonist, would potently inhibit bone resorption, thereby increasing bone mass as assessed by bone mineral density (BMD) in women with postmenopausal osteoporosis. In a multicenter, randomized, double-blind, placebo-controlled, 12-month study, 227 women (average 63 yr) with low lumbar spine or femoral neck BMD were randomly assigned to receive 100 or 400 mg L-000845704 once daily (qd), 200 mg L-000845704 twice daily (bid), or placebo. L-000845704 increased lumbar spine BMD (2.1, 3.1, and 3.5% for the 100-mg-qd, 400-mg-qd, and 200-mg-bid treatment groups, respectively, vs. -0.1% for placebo; P < 0.01 all treatments vs. placebo). Only 200 mg L-000845704 bid significantly increased BMD at the hip (1.7 vs. 0.3% for placebo; P < 0.03) and femoral neck (2.4 vs. 0.7% for placebo; P < 0.05). No L-000845704 group increased total body BMD. All doses of L-000845704 resulted in a similar approximately 42% decrease from baseline of N-telopeptide cross-links (P < 0.001 vs. placebo). L-000845704 was generally well tolerated; adverse events resulting in discontinuation from the study were relatively infrequent. In conclusion, the antiresorptive effect of the alphaVbeta3 integrin antagonist L-000845704 translated into significant increases in lumbar spine BMD. Furthermore, 200 mg L-000845704 bid provided efficacy at the hip sites. These data suggest that the alphaVbeta3 integrin antagonist L-000845704 could be developed as an effective therapeutic agent for osteoporosis.
Assuntos
Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Integrina alfaVbeta3/antagonistas & inibidores , Osteoporose Pós-Menopausa/tratamento farmacológico , Idoso , Reabsorção Óssea/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Osteogênese/efeitos dos fármacosRESUMO
This open-label, randomized, placebo-controlled, incomplete-block, 3-period crossover pilot study investigated the effects of peroxisome proliferator-activated receptor alpha- and gamma-agonists on biomarkers of lipid and glucose metabolism in 12 nondiabetic subjects. Plasma samples were collected before and after each 14-day treatment with placebo, fenofibrate (201 mg/d), rosiglitazone (4 mg twice daily), and combined fenofibrate (201 mg/d) plus rosiglitazone (4 mg twice daily). Except for triglycerides (P < .042) and free fatty acids (P < .074), no significant interaction was demonstrated between fenofibrate and rosiglitazone; thus, the effect due to each drug alone was evaluated (presence/absence of drug). Fenofibrate significantly (P < .050) increased lipoprotein lipase activity (35%) and decreased apolipoproteins B (13%) and C-III (20%). Rosiglitazone significantly (P < .050) decreased fasting glucose (7.3%) and increased apolipoprotein C-III (19%) and adiponectin (137%). Fenofibrate and rosiglitazone also produced effects on triglycerides and free fatty acids, but it was not possible to determine if these effects were synergistic in nature.
Assuntos
Glicemia/metabolismo , Fenofibrato/farmacologia , Hipolipemiantes/farmacologia , Lipídeos/sangue , PPAR alfa/agonistas , PPAR gama/agonistas , Tiazolidinedionas/farmacologia , Adolescente , Adulto , Biomarcadores/sangue , Estudos Cross-Over , Interações Medicamentosas , Humanos , Masculino , Projetos Piloto , RosiglitazonaRESUMO
Sudden intense sensory stimuli elicit a cascade of involuntary responses, including a short-latency skeletal muscular response ('eyeblink startle response') and longer-latency autonomic responses. These responses are enhanced when subjects anticipate an aversive event compared to periods when subjects are resting ('fear potentiation'). It has been reported previously that the anxiolytic diazepam can suppress fear-potentiation of the eyeblink startle response in human volunteers. The present experiment aimed to confirm and extend these observations by examining the effect of another benzodiazepine, lorazepam, on the eyeblink and skin conductance components of the acoustic startle, and on fear-potentiation of these responses. Eighteen male volunteers participated in three weekly sessions in which they received oral treatment with placebo, lorazepam (1 mg) and lorazepam (2 mg), according to a balanced three-period, crossover, double-blind design. Two hours after ingestion of the treatments, electromyographic responses of the orbicularis oculi muscle and skin conductance responses were evoked by sound pulses during alternating periods in which the threat of an electric shock (electrodes attached to the subject's wrist) was present (THREAT) and absent (SAFE). The THREAT condition was associated with significant increase in the amplitude of the electromyographic (EMG) and skin conductance responses; there were also increases in baseline skin conductance, the number and amplitude of 'spontaneous' skin conductance fluctuations and self-rated anxiety. Lorazepam attenuated the effect of THREAT on self-rated anxiety and on the amplitude of the EMG response, but had no significant effect on fear-potentiation of the skin conductance responses. These results extend previous findings of the effect of diazepam on the fear-potentiated eyeblink startle response to lorazepam, and suggest that fear-potentiation of the later autonomic component of the startle response may be less sensitive to benzodiazepines than the fear-potentiated eyeblink response and self-rated anxiety.
Assuntos
Medo/psicologia , Hipnóticos e Sedativos/farmacologia , Lorazepam/farmacologia , Reflexo de Sobressalto/efeitos dos fármacos , Estimulação Acústica , Adolescente , Adulto , Ansiedade/psicologia , Piscadela/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Eletromiografia/efeitos dos fármacos , Eletrochoque , Fusão Flicker/efeitos dos fármacos , Resposta Galvânica da Pele/efeitos dos fármacos , Humanos , MasculinoRESUMO
Studies in four children with congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency provide evidence for two separate 11 beta-hydroxylating systems in the adrenal zona fasciculata and zona glomerulosa. In addition, these studies support the proposal that the adrenal 11 beta- and 18-hydroxylating activities are related and may involve the same enzyme protein and catalytic site. In the untreated or poorly treated state, despite elevation of deoxycorticosterone (DOC) and tetrahydrodeoxycorticosterone, urinary free 18-hydroxy-DOC was in the low normal range and did not increase normally with ACTH. PRA and urinary free 18-hydroxycorticosterone (18-OHB), tetrahydroaldosterone (TH Aldo), and pH 1 aldosterone were suppressed in the untreated and ACTH periods. Glucocorticoid administration suppressed plasma ACTH, and urinary tetrahydro-DOC and free DOC excretion decreased to the normal range. Concomitantly, there was a rise in PRA accompanied by parallel increase in urinary 18-OHB, urinary TH Aldo, and pH 1 aldosterone. While on dexamethasone, a low sodium diet (10 meq/day) resulted in prompt sodium retention, with a further rise in PRA and urinary 18-OHB, TH Aldo, and pH 1 aldosterone. These studies indicate the presence of both an 11 beta- and an 18-hydroxylase deficiency in the zona fasciculata and normal 11 beta- and 18-hydroxylase function in the zona glomerulosa, suggesting that these two enzymatic functions are related and that separate enzyme systems are present in the two zones.
Assuntos
Hiperplasia Suprarrenal Congênita , Hiperplasia Suprarrenal Congênita/fisiopatologia , Hipertensão/fisiopatologia , Esteroide Hidroxilases/deficiência , Adolescente , Corticosteroides/metabolismo , Hiperplasia Suprarrenal Congênita/complicações , Hormônio Adrenocorticotrópico/sangue , Androgênios/sangue , Criança , Pré-Escolar , Dexametasona/uso terapêutico , Feminino , Humanos , Hidroxiprogesteronas/sangue , Hipertensão/complicações , Masculino , Renina/sangueRESUMO
The effect of a continuous 5-day ACTH infusion (40 U/24 h) on adrenocorticoid function, electrolyte metabolism, and blood pressure was investigated in eight normotensive children and eight patients with hypertension of unknown origin. There was a continuous rise of plasma cortisol and deoxycorticosterone in all patients. Plasma aldosterone rose transiently in the normotensive and the hypertensive group. A transient kaliuresis and a continuous fall in serum K+ were observed in all patients. ACTH induced sodium retention and weight gain. The observed increase in systolic blood pressure correlated significantly with the cumulative sodium retention in the normotensive and the hypertensive groups. No correlation between sodium retention and diastolic pressure was found. ACTH on a low salt diet (10 meq/24 h) produced a blood pressure rise which was smaller than that on regular salt. The blood pressure rise did not correlate with any of the hormones measured. This study provides evidence for an unidentified ACTH-stimulable adrenal factor capable of raising blood pressure in normotensive children and patients with juvenile hypertension. The ACTH-induced blood pressure rise is only partly salt dependent and the mechanism of the rise remains unclear.
Assuntos
Corticosteroides/sangue , Hormônio Adrenocorticotrópico/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Eletrólitos/metabolismo , Hipertensão/fisiopatologia , Adolescente , Adulto , Aldosterona/sangue , Peso Corporal/efeitos dos fármacos , Criança , Desoxicorticosterona/sangue , Humanos , Hidrocortisona/sangue , Hipertensão/metabolismo , Potássio/metabolismo , Sódio/metabolismoRESUMO
Urinary 6beta-hydroxycortisol (6betaOHF) excretion was measured and compared with free cortisol and 17-hydroxycorticosteroid (17OH) excretion in normal children, patients with Cushing's syndrome or disease (CSD), and patients during cortisol therapy. Normal 6betaOHF excretion in children was 0.23 +/- 0.03 mg/m2/24 h (mean +/- SE). No sex difference was found. ACTH infusion (40 U/day for 5 days) and high dose cortisol altered the 6 betaOHF:17OH ratio so that it was indistinguishable from the ratio seen in CSD. The fact that both Cushing's disease and high dose cortisol therapy caused the same change in the 6 betaOHF:17OH ratio suggests that cortisol and not ACTH induced 6beta-hydroxylase in hypercortisolemic subjects. Since the 6betaOHF:17OH ratio in CSD patients was always well above the normal range, measurement of 6betaOHF excretion was a better and more rapid test for chronic hypercortisolemia than urinary 17OH or free cortisol. Thus, measurement of urinary 6betaOHF is suggested as a good diagnostic test for hypercortisolemic states.
Assuntos
17-Hidroxicorticosteroides/urina , Hidrocortisona/análogos & derivados , Hidrocortisona/urina , Adolescente , Hormônio Adrenocorticotrópico , Adulto , Criança , Síndrome de Cushing/tratamento farmacológico , Síndrome de Cushing/urina , Feminino , Humanos , Hidrocortisona/uso terapêutico , MasculinoRESUMO
We describe the clinical course of a boy who developed progressive adrenal failure, beginning with failure of the zona glomerulosa, as part of polyglandular autoimmune disease. Initially the patient presented with hypoparathyroidism and mucocutaneous candidiasis. ACTH tests at ages 8 and 11 yr resulted in a normal response of both mineralo- and glucocorticoids. The constellation of hyponatremia , hyperkalemia, and growth failure at age 14 yr prompted a reevaluation. A repeat ACTH test, assessing individual contributions of zone fasciculata and glomerulosa, showed normal plasma cortisol, desoxycorticosterone, and corticosterone responses and a normal urinary response of 18-hydroxydeoxycorticosterone and tetrahydrodeoxycorticosterone. Urinary 18-hydroxycorticosterone and urinary as well as plasma aldosterone were undetectable. PRA was markedly elevated. The ACTH response of adrenal androgens, presumably metabolic products of the zona reticularis, was also deficient. Antiadrenal antibodies against all three layers of the adrenal cortex were present. Mineralocorticoid therapy resulted not only in normalization of electrolytes and PRA but also in catch-up growth. Repeat testing of fasciculata function at age 19 yr now shows that the patient's cortisol response to ACTH response in abnormal. The course of this patient suggest that in addition to monitoring the electrolyte status, periodic tests for both mineralo- and glucocorticoid synthesis should be performed in children with polyglandular autoimmune disease because progressive adrenal insufficiency may go unrecognized.
Assuntos
Glândulas Suprarrenais/fisiopatologia , Doenças Autoimunes/fisiopatologia , Hormônio Adrenocorticotrópico , Adulto , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Candidíase Mucocutânea Crônica/complicações , Corticosterona/sangue , Desoxicorticosterona/sangue , Fludrocortisona/uso terapêutico , Humanos , Hidrocortisona/sangue , Hipoparatireoidismo/complicações , MasculinoRESUMO
BACKGROUND: This study compared directly the renal effects of two selective cyclooxygenase (COX)-2 inhibitors (rofecoxib and celecoxib) with naproxen (dual COX-1/COX-2 inhibitor) and placebo in healthy elderly subjects on a sodium-replete diet. METHODS: A total of 67 elderly subjects stabilized in the clinic for weight and urinary sodium on a controlled 200-mEq sodium diet were randomized in a double-blind fashion to receive rofecoxib, 25 mg daily (n = 17); celecoxib, 200 mg twice daily (n = 17); naproxen, 500 mg twice daily (n = 17); or matching placebo (n = 16) for 28 days. Subjects were sequestered in the clinic for the first 14 treatment days on the controlled diet. RESULTS: Daily urinary sodium excretion during the first 72 hours of treatment (primary endpoint) significantly decreased in rofecoxib, celecoxib, and naproxen groups compared with baseline (P < or =.05). Rofecoxib and celecoxib decreases in urinary sodium excretion rates that were comparable with each other, on the basis of predefined boundaries (-39.5 versus -27.1 mEq/d, respectively) and to naproxen (-40.6, mEq/d). Rofecoxib, celecoxib, and naproxen increased mean systolic blood pressure to a similar degree (3.4, 4.3, and 3.1 mm Hg, respectively, versus -1.3 mm Hg for placebo) after 14 days of treatment; small changes also occurred in diastolic blood pressure (0.3, 0.8, and -0.4 mm Hg, respectively, versus -1.4 mm Hg for placebo). Changes from baseline in creatinine clearance, body weight, and urinary potassium excretion among active treatments were similar. After 28 days of treatment, findings were generally consistent with those at 14 days. No subject reported edema or discontinued treatment as the result of an adverse experience. CONCLUSION: In healthy elderly subjects on a sodium-replete diet, the COX-2 inhibitors rofecoxib and celecoxib did not differ from a nonselective nonsteroidal anti-inflammatory drug (naproxen), in influencing renal function as measured by urinary sodium excretion, systolic and diastolic blood pressure, creatinine clearance, or weight change.
Assuntos
Inibidores de Ciclo-Oxigenase/efeitos adversos , Rim/efeitos dos fármacos , Lactonas/efeitos adversos , Naproxeno/efeitos adversos , Sulfonamidas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal , Celecoxib , Creatinina/urina , Dieta , Método Duplo-Cego , Eletrólitos/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/urina , Pirazóis , Sódio/urina , Cloreto de Sódio na Dieta , SulfonasRESUMO
In Trypanosoma brucei bloodstream variants 118 cl 1, 118a and 118b, the actively transcribed VSG gene expression site (ES) is located on a 1.5 Mb chromosome. The promoter region for this polycistronic transcription unit is unusual in that there are two, tandemly located, promoter repeats, each 2.1 kb in size, separated by 13 kb of intervening DNA. As previously shown, at inactivation of this ES, the promoter region was rearranged with the deletion of 15 kb of DNA. This result prompted us to search through the deleted DNA sequences to identify additional genes that might play a role in the inactivation of ESs. In this report, we identify a gene, encoding a putative transmembrane protein, that was deleted at this locus by the rearrangement event. This gene, which we tentatively call expression-site-associated-gene 10 (ESAG10), contains 10 potential transmembrane domains and had been located to T. brucei stock 427-60, ES-containing chromosomes.
Assuntos
Genes de Protozoários , Proteínas de Protozoários/genética , Trypanosoma brucei brucei/genética , Glicoproteínas Variantes de Superfície de Trypanosoma/genética , Sequência de Aminoácidos , Animais , Mapeamento Cromossômico , Clonagem Molecular , DNA de Protozoário/genética , Expressão Gênica , Variação Genética , Proteínas de Membrana/química , Proteínas de Membrana/genética , Dados de Sequência Molecular , Regiões Promotoras Genéticas , Proteínas de Protozoários/química , Sequências Repetitivas de Ácido Nucleico , Deleção de SequênciaRESUMO
The parasite Trypanosoma brucei changes its variant surface glycoprotein (VSG) coat to escape the host immune system. At a chromosomal locus, we analyzed the promoter that controls expression of VSG genes, using a system developed in collaboration with Urményi and Van der Ploeg (Urményi, T.P. and Van der Ploeg, L.H.T. (1995) Nucleic Acids Res. 23,1010-1016), and showed that the variant surface glycoprotein expression site (VSG ES) promoter directed < 6% the CAT activity produced by the procyclic acidic repetitive protein (PARP) promoter at the same locus. We identified a fragment from the PARP promoter (bp -743 to -111) that contained no intrinsic promoter activity. However, when this fragment was cloned 5' to 3' upstream of the VSG ES promoter, and this hybrid PARP/VSG ES promoter was stably integrated at the RNA polymerase (Pol) II largest subunit gene locus, expression from a CAT gene cassette increased 10-fold. Nascent RNA analysis independently showed that the relative efficiency of alpha-amanitin-resistant transcription directed by the hybrid PARP/VSG ES promoter was more than 6-fold higher than that directed by the wild-type VSG ES promoter. Furthermore, using nascent RNA protection assays, we mapped the transcription start site of the hybrid PARP/VSG ES promoter to the same initiation site as that of the wild-type VSG ES promoter. Finally, we evaluated the functional activity of the hybrid PARP/VSG ES mutant promoter at the dominant VSG gene expression site on the 1.5-Mb chromosome. At this locus, as well, the hybrid PARP/VSG ES promoter directed almost 3-times as much CAT activity as that of the wild-type VSG ES promoter.
Assuntos
Glicoproteínas de Membrana/genética , Regiões Promotoras Genéticas/genética , Proteínas de Protozoários/genética , Trypanosoma brucei brucei/genética , Glicoproteínas Variantes de Superfície de Trypanosoma/genética , Amanitinas/farmacologia , Animais , Cloranfenicol O-Acetiltransferase/biossíntese , Cloranfenicol O-Acetiltransferase/genética , DNA de Protozoário/genética , DNA Recombinante/genética , Regulação da Expressão Gênica/genética , Genes Reporter/genética , Inibidores da Síntese de Ácido Nucleico/farmacologia , RNA Polimerase II/genética , RNA Mensageiro/análise , RNA Mensageiro/biossíntese , RNA de Protozoário/análise , RNA de Protozoário/biossíntese , Transcrição Gênica/genética , Trypanosoma brucei brucei/crescimento & desenvolvimentoRESUMO
Ornithine decarboxylase (ODC) is a rate limiting enzyme in the biosynthesis of polyamines. We report here the construction of ODC gene deficient Trypanosoma brucei brucei cell lines by homologous recombination and disruption of the two alleles of the ODC gene. With our first stable transfection vector, we replaced the 2.8 kb SacII ODC gene-containing fragment with a hygromycin-B-phosphotransferase gene (hph) cassette transcribed under the control of the endogenous promoter. For the second ODC allele knock-out, we stably transfected similar constructs that contained either the phleomycin or G418 resistance gene cassette, and included 1 mM putrescine in the media. These experiments resulted in two separate ODC- lines: one hygromycin and phleomycin resistant, the other hygromycin and G418 resistant. The two ODC gene knockout lines were verified by Southern and Northern hybridization, and confirmed by Western blot and enzymatic activity assay. There is no ODC expression in the two ODC- lines and the ODC messages in the single ODC gene knockouts were only half of that of the wild type. When grown in the presence of putrescine, the ODC- lines showed little difference, morphologically, from wild type trypanosomes. The growth rate of these lines varied greatly, depending on the concentration of the putrescine. Interestingly, when putrescine was completely withdrawn from the media, the ODC- trypanosomes soon reached a plateau phase and some cells remained viable for 7-8 weeks. The starved cells could be rescued by the addition of putrescine or introducing back the ODC gene. Cell cycle analysis suggested that putrescine is required for G1-S transition in the procyclic form T. brucei.