Background: A post-exposure regrowth model utilizing the well-tried Bactec radiometric system, which would simulate in vivo situations at the site of invasive disease, was developed to measure drug activity against multiplying Mycobacterium tuberculosis. Aims: The aims of this dissertation were to (a) construct a radiometric model simulating drug efficacy relating to the combined bactericidal activity and delays in regrowth due to the action of anti¬tuberculosis (TB) agents, (b) compare the killing kinetics of drugs singly and in combinations by the time-kill curve method, with the radiometrically-determined regrowth model, and (c) assess whether the Bactec radiometric regrowth model could predict likely bactericidal activities of drugs. Design and methods: Drug concentrations in the time-kill curve method were in a range of achievable drug concentrations at the site of infection and in multiples of the minimal inhibitory concentration (MIC), (1x, 2x or 3x, and 8x). Exposure times of 6h, 24h, 48h and 72h were used and these were based on pharmacokinetic data reflecting likely periods of in vivo exposure in TB lesions. Standardized inocula of approximately 106CFU/mi of actively multiplying M. tuberculosis strains were used. The same concentrations, exposure times and bacterial concentrations were used for the assessment of radiometrically-determined post-exposure regrowth times of M. tuberculosis. Growth times were recorded as the number of days required to reach a predetermined growth index (GI) level in the Bactec system, and were expressed as T400 readings in days. Simple linear regression and a mathematical logistic model were used to assess whether the radiometric post-exposure regrowth model could predict the bactericidal activity of the drugs. For drug combination studies, 1MIC of isoniazid (INH) and rifampicin (RMP) were used singly and in combination while 2MIC of ethambutol (EMB), streptomycin (SM), ofloxacin (OFL) and amikacin (AMK) were used in combinations studies. Colony counts at Oh and following 24h exposures were performed and regrowth patterns were determined using the T400 method. M. tuberculosis H37Rv was tested and subsequently resistant strains. Results: INH and RMP were highly bactericidal while EMS showed moderate activity in the time-kill curve method. The three drugs produced the best curves, showing longer regrowth times and markedly depressed rates of regrowth in the Sactec post-exposure regrowth model. Using simple linear regression, a linear relationship between bacterial survivors and the radiometric regrowth times, T400, was achieved for all drugs tested. Even better agreement was found when control-related regrowth times, (T-C) 400, were used in the analysis. Conditions compromising the linear relationsbip in the radiometric regrowth model, for OFL and less markedly EMS and AMK, were likely postantibiotic effects (PAEs) brought on by the short exposure time (6h), and drug carry-over effects due to concentrations ≥ 8 MIC for INH, RMP and 8M (10x and 20x MICs). The mathematical logistic model showed good correlation between bactericidal activity and regrowth for INH and RMP but not for EMB, SM, OFL and AMK. Drug combination effects in the two techniques depended on the criteria used to describe synergy. Generally, it was found in drug combination experiments that the drugs did not influence each other to a meaningful extent. Discussion and conclusions: For prediction of bactericidal activity, interpretation of the radiometrically-determined regrowth model needs to accommodate PAEs and the effect of subinhibitory concentrations. The validity of the mathematical logistic model is not clear. Technical aspects of future studies such as better organism dispersal, need to be improved to achieve a more reliable evaluation based on the logistic model. For drug combination studies, the radiometric regrowth model yielded findings that were difficult to interpret in relation to published data, reinforcing the need for the use of internationally standardized techniques which would give statistically reliable data. The radiometrically-determined regrowth model showed good discrimination between the standard activities of anti- TB agents, correlating with clinical efficacy. It is simple to perform and could prove to be useful for the screening of candidate anti- TB drugs. Improved technical stringency and the evaluation of poorly active control drugs, are however needed before proof of validity of the model can be established. / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2007. / Medical Microbiology / unrestricted

Bibliography: leaves 315-366. / 368 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Assesses the action of dimethylxanthines on the contractility of respriatory and quadriceps femoris muscle in normal subjects and in patients at risk of respiratory muscle fatigue, using accepted techniques. / Thesis (M.D.)--University of Adelaide, Faculty of Medicine, 1992

The aim of this study was to investigate the possible toxicity of the flavonoid-containing plant, Artemisia afra and especially establish the safety of the aqueous extract of this plant after acute and chronic administration to mice and rats respectively.

The aim of this study was to investigate the possible toxicity of the flavonoid-containing plant, Artemisia afra and especially establish the safety of the aqueous extract of this plant after acute and chronic administration to mice and rats respectively.

Post-marketing surveillance refers to any non-experimental or observational study, method, or monitoring strategy that is applied to obtain information on drug experience (primarily adverse) after a drug has been approved for clinical use. One of the major problems in post-marketing surveillance studies is the lack or under-reporting of drug experiences by health care professionals. This study was developed to describe the impact of three different prescription event monitoring programmes on the reporting of adverse drug reactions (ADR's) in the hospital situation. The intensive ADR monitoring programme and two voluntary ADR monitoring programmes which followed were conducted in the medical wards of an urban teaching and referral hospital. All patients admitted to the designated wards were monitored by a dedicated pharmacist in the intensive programme, ward pharmacists in the first voluntary programme and by medical and nursing staff in the second voluntary programme. The pharmacist monitored a cohort of patients prospectively in two medical wards for a period of three months. The patient's record was linked with any suspected ADR. All details, i.e. patient drug orders, characteristics and ADR description, were recorded and then reported. From 228 patients monitored, 25 cases have been reported. The impact of the intensive ADR monitoring programme was a reporting rate of 11 percent. Reports were received on ADR's of a particularly mild, common and pharmacologically predictable (type A) nature. The first voluntary ADR monitoring programme comprised the reporting of suspected AD R's and the recording of drug orders for the patients and the patient characteristics. The ward pharmacists monitored for suspected AD R's in all patients during their regular ward rounds. Six cases were reported in a population of 1506 patients monitored during the three months. The reports were mainly on moderate to severe suspected AD R's of pharmacologically unpredictable (type B) nature. The rate of reports received by the surveillance unit in this study was 4 reports per ward pharmacist per annum. The second voluntary ADR monitoring programme comprised the prospective monitoring of 1555 patients by medical and nursing staff during their stay at the designated medical wards during the three month period. Patients were monitored for any ADR and when an ADR was suspected, the patient characteristics and drug orders were recorded and reported to the surveillance unit. Ten cases were reported represented by six reports from doctors and four by sisters. The reporting rate was 2 reports per doctor in four years and 3 reports for each member of the nursing team in 5 years. Reports were mainly received on moderate to severe suspected ADR's of a pharmacologically unpredictable (type B) nature.

There is a significant current need to elucidate the molecular mechanisms of the side-effects caused by widely-used pharmaceuticals. Examples include the acute nephrotoxicity and irreversible ototoxicity promoted by the cationic drugs gentamicin and cisplatin. Gentamicin is an aminoglycoside antibiotic used for the prevention and treatment of life-threatening gram-negative bacterial infections, such as tuberculosis and meningitis. Cisplatin is used to treat a broad spectrum of cancers including head and neck, ovarian, cervical, stomach, bladder, sarcoma, lymphoma, testicular cancer and others. The objective of this study is to design and synthesize rhodamine derivatives that can be used for the construction of geometrically well-defined cationic drug conjugates. The long-term goal is to use the conjugates as tools to aid in elucidating the properties and identities of ion channels involved in the uptake of cationic pharmaceuticals into kidney and cochlear hair cells. This will shed light on the origin and potential prevention of unwanted side effects such as nephrotoxicity and ototoxicity associated with specific cationic drugs. A series of extended rhodamine analogs with reactive groups for biomolecule conjugation has been synthesized. These fluorophores show similar spectral properties to their prototype, Texas Red succinimidyl ester (TR-SE). However, they contain rigid linkers between the fluorophore and amine-reactive moiety. The resultant gentamicin conjugates of these materials are rigidified enabling one to assess channel pore dimensions without the confounding issue of conjugate folding. Preliminary cell studies are promising, as one observes reduced gentamicin uptake in both kidney and sensory hair cell upon systematically increasing the dimension of the fluorophore. This work has enabled us to tentatively assign the maximum dilated MET channel pore size as between 1.44 nm to 1.56 nm. However, this preliminary finding, though encouraging, needs further validation via ongoing studies with larger diameter fluorophore conjugates, A cisplatin-Texas Red conjugate has also been synthesized to enable studies of cellular uptake mechanisms. This conjugate preserves not only the spectral properties of Texas Red after conjugation, but also the cytotoxicity of cisplatin. This has been validated in zebrafish. The series of rhodamine probes that have been conjugated to gentamicin should be similarly useful for cisplatin studies. These studies are planned. Additional future work includes the synthesis of semi-flexible (glycol) and flexible (alkyl) linkers to evaluate structure-activity relationships.

Indiana University-Purdue University Indianapolis (IUPUI) / Pharmacodynamics (PD) studies the relationship between drug concentration and drug effect on target sites. This field has recently gained attention as studies involving PD Drug-Drug interactions (DDI) assure discovery of multi-targeted drug agents and novel efficacious drug combinations. A PD drug combination could be synergistic, additive or antagonistic depending upon the summed effect of the drug combination at a target site. The PD literature has grown immensely and most of its knowledge is dispersed across different scientific journals, thus the manual identification of PD DDI is a challenge. In order to support an automated means to extract PD DDI, we propose Pharmacodynamics Miner (PD-Miner). PD-Miner is a text-mining tool, which is capable of identifying PD DDI from in vitro PD experiments. It is powered by two major features, i.e., collection of full text articles and in vitro PD ontology. The in vitro PD ontology currently has four classes and more than hundred subclasses; based on these classes and subclasses the full text corpus is annotated. The annotated full text corpus forms a database of articles, which can be queried based upon drug keywords and ontology subclasses. Since the ontology covers term and concept meanings, the system is capable of formulating semantic queries. PD-Miner extracts in vitro PD DDI based upon references to cell lines and cell phenotypes. The results are in the form of fragments of sentences in which important concepts are visually highlighted. To determine the accuracy of the system, we used a gold standard of 5 expert curated articles. PD-Miner identified DDI with a recall of 75% and a precision of 46.55%. Along with the development of PD Miner, we also report development of a semantically annotated in vitro PD corpus. This corpus includes term and sentence level annotations and serves as a gold standard for future text mining.

Indiana University-Purdue University Indianapolis (IUPUI) / Drug-drug interactions (DDIs) refer to situations where one drug affects the pharmacokinetics or pharmacodynamics of another. DDIs represent a major cause of morbidity and mortality. A common adverse drug reaction (ADR) that can result from, or be exacerbated by DDIs is drug-induced myopathy. Identifying DDIs and understanding their underlying mechanisms is key to the prevention of undesirable effects of DDIs and to efforts to optimize therapeutic outcomes. This dissertation is dedicated to identification of clinically important myopathic DDIs and to elucidation of their underlying mechanisms. Using data mined from the published cytochrome P450 (CYP) drug interaction literature, 13,197 drug pairs were predicted to potentially interact by pairing a substrate and an inhibitor of a major CYP isoform in humans. Prescribing data for these drug pairs and their associations with myopathy were then examined in a large electronic medical record database. The analyses identified fifteen drug pairs as DDIs significantly associated with an increased risk of myopathy. These significant myopathic DDIs involved clinically important drugs including alprazolam, chloroquine, duloxetine, hydroxychloroquine, loratadine, omeprazole, promethazine, quetiapine, risperidone, ropinirole, trazodone and simvastatin. Data from in vitro experiments indicated that the interaction between quetiapine and chloroquine (risk ratio, RR, 2.17, p-value 5.29E-05) may result from the inhibitory effects of quetiapine on chloroquine metabolism by cytochrome P450s (CYPs). The in vitro data also suggested that the interaction between simvastatin and loratadine (RR 1.6, p-value 4.75E-07) may result from synergistic toxicity of simvastatin and desloratadine, the major metabolite of loratadine, to muscle cells, and from the inhibitory effect of simvastatin acid, the active metabolite of simvastatin, on the hepatic uptake of desloratadine via OATP1B1/1B3. Our data not only identified unknown myopathic DDIs of clinical consequence, but also shed light on their underlying pharmacokinetic and pharmacodynamic mechanisms. More importantly, our approach exemplified a new strategy for identification and investigation of DDIs, one that combined literature mining using bioinformatic algorithms, ADR detection using a pharmacoepidemiologic design, and mechanistic studies employing in vitro experimental models.

Indiana University-Purdue University Indianapolis (IUPUI) / Model-based drug development has become an essential element to potentially make drug development more productive by assessing the data using mathematical and statistical approaches to construct and utilize models to increase the understanding of the drug and disease. The modeling and simulation approach not only quantifies the exposure-response relationship, and the level of variability, but also identifies the potential contributors to the variability. I hypothesized that the modeling and simulation approach can: 1) leverage our understanding of pharmacokinetic-pharmacodynamic (PK-PD) relationship from pre-clinical system to human; 2) quantitatively capture the drug impact on patients; 3) evaluate clinical trial designs; and 4) identify potential contributors to drug toxicity and efficacy. The major findings for these studies included: 1) a translational PK modeling approach that predicted clozapine and norclozapine central nervous system exposures in humans relating these exposures to receptor binding kinetics at multiple receptors; 2) a population pharmacokinetic analysis of a study of sertraline in depressed elderly patients with Alzheimer’s disease that identified site specific differences in drug exposure contributing to the overall variability in sertraline exposure; 3) the utility of a longitudinal tumor dynamic model developed by the Food and Drug Administration for predicting survival in non-small cell lung cancer patients, including an exploration of the limitations of this approach; 4) a Monte Carlo clinical trial simulation approach that was used to evaluate a pre-defined oncology trial with a sparse drug concentration sampling schedule with the aim to quantify how well individual drug exposures, random variability, and the food effects of abiraterone and nilotinib were determined under these conditions; 5) a time to event analysis that facilitated the identification of candidate genes including polymorphisms associated with vincristine-induced neuropathy from several association analyses in childhood acute lymphoblastic leukemia (ALL) patients; and 6) a LASSO penalized regression model that predicted vincristine-induced neuropathy and relapse in ALL patients and provided the basis for a risk assessment of the population. Overall, results from this dissertation provide an improved understanding of treatment effect in patients with an assessment of PK/PD combined and with a risk evaluation of drug toxicity and efficacy.