Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 98-113).

Submitted by Carlos Alberto Zanutto Bassetto Júnior null (cbjunior@fc.unesp.br) on 2016-06-30T16:14:01Z No. of bitstreams: 1 DocNãoPublicação_carlosbassettojr.pdf: 427722 bytes, checksum: fe38077e0c0376645f906842534a3f88 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-07-05T16:31:24Z (GMT) No. of bitstreams: 1 bassettojunior_caz_dr_bauru.pdf: 201721 bytes, checksum: afaa803c4d84d32fc5d6b4fc9fe23555 (MD5) / Made available in DSpace on 2016-07-05T16:31:25Z (GMT). No. of bitstreams: 1 bassettojunior_caz_dr_bauru.pdf: 201721 bytes, checksum: afaa803c4d84d32fc5d6b4fc9fe23555 (MD5) Previous issue date: 2016-06-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Esta tese teve como objetivo estudar as moléculas orgânicas (N-alquilbenzenossulfonamidas) como inibidoras de canais para potássio do tipo KV3.1, heterologamente expressos em células L-929. Com o presente estudo constatou-se que as moléculas, N-alquilbenzenossulfonamidas, produzem efeitos inibitórios sobre KV3.1. Através da técnica de whole cell patch clamp, observou-se que os valores de IC50 para as moléculas que bloquearam o canal foram 13,5 μM, 16,9 μM, 25,9 μM, 34,2 μM, 34,9 μM e 60 μM, respectivamente, para 4-cloro-3-nitro-N-butilbenzenossulfonamida (SMD2), 4-cloro-3-nitro-N-furfutilbenzenossulfonamida (SMD3), 4-[N-(3’aminopropil)-2-pirrolidona]-3-nitro-N-butilbenzenossulfonamida (SMD2_APP), 4-[N-(3’aminopropil)-2-pirrolidona]-3-nitro-N-furfurilbenzenossulfonamida (SMD3_APP), 4-cloro-N-butilbenzenossulfonamida (SMD2_SN) e 4-cloro-N-furfurilbenzenossulfonamida (SMD3_SN). O efeito de todas as moléculas mostrou-se reversível quanto à ligação com o canal e todas atuaram como bloqueadores de canal aberto. Em SMD2, molécula que mostrou o menor valor de IC50, observou-se um deslocamento de -8 mV em relação ao controle, nas curvas de condutância versus voltagem, nas cinéticas de ativação e na recuperação a partir da inativação em relação à voltagem. O SMD2 não alterou as constantes de tempo de desativação, embora tenha mudado as constantes de ativação e inativação, além de ter induzido o fenômeno de tail crossover. Observou-se que para potenciais mais despolarizados, ocorreu o alívio do bloqueio (Block Relief). Não foi observado o efeito da dependência do pH para o bloqueio e SMD2 não mudou a seletividade do canal. Constatou-se que pulsos despolarizantes de curta duração induzem efeitos menos intensos, ao passo que pulsos despolarizantes mais longos, produzem efeitos mais intensos de SMD2 sobre o canal. Além disso, foi observado que, quanto mais o canal é usado, ou seja, aberto, mais ele é bloqueado por SMD2. Todos esses dados sugerem que SMD2 não interage com o estado fechado e nem com o estado inativado do canal, mas sim com seu estado aberto, apresentando também um efeito dependente de uso. De um ponto de vista farmacológico, isso indica que SMD2 pode ser uma molécula importante na modulação da atividade dos canais KV3.1, presentes em células com altas frequências de disparos de potencial de ação, podendo constituir uma nova classe de moduladores farmacológicos desses canais. / This thesis had the aim of studying the organic molecules (N-alkylbenzenesulfonamides) that block KV3.1 potassium channel heterologously expressed in L-929 cells. It was found that N-alkylbenzenesulfonamides have restrained effects on KV3.1. Through the whole cell patch clamp technique, it was observed that the values of IC50, for molecules that block the channel, were 13,5 μM, 16,9 μM, 25,9 μM, 34,2 μM, 34,9 μM and 60 μM, respectively 4-Chloro-3-nitro-N-butylbenzenesulfonamide (SMD2), 4-Chloro-3-nitro-N-furfurylbenzene-sulfonamide (SMD3), 4-[N-(3′-Aminopropyl)-2-pyrrolidone]-3-nitro-N-butylbenzenesulfona-mide (SMD2_APP), 4-[N-(3′-Aminopropyl)-2-pyrrolidone]-3-nitro-N-furfurylbenzene-sulfonamide (SMD3_APP), 4-Chloro-N-butyllbenzenesulfonamide (SMD2_SN) e 4-Chloro-N-furfurylbenzenesulfonamide(SMD3_SN). The effect of all molecules was reversible regards to the linking with the channel and all act as open channel blocker. In SMD2, molecule which showed the smallest value of IC50, it was observed a displacement of -8 mV compared to control, for conductance curves versus voltage, for the kinetics of activation and for the recovery from inactivation in relation to voltage. SMD2 did not change the deactivation of time constants, although it changed the activation and inactivation constants, and more, SMD2 have induced tail crossover phenomenon. It was observed that, for more depolarized potentials, there was a block relief. It was not observed the effect of pH dependence for the block and SMD2 did not change the channel selectivity. It was observed that, short duration depolarizing pulses prompt less intense effects, whereas long duration depolarizing pulses prompt more intense effects of SMD2 on the channels. Furthermore, it was observed that the more the channel is used, in an open state, the more it is blocked by SMD2. All of these data suggest that SMD2 does not interact neither with the closed state nor the inactivated state of channel, but with its open state presenting an use-dependent manner, also showing a use-dependent effect. In a pharmacological point of view, this indicates that SMD2 may be an important molecule in the modulation of the activity in the KV3.1 channels, presents in cells with high frequency of firing of action potential and may constitute a new class of pharmacological modulators.

The purpose of my study was to determine and compare the effects of three calcium antagonists on systemic hemodynamics, ECG, blood flow distribution, tissue conductance and venous tone of the rat. The effects of a representative drug from Spedding's (1985) three subclasses of calcium antagonists on systemic hemodynamics, ECG, cardiac output and the distribution of blood flow were investigated by the microsphere technique in pentobarbital-anesthetized rats. The representative drugs were: I, nifedipine (12 and 35 µg/kg/min); II, verapamil (43 and 83 µg/kg/min) and III, flunarizine (174 and 275 µg/kg/min). Low and high doses were selected to give a decrease in mean arterial pressure of 10 and 20 mmHg, respectively, compared with control rats. At equal depressor levels, all the drugs similarly decreased total peripheral resistance while slightly but not significantly increasing cardiac output (CO) and stroke volume. Heart rate was decreased by verapamil and flunarizine, but increased by nifedipine. The high dose of nifedipine decreased contractility as measured by dP/dt and had no effect on PR-interval, while verapamil decreased dP/dt and prolonged the PR-interval. The low dose of nifedipine and both doses of flunarizine slightly but not significantly decreased dP/dt and had no effect on PR-interval. All three drugs similarly affected the distribution of blood flow. Blood flow to lungs, liver, and heart was increased while flow to the intestine, kidneys, spleen and skin was decreased. Arterial conductances in lungs, liver, heart and skeletal muscle were increased by the three drugs. These results show that representative drugs from the three subclasses of calcium antagonists had similar effects on the distribution of blood flow and arterial conductances but different chronotropic, dromotropic and inotropic effects. A final set of experiments were designed to evaluate calcium antagonist actions on venous tone, as venous tone is a primary determinant of CO and the calcium antagonists generally increase CO. The effects of three calcium antagonists, verapamil, nifedipine and flunarizine on mean arterial pressure (MAP), heart rate (HR) and mean circulatory filling pressure (MCFP), an index of total body venous tone, were investigated in the. conscious rat. Infusions of all three drugs caused a dose-dependent decrease in MAP and an increase in MCFP, compared with the corresponding values in control rats. HR was decreased by verapamil and flunarizine and slightly increased by nifedipine. Further experiments investigated whether the increase in MCFP by verapamil was indirectly caused by reflex activation of the autonomic nervous system. Rats were pretreated with a continuous infusion of the ganglionic blocker hexamethonium prior to infusion of verapamil. After treatment with hexamethonium, verapamil did not increase the MCFP. In fact the highest dose of verapamil significantly decreased MCFP. The results suggest that calcium antagonists have greater dilator effects in arterioles compared to veins. It appears that any direct venodilator effects of verapamil in conscious rats are masked due to reflex activation of the autonomic nervous system. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Doctor of Philosophy / Department of Chemistry / Stefan Bossmann / Tris-homoleptic ruthenium(II)-quaterpyridyl and quaterpyridinium complexes, with +8 and +14 charge were synthesized by utilizing high pressure reaction pathway. These complexes have diameters ranging from 1.82 to 4.55 nm according to the molecular modeling calculations. These ruthenium complexes are highly luminescent and contain long excited state life times. The novel ruthenium(II)-quaterpyridinium complexes exhibit superior reactivity as sensitizer-relay-assemblies (SRA‟s) in sacrificial systems for water and carbon dioxide reductions, while harvesting the ultraviolet- and most of the visible fraction of the incident solar spectrum. Ru(II)-quaterpyridinium complexes and Pd/TiO2 catalysts were successfully used as the catalytic system for the photo catalytic reduction of water and carbon dioxide to hydrogen and methane respectively. Phosphonate-tethered Ru(II)-quaterpyridinium complexes were synthesized from Ru(II)-tris-quaterpyridyl complexes. These complexes form stable adhesive layers on indium tin oxide (ITO) electrodes. A series of differential pulse voltammetry experiments were carried out to measure the ground state and excited state redox potentials of all the Ru(II)quaterpyridinium complexes. The reductive potentials obtained were compared with the reductive potentials of CO2 to CH4 and H2O to H2 reductions. The measurements obtained from the experiments confirmed that it is possible to thermodynamically oxidize water and reduce CO2 by using phosphonate-tethered Ru(II)-quaterpyridinium complexes. These complexes are successfully utilized as prototypes for mycobacterial channel blockers. The Ru(II) complexes show distinct changes in their luminescence spectra when bound to the porin MspA from M. smegmatis, which is a non-pathogenic relative of M. tuberculosis. By using HPLC, we have determined binding constants of the Ru(II)-complexes to MspA in phosphate buffer (0.05 M, pH = 6.8) ranging from 5.2 x 109 M-1 (Ru-C2) to 1.8 x 109 M-1 (Ru-C4). Our findings indicate that channel blocking is a promising treatment strategy for mycobacterial infections. Poly-N-isopropyl-acrylamide/acetic acid copolymers were synthesized and characterized by elemental analysis and gel permeation chromatography. The average composition of the copolymers determined from CHN analysis is in excellent correlation with the feed composition indicating that the radical polymerization process is indeed statistical. Crosslinking of individual polymer chains permitted the generation of ultraflat layers on Mica surfaces by a simple spin-casting procedure, which are able to host the mycobacterial channel protein MspA, while retaining its channel function.

As concepções de moduladores da dinâmica dos microtúbulos, que levam ao bloqueio do ciclo celular, e de bloqueadores de canais de cálcio tipo L (Cav), tais como o 1,4-di-hidropiridinas e análogos, que diminuem a resistência do organismo humano aos tratamentos quimioterápicos através da inibição da proteína de transmembrana P-gp, são estratégias importantes tanto para terapias antitumorais quanto para leishmanicida. Esta abordagem tem mostrado resultados interessantes na diminuição da resistência à quimioterapia em câncer chamada de MDR (do inglês Multi Drug Resistence), além de também serem uma estratégia importante para controlar a fase inicial da leishmaniose. Diante desse contexto, e baseado no estudo de Ueki 2013 e colaboradores que, a partir de estudos anteriores, os quais relatam a superexpressão das enzimas estona deacetilase (HDAC) e catepsina L (CTSL) em células tumorais, propuseram um pró-fármaco seletivo, planejado a partir de um espaçador de lisina acetilada, que garante a liberação do fármaco seletivamente nas células tumorais, trabalhamos no desenvolvimento de uma nova proposta de pró-fármaco trifuncional. Nossa proposta foi desenvolvida a partir de estudos de triagem virtual, baseados em ligantes e em estrutura, predição das propriedades farmacocinéticas e toxicológicas (ADME/Tox) e também técnicas de bioinformática para a construção de um modelo de canal de cálcio, devido à inexistência de estruturas, do mesmo, que estivessem depositadas no banco de dados de proteínas PDB (Protein Data Bank). Paralelamente, nosso grupo de síntese colaborador sintetizou, através de técnicas de \"Click Chemistry\" e reações de Mitsunobu multicomponentes, uma biblioteca de novos híbridos trifuncionais, os quais, após estudos de atividade biológica, foram avaliados (in silico) frente à estrutura da tubulina, e os compostos mais promissores desta biblioteca serviram de base para novos estudos de triagem virtual. Para a obtenção dos nossos hits, executamos 4 estratégias de triagem virtual, separadas em 2 tarefas. Ao final, selecionarmos um total 59 hits, dos quais, 9 hits apresentam promissoras atividades bloqueadoras do canal de cálcio e 65 hits apresentam promissoras atividades moduladoras da tubulina. Estes hits seguem em estágio de compra e ensaios in vitro e após comprovada a eficácia dos mesmos, estes futuramente farão parte de uma nova proposta de pró-farmaco trifuncional. / The concepts of modulating microtubule dynamics, and calcium channel L-types (CAV) blockers are important strategies for anticancer and antileishmanial therapies. Microtubule modulators that blocks the cell cycle and the calcium channel blockers, such as, 1,4-dihydropyridines and analogues, reduce the resistance of the human body to chemotherapeutic treatments by inhibiting transmembrane P-gp protein. This approach has shown interesting results in reduced resistance to chemotherapy in cancer called MDR (Multi Drug Resistance), and an important strategy for controlling the early stage of leishmaniasis. In this context, we work to develop a new proposal for trifunctional prodrug. We have based on the study of Ueki 2013 and collaborators, which, from earlier studies with reported overexpression of both deacetylase estona enzymes (HDACs) and cathepsin L (CTSL) in tumor cells, proposed a selective prodrug. We considering an acetylated lysine link/spacer, which ensures the release of the drug selectively in tumor cells, have now designed this selective prodrug. Our proposal was developed from virtual screening studies, based on ligands and structure, prediction of pharmacokinetic and toxicological properties (ADME / Tox) and also bioinformatics techniques for the construction of a calcium channel model, due to the inexistence of Structures of the same that were deposited in the database of proteins PDB (Protein Data Bank). At the same time, our collaborating synthesis group synthesized, through Click Chemistry techniques and Mitsunobu multicomponent reactions, a library of new trifunctional hybrids, which, after studies of biological activity, were evaluated (in silico) against the structure of tubulin , And the most promising compounds from this library served as the basis for further virtual screening studies. To obtain our hits, we performed 4 virtual screening strategies, separated into 2 tasks. In the end, we selected 59 hits, of which 9 hits show promising calcium channel blocking activities and 65 hits show promising tubulin modulating activities. These hits follow in vitro purchase and testing, and after proven effectiveness, they will be part of a new tri prodrug proposal.

Introdução: A litotripsia extracorpórea por ondas de choque (LEOC) é o tratamento mais utilizado para cálculos renais de até 20 mm. O uso adjuvante de algumas drogas pode aumentar as taxas de sucesso do procedimento e diminuir a sua morbidade. Objetivos: Avaliar os efeitos da tansulosina e do nifedipino nas taxas de sucesso, nos episódios de dor e na velocidade de eliminação dos fragmentos após o tratamento de cálculos renais de 5 a 20 mm com uma única sessão de LEOC. Casuística e Métodos: Foram estudados prospectivamente 136 indivíduos portadores de cálculos renais entre 5 e 20 mm, submetidos à LEOC entre 2006 e 2009. Os pacientes foram divididos aleatoriamente em 3 grupos para receber diariamente tansulosina 0,4 mg, nifedipino retard 20mg ou placebo por até 30 dias da realização de LEOC. A analgesia foi feita com celecoxibe 200 mg. Os pacientes foram avaliados semanalmente por meio de radiografia de abdome. Foi definido como sucesso do tratamento a ausência de fragmentos maiores que 4 mm ao final de 30 dias. Os parâmetros avaliados foram: taxa de sucesso do tratamento, ocorrência de rua de cálculos, necessidade de analgésicos, intensidade de dor após a LEOC, tempo de eliminação de fragmentos, efeitos adversos da medicação e visitas ao Pronto Socorro. Resultados: Cento e onze pacientes completaram o estudo. Não houve diferenças demográficas entre os pacientes e nem em relação ao tamanho dos cálculos entre os grupos. As taxas de sucesso foram de 60,5% (23 de 38) no Grupo Tansulosina, 48,6% (17 de 35) no Grupo Nifedipino e 36,8% (14 de 38) no Grupo Placebo. (p=0,118) Entre os pacientes com cálculos de 10 a 20 mm, a taxa de sucesso foi significativamente maior nos Grupos Tansulosina (61,9%) e Nifedipino (60,0%) do que no Grupo Placebo (26,1%) (p=0,024), porém não foi significativa entre os cálculos de 5 a 9 mm (p=0,128). O Número Necessário para Tratar (NNT) da Tansulosina foi de 2,9 e o do Nifedipino foi de 3, considerando-se o uso para cálculos de 10 a 20 mm. Os pacientes que usaram nifedipino tiveram mais efeitos adversos do que os do Grupo Placebo (28,5 % x 2,6% respectivamente, p = 0,009), porém sem levar à interrupção do uso da drogas. Não houve diferença significativa entre os grupos Tansulosina x Nifedipino e Tansulosina x Placebo em relação aos efeitos adversos (p= 0,15 e p = 0,054, respectivamente). Não houve diferença entre os grupos com relação à intensidade da dor observada após o tratamento (p=0,28), ao número de comprimidos de Celecoxibe (p=0,39), ao tempo de eliminação dos fragmentos (p=0,6), à ocorrência de rua de cálculos (p=0,482) e ao número de vistas ao Pronto Socorro (p=0,175). Conclusões: O uso adjuvante de tansulosina ou de nifedipino após LEOC aumenta a taxa de sucesso para cálculos renais entre 10 e 20 mm, porém sem diminuir a intensidade da dor ou a necessidade de analgésicos após o tratamento, nem o tempo de eliminação dos fragmentos / Purpose: We evaluated the effects of the adjuvant use of tamsulosin and nifedipine after extracorporeal shock wave lithotripsy (SWL) for 5-20 mm kidney stones. Materials and Methods: We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones between 2006 and 2009. Patients were divided into three groups to receive daily treatments of 0.4 mg tamsulosin, 20 mg nifedipine retard or placebo for up to 30 days after one session of SWL. The parameters assessed were success rate, analgesic requirements, pain intensity, time to clearance, adverse effects and occurrence of Steinstrasse. Results: The success rate was 60.5% (23 of 38) in the Tamsulosin group, 48.6% (17 of 35) in the Nifedipine group and 36.8% (14 of 38) in the Placebo group (p=0.118). For stones ranging from 10 to 20 mm, the success rates were significantly higher in the Tamsulosin (61.9%) and Nifedipine groups (60.0%) when compared with the Placebo group (26.1%) (p=0.024), but not for the 5-9 mm stones (p=0.128). The Number Needed to Treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the Nifedipine than the Placebo Group (28.5% vs. 2.6%, respectively, p=0.009). There was no difference among groups with regard to stone and demographic characteristics, pain intensity, time to clearance and Steinstrasse. Conclusions: Adjuvant use of tamsulosin or nifedipine after SWL significantly increased the success rates for 10 to 20 mm renal stones and could be recommended. Both drugs had similar beneficial effects and adverse events

As concepções de moduladores da dinâmica dos microtúbulos, que levam ao bloqueio do ciclo celular, e de bloqueadores de canais de cálcio tipo L (Cav), tais como o 1,4-di-hidropiridinas e análogos, que diminuem a resistência do organismo humano aos tratamentos quimioterápicos através da inibição da proteína de transmembrana P-gp, são estratégias importantes tanto para terapias antitumorais quanto para leishmanicida. Esta abordagem tem mostrado resultados interessantes na diminuição da resistência à quimioterapia em câncer chamada de MDR (do inglês Multi Drug Resistence), além de também serem uma estratégia importante para controlar a fase inicial da leishmaniose. Diante desse contexto, e baseado no estudo de Ueki 2013 e colaboradores que, a partir de estudos anteriores, os quais relatam a superexpressão das enzimas estona deacetilase (HDAC) e catepsina L (CTSL) em células tumorais, propuseram um pró-fármaco seletivo, planejado a partir de um espaçador de lisina acetilada, que garante a liberação do fármaco seletivamente nas células tumorais, trabalhamos no desenvolvimento de uma nova proposta de pró-fármaco trifuncional. Nossa proposta foi desenvolvida a partir de estudos de triagem virtual, baseados em ligantes e em estrutura, predição das propriedades farmacocinéticas e toxicológicas (ADME/Tox) e também técnicas de bioinformática para a construção de um modelo de canal de cálcio, devido à inexistência de estruturas, do mesmo, que estivessem depositadas no banco de dados de proteínas PDB (Protein Data Bank). Paralelamente, nosso grupo de síntese colaborador sintetizou, através de técnicas de \"Click Chemistry\" e reações de Mitsunobu multicomponentes, uma biblioteca de novos híbridos trifuncionais, os quais, após estudos de atividade biológica, foram avaliados (in silico) frente à estrutura da tubulina, e os compostos mais promissores desta biblioteca serviram de base para novos estudos de triagem virtual. Para a obtenção dos nossos hits, executamos 4 estratégias de triagem virtual, separadas em 2 tarefas. Ao final, selecionarmos um total 59 hits, dos quais, 9 hits apresentam promissoras atividades bloqueadoras do canal de cálcio e 65 hits apresentam promissoras atividades moduladoras da tubulina. Estes hits seguem em estágio de compra e ensaios in vitro e após comprovada a eficácia dos mesmos, estes futuramente farão parte de uma nova proposta de pró-farmaco trifuncional. / The concepts of modulating microtubule dynamics, and calcium channel L-types (CAV) blockers are important strategies for anticancer and antileishmanial therapies. Microtubule modulators that blocks the cell cycle and the calcium channel blockers, such as, 1,4-dihydropyridines and analogues, reduce the resistance of the human body to chemotherapeutic treatments by inhibiting transmembrane P-gp protein. This approach has shown interesting results in reduced resistance to chemotherapy in cancer called MDR (Multi Drug Resistance), and an important strategy for controlling the early stage of leishmaniasis. In this context, we work to develop a new proposal for trifunctional prodrug. We have based on the study of Ueki 2013 and collaborators, which, from earlier studies with reported overexpression of both deacetylase estona enzymes (HDACs) and cathepsin L (CTSL) in tumor cells, proposed a selective prodrug. We considering an acetylated lysine link/spacer, which ensures the release of the drug selectively in tumor cells, have now designed this selective prodrug. Our proposal was developed from virtual screening studies, based on ligands and structure, prediction of pharmacokinetic and toxicological properties (ADME / Tox) and also bioinformatics techniques for the construction of a calcium channel model, due to the inexistence of Structures of the same that were deposited in the database of proteins PDB (Protein Data Bank). At the same time, our collaborating synthesis group synthesized, through Click Chemistry techniques and Mitsunobu multicomponent reactions, a library of new trifunctional hybrids, which, after studies of biological activity, were evaluated (in silico) against the structure of tubulin , And the most promising compounds from this library served as the basis for further virtual screening studies. To obtain our hits, we performed 4 virtual screening strategies, separated into 2 tasks. In the end, we selected 59 hits, of which 9 hits show promising calcium channel blocking activities and 65 hits show promising tubulin modulating activities. These hits follow in vitro purchase and testing, and after proven effectiveness, they will be part of a new tri prodrug proposal.

Introdução: A litotripsia extracorpórea por ondas de choque (LEOC) é o tratamento mais utilizado para cálculos renais de até 20 mm. O uso adjuvante de algumas drogas pode aumentar as taxas de sucesso do procedimento e diminuir a sua morbidade. Objetivos: Avaliar os efeitos da tansulosina e do nifedipino nas taxas de sucesso, nos episódios de dor e na velocidade de eliminação dos fragmentos após o tratamento de cálculos renais de 5 a 20 mm com uma única sessão de LEOC. Casuística e Métodos: Foram estudados prospectivamente 136 indivíduos portadores de cálculos renais entre 5 e 20 mm, submetidos à LEOC entre 2006 e 2009. Os pacientes foram divididos aleatoriamente em 3 grupos para receber diariamente tansulosina 0,4 mg, nifedipino retard 20mg ou placebo por até 30 dias da realização de LEOC. A analgesia foi feita com celecoxibe 200 mg. Os pacientes foram avaliados semanalmente por meio de radiografia de abdome. Foi definido como sucesso do tratamento a ausência de fragmentos maiores que 4 mm ao final de 30 dias. Os parâmetros avaliados foram: taxa de sucesso do tratamento, ocorrência de rua de cálculos, necessidade de analgésicos, intensidade de dor após a LEOC, tempo de eliminação de fragmentos, efeitos adversos da medicação e visitas ao Pronto Socorro. Resultados: Cento e onze pacientes completaram o estudo. Não houve diferenças demográficas entre os pacientes e nem em relação ao tamanho dos cálculos entre os grupos. As taxas de sucesso foram de 60,5% (23 de 38) no Grupo Tansulosina, 48,6% (17 de 35) no Grupo Nifedipino e 36,8% (14 de 38) no Grupo Placebo. (p=0,118) Entre os pacientes com cálculos de 10 a 20 mm, a taxa de sucesso foi significativamente maior nos Grupos Tansulosina (61,9%) e Nifedipino (60,0%) do que no Grupo Placebo (26,1%) (p=0,024), porém não foi significativa entre os cálculos de 5 a 9 mm (p=0,128). O Número Necessário para Tratar (NNT) da Tansulosina foi de 2,9 e o do Nifedipino foi de 3, considerando-se o uso para cálculos de 10 a 20 mm. Os pacientes que usaram nifedipino tiveram mais efeitos adversos do que os do Grupo Placebo (28,5 % x 2,6% respectivamente, p = 0,009), porém sem levar à interrupção do uso da drogas. Não houve diferença significativa entre os grupos Tansulosina x Nifedipino e Tansulosina x Placebo em relação aos efeitos adversos (p= 0,15 e p = 0,054, respectivamente). Não houve diferença entre os grupos com relação à intensidade da dor observada após o tratamento (p=0,28), ao número de comprimidos de Celecoxibe (p=0,39), ao tempo de eliminação dos fragmentos (p=0,6), à ocorrência de rua de cálculos (p=0,482) e ao número de vistas ao Pronto Socorro (p=0,175). Conclusões: O uso adjuvante de tansulosina ou de nifedipino após LEOC aumenta a taxa de sucesso para cálculos renais entre 10 e 20 mm, porém sem diminuir a intensidade da dor ou a necessidade de analgésicos após o tratamento, nem o tempo de eliminação dos fragmentos / Purpose: We evaluated the effects of the adjuvant use of tamsulosin and nifedipine after extracorporeal shock wave lithotripsy (SWL) for 5-20 mm kidney stones. Materials and Methods: We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones between 2006 and 2009. Patients were divided into three groups to receive daily treatments of 0.4 mg tamsulosin, 20 mg nifedipine retard or placebo for up to 30 days after one session of SWL. The parameters assessed were success rate, analgesic requirements, pain intensity, time to clearance, adverse effects and occurrence of Steinstrasse. Results: The success rate was 60.5% (23 of 38) in the Tamsulosin group, 48.6% (17 of 35) in the Nifedipine group and 36.8% (14 of 38) in the Placebo group (p=0.118). For stones ranging from 10 to 20 mm, the success rates were significantly higher in the Tamsulosin (61.9%) and Nifedipine groups (60.0%) when compared with the Placebo group (26.1%) (p=0.024), but not for the 5-9 mm stones (p=0.128). The Number Needed to Treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the Nifedipine than the Placebo Group (28.5% vs. 2.6%, respectively, p=0.009). There was no difference among groups with regard to stone and demographic characteristics, pain intensity, time to clearance and Steinstrasse. Conclusions: Adjuvant use of tamsulosin or nifedipine after SWL significantly increased the success rates for 10 to 20 mm renal stones and could be recommended. Both drugs had similar beneficial effects and adverse events

Glutamate excitotoxicity is the predominant mechanism implicated in neuronal cell death associated with neurological disorders such as stroke, epilepsy, traumatic brain injury and ALS. Excessive stimulation of NMDA subtypes of glutamate receptors leads to protracted intracellular calcium elevations triggering calcium mediated neurotoxic mechanisms culminating in delayed neuronal cell death. In addition, glutamate excitotoxicity induces a NMDA dependent extended neuronal depolarization mediated by continuous calcium influx that correlates with delayed neuronal death. Attempts to prevent neuronal death by blocking calcium entry into the neurons using calcium channel blockers or NMDA receptor antagonists have failed to provide any beneficial effects in clinical trials. Thus, calcium continues to enter the neurons despite the presence of calcium entry blockers. This phenomenon is known as the "calcium paradox of stroke" and represents a major problem in developing effective therapies for treatment of stroke. Here employing a combination of patch clamp recordings, fluorescent calcium imaging and neuronal cell death assays in well-characterized in vivo and in vitro models of glutamate excitotoxicity, we report the discovery of a novel calcium permeable ion channel that is activated by excitotoxic glutamate injury and mediates a calcium current that is an early initiating step in causing neuronal death. Blocking this calcium permeable channel with high concentrations of Zn2+ or Gd3+ by removing extracellular calcium for a significant time period after the initial injury is effective in preventing calcium entry, apoptosis and neuronal death, thus accounting for the calcium paradox. This injury induced-calcium permeable channel provides a unique mechanism for calcium entry following stroke and offers a new target for extending the therapeutic window for preventing neuronal death after the initial excitotoxic (stroke) injury.