<p>Despite major advances in the understanding of the biology of chronic lymphocytic leukaemia (CLL), progress in improving its treatment has been limited and it still remains an incurable disorder. In the present research, we have performed <i>in vitro</i> drug sensitivity testing of primary CLL cells for preclinical evaluation of cytotoxic drugs, using the fluorometric microculture cytotoxicity assay (FMCA).</p><p>The tumour type-specific activities of 14 standard drugs, evaluated <i>in vitro</i> on tumour cells from patients with CLL and acute leukaemias, were in good agreement with their known clinical activities. A correlation between drug treatment and development of cellular drug resistance was demonstrated in CLL, but not in the acute leukaemias. Moreover, the nucleoside analogues fludarabine, cladribine, cytarabine and gemcitabine, as well as the anthracycline idarubicin, were highly active in CLL cells.</p><p>A new cytotoxic drug candidate, CHS 828, was evaluated in primary cell cultures from a broad spectrum of tumours. CHS 828 was highly active against haematological malignancies <i>in vitro</i>, especially CLL, but also against some solid tumours. The drug appeared to be non cross-resistant with standard drugs.</p><p>In addition, the relationship between drug sensitivity <i>in vitro</i> and a recently described prognostic factor in CLL, the mutational status of the immunoglobulin variable heavy chain (IgV_H) gene, was evaluated. Interestingly, cells with unmutated IgV_H genes were more chemosensitive than the mutated cells. </p><p>In summary, our results indicate that <i>in vitro</i> studies on tumour cellsfrom leukaemia patients may yield considerable information regarding the activity, mechanisms of action and cross-resistance of cytotoxic drugs, as well as concerning the relationship between drug sensitivity and prognostic factors, which can be useful in the preclinical evaluation of new cytotoxic drugs. Furthermore, the results suggest that the pyrimidine analogues cytarabine and gemcitabine, as well as the anthracycline idarubicin, may have a role in the treatment of CLL. The new cyanoguanidine CHS 828 is highly active in CLL cells and appears to be non cross-resistant with standard drugs. The poorer prognosis in patients with CLL cells with unmutated IgV_H genes can not be explained by increased chemoresistance.</p>

Despite major advances in the understanding of the biology of chronic lymphocytic leukaemia (CLL), progress in improving its treatment has been limited and it still remains an incurable disorder. In the present research, we have performed in vitro drug sensitivity testing of primary CLL cells for preclinical evaluation of cytotoxic drugs, using the fluorometric microculture cytotoxicity assay (FMCA). The tumour type-specific activities of 14 standard drugs, evaluated in vitro on tumour cells from patients with CLL and acute leukaemias, were in good agreement with their known clinical activities. A correlation between drug treatment and development of cellular drug resistance was demonstrated in CLL, but not in the acute leukaemias. Moreover, the nucleoside analogues fludarabine, cladribine, cytarabine and gemcitabine, as well as the anthracycline idarubicin, were highly active in CLL cells. A new cytotoxic drug candidate, CHS 828, was evaluated in primary cell cultures from a broad spectrum of tumours. CHS 828 was highly active against haematological malignancies in vitro, especially CLL, but also against some solid tumours. The drug appeared to be non cross-resistant with standard drugs. In addition, the relationship between drug sensitivity in vitro and a recently described prognostic factor in CLL, the mutational status of the immunoglobulin variable heavy chain (IgVH) gene, was evaluated. Interestingly, cells with unmutated IgVH genes were more chemosensitive than the mutated cells. In summary, our results indicate that in vitro studies on tumour cellsfrom leukaemia patients may yield considerable information regarding the activity, mechanisms of action and cross-resistance of cytotoxic drugs, as well as concerning the relationship between drug sensitivity and prognostic factors, which can be useful in the preclinical evaluation of new cytotoxic drugs. Furthermore, the results suggest that the pyrimidine analogues cytarabine and gemcitabine, as well as the anthracycline idarubicin, may have a role in the treatment of CLL. The new cyanoguanidine CHS 828 is highly active in CLL cells and appears to be non cross-resistant with standard drugs. The poorer prognosis in patients with CLL cells with unmutated IgVH genes can not be explained by increased chemoresistance.

The interferon (IFN) response is a crucial component of cellular innate immunity, vital for controlling virus infections. Dysregulation of the IFN response however can lead to serious medical conditions including autoimmune disorders. Modulators of IFN induction and signalling could be used to treat these diseases and as tools to further understand the IFN response and viral infections. We have developed cell-based assays to identify modulators of IFN induction and signalling, based on A549 cell lines where a GFP gene is under the control of the IFN-β promoter (A549/pr(IFN-β).GFP) and the ISRE containing MxA promoter (A549/pr(ISRE).GFP) respectively. The assays were optimized, miniaturized and validated as suitable for HTS by achieving Z' Factor scores >0.6. A diversity screen of 15,667 compounds using the IFN induction reporter assay identified 2 hit compounds (StA-IFN-1 and StA-IFN-4) that were validated as specifically inhibiting IFNβ induction. Characterisation of these molecules demonstrated that StA-IFN-4 potently acts at, or upstream, of IRF3 phosphorylation. We successfully expanded this HTS platform to target viral interferon antagonists acting upon IFN-signalling. An additional assay was developed where the A549/pr(ISRE).GFP.RBV-P reporter cell line constitutively expresses the Rabies virus phosphoprotein. A compound inhibiting viral protein function will restore GFP expression. The assay was successfully optimized for HTS and used in an in-house screen. We further expanded this assay by placing the expression of RBV-P under the control of an inducible promoter. This demonstrates a convenient approach for assay development and potentiates the targeting of a variety of viral IFN antagonists for the identification of compounds with the potential to develop a novel class of antiviral drugs.

published_or_final_version / abstract / Community Medicine / Master / Master of Public Health

Alcohol dependence is a major public health concern. Despite the FDA’s approval of multiple anti-relapse drugs, relapse rates remain unacceptably high. Furthermore, cognitive deficits among chronic drinkers are evident and are suggested to contribute to relapse risk. Current evidence suggests that several critical features of alcoholism and alcohol-associated neurodegeneration are mechanistically linked to glutamatergic actions; specifically, they appear positively affected by glutamatergic inhibition, particularly inhibition via polyamine modulation of a subpopulation of n-methyl-d-aspartate receptors. The current project was designed to evaluate the performance of two putative polyamine modulators (JR-220 and CP-101,606) in a variety of screens designed to identify the potential to reduce withdrawal severity, neurotoxicity and relapse risk. Screens included a complex organotypic screen designed to assess neuroprotective potential (Experiment 1), a simple behavioral screen designed to assess withdrawal severity (Experiment 2) as well as several more complex behavioral screens designed to examine cue-conditioning during withdrawal (Experiment 3), relapse behavior (Experiment 4), stress-associated consumption (Experiment 5) and binge-like consumption (Experiment 6). An additional open field experiment (Experiment 7) was conducted in order to address interpretational issues concerning activity in Experiments 2-6. Finally, as a first step in moving beyond simple screening, we expanded our binge screen to adhere more closely to an established, validated model of binge consumption (Experiment 8). While some interpretational issues were noted, taken together, the results from these experiments provide strong evidence for both drugs as potential pharmacotherapies for alcoholism and further implicate polyamines and NR2B subunits as critical mechanisms in ETOH consumption and withdrawal.

<p>Artemisia Afra, a popular South African traditional herbal medicine is commonly administered as a tea infusion of the leaves. However, clinical trials proving it safety and efficacy are lacking mainly due to the absence of good quality dosage forms and credible placebos for the plant. The objectives of this study were to prepare a standardized preparation of the plant leaves and freeze-dried aqueous extract powder of the leaves, in a tea bag dosage form and to design and prepare credible placebos for these plant materials.</p>

Par l'utilisation de techniques statistiques poussées, l'approche de population rend l'estimation des propriétés pharmacocinétiques (étude des phénomènes d'absorption, distribution, métabolisme et élimination du médicament dans l'organisme) possible chez les patients inclus dans les études de Phase III, en dépit d'un nombre de prélèvements sanguins réduit. Elle permet également d'évaluer, parmi les caractéristiques des patients, les sources de variabilité interindividuelle (covariables) pouvant expliquer les différences potentielles observées dans telle ou telle sous-population.Après un bref rappel bibliographique de la technique, nous présentons les résultats des analyses effectuées sur trois candidats-médicaments en fin de développement clinique. Le premier exemple détaille le processus d'une analyse de population réalisée chez plus de 3000 patients ainsi que les résultats d'une analyse pharmacocinétique/pharmacodynamique. Dans la deuxième partie, nous insistons sur une technique particulière de validation (le bootstrap) et détaillons l'étape de simulation mise en place pour appuyer les conclusions de l'analyse. La dernière analyse présente enfin un modèle pharmacocinétique de population combinant les données d'un produit parent et de son métabolite actif, l'autre originalité de l'analyse étant l'utilisation du randomization test afin de vérifier l'inclusion de covariables dans le modèle.Les conclusions de ces analyses permettent de mieux appréhender la cinétique des trois molécules dans leur population cible par la mise en évidence d'éventuelles sous-populations à risque et, ainsi, de veiller à leur efficacité et à leur absence de toxicité. / Using sophisticated statistical techniques, the population approach allows estimating the pharmacokinetic properties (study of the absorption, distribution, metabolism and elimination phenomena of a drug into the body) in patients included in Phase III studies, despite a low number of blood samples collected. It also allows evaluating, from the patients' characteristics, the sources of interindividual variability (covariates) that may explain the potential differences observed in a given subpopulation.After a brief review of the technical aspects of the population approach, the results of the analyses performed on three drugs in the end of their clinical development will be presented. The first example details the process of a population analysis carried out in more than 3000 patients, together with the results of a pharmacokinetic/pharmacodynamic analysis. In a second part, we underline a validation technique (the bootstrap) and the simulation study performed to emphasize the conclusions of the study. The last example presents a population pharmacokinetic model applied to the simultaneous fit of data from a parent drug and its active metabolite, the other originality of the analysis being the use of the randomization test to verify the covariates inclusion in the model.The conclusions of these analyses allow a better understanding of the kinetics of the three drugs in their target population by emphasizing potential subpopulations at risk and, hence, participate to verify their efficacy and their absence of toxicity.

Pharmacometrics is a quantitative science that is rapidly changing the landscape of drug development, and particularly so for the pediatric population. The motivation behind the research underlying this dissertation is to contribute towards the improvement of pediatric drug development by the astute application of pharmacometric methods. Two distinct research areas have been focused upon: 1- improving pediatric pharmacokinetic (PK) trial design and 2- improving pediatric dosing of warfarin by using a genetics-based dosing regimen. The first project examined in detail the feasibility of and simulation-based methodology for implementing a recent regulatory PK quality standard. The focus was on designing pediatric PK trials that employ sparse sampling and population analysis methods, using a simulation-estimation platform. The research provided clarity on the impact of various trial design elements, such as PK sampling, adult data inclusion, PK variability and analysis method on sample size adequacy to honor the standard. The PK quality standard was found to be practically feasible in terms of sample size adequacy. Informative sampling schedule for a given number of PK samples per subject is assumed during trial design. Recommendations are made to: 1- use prior adult or pediatric data for trial design and analysis, wherever possible and 2 - use one-stage population analysis methods and biologically feasible covariate models for designing pediatric PK studies. The second project involved derivation of the first ever pediatric warfarin dosing regimen, including starting dose and titration scheme, based on pharmacogenetics (Cyp2c9 *1/*2/*3 and VKORc1 -1629 G>A polymorphisms). While extensive research and several dosing models for warfarin use in adults exist, there is paucity of data in pediatrics. A validated adult warfarin population PKPD model was bridged using physiological principles and limited pediatric data to arrive at a pediatric PKPD model and dosing regimen. Pediatric data (n=26) from an observational study conducted at the Children’s Hospital Los Angeles (CHLA) was used to qualify the pediatric model. A 2-step pediatric starting dose based on body weight (<20 kg and ≥20 kg) for each of 18 (6 Cyp2c9 x 3 VKORC1) genotype categories is proposed. The titration scheme involves percentage changes relative to previous dose, based on latest patient INR. The dosing regimen targets a major (≥ 60%) proportion of INRs within therapeutic range of 2.0-3.0, by the second week into warfarin therapy. Simulataneously, bleeding and thromboembolic risks are minimized via minimal proportions (≤ 10% and ≤ 20%) of INRs > 3.5 and INRs < 2.0, respectively. In simulations, the proposed dosing regimen performed better on target INR outcomes than the standard-of-care dosing used in the CHLA patients. Given the challeneges in and low likelihood of conducting pediatric warfarin clinical studies, the proposed dosing regimen is believed to be an important advance in pediatric warfarin therapy. Prospective warfarin studies in pediatrics using the proposed dosing regimen are recommended to refine and validate the suggested dosing strategy.

Sulfated low molecular weight lignins (LMWLs) have shown good activity as anticoagulants by allosterically inhibiting thrombin, as well as promising agents for treating emphysema through inhibition of elastolysis, oxidation, and inflammation. Sulfated LMWLs are chemo-enzymatically synthesized from starting monomers caffeic, ferulic, and sinapic acid into sulfated dehydropolymers known as CDS, FDS, and SDS. To further the LMWLs’ development as drugs, their structural composition and physicochemical characteristics were defined in this work. The molecular weight distribution profile of the sulfated LMWLs from size exclusion chromatography performed on a high pressure liquid chromatography system (SEC-HPLC) changed from bimodal when no surfactant is used in the mobile phase of the HPLC to unimodal when surfactant is used in the mobile phase. This indicates that some large molecular weight species, likely an aggregate of smaller molecular weight chains, are disrupted when surfactant is present. The resulting estimates of molecular weight calculated when surfactant is used in the mobile phase resulted in peak average molecular weights of 5700 Da for CDS, 7400 Da for FDS, and 4300 Da for SDS. These molecular weights are 17-45% higher and can be considered more accurate than the previously reported molecular weights (CDS: 3320 Da, FDS: 4120 Da, SDS: 3550 Da) because they were measured directly whereas previous estimates were calculated from GPC-HPLC data of the unsulfated LMWL precursors. Elemental analysis and distribution coefficient measurements were also performed on the LMWL library, revealing information about the level of sulfation and hydrophobic character of the sulfated LMWLs.

Orientador : Hérida Regina Nunes Salgado / Coorientador: Cristina Helena dos Reis Serra / Banca: Marlus Chorilli / Banca: Marcello Garcia Trevisan / Banca: Fernanda Nervo Raffin / Banca: Ana Dóris de Castro / Resumo: O darunavir, antirretroviral inibidor de protease, compõe a terapia considerada altamente eficaz no tratamento da síndrome da imunodeficiência humana adquirida, e é um dos fármacos disponibilizados gratuitamente pelo Sistema Único de Saúde (SUS). Os produtos genéricos têm contribuído para a manutenção e abrangência desta política de distribuição gratuita de medicamentos, ao reduzir os custos desses produtos. Neste propósito, este estudo busca fornecer informações sobre o comportamento físicoquímico e estabilidade do fármaco e da formulação, diante de diferentes condições climáticas, bem como, sobre sua solubilidade e liberação a partir da formulação. Além disso, pretende apresentar ferramentas in vitro e in silico que contribuam, no futuro próximo, para a produção de novos produtos contendo darunavir que apresentem alta qualidade, especialmente, genéricos do medicamento referência. Para tanto, a solubilidade do fármaco foi investigada em diferentes meios. A baixa solubilidade aquosa do fármaco foi verificada, e os meios adequados aos testes de dissolução foram escolhidos. O perfil de dissolução in vitro do darunavir e de absorção in vivo a partir papel dos comprimidos de Prezista® contendo 300 mg de fármaco foram investigados. Obtevese um perfil de dissolução discriminativo para o produto e um método de quantificação por espectrofotometria derivada foi desenvolvido e validade. Uma correlação entre os dados de fração dissolvida in vitro e fração absorvida in vivo do darunavir foi alcançada (r2= 0,95). Este é um método preditivo para avaliar o desempenho in vivo do darunavir a partir de comprimidos de liberação imediata, com base em dados in vitro, e é importante para minimizar o uso de animais e seres humanos em experimentos durante o desenvolvimento novos produtos farmacêuticos contendo darunavir. Além disso, uma ferramenta in silico foi desenvolvida e validada para a previsão da ... / Abstract: Darunavir, a protease inhibitor, constitute the highly active antiretroviral therapy against the acquired immunodeficiency syndrome. It is one of agents given free by the Brazilian Health System (SUS). Generic products have contributed to the maintenance and the policy of free distribution of medicines by the decreasing of costs of these products. In this way, this study seeks to provide information on the physical and chemical behavior and stability of the drug and formulation, facing different weather conditions, as well as provide information on their solubility and release from the formulation. It also aims to provide in vitro and in silico tools to contribute in the near future, for the production of new products containing darunavir, especially generic medicines. Therefore, the solubility of the drug was investigated in different media. The low aqueous solubility of the drug was observed, and suitable media for dissolution testing were chosen. The in vitro dissolution profile of darunavir and the in vivo absorption from Prezista® (tablets containing 300 mg of drug) were investigated. It was obtained a discriminating dissolution profile of the product and a method of quantification by spectrophotometry derivative was developed and validated. A correlation between the data of in vitro dissolved fraction and in vivo absorbed fraction of darunavir was achieved (r2 = 0.95). This is a predictive method to evaluate the in vivo performance of darunavir from immediate-release tablets, based on in vitro data, and it is important to minimize the use of animals and humans in experiments during the development of new medicines containing darunavir. In addition, an in silico tool was developed and validated for predicting the oral bioavailability of darunavir formulations, from their dissolution profile. For this, physiologically based pharmacokinetic modeling was applied through Simcyp® software. These, in vitro and in silico tools, assist in ... / Doutor