Sulforaphane is an isothiocyanate found in high concentrations in cruciferous vegetables like broccoli. Sulforaphane has received much attention due to the evidence that it inhibits phase I carcinogen-bioactivating enzymes and/or induces phase II antioxidant enzymes as well as metallothioneins (MTs) (Perocco et al., 2006; Clarke et al., 2008; Yeh & Yen, 2009). Since MTs and antioxidant enzymes are involved in the scavenging of reactive oxygen species (ROS), the question was raised whether sulforaphane can provide protection against increased oxidative stress and if sulforaphane exposure of a human hepatocellular carcinoma cell line, like HepaRG cells, will have a negative impact on phase I and II biotransformation in these cells. Oxidative stress was exogenously induced in HepaRG cells with tert- Butyl hydroperoxide (t-BHP). Phase I and phase II biotransformation pathways were assessed with caffeine, paracetamol, aspirin, sodium benzoate, and paraaminobenzoic acid, respectively, as probe substances. Through the use of a liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS/MS) assay, the biotransformation of caffeine in phase I and the formation of paracetamol, aspirin, sodium benzoate and para-aminobenzoic acid conjugates in phase II were investigated. This involved elucidating the time it took for the whole probe to be completely biotransformed during phase I biotransformation and the unique conjugates formed during phase II biotransformation in HepaRG cells. The optimal t-BHP concentration and exposure time in HepaRG cells were standardized with a 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. LC-ESI-MS/MS assays to monitor phase I and phase II biotransformation were optimized and validated. The optimal sulforaphane concentration and exposure time in HepaRG cells were standardized with a MTT assay. To evaluate the possible protective effect of sulforaphane against oxidative stress, HepaRG cells were pre-incubated with sulforaphane followed by the induction of oxidative stress with t-BHP and the quantification of the amount of viable cells with a MTT assay. To investigate the effect of sulforaphane on phase I and phase II biotransformation pathways, HepaRG cells were first pre-incubated with sulforaphane followed by the addition of a specific probe substance and the assessment of the biotransformation of the probe with a LC-ESI-MS/MS assay. The results partially supported the hypothesis of the study that sulforaphane will protect HepaRG cells against oxidative stress without negatively influencing phase I and phase II biotransformation. The results indicated that sulforaphane provided partial protection against t-BHP induced oxidative stress and had no effect on phase II paracetamol biotransformation in HepaRG cells. / Thesis, MSc (Biochemistry), North-West University, Potchefstroom Campus, 2013.

Sulforaphane is an isothiocyanate found in high concentrations in cruciferous vegetables like broccoli. Sulforaphane has received much attention due to the evidence that it inhibits phase I carcinogen-bioactivating enzymes and/or induces phase II antioxidant enzymes as well as metallothioneins (MTs) (Perocco et al., 2006; Clarke et al., 2008; Yeh & Yen, 2009). Since MTs and antioxidant enzymes are involved in the scavenging of reactive oxygen species (ROS), the question was raised whether sulforaphane can provide protection against increased oxidative stress and if sulforaphane exposure of a human hepatocellular carcinoma cell line, like HepaRG cells, will have a negative impact on phase I and II biotransformation in these cells. Oxidative stress was exogenously induced in HepaRG cells with tert- Butyl hydroperoxide (t-BHP). Phase I and phase II biotransformation pathways were assessed with caffeine, paracetamol, aspirin, sodium benzoate, and paraaminobenzoic acid, respectively, as probe substances. Through the use of a liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS/MS) assay, the biotransformation of caffeine in phase I and the formation of paracetamol, aspirin, sodium benzoate and para-aminobenzoic acid conjugates in phase II were investigated. This involved elucidating the time it took for the whole probe to be completely biotransformed during phase I biotransformation and the unique conjugates formed during phase II biotransformation in HepaRG cells. The optimal t-BHP concentration and exposure time in HepaRG cells were standardized with a 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. LC-ESI-MS/MS assays to monitor phase I and phase II biotransformation were optimized and validated. The optimal sulforaphane concentration and exposure time in HepaRG cells were standardized with a MTT assay. To evaluate the possible protective effect of sulforaphane against oxidative stress, HepaRG cells were pre-incubated with sulforaphane followed by the induction of oxidative stress with t-BHP and the quantification of the amount of viable cells with a MTT assay. To investigate the effect of sulforaphane on phase I and phase II biotransformation pathways, HepaRG cells were first pre-incubated with sulforaphane followed by the addition of a specific probe substance and the assessment of the biotransformation of the probe with a LC-ESI-MS/MS assay. The results partially supported the hypothesis of the study that sulforaphane will protect HepaRG cells against oxidative stress without negatively influencing phase I and phase II biotransformation. The results indicated that sulforaphane provided partial protection against t-BHP induced oxidative stress and had no effect on phase II paracetamol biotransformation in HepaRG cells. / Thesis, MSc (Biochemistry), North-West University, Potchefstroom Campus, 2013.

Made available in DSpace on 2015-05-14T13:00:15Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 849258 bytes, checksum: 8375e090134f0298c00baace065c84c1 (MD5) Previous issue date: 2010-11-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The acne vulgaris is the most prevalent dermatologic disease of teen age. Many drugs are used in the treatment of acne but it is necessary a drug with safety and efficacy. The gel extracted from the bark Anacardium occidentale Linn. is indicated for topical treatment of inflammatory diseases. The purpose of this study was to evaluate the clinical pharmacology of this formulation in healthy volunteers. For this, a non-randomized open clinical trial was conducted with 40 healthy volunteers (22 female and 18 male), who administered the topical gel in their faces during 3 weeks. The volunteers were included in the study only when considered healthy after clinical assessment, physical examination and laboratory tests which preceded the study. The laboratory tests included: hematological, biochemical and serological analysis. The clinical and laboratory evaluation were repeated after the first week and at the end of the third week after the last administration. This gel was well tolerated by the 40 volunteers, and it has showed no adverse events. The clinical and laboratory data assessed before, during and after the test showed no signals of toxicity in various organs and systems evaluated, confirming the safety of the preparation for use in trials of therapeutic efficacy. A randomized, investigator-blinded, controlled study was conducted to evaluate the efficacy and safety of gel obtained from the bark of Anacardium occidentale Linn. (AO) versus adapalene gel 0,1%. Subjects were assigned randomly to receive either adapaleno gel 0,1% or AO once daily for 12 weeks. A total of 43 subjects with mild to moderate acne vulgaris (AV) were enrolled. Adapalene gel 0,1% was significantly superior to AO in noninflammatory lesion counts (p<0,005). But, the efficacy was statistically similar between two group for inflammatory lesion counts and in the reduction of total lesion count (p<1,0). Treatment-related adverse events were mostly mild-to-moderate in the group of adapaleno gel 0,1%. But in the group of AO no adverse events was seen. The results of this study show that Adapalene 0,1% gel was superior to AO in noninflammatory lesions of AV but similar in inflammatory and total counts lesions while AO was superior in safety and tolerability profile to adapaleno 0,1% gel. / A acne vulgar é a dermatose mais prevalente entre os adolescentes apresenta um grande impacto psico-social. Várias classes de fármacos são utilizadas no tratamento da AV, porém ainda não há um fármaco que seja ao mesmo tempo seguro e eficaz. O objetivo desse estudo foi avaliar a farmacologia clínica do o hidrogel obtido a partir do extrato etanólico bruto da casca de Anacardium occidentale Linn. (AO) em voluntários saudáveis. Para atingir este objetivo realizou-se um ensaio clínico não aleatório, aberto, com 40 voluntários sadios, sendo 22 mulheres e 18 homens, os quais aplicaram o gel na face uma vez ao dia, durante três semanas. Os voluntários foram incluídos no estudo somente após serem considerados saudáveis, depois de avaliações clínica e laboratorial que antecederam o estudo. A avaliação laboratorial consistiu de análise hematológica, bioquímica e sorológica. As avaliações clínica e laboratorial foram repetidas após a primeira semana e no final do tratamento, na terceira semana do estudo. A aplicação tópica do gel deste fitoterápico foi bem tolerada pelos 40 voluntários sadios os quais não apresentaram efeitos adversos. Os exames clínicos e laboratoriais realizados antes, durante e após o ensaio não evidenciaram sinais de toxidade na pele e nem nos diversos órgãos e sistemas avaliados, demonstrando segurança do produto, sendo estes resultados promissores para a realização de ensaios de eficácia terapêutica. Um ensaio clínico farmacológico, randomizado, duplo cego, controlado foi realizado para avaliar a eficácia e segurança (ensaio de fase II) do hidrogel obtido a partir do extrato etanólico bruto da casca de AO comparando-o com adapaleno gel a 0,1%. Os indivíduos foram designados randomicamente a receber o gel de AO ou o adapaleno gel a 0,1% diariamente durante 12 semanas. Foi recrutado um grupo total de 43 indivíduos com acne vulgar (AV) leve e moderada. O adapaleno gel a 0,1% foi significativamente superior ao gel de AO na contagem das lesões não inflamatórias (cômedos). Contudo, para as lesões de natureza inflamatória da AV não houve diferenças estatisticamente significativas entre os dois grupos tratados. Resultados semelhantes, foram obtidos, em relação à redução na contagem total das lesões da AV, houve 42,7% de redução na contagem total das lesões da AV com AO e 43,1% para o gel de adapaleno a 0,1 %, não havendo diferença estatística entre os grupos tratados. Os efeitos adversos relatados foram, em sua maioria, de leves a moderados no grupo que utilizou o adapaleno e não ocorreu nenhum evento adverso no grupo tratado com o gel da AO. Os resultados desse estudo mostram que tanto o adapaleno gel como o AO foram eficazes no tratamento da AV, sendo o gel de adapaleno a 0,1% superior ao gel de AO para as lesões não inflamatórias da AV, porém, os dois produtos foram estatisticamente semelhantes para a redução na contagem total das lesões e naquelas de natureza inflamatória. O perfil de segurança e tolerabilidade foi superior para AO.

Hintergrund: Während die Monotherapie mit Lenalidomid (Revlimid®) bei der Behandlung von rezidivierten/refraktären Patienten mit Multiplem Myelom (MM) bewährt ist, werden Kombinationstherapien mit Lenalidomid immer noch untersucht. In der vorliegenden Dosisfindungsstudie wurde eine Kombinationstherapie bestehend aus Lenalinomid, Bendamustin und Prednisolon (RBP) an Patienten mit fortgeschrittenem MM getestet. Methoden: Die erste Patientenkontrollgruppe erhielt eine Anfangsdosis Lenalidomid von 10 mg/d d1-21, Bendamustin von 60 mg/m²/d d1-2 und Prednisolon von 100 mg/d d1-4. Weitere Patientengruppen (jeweils 3-6 Personen) erhielten in Stufen eine steigende Lenalidomid-Dosis von 15, 20 sowie 25 mg und nach Erreichen von 25 mg Lenalidomid eine ansteigende Dosis Bendamustin von zunächst 60 mg/m² und dann 75 mg/m². Ergebnisse: 21 Patienten (jeweils 3 in den ersten drei Dosierungsstufen und jeweils 6 in den beiden letzten Dosierungsstufen) wurden in dieser Phase-I-Studie eingeschlossen. Alle Patienten erhielten mindestens 2 Zyklen der Therapie. Zwei Patienten entwickelten eine dosislimitierende Hämatotoxizität, ein Patient bei 25 mg/d Lenalidomid in Kombination mit 60 mg/m² Bendamustin und ein Patient in der höchsten Dosierungsstufe (25 mg/d Lenalidomid in Kombination mit 75 mg/m² Bendamustin). Die maximal tolerable Dosis wurde nicht erreicht. 16 Patienten (76%) sprachen nach mindestens zwei Zyklen RBP mit 1 sCR, 1 nCR, 5 VGPR und 9 RP an. Nach einer medianen Beobachtungszeit von 16 Monaten lag das PFS nach 18 Monaten bei 48% und OS bei 64%. Schlussfolgerung: RBP mit einer Dosis von 25 mg Lenalidomid (d 1-21) und 75 mg/m² Bendamustin (d 1-2) ist gut verträglich bei Patienten mit rezidiviertem/refraktärem MM.:Zusammenfassung II Abstract III Inhaltsverzeichnis IV Abbildungsverzeichnis VI Tabellenverzeichnis VII Abkürzungsverzeichnis VIII 1 Einleitung 1 1.1 Multiples Myelom 1 1.1.1 Terminologie 1 1.1.2 Epidemiologie 1 1.1.3 Ätiologie 2 1.1.4 Pathogenese 2 1.1.5 Klinik 3 1.1.5.1 Symptome des Skelettsystems 3 1.1.5.2 Anämiesymptome 3 1.1.5.3 Nierenbeteiligung 4 1.1.5.4 Infektionen 4 1.1.6 Diagnostik 5 1.1.6.1 Labordiagnostik 5 1.1.6.1.1 Myelomproteindiagnostik 5 1.1.6.1.2 Blutbild 6 1.1.6.1.3 Nierenwerte 6 1.1.6.1.4 ß2-Mikroglobulin 6 1.1.6.1.5 Knochenmarkdiagnostik 7 1.1.6.1.6 Knochenmarkmorphologie 7 1.1.6.1.7 Durchflusszytometrie 7 1.1.6.1.8 Zytogenetik 7 1.1.6.2 Radiologische Diagnostik 8 1.1.7 Diagnosekriterien, Differentialdiagnose, Klassifikation und Stadieneinteilung 9 1.2 Therapie 12 1.2.1 Konventionelle Chemotherapie 12 1.2.2 Neue Substanzen 13 1.2.2.1 Immunmodulatorische Substanzen 13 1.2.2.1.1 Thalidomid 13 1.2.2.1.2 Lenalidomid 14 1.2.2.1.3 Pomalidomid 14 1.2.2.2 Proteasom-Inhibitoren 15 1.2.2.2.1 Bortezomib 15 1.2.2.2.2 Carfilzomib 15 1.2.2.2.3 Ixazomib 16 1.2.2.3 HDAC-Inhibitoren 16 1.2.2.4 Monoklonale Antikörper 16 1.2.2.4.1 Daratumomab 17 1.2.2.4.2 Elotuzumab 17 1.2.3 Transplantationen 17 1.2.3.1 Autologe Stammzelltransplantation 17 1.2.3.2 Allogene Stammzelltransplantation 18 1.3 Zielstellung der Arbeit 19 2 Material und Methoden 21 2.1 Patienten 21 2.1.1 Einschlusskriterien 21 2.1.2 Ausschlusskriterien 23 2.2 Studiendesign 24 2.3 Behandlungsprotokoll 25 2.4 Definition des Therapieansprechens 26 2.5 Bestimmung der Therapieeffektivität und Toxizität 26 2.6 Statistische Methoden 27 3 Ergebnisse 28 3.1 Patientencharakteristika 28 3.2 Dosiseskalation 30 3.3 Remission und Überleben 31 3.4 Toxizität 34 4 Diskussion 36 Literaturverzeichnis 40 Erklärung über den Anteil an der Promotionsarbeit 51 Erklärung über die eigenständige Abfassung der Arbeit 52 Danksagung 53

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Le but principal d'un essai de phase I en oncologie est d'identifier, parmi un nombre fini de doses, la dose à recommander d'un nouveau traitement pour les évaluations ultérieures, sur un petit nombre de patients.Le critère de jugement principal est classiquement la toxicité. Bien que la toxicité soit mesurée pour différents organes sur une échelle gradée, elle est généralement réduite à un indicateur binaire appelé "toxicité dose-limitante" (DLT). Cette simplification très réductrice est problématiqu, en particulier pour les thérapies, dites "thérapies ciblées", associées à peu de DLTs.Dans ce travail, nous proposons un score de toxicité qui résume l'ensemble des toxicités observées chez un patient. Ce score, appelé TTP pour Total Toxicity Profile, est défini par la norme euclidienne des poids associés aux différents types et grades de toxicités possibles. Les poids reflètent l'importance clinique des différentes toxicités.\\ Ensuite, nous proposons la méthode de recherche de dose, QLCRM pour Quasi-Likelihood Continual Reassessment Method, modélisant la relation entre la dose et le score de toxicité TTP à l'aide d'une régression logistique dans un cadre fréquentiste.A l'aide d'une étude de simulation, nous comparons la performance de cette méthode à celle de trois autres approches utilisant un score de toxicité : i) la méthode de Yuan et al. (QCRM) basée sur un modèle empirique pour estimer, dans un cadre bayésien, la relation entre la dose et le score, ii) la méthode d'Ivanova et Kim (UA) dérivée des méthodes algorithmiques et utilisant une régression isotonique pour estimer la dose à recommander en fin d'essai, iii) la méthode de Chen et al. (EID) basée sur une régression isotonique pour l'escalade de dose et l'identification de la dose à recommander. Nous comparons ensuite ces quatre méthodes utilisant le score de toxicité aux méthodes CRM basées sur le critère binaire DLT. Nous étudions également l'impact de l'erreur de classement des grades pour les différentes méthodes, guidées par le score de toxicité ou par la DLT.Enfin, nous illustrons le processus de construction du score de toxicité ainsi que l'application de la méthode QLCRM dans un essai réel de phase I. Dans cette application, nous avons utilisé une approche Delphi pour déterminer avec les cliniciens la matrice des poids et le score de toxicité jugé acceptable.Les méthodes QLCRM, QCRM, UA et EID présentent une bonne performance en termes de capacité à identifier correctement la dose à recommander et de contrôle du surdosage. Dans un essai incluant 36 patients, le pourcentage de sélection correcte de la dose à recommander obtenu avec les méthodes QLCRM et QCRM varie de 80 à 90% en fonction des situations. Les méthodes basées sur le score TTP sont plus performantes et plus robustes aux erreurs de classement des grades que les méthodes CRM basées sur le critère binaire DLT.Dans l'application rétrospective, le processus de construction du score apparaît faisable facilement. Cette étude nous a conduits à proposer des recommandations pour guider les investigateurs et faciliter l'utilisation de cette approche dans la pratique.En conclusion, la méthode QLCRM prenant en compte l'ensemble des toxicités s'avère séduisante pour les essais de phase I évaluant des médicaments associés à peu de DLTs a priori, mais avec des toxicités multiples modérées probables.

The clinical trial is the most import study for the development of successful novel drugs. The aim of this dissertation is to develop innovative statistical methods to overcome the three main obstacles in clinical trials: (1) lengthy trial duration and inaccurate maximum tolerated dose (MTD) in phase I trials; (2) heterogeneity in drug effect when patients are given the same prescription and same dose; and (3) high failure rates of expensive phase III confirmatory trials due to the discrepancy in the endpoints adopted in phase II and III trials. Towards overcoming the first obstacle, we originally develop a hybrid design for the time-to-event dose escalation method with overdose control using a normalized equivalent toxicity score (NETS) system. This hybrid design can substantially reduce sample size, shorten study length, and estimate accurate MTD by employing a parametric model and adaptive Bayesian approach. Toward overcoming the second obstacle, we propose a new approach to incorporate patients’ characteristic using our proposed design in phase I clinical trials which considers the personalized information for patients who participant in the trials. To conquer the third obstacle, we propose a novel two-stage screening design for phase II trials whereby the endpoint of percent change in of tumor size is used in an initial screening to select potentially effective agents within a short time interval followed by a second screening stage where progression free survival is estimated to confirm the efficacy of agents. These research projects will substantially benefit both cancer patients and researchers by improving clinical trial efficiency and reducing cost and trial duration. Moreover, they are of great practical meaning since cancer medicine development is of paramount importance to human health care.

Statistical process control (SPC) is a toolbox to detect changes in the output of a process distribution. It can serve as a valuable resource to maintain high quality in a manufacturing process. This report is based on the work on evaluating and implementing methods for SPC in the process of chromatography instrument manufacturing at GE Healthcare, Umeå. To handle low volume and non-normally distributed process output data, non-parametric methods are considered. Eight control charts, three for for Phase I analysis, and five for Phase II analysis, are evaluated in this study. The usability of the charts are assessed based on ease of interpretation and the performance to detect distributional changes. The later is evaluated with simulations. The result of the project is the implementation of the RS/P-chart, suggested by Capizzi et al (2013), for Phase I analysis. Of the considered Phase I methods (and simulation scenarios), the RS/P-chart has the highest overall probability, of detecting a variety of distributional changes. Further, the RS/P-chart is easily interpreted, facilitating the analysis. For Phase II analysis, the use of two control charts, one based on the Mann-Whitney U statistic, suggested by Chakraborti et al (2008), and one on the Mood test statistic for dispersion, suggested by Ghute et al (2014), have been implemented. These are chosen mainly based on the ease of interpretation. To reduce the detection time for changes in the process distribution, the change-point chart based on the Cramer Von Mises statistic, suggested by Ross et al (2012), could be used instead. Using single observations, instead of larger samples, this chart is updated more frequently. However, this efficiently increases the false alarm rate and the chart is also considered much more difficult to interpret for the SPC practitioner. / Statistisk processkontroll (SPC) är en samling verktyg för att upptäcka förändringar, i fördelningen, hos utfallen i en process. Det kan fungera som en värdefull resurs för att upprätthålla en hög kvalitet i en tillverkningsprocess. Denna rapport är baserad på arbetet med att utvärdera och implementera metoder för SPC i en monteringsprocess av kromatografiinstrument på GE Healthcare, Umeå. Åtta styrdiagram, tre för för fas I analys, och fem för fas II analys, studeras i denna rapport. Användbarheten hos styrdiagrammen bedöms efter hur enkla de är att tolka och förmågan att upptäcka fördelningsförändringar. Den senare utvärderas med simuleringar. Resultatet av projektet är införandet av RS/P-metod, utvecklad av Capizzi et al (2013), för analysen i fas I. Av de utvärderade metoderna, (och simuleringsscenarier), har RS/P-diagrammet den högsta övergripande sannolikheten, för att upptäcka en mängd olika fördelningsförändringar. Vidare är metodens grafiska diagram lätt att tolka, vilket underlättar analysen. För fas II analys, har två styrdiagram, ett baserat på Mann-Whitney's U teststatistika, som föreslagits av Chakraborti et al (2008), och ett på Mood's teststatistika för spridning, som föreslagits av Ghute et al (2014), implementerats. Styrkan i dessa styrdiagram ligger främst i dess enkla tolkning. För snabbare identifiering av processförändringar kan styrdiagrammet baserat på Cramer von Mises teststatistika, som föreslagits av Ross et al (2012), användas. Baserat på enskilda observationer, istället för stickprov, har styrdiagrammet en högre uppdateringsfrekvens. Detta leder dock till ett ökat antal falska larm och styrdiagrammet anses dessutom vara avsevärt mycket svårare att tolka för SPC-utövaren.

Made available in DSpace on 2015-05-14T13:00:08Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1948005 bytes, checksum: 96df7a3d564809417a83d020664df9fc (MD5) Previous issue date: 2014-11-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Herpes simplex labialis, one of the most prevalent viral infections worldwide, is a chronic, relapsing incurable disease, persist throughout the lifetime of the host, usually in a latent form. Facing the difficulty of finding an effective therapy to traditional medicine, we seek new possibilities in complementary medicine treatment for this condition. The study aimed to perform non-clinical and clinical phase I and II toxicological tests with topical antiviral celodenina, neoflavonide synthesized from the ethanol extract of the stem bark of Coutarea hexandra (Jacq) K. Shum, topically. Preclinical studies have evaluated the dermal primary skin irritation - acute effect (single dose) and acute eye irritation (single dose) and in both experiments albino rabbits Zealanders, healthy adults were used in number 12, being 6 males and 6 females (control and treated) at a dose of 0.5 g of the cream. The assessment of primary skin irritation demonstrated that the cream does not irritate the skin of rabbits tested in Drug Testing Laboratory of the Federal University of Paraíba, since none showed any degree of erythema and edema throughout the experiment. Regarding eye irritation simple, cream showed low irritant effect, as only 33.3% rabbits showed redness in conjunctiva during the first 24 hours after application of the test substance. Did not identify any changes in the iris and cornea, in any animal throughout the experiment. To investigate the clinical phase I toxicity in humans, the celodenina, 30 volunteers were selected, of both sexes, clinically healthy, aged between 18 and 65 years. Study participants were treated daily, the night shift, by dermal route, with the cream for a period of four weeks and evaluated before the start of the study and after its termination hematology (CBC), biochemical (glucose, urea, creatinine, total cholesterol, AST, ALT, alkaline phosphatase), in order to detect possible changes resulting from use of cream in them, as well as to compare the results before and after the study. No abnormal values for both hematological variables as for biochemical between times and groups were highlighted. During treatment with the cream, some adverse reactions were observed in participants: local dryness (7%), burning (13%), tingling (7%) and erythema (7%), but the number of affected subjects was small, and symptoms and signs reported occurred in the first week of the study, not requiring specific treatment, disappearing spontaneously. Clinical phase II trials were randomized, double-blind, comparing celodenina 4% with placebo in 33 patients with recurrent herpes labialis between 18 and 65 years, who used these substances three times daily for 15 days. Patients were also assessed before and after the study of hematological and biochemical tests, which showed no significant values between times. Few adverse effects were reported, burning (21%) and local dryness (5.3%), both mildly during the first 30 minutes after application in the first five days. Herpes recurrences were evaluated for 30, 60 and 90 days and the participants treated with celodenina 4% had lower percentage of same relative to placebo at all time. These results suggest a low toxicity of the product, satisfactorily efficient control of relapses and indicate that this formulation can be used in Phase III clinical trials, dose and route of administration tested in the treatment of recurrent herpes labialis. / O herpes simples labial, uma das infecções virais mais prevalentes no mundo, é doença crônica, recidivante e incurável, persistindo durante toda a vida do hospedeiro, geralmente sob a forma latente. Frente à dificuldade de se encontrar uma terapia eficaz com a medicina tradicional, busca-se na medicina complementar novas possibilidades de tratamento para esta patologia. O estudo objetivou realizar ensaios toxicológicos, não clínico e clínicos fase I e II, com o antiviral celodenina, neoflavonoide sintetizado, a partir do extrato etanólico das cascas do caule de Coutarea hexandra (Jacq) K. Shum, via tópica. Os estudos dermais não clínicos avaliaram a irritação primária da pele efeito agudo (dose simples) e a irritação ocular aguda (dose simples) e em ambos os experimentos foram utilizados coelhos albinos neozelandeses, sadios, adultos, em número de 12, sendo 6 machos e 6 fêmeas (controle e tratado) para uma dose de 0,5 g do referido creme. A avaliação da irritação primária da pele demonstrou que o creme não é irritante para a pele dos coelhos testados no Laboratório de Ensaios Toxicológicos da Universidade Federal da Paraíba, já que nenhum deles apresentou nenhum grau de eritema e edema durante todo o experimento. Em relação à irritação ocular simples, o creme demonstrou efeito de baixa irritabilidade, porque apenas 33,3% coelhos apresentaram rubor em conjuntiva nas primeiras 24 horas após a aplicação da substância em estudo. Não foi identificada nenhuma alteração na íris e na córnea, em qualquer dos animais em todo o experimento. Para investigar a toxicidade clínica fase I, em seres humanos, da celodenina, foram selecionados 30 voluntários, de ambos os sexos, clinicamente saudáveis, com faixa etária compreendida entre 18 e 65 anos. Os participantes do estudo foram tratados diariamente, no turno da noite, por via dermal, com o creme por um período de 4 semanas e avaliados antes do início do estudo e após o seu término com exames hematológicos (hemograma completo), bioquímicos (glicemia, uréia, creatinina, colesterol total, AST, ALT, fosfatase alcalina), com o objetivo de detectar possíveis alterações decorrentes da utilização do creme nos mesmos, bem como, comparar os resultados antes e após o término do estudo. Não foram evidenciados valores alterados, tanto para as variáveis hematológicas como para as bioquímicas entre os tempos e os grupos. Ao longo do tratamento com o creme, foram observadas algumas reações adversas nos participantes: ressecamento local (7%), ardor (13%), formigamento (7%) e eritema (7%), mas o número de voluntários acometidos foi pequeno, e os sintomas e sinais relatados ocorreram na primeira semana do estudo, não necessitando de tratamento específico, desaparecendo espontaneamente. Os estudos clínicos fase II foi randomizado, duplo-cego, comparando a celodenina 4% com placebo em 33 pacientes portadores de herpes labial recorrente entre 18 e 65 anos, que utilizaram as referidas substâncias 3 vezes ao dia durante 15 dias. Os pacientes também foram avaliados antes e após o término do estudo com exames hematológicos e bioquímicos, os quais não demonstraram valores significativos entre os tempos. Poucos efeitos adversos foram relatados, o ardor (21%) e o ressecamento local (5,3%), ambos, de forma branda, durante os primeiros 30 minutos após a aplicação nos primeiros 5 dias. As recidivas herpéticas foram avaliadas durante 30, 60 e 90 dias e os participantes tratados com celodenina 4% apresentaram menor percentual das mesmas em relação ao placebo em todos os tempos. Estes resultados sugerem a baixa toxicidade do produto, eficiência satisfatória no controle das recidivas e indicam que esta formulação pode ser utilizada para testes clínicos fase III, na dose e via de administração testada no tratamento do herpes labial recorrente.

Made available in DSpace on 2015-05-14T13:00:16Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1932289 bytes, checksum: a18b6ccc194715163ed381d04f52ec3d (MD5) Previous issue date: 2011-02-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The study aimed to perform toxicological tests and preclinical dermal clinical phase I, the hydrogel obtained from the hydroalcoholic extract from the bark of Anacardium occidentale Linn. The dermal preclinical studies have assessed the primary irritation of the skin - acute (single dose) and acute eye irritation (single dose) and in both experiments were used rabbits albino, New Zealand, healthy adults, numbering 12, with 6 males and 6 females (control and treated) for a dose of 0.5 g of the hydrogel obtained from the alcoholic extract of Anacardium occidentale Linn. The evaluation of primary irritation of the skin demonstrated that the hydrogel from the stem bark of Anacardium occidentale Linn is not irritating to the skin of rabbits tested in our laboratory, since only 25% of the rabbits showed barely perceptible erythema in the initial phase of the experiment (first time), and no degree of swelling was observed in rabbits throughout the experiment. In relation to the simple eye irritation, the hydrogel from the stem bark of Anacardium occidentale Linn also did not showed irritant effect, because only 33,3% and 8,3% rabbits showed, respectively, conjunctival redness and swelling in the first 24 hours after application of test substance. Did not present any change in level of the iris and cornea, in any animal throughout the experiment. To investigate the clinical phase I toxicity in humans, hydrogel from the stem bark of Anacardium occidentale Linn, we selected 28 volunteers, clinically healthy, aged between 18 and 25. Study participants were divided into two groups, male and female, with 14 participants each, and treated daily, on the night shift, via dermal, with the hydrogel from the stem bark of Anacardium occidentale Linn by a period of 4 weeks. The volunteers were tested before the start of the study and eight weeks after the study, haematological (CBC) and biochemical (glucose, urea, creatinine, total cholesterol, AST, ALT, alkaline phosphatase), in order to detect possible changes arising from the use of hydrogel in patients, as well as compare the results before and after the study. There was no evidence values changed for both hematology and for biochemical variables between times and groups. During treatment with the hydrogel from the stem bark of Anacardium occidentale Linn, Some adverse reactions were observed in participants: tingling, redness, and stinging, but the number of volunteers affected was small, and the reported symptoms occurred during the first weeks of the study and did not require specific treatment and disappeared spontaneously. Only 3,5% of the female volunteers reported feeling oily skin in three weeks of the study. In contrast, 10,7% (first week) and 3,5% (second week) of male volunteers reported skin feeling soft, "cleaner". These results suggest and the low toxicity of the product and indicate that this herbal formulation can be used by the population, the dose and route of administration tested. / O estudo objetivou realizar ensaios toxicológicos pré-clínicos dermais e clínicos fase I, com o hidrogel obtido a partir do extrato alcoólico das cascas de Anacardium occidentale Linn. Os estudos dermais pré-clínicos avaliaram a irritação primária da pele efeito agudo (dose simples) e a irritação ocular aguda (dose simples) e em ambos os experimentos foram utilizados coelhos albinos neozelandeses, sadios, adultos, em número de 12, sendo 6 machos e 6 fêmeas (controle e tratado) para uma dose de 0,5 g do hidrogel obtido a partir do extrato alcoólico das cascas de Anacardium occidentale Linn. A avaliação da irritação primária da pele demonstrou que o hidrogel das cascas do caule de Anacardium occidentale Linn não é irritante para a pele dos coelhos testados em nosso laboratório, já que apenas 25% dos coelhos estudados apresentaram eritema apenas perceptível, na fase inicial do experimento (primeira hora), e nenhum grau de edema foi observado nos coelhos durante todo o experimento. Em relação à irritação ocular simples, o hidrogel das cascas do caule de Anacardium occidentale Linn demonstrou também efeito não irritativo, porque apenas 33,3% e 8,3% dos coelhos, respectivamente, apresentaram rubor e edema em conjuntiva nas primeiras 24 horas após a aplicação da substância em estudo. Não foi identificada nenhuma alteração na íris e na córnea, em qualquer dos animais em todo o experimento. Para investigar a toxicidade clínica fase I, em seres humanos, do hidrogel das cascas do caule de Anacardium occidentale Linn, foram selecionados 28 voluntários, clinicamente saudáveis, com faixa etária compreendida entre 18 e 25 anos. Os participantes do estudo foram distribuídos em dois grupos, masculino e feminino, com 14 participantes cada um, e tratados diariamente, no turno da noite, por via dermal, com o hidrogel das cascas do caule de Anacardium occidentale Linn por um período de 4 semanas. Os voluntários foram avaliados antes do início do estudo e 8 semanas após o seu término com exames hematológicos (hemograma completo), bioquímicos (glicemia, uréia, creatinina, colesterol total, AST, ALT, fosfatase alcalina), com o objetivo de detectar possíveis alterações decorrentes da utilização do hidrogel nos pacientes, bem como, comparar os resultados antes e após o término do estudo. Não foram evidenciados valores alterados, tanto para as variáveis hematológicas como para as bioquímicas entre os tempos e os grupos. Ao longo do tratamento com o hidrogel das cascas do caule de Anacardium occidentale Linn, foram observadas algumas reações adversas nos participantes: formigamento, hiperemia, e ardência, mas o número de voluntários acometidos foi pequeno, e os sintomas relatados ocorreram nas primeiras semanas do estudo, não necessitando de tratamento específico, desaparecendo espontaneamente. Apenas 3,5% dos voluntários do sexo feminino relatou sensação de pele oleosa nas 3 últimas semanas do estudo. Em contrapartida, 10,7% (primeira semana) e 3,5% (segunda semana) dos voluntários do sexo masculino referiram sensação de pele macia, mais limpa . Estes resultados sugerem a baixa toxicidade do produto e indicam que esta formulação fitoterápica pode ser utilizada pela população, na dose e via de administração testada.