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Coronary artery disease (CAD) is the most prevalent disorder and the leading cause of death worldwide. There are a number of CAD medications, which are effective and safe in most patients, but have been associated with adverse reactions such as angioedema induced by angiotensin I-converting enzyme inhibitors (AE-ACEi). In this study, we identified aminopeptidase P (APP) activity as an endophenotype for AE-ACEi, which is a heritable quantitative trait (heritability =0.336 +/- 0.251 SD) and is significantly reduced in a majority of our cases. Although initial mutation screening did not reveal any coding variants in XPNPEP2, which encodes membrane-bound APP, subsequent linkage analysis of APP activity in eight families provided a maximum LOD score (3.75) for this locus. Sequencing of additional cases identified a splice variant (314_431del) and a non-coding polymorphism (rs3788853) in this locus, which cosegregate with low plasma APP activity. The latter accounts for the linkage signal and is associated with AE-ACEi (P = 0.036). In addition, we identified other potential loci for APP activity and demonstrated that certain ACEi (Captopril and Enalapril) non-specifically inhibit APP activity. Furthermore, we detected polymorphisms associated with reduced APP and ACE activities among females with estrogen-dependent inherited angioedema. / We also conducted a genetic investigation of depression among CAD patients to identify common susceptibility loci which might explain the correlation between these diseases. Our candidate gene association study identified a polymorphism (rs216873) in the von Willebrand factor gene that was significantly associated (P = 7.4 x 10-5) with elevated depressive symptoms in our CAD cohort. These results suggest that risk factors for atherosclerosis also underlie susceptibility to depression among CAD patients. / This dissertation contributes to the field of genetics and pharmacogenomics of CAD. A better understanding of the toxic effects of CAD drugs will assist in the development of safer and more effective treatments. In addition, our results may facilitate clinical assays to identify individuals who are susceptible to angioedema prior to ACEi or estrogen therapy. Finally, our genetic investigation of depression in CAD patients reveals a novel drug target (VWF) for treatment of depression in cardiac cases.

Pea protein hydrolysate (PPH) has antihypertensive effects and prostanoids have been implicated in renal diseases. To investigate the role of PPH and prostanoids on renal and cardiovascular effects in cardio-renal disease, normal and diseased Han:SPRD-cy rats were given diets containing either 0, 0.5% or 1% PPH for 8 weeks. At termination, diseased rat kidneys displayed increased renal cyst growth, fibrosis, plasma creatinine and lower monocyte chemoattractant protein-1. Diseased rats also exhibited left ventricular (LV) hypertrophy, elevated systolic and diastolic blood pressures and LV end diastolic and systolic pressures. Four of five prostanoids were elevated in diseased rat kidneys. PPH attenuated systolic blood pressure, but not other components of the cardio-renal syndrome. PPH also increased select prostanoids in normal and diseased rats. Thus, dietary PPH attenuates hypertension in the Han:SPRD-cy rat, but does not ameliorate other components of disease, possibly due to increased prostanoid effects or an insufficient treatment length.

Pea protein hydrolysate (PPH) has antihypertensive effects and prostanoids have been implicated in renal diseases. To investigate the role of PPH and prostanoids on renal and cardiovascular effects in cardio-renal disease, normal and diseased Han:SPRD-cy rats were given diets containing either 0, 0.5% or 1% PPH for 8 weeks. At termination, diseased rat kidneys displayed increased renal cyst growth, fibrosis, plasma creatinine and lower monocyte chemoattractant protein-1. Diseased rats also exhibited left ventricular (LV) hypertrophy, elevated systolic and diastolic blood pressures and LV end diastolic and systolic pressures. Four of five prostanoids were elevated in diseased rat kidneys. PPH attenuated systolic blood pressure, but not other components of the cardio-renal syndrome. PPH also increased select prostanoids in normal and diseased rats. Thus, dietary PPH attenuates hypertension in the Han:SPRD-cy rat, but does not ameliorate other components of disease, possibly due to increased prostanoid effects or an insufficient treatment length.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2001. / Typescript. Bibliography: leaves 161-195.

Το σύνδρομο πολυκυστικών ωοθηκών (PCOS) αποτελεί την πιο συχνή ενδοκρινολογική διαταραχή των γυναικών αναπαραγωγικής ηλικίας που χαρακτηρίζεται από κεντρικού τύπου παχυσαρκία, ακμή , υπερτρίχωση και διαταραχές των εμμηνορησιακών κύκλων που οφείλονται στην υπερανδρογοναιμία και την χρόνια ανωοθυλακιορρηξία. Οι γυναίκες με PCOS αναπτύσσουν και μεταβολικού τύπου διαταραχές όπως η υπερινσουλιναιμία λόγω αντίστασης στην ινσουλίνη, η υπέρταση, ο σακχαρώδης διαβήτης, η δυσλιπιδαιμία και το μεταβολικό σύνδρομο. Σημαντικό ρόλο στην παθοφυσιολογία της των παραπάνω μεταβολικών διαταραχών ασκεί το σύστημα Ρενίνης-Αγγειοτενσίνης-Αλδοστερόνης (Renin-Angiotensin-Aldosterone System – RAAS) που διακρίνεται σε ενδοκρινές κι ιστικό. Στο ιντρόνιο 16 του γονιδίου του ενζύμου ACE(17q23) έχει βρεθεί ο πολυμορφισμός I/D που προκύπτει από την παρουσία ( Insertion– I) ή την απουσία (Deletion–D) μιας Αlu αλληλουχίας μήκους 287 bp, δημιουργώντας τρείς διακριτούς γονότυπους: II, ID και DD Με δεδομένο το ρόλο του συστήματος RAAS σε σχέση με τους παράγοντες κινδύνου για καρδιαγγειακή νόσο και κυρίως με την αντίσταση στην ινσουλίνη, ο ρόλος του πολυμορφισμού ACE I/D έχει καταστεί αντικείμενο μελέτης ως προς την εκδήλωση καρδιαγγειακών συμβαμάτων. Στην παρούσα μελέτη προσδιορίστηκε ο πολυμορφισμός ACE I/D σε 156 φυσιολογικές γυναίκες και σε 212 γυναίκες με την πιο βαριά μορφή του συνδρόμου πολυκυστικών ωοθηκών που είναι η ύπαρξη βιοχημικής υπερανδρογοναιμίας και χρόνιας ανωοθυλακιορηξίας. Το συμπέρασμα μετά τη στατιστική ανάλυση ήταν ότι ο γονότυπος ΙΙ συνδέεται στατιστικώς σημαντικά με την την αντίσταση στην ινσουλίνη κι ο γονότυπος ΙD με τα επίπεδα της 17-OH προγεστερόνης, πρόδρομης ορμόνης κατά την βιοσύνθεση των ανδρογόνων που ίσως σημαίνει με τοπικά αυξημένη ενεργότητα του RAS. Tα ευρήματα αυτά ανάγουν τον πολυμορφισμό της ACE σε ένα πιθανά πολύτιμο δείκτη αυξημένου καρδιαγγειακού κινδύνου στις γυναίκες με PCOS. / The polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age, characterized by central obesity, acne, hirsutism and disorders menstrual cycles due to hyperandrogonemia and chronic anovulation. Women with PCOS develop type and metabolic disorders such as hyperinsulinemia due to insulin resistance, hypertension, diabetes mellitus, dyslipidemia and metabolic syndrome. Important role in the pathophysiology of these metabolic disorders has the renin-angiotensin-aldosterone system (Renin-Angiotensin-Aldosterone System - RAAS), which is divided into endocrine and tissue. In intron 16 of the gene of the enzyme ACE (17q23) has found a polymorphism I / D resulting from the presence (Insertion-I) or absence (Deletion-D) of an Alu sequence length of 287 bp, creating three distinct genotypes: II,ID,DD. Given the role of the RAAS system in relation to risk factors for cardiovascular disease and especially with insulin resistance, the role of polymorphism ACE I / D has become a subject of study as to the occurrence of cardiovascular events. This study identified a polymorphism ACE I / D in 156 healthy women and 212 women with the most severe form of polycystic ovarian syndrome is the presence of biochemical hyperandrogonemia and chronic anovulation. The conclusion after statistical analysis was that the II genotype is associated statistically significant with insulin resistance and ID genotype with levels of 17-OH progesterone hormone precursor in the biosynthesis of androgens which it might means locally increased activity of RAS. These findings suggest the polymorphism of the ACE in a potentially valuable indicator of increased cardiovascular risk in women with PCOS.

Angiotensin-converting enzyme (ACE) inhibitors are some of the most commonly prescribed medications for hypertension. They are cited in many papers as the treatment most often recommended by guidelines and favoured over other antihypertensive drugs as first-line agents especially when other high-risk conditions are present, such as diabetic nephropathy. The development of captopril (CPT) was amongst the earliest successes of the revolutionary concept of structure-based drug design. Due to its relatively poor pharmacokinetic profile or short half-life of about 1 hour, the formulation of sustained-release microcapsule dosage form is useful to improve patient compliance and to achieve predictable and optimized therapeutic plasma concentrations. Currently, CPT is mainly administered in tablet form. One of the difficulties of CPT formulation has been reported to be its instability in aqueous solutions. CPT is characterized by a lack of a strong chromophore and, therefore, not able to absorb at the more useful UV–Vis region of the spectrum. For this reason, an accurate, simple, reproducible, and sensitive HPLC-ECD method was developed and validated for the determination of CPT in dosage forms. The method was successfully applied for the determination of CPT in commercial and developed formulations. Possible drug-excipient and excipient-excipient interactions were investigated prior to formulating CPT microcapsules because successful formulation of a stable and effective solid dosage form depends on careful selection of excipients. Nuclear magnetic resonance spectroscopy, Fourier transform infra-red spectroscopy (FT-IR), differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) were used for the identification and purity testing of CPT and excipients. The studies revealed no thermal changes during stress testing of binary and whole mixtures which indicate absence of solid state interactions. There were no shifts, appearance and disappearance in the endothermic or exothermic peaks and on the change of other associated enthalpy values on thermal curves obtained with DSC method. Characteristic peaks for common functional groups in the FT-IR were present in all the mixtures indicating the absence of incompatibility. The techniques used in this study can be said to have been efficient in the characterization and evaluation of the drug and excipients. The technique of microencapsulation by oil-in-oil was used to prepare CPT microcapsules. The effects of polymer molecular weight, homogenizing speed on the particle size, flow properties, morphology, surface properties and release characteristics of the prepared CPT microcapsules were examined. In order to decrease the complexity of the analysis and reduce cost response surface methodology using best polynomial equations was successfully used to quantify the effect of the formulation variables and develop an optimized formulation thereby minimizing the number of experimental trials. There was a burst effect during the first stage of dissolution. Scanning electron microscopy (SEM) results indicated that the initial burst effect observed in drug release could be attributed to dissolution of CPT crystals present at the surface or embedded in the superficial layer of the matrix. During the preparation of microcapsules, the drug might have been trapped near the surface of the microcapsules and or might have diffused quickly through the porous surface. The release kinetics of CPT from most formulations followed Fickian diffusion mechanism. SEM photographs showed that diffusion took place through pores at the surface of the microcapsules. The Kopcha model diffusion and erosion terms showed predominance of diffusion relative to swelling or erosion throughout the entire test period. Drug release mechanism was also confirmed by Makoid-Banakar and Korsmeyer-Peppas models exponents which further support diffusion release mechanism in most formulations. The models postulate that the total of drug release is a summation of a couple of mechanisms; burst release, relaxation induced controlled-release and diffusional release. Inspection of the 2D contour and 3D response surfaces allowed the determination of the geometrical nature of the surfaces and further providing results about the interaction of the different variables used in central composite design (CCD). The wide variation indicated that the factor combinations resulted in different drug release rates. Lagrange, canonical and mathematical modelling were used to determine the nature of the stationery point of the models. This represented the optimal variables or stationery points where there is interaction in the experimental space. It is difficult to understand the shape of a fitted response by mere inspection of the algebraic polynomial when there are many independent variables in the model. Canonical and Lagrange analyses facilitated the interpretation of the surface plots after a mathematical transformation of the original variables into new variables. In conclusion, these results suggest the potential application of Eudragit® / Methocel® microcapsules as suitable sustained-release drug delivery system for CPT.

Orientadores: Tatiana de Sousa da Cunha, Fernanda Klein Marcondes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T06:59:33Z (GMT). No. of bitstreams: 1 Sanches_Andrea_M.pdf: 1126813 bytes, checksum: 30cc93581a60db907dc7c938e7d40caf (MD5) Previous issue date: 2012 / Resumo: O estresse crônico é um fator de risco para o desenvolvimento de hipertensão, aterosclerose e diabetes. O protocolo de estresse crônico moderado e imprevisível (ECMI) é um modelo animal de estresse crônico. Em estudo prévio, foi observado que o ECMI induziu resistência à insulina, dislipidemia e disfunção endotelial, em ratos. Considerando que o aumento na atividade do sistema renina-angiotensina (SRA) tem sido associado à disfunção endotelial e à resistência à insulina, o objetivo deste estudo foi investigar a participação do SRA sobre os efeitos cardiovasculares e metabólicos induzidos pelo ECMI, em ratos. Foram utilizados 62 ratos machos Sprague-Dawley, com dois meses de idade. A duração do período experimental foi de 7 semanas. No Experimento 1, os animais foram divididos em 2 grupos: controle e estresse. O ECMI foi aplicado nas semanas 3, 4 e 5 e os animais foram eutanasiados 1 e 15 dias após a aplicação do protocolo de ECMI. O ECMI aumentou a atividade sistêmica da renina e da enzima conversora de angiotensina (ECA), da ECA na aorta torácica e as concentrações plasmáticas de angiotensina II e angiotensina (1-7). Com base nestes resultados, que mostraram aumento da atividade do SRA induzido pelo ECMI, o Experimento 2 foi delineado com o objetivo de avaliar a participação da angiotensina II e do seu receptor AT1 nos efeitos desencadeados pelo ECMI sobre a captação de glicose e sobre o sistema cardiovascular. Outros animais foram divididos em 4 grupos experimentais: controle, estresse, controle losartan (antagonista do receptor AT1 - 50 mg/Kg/dia, v.o.) e estresse losartan. O ECMI induziu aumento da área sob a curva, no teste de tolerância à glicose (TTG), diminuição da resposta vasodilatadora à acetilcolina na aorta torácica in vitro e aumento da pressão arterial in vivo, em comparação com o grupo controle, sem haver diferença entre os grupos controle, controle losartan e estresse losartan. Estes resultados mostram que os efeitos do ECMI levaram ao processo de disfunção endotelial em ratos, os quais foram associados positivamente à hiperatividade do SRA, bem como foram cancelados pelo tratamento com losartan. Assim, este estudo esclarece parte dos mecanismos fisiológicos envolvidos nas alterações metabólicas e cardiovasculares decorrentes do estresse crônico, demonstrando que estas alterações são mediadas pelo receptor AT1, provavelmente pela ligação da angiotensina II ao mesmo / Abstract: Chronic stress is a risk factor for the development of hypertension, atherosclerosis and diabetes. The protocol of chronic mild and unpredictable stress (CMUS) is an animal model of chronic stress. Previously, it has been shown that CMUS induced insulin resistance, dyslipidemia and endothelial dysfunction in rats. Considering that endothelial dysfunction and insulin resistance have been associated with high activity of renin-angiotensin system (RAS), the aim of this study was to investigate the involvement of RAS components on cardiovascular effects induced by CMUS in rats. Sixty two male Sprague-Dawley rats, (2 months old) were used. The experiment period was 7 weeks. In experiment 1, animals were divided into 2 groups: control and stress. The CMUS was applied on weeks 3, 4 and 5 and animals were euthanized 1 and 15 days after the CMUS. The CMUS increased systemic renin and angiotensin converting enzyme (ACE) activity, ACE activity in the thoracic aorta and plasma angiotensin II and angiotensin (1-7) concentrations. Based on these results, showing increased activity of the RAS induced by ECMI, the second experiment was designed to evaluate the involvement of angiotensin II and its AT1 receptor in the effects triggered by CMUS on glucose uptake and on cardiovascular system. Other animals were divided into 4 experimental groups: control, stress, losartan control (AT1 receptor antagonist, losartan - 50 mg /kg/day, orally) and losartan stress. The CMUS induced an increase in area under the curve in the glucose tolerance test (GTT), decreased the in vitro vasodilator response to acetylcholine in the thoracic aorta and increased blood pressure, compared to control group, without difference among control, losartan control and losartan stress group. These results show that the effects of CMUS led to endothelial dysfunction in rats, which was positively associated with hyperactivity of the RAS and was canceled by the treatment with losartan. Thus, this study explains part of the physiological mechanisms involved in cardiovascular and metabolic changes resulting from chronic stress, demonstrating that these changes are mediated by the AT1 receptor, probably by angiotensin II binding to it / Mestrado / Fisiologia Oral / Mestre em Odontologia

Class of 2014 Abstract / Specific Aims: To identify reasons that an angiotensin converting enzyme inhibitor (ACEi) would not be indicated in diabetic patients with repeated clinical alerts to add ACEi therapy for preservation of renal function and/or hypertension. In addition, to identify if these repeated clinical alerts to add ACEi therapy are appropriate. Methods: Eligible patient charts were reviewed by researchers using a data dictionary to complete a standardized spreadsheet with patient demographic information (age, gender, and location), type of diabetes mellitus, evidence indicative of comorbid hypertension, action taken by pharmacist in response to clinical alert (letter sent to patient and letter sent to prescriber), and rationale of that action. This data, along with SOAP notes of patient interactions, was used by researchers to classify the repeated clinical alert as appropriate or inappropriate. Main Results: There were a total of 200 charts reviewed (male n = 61 (30.5%), female n = 139 (69.5%), mean age = 70 ± 11 years). Reasons for not contacting patients again include previous failure or adverse drug reaction (n = 62, 31.0%), patient did not meet call script requirements (n = 55, 27.5%), patient did not have diabetes or hypertension (n = 20, 10.0%), potential drug-disease interaction (n = 17, 8.5%), overlapping or previously addressed alerts (1.9%), or documentation was provided for “other” reasons (n = 43, 21.5%). The previous failure or adverse drug reaction rationale was appropriate in 32 of 62 repeated clinical alerts (52%; χ2= 10.15). The patient did not have diabetes or hypertension rationale was appropriate in 11 of 20 repeated clinical alerts (55%, χ2= 2.72). The potential drug-disease interaction rationale was appropriate in 3 of 17 repeated clinical alerts (8%, χ2= 9.89). The patient did not meet call script requirements rationale was appropriate in 31 of 55 repeated clinical alerts (56%, χ2= 6.91). The overlapping or previous alerts rationale was appropriate in 2 of 3 repeated clinical alerts (67%, χ2= 0.18). The “other” rationale were appropriate in 22 of 43 repeated clinical alerts (51%, χ2= 7.21) Overall, retrigger alerts were considered appropriate 50.5% of the time compared to the predicted value of 90% (χ2= 347 > critical value = 3.84 for p = 0.05 Conclusion: There are multiple reasons pharmacists do not recommend initiating ACEi therapy in patients with diabetes. Although the Medication Management Center (MMC) has rationale of these reasons documented after individual patient interactions, there are still several reasons why a retrigger alert would be appropriate despite that rationale. In addition, retrigger alerts were not considered appropriate as frequently as expected.