Towards new transmission-blocking combination therapies - pharmacokinetics of 10-amino-artemisinins and 11-aza-artemisinin, and comparison with DHA and artemether

As artemisinin combination therapies (ACTs) are compromised by resistance, we are evaluating triple combination therapies (TACTs) comprising an amino-artemisinin, a redox drug and third drug with different mode of action. Thus, here we briefly review efficacy data on artemisone, artemiside, other amino-artemisinins and 11-aza-artemisinin, and conduct ADME profiling in vitro and PK profiling in vivo via iv and po administration to mice. The sulfamide derivative has a notably long murine microsomal half-life ( t 1/2 >150 min), low intrinsic liver clearance and total plasma clearance rates ( CL int 189.4, CL tot 32.2 mL/min/kg), and high relative bioavailability (F 59%). Kinetics are somewhat similar for 11-aza-artemisinin ( t 1/2 >150 min, CL int 576.9, CL tot 75.0 mL/min/kg), although bioavailability is lower (F 14%). In contrast, artemether is rapidly metabolized to DHA ( t 1/2 17.4 min) and eliminated ( CL int 855.0, CL tot 119.7 mL/min/kg), and has low oral bioavailability F of 2%. Whilst artemisone displays low t 1/2 of <10 min and high CL int of 302.1, it displays a low CL tot of 42.3 mL/min/kg, and moderate bioavailability F of 32%. Its active metabolite M1 displays a much improved t 1/2 of >150 min and a reduced CL int of 37.4 mL/min/kg. Artemiside has t 1/2 12.4 min and CL int 673.9 and CL tot 129.7 mL/kg/min, likely a reflection of its surprisingly rapid metabolism to artemisone, reported here for the first time. DHA is not formed from any amino-artemisinin. Overall, the efficacy and PK data strongly support the development of selected amino-artemisinins as components of new TACTs.

New 99mTc Radiotracers for Myocardial Perfusion Imaging by SPECT

Objective: Myocardial Perfusion Imaging (MPI) with radiotracers is an integral component in evaluation of the patients with known or suspected coronary artery diseases (CAD). 99mTc-Sestamibi and 99mTc-Tetrofosmin are commercial radiopharmaceuticals for MPI by single photon-emission computed tomography (SPECT). Despite their widespread clinical applications, they do not meet the requirements of an ideal perfusion imaging agent due to their inability to linearly track the regional myocardial blood flow rate at >2.5 mL/min/g. With tremendous development of CZT-based SPECT cameras over the past several years, the nuclear cardiology community has been calling for better perfusion radiotracers with improved extraction and biodistribution properties. Methods: This review will summarize recent research efforts on new cationic and neutral 99mTc radiotracers for SPECT MPI. The goal of these efforts is to develop a 99mTc radiotracer that can be used to detect perfusion defects at rest or under stress, determine the regional myocardial blood flow, and measure the perfusion and left ventricular function. Results: The advantage of cationic radiotracers (e.g. 99mTc-Sestamibi) is their long myocardial retention because of the positive molecular charge and fast liver clearance kinetics. 99mTc-Teboroxime derivatives have a high initial heart uptake (high first-pass extraction fraction) due to their neutrality. 99mTc- 3SPboroxime is the most promising radiotracer for future clinical translation considering its initial heart uptake, myocardial retention time, liver clearance kinetics, heart/liver ratios and SPECT image quality. Conclusion: 99mTc-3SPboroximine is an excellent example of perfusion radiotracers, the heart uptake of which is largely relies on the regional blood flow. It is possible to use 99mTc-3SPboroximine for detection of perfusion defect(s), accurate quantification and determination of regional blood flow rate. Development of such a 99mTc radiotracer is of great clinical benefit for accurate diagnosis of CAD and assessing the risk of future hard events (e.g. heart attack and sudden death) in cardiac patients.

Safety profile of pharmacotherapy in paitionts with non-alcogolic fatty liver disease

NAFLD is a leader among chronic liver diseases worldwide. Polymorbidity of such patients requires the appointment of different groups of drugs. The quality of pharmacological correction, which is determined in achieving the desired therapeutic effect and the absence of adverse reactions of the therapy, depends on the functional state of the liver. In diseases of the liver clearance of drugs is reduced, and the period of their half-life increases. Thus, drugs with high hepatic extraction may increase the risk of overdose. In this connection, prior to therapy, laboratory and instrumental control of liver function is necessary to reduce the risk of its drug damage, side effects of pharmacotherapy and prevention of complications.

Investigating clearance mechanisms for recombinant activated factor VII in a perfused liver model

SummaryClearance mechanisms for recombinant activated human FVII (rFVIIa; NovoSeven®), a heterogeneously glycosylated protein, have yet to be fully elucidated, but may involve the liver. The effects of the γ-carboxy glutamic acid (Gla) domain and the sialic acid content of the protein on rFVIIa clearance were investigated following intravenous administration of rFVIIa lacking the Gla domain, des(1–44) rFVIIa and asialo-rFVIIa in pharmacokinetic (PK) studies and perfused rat livers. PK parameters for both rFVIIa and des(1–44) rFVIIa had similar biphasic clearance profiles, as well as half-lives ([t½]=80 and 88 minutes, respectively), while asialo-rFVIIa was cleared quickly (t½=21 minutes) with a linear clearance profile. Perfused liver studies with all proteins (10 nM) mirrored the trends in profiles observed in the PK study. rFVIIa and des(1–44) rFVIIa were cleared to a similar extent, 41% and 35%, respectively, after 1 h, whereas plasma-derived FVII from humans (which has a higher sialylation content than rFVIIa) was cleared to a lesser extent (21%). Asialo-rFVIIa, on the other hand, was almost totally cleared and when an excess of asialo-orosomucoid was added to the perfusate, its clearance was significantly reduced (by 34%) and also for rFVIIa, albeit to a lesser extent (by 14%). Together these data suggest that carbohydrate receptor(s) (e.g. the asialoglycoprotein receptor, ASGPR) play a role in asialo-rFVIIa and rFVIIa clearance. In vivo and liver clearance data correlated well showing similar trends and indi-cated that rFVIIa clearance is not affected by the Gla domain, but rather by a subpopulation of N-glycosylated structures on rFVIIa.