Population pharmacokinetics of voriconazole and CYP2C19 polymorphisms for optimizing dosing regimens in renal transplant recipients.

AIMS: The aims of the present study were to characterize the pharmacokinetics of voriconazole in renal transplant recipients and to identify factors significantly affecting pharmacokinetic parameters. We also aimed to explore the optimal dosing regimens for patients who developed invasive fungal infections. METHODS: A total of 105 patients (342 concentrations) were included prospectively in a population pharmacokinetic analysis. Nonlinear mixed-effects models were developed using Phoenix NLME software. Dosing simulations were performed based on the final model. RESULTS: A one-compartment model with first-order absorption and elimination was used to characterize voriconazole pharmacokinetics. Population estimates of clearance, volume of distribution and oral bioavailability were 2.88 l·h-1 , 169.3 l and 58%, respectively. The allele frequencies of cytochrome P450 gene (CYP) 2C19*2, *3 and *17 variants were 29.2%, 5.2% and 0.5%, respectively. CYP2C19 genotype had a significant effect on the clearance. Voriconazole trough concentrations in poor metabolizers were significantly higher than in intermediate metabolizers and extensive metabolizers alike. The volume of distribution increased with increased body weight. The oral bioavailability was substantially lower within 1 month after transplantation but increased with postoperative time. Dosing simulations indicated that during the early postoperative period, poor metabolizers could be treated with 150 mg intravenously or 250 mg orally twice daily; intermediate metabolizers with 200 mg intravenously or 350 mg orally twice daily; and extensive metabolizers with 300 mg intravenously twice daily. CONCLUSIONS: Using a combination of CYP2C19 genotype and postoperative time to determine the initial voriconazole dosing regimens followed by therapeutic drug monitoring could help to advance individualized treatment in renal transplantation patients with invasive fungal infections.

[Evaluation of 126 radical cystectomy with orthotopic ileal or sigmoidocolic neobladder].

OBJECTIVE: To evaluate the long-term clinical effects of orthotopic ileal or sigmoidocolic neobladder. METHODS: One hundred and twenty six patients with bladder cancer who underwent radical cystectomy and orthotopic ileal or sigmoidocolic neobladder from 1989 to 2001 were followed up, the clinical data was collected and analysed. Hautmann orthotopic ileal neobladder was performed on 84 cases and orthotopic sigmoidocolic neobladder was performed on 42 cases; Lymph node clearing during surgery was performed on 62 cases, chemotherapy and radiotherapy was performed on 64 cases after surgery. The continence and complications were compared between sigmoidocolic group and ileal group, the tumor recurrent rate and the 5-year survival rate were compared between lymphnode clearing group and chemoradical therapy group. RESULTS: Complete follow up was performed in 122 cases. Ureter broaden and urine backflow rate were higher in sigmoidocolic group than in ileal group (P < 0.05), nocturnal continence rate in sigmoidocolic group was higher than in ileal group (P < 0.05); Post-surgical tumor recurrent rate in lymphnode clearing group was lower than in chemoradical therapy group (P < 0.05), the 5-year survival rate in lymphnode clearing group was higher than in chemoradical therapy group (P < 0.05). The overall short-term complication rate was 15.9% (20/126), the overall long-term complication rate was 9.8% (12/122). CONCLUSION: The effects of orthotopic ileal or sigmoidocolic neobladder were satisfactory with low complication rate, lymphnode clearing during the surgery can increase the 5-year survival rate when compared with the chemoradical group.

Mechanism and Treatment Strategy of Osteoporosis after Transplantation.

Osteoporosis (OP) has emerged as a frequent and devastating complication of organ solid transplantation process. Bone loss after organ transplant is related to adverse effects of immunosuppressants on bone remodeling and bone quality. Many factors contribute to the pathogenesis of OP in transplanted patients. Many mechanisms of OP have been deeply approached. Drugs for OP can be generally divided into "bone resorption inhibitors" and "bone formation accelerators," the former hindering bone resorption by osteoclasts and the latter increasing bone formation by osteoblasts. Currently, bisphosphonates, which are bone resorption inhibitors drugs, are more commonly used clinically than others. Using the signaling pathway or implantation bone marrow stem cell provides a novel direction for the treatment of OP, especially OP after transplantation. This review addresses the mechanism of OP and its correlation with organ transplantation, lists prevention and management of bone loss in the transplant recipient, and discusses the recipients of different age and gender.

Attenuation of Porphyromonas gingivalis oral infection by α-amylase and pentamidine.

The Porphyromonas gingivalis bacterium is one of the most influential pathogens in oral infections. In the current study, the antimicrobial activity of α-amylase and pentamidine against Porphyromonas gingivalis was evaluated. Their in vitro inhibitory activity was investigated with the agar overlay technique, and the minimal inhibitory and bactericidal concentrations were determined. Using the bactericidal concentration, the antimicrobial actions of the inhibitors were investigated. In the present study, multiple techniques were utilized, including scanning electron microscopy (SEM), general structural analysis and differential gene expression analysis. The results obtained from SEM and bactericidal analysis indicated a notable observation; the pentamidine and α-amylase treatment destroyed the structure of the bacterial cell membranes, which led to cell death. These results were used to further explore these inhibitors and the mechanisms by which they act. Downregulated expression levels were observed for a number of genes coding for hemagglutinins and gingipains, and various genes involved in hemin uptake, chromosome replication and energy production. However, the expression levels of genes associated with iron storage and oxidative stress were upregulated by α-amylase and pentamidine. A greater effect was noted in response to pentamidine treatment. The results of the present study demonstrate promising therapeutic potential for α-amylases and pentamidine. These molecules have the potential to be used to develop novel drugs and broaden the availability of pharmacological tools for the attenuation of oral infections caused by Porphyromonas gingivalis.

[Effect of sonicated extracts of Porphyromonas gingivalis on osteogenic differentiation of mouse osteoblasts].

OBJECTIVE: To investigate the effects of sonicated extracts of Porphyromonas gingivalis (Pg) on osteogenic differentiation of mouse osteoblast cell line MC3T3-E1. METHODS: PgW83 was cultured under standard anaerobic conditions and extracted by sonication. Mouse osteoblast cell line MC3T3-E1 was cultured with various concentrations of the extraction (0, 10, 100, 1000 mg/L). Western blotting was applied to investigate the expression of osteocalcin (OC), bone sialoprotein (BSP), osteopontin (OPN) and osteonectin (ON). The activity of alkaline phosphatase (ALP) was detected by microplate reader after 14 days. Mineralization nodule formation was measured by alizarin red staining after 21 days. RESULTS: Compared with the control group, the extracts of Pg decreased OC and ON expression in a dose-dependent manner (OC relative expression:1.000 ± 0.000,0.852 ± 0.110,0.625 ± 0.451,0.213 ± 0.053), (ON relative expression: 1.000 ± 0.000, 1.035 ± 0.133,0.141 ± 0.023,0.020 ± 0.003) (P < 0.05). The expression of OPN was down-regulated significantly in MC3T3-E1 treated with 1000 mg/L extraction (0.572 ± 0.162) compared with control group, 10 and 100 mg/L (1.000 ± 0.000, 1.029 ± 0.135, 1.199 ± 0.337) (P < 0.05). The expression of BSP remained unchanged when the cells were cultured with or without extraction (BSP relative expression:1.000 ± 0.000,0.831 ± 0.182,0.897 ± 0.115,0.778 ± 0.235) (P > 0.05). Meanwhile, the extracts of Pg decreased ALP activity [control group:(0.0275 ± 0.0014) U/gprot, 10 mg/L: (0.0140 ± 0.0011) U/gprot, 100 mg/L: (0.0057 ± 0.0013) U/gprot, 1000 mg/L: (0.0020 ± 0.0008) U/gprot] (P < 0.05) and reduced mineralization nodule formation. CONCLUSIONS: The results suggest that Pg may inhibit osteoblasts'osteogenic function by down-regulation of osteogenic differentiation related proteins.

[Effect of caspase-dependent pathway on apoptosis of human gingival fibroblasts induced by advanced glycation end products].

OBJECTIVE: To investigate the effect of synthesized advanced glycation end products (AGE) on apoptosis of human gingival fibroblasts (HGF) and the possible role of caspase-dependent pathway in the process of AGE-induced apoptosis. METHODS: HGF were incubated with AGE-human serum albumin (AGE-HSA). The activity of caspase-8, caspase-9 and caspase-3 were detected by microplate reader after 12 and 24 hours. HGF were incubated with caspase inhibitors for 1 hour, and then incubated with AGE-HSA for 24 hours, HGF was first stained by Hoechst33258 and observed under inverted microscope, and then double stained by annexin V and propidine iodide (PI) and observed by flow cytometry (FCM). The activity of caspase-3 was determined by caspase-3 assay kit and observed by microplate reader. RESULTS: Caspases activity of caspase-8, -9, -3 was 0.1097 ± 0.0051, 0.0965 ± 0.0051 and 0.1280 ± 0.0103 after 12 h of incubation with AGE-HSA and HGF, respectively, and 0.1558 ± 0.0053, 0.1308 ± 0.0035 and 0.1954 ± 0.0051 after 24 h of incubation with AGE-HSA and HGF, respectively (P < 0.05). Positive cells number was 247.7 ± 32.4, 200.1 ± 14.6, 154.1 ± 14.4 and 131.3 ± 14.6 in caspase inhibitor groups by Hoechst33258 staining, respectively. Apoptotic rate was (25.57 ± 2.20)%, (38.87 ± 3.31)%, (17.17 ± 2.24)% and (14.73 ± 2.48)% in caspase inhibitor groups by annexin V-PI staining, respectively. The difference between different groups was significant (P < 0.05). Caspase-3 activity was reduced to 0.1274 ± 0.0076, 0.1465 ± 0.0062, 0.1044 ± 0.0051 in caspase inhibitor groups, respectively. The difference between different groups was significant (P < 0.05). CONCLUSIONS: Apoptosis of HGF induced by AGE-HSA may be mainly through activation of caspase-dependant pathway in which cytoplasmic pathway may play a predominant role.

[Remineralization of artificial root caries by fluoride dentifrice of different fluoride concentration in vitro].

PURPOSE: Although the effectiveness of fluoride dentifrice in remineralizing enamel caries has been established, the optimum fluoride concentration for remineralization root caries has not been defined. The aim of this study was to assess and compare the effect of 1.1g/L, 1.45g/L and 5g/L fluoride dentifrices in remineralization of artificial root caries. METHODS: Sound human tooth fragments obtained from the cervical portion of root were stored in a demineralization solution for 96h at 37 degrees centigrade to induce artificial root caries lesions. The fragments were then randomly divided into four treatment groups including 1.1g/L, 1.45g/L, 5g/L fluoride dentifrice group and non-fluoride dentifrice control group. The demineralized samples were pH-cycled through treatment solutions, acidic buffer and neutral buffer for 8 days at 6 cycles per day. The samples were evaluated using electrical caries monitor(ECM), polarized light microscopy (PLM) and confocal laser scanning microscopy (CLSM). The data was analyzed using ANOVA with SPSS13.0 software package. RESULTS: Variations of LgECM, total fluorescence and average fluorescence from CLSM after remineralization in fluoride dentifrice groups were significantly higher than those in the control group(P<0.05) Variations of LgECM, total fluorescence and average fluorescence from CLSM after remineralization in the 5g/L fluoride dentifrice group were significantly higher than those in the 1.1g/L and 1.45g/L fluoride dentifrice groups(P<0.05). PLM observation showed that a banding or deposit of mineral appeared within the lesions of specimens in the fluoride dentifrice groups. A wider mineral band was seen in the 5g/L fluoride dentifrice group than in the 1.1g/L and 1.45g/L fluoride dentifrice groups. CONCLUSIONS: Fluoride dentifrice is effective in remineralizing artificial root caries and 5g/L fluoride dentifrice has better effect than 1.1g/L and 1.45g/L fluoride dentifrices.

[Influence of environmental factors on synthesis rate of hydrogen peroxide by Streptococcus oralis].

OBJECTIVE: To investigate the influence of a broad range of environmental conditions on initial rates of hydrogen peroxide produced by Streptococcus oralis (S. oralis). METHODS: For each rate measurement, 1 ml aliquots of 10(12) cells/L mid-logarithmic phase S. oralis in TSBY were centrifuged and respectively washed by phosphate buffer containing 0.01-10 mmol/L glucose or sucrose, phosphate buffer with 5.0-7.5 pH or Bis-Tris buffer containing 0.01-100 mmol/L Ca(2+), 0.01-100 mmol/L F(-) or 0.01-100 mmol/L HFPO(3)(-). After S. oralis was cultured in respective buffer for 10, 20 and 30 min at 37 degrees C, the concentration of hydrogen peroxide in supernatant was assayed spectrophotometrically in 96-well micro-plate by ABTS-HRP at A(405). RESULTS: Synthesis rate of hydrogen peroxide by S. oralis was 7.48 micromol/L per minute without carbohydrate, the synthesis rate of hydrogen peroxide by S. oralis increased with 0.01-10 mmol/L glucose and 0.01-10 mmol/L sucrose, but there was no statistically significant difference in synthesis rate among the carbohydrate groups. The rates of H2O2 synthesis were inhibited in the buffer at pH 5.0-6.0, compared with pH 7.0 (P < 0.05). Ca(2+) had little influence on the rate of H2O2 synthesis. IC(50) of H2O2 synthesis rates by S. oralis responded to FHPO(3)(-) and F(-) were 12.65 mmol/L and 1.90 mmol/L respectively. CONCLUSIONS: Environmental conditions may influence the synthesis rate of H2O2 by S. oralis.