Orientador: Ney Carter do Carmo Borges / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T15:34:25Z (GMT). No. of bitstreams: 1 Moreira_RobertoFernandes_D.pdf: 2940817 bytes, checksum: 525d43271d9ecc3f57856c7a4f024a5d (MD5) Previous issue date: 2014 / Resumo: Na última década, a evolução dos aspectos técnicos da regulamentação brasileira na área de medicamentos, tendo como base princípios científicos, é inquestionável. A implantação das legislações contribuiu para o aprimoramento da fabricação e garantia de qualidade dos medicamentos no país, introduzindo conceitos tais como equivalência farmacêutica, biodisponibilidade e bioequivalência. O teste de bioequivalência é fundamental para garantir que dois medicamentos que comprovaram a equivalência farmacêutica apresentará o mesmo desempenho no organismo em relação à biodisponibilidade, expressa em termos da quantidade absorvida do fármaco, a partir da forma farmacêutica ministrada, e da velocidade do processo de absorção. Os procedimentos analíticos descritos neste trabalho estão em conformidade com os requisitos do FDA e da ANVISA para a quantificação de drogas em estudos farmacocinéticos em humanos. Neste trabalho, descrevemos o primeiro método desenvolvido para a quantificação de clorpromazina em plasma humano utilizando Cromatografia Líquida de Ultra Eficiência (CLUE) acoplado a um espectrômetro de massa triplo quadrupolo em tandem e electrospray em modo positivo (CLUE-ES(+)-EM/EM). O analito e o padrão interno (IS) foram extraídos do plasma humano pela técnica líquido-líquido com éter dietílico/diclorometano (70/30, V/V). A cromatografia foi conduzida isocraticamente num Aquity UPLC BEH C18 1,7 mm (50 mm x 2,1 mm di) operando a 40°C. A fase móvel foi uma mistura de 65% de água + 1% de ácido fórmico e 35% de acetonitrilo a uma taxa de fluxo de 0,5 mL/min. O limite de quantificação foi de 0,5ng/ml e uma curva de calibração linear 0,5-200ng/ml, mostrando precisão intra-ensaio de 2,4 a 5,8%, e precisão inter-ensaio foi de 3,6 a 9,9%. A exatidão intra-ensaio variou de 96,9 a 102,5%, enquanto a exatidão inter-ensaio variou de 94,1 a 100,3%. Este método de análise foi aplicado em um estudo de biodisponibilidade relativa, a fim de comparar uma formulação teste na dose de 100mg de clorpromazina contra uma formulação referência em 57 voluntários de ambos os sexos. Além disso, descrevemos o método analítico para quantificação de ondansetrona em plasma humano utilizando CLAE-EM/EM, associado ao menor tempo de análise cromatográfica descrita e baixo volume de plasma para extração do ativo. Amostras de plasma humano foram extraídas com éter metil-terc-butílico e analisadas por CLAE-ES-EM/EM. O limite de quantificação foi de 0,2ng/mL e o método foi linear no intervalo de 0,2-60ng/ml. A precisão intra-ensaio ficou entre 1,6 a 7,7%, enquanto que a precisão inter-ensaio variou de 2,1 a 5,1%. As exatidões intra-ensaio variaram de 97,5 a 108,2% e a exatidão inter-ensaio variaram de 97,3 a 107,0%. Este método analítico foi utilizado em um estudo de biodisponibilidade relativa de duas formulações farmacêuticas contendo 8 mg de ondansetrona cada em 25 voluntários saudáveis, usando, o delineamento cruzado em dois períodos. Finalmente, o método analítico para quantificação de imipramina utiliza CLUE-EM/EM, apresentando baixo limite de quantificação associado ao menor tempo de análise cromatográfica em comparação aos trabalhos descritos na literatura. A imipramina e o IS foram extraídos a partir de plasma humano utilizando éter dietílico/diclorometano (60/40, V/V) e analisadas por CLUE-ES+-EM/EM. A cromatografia foi realizada em modo isocrático em um CLUE BEH C18 1.7 Aquity One (100 mm x 2,1 mm di) operando a 40ºC. A fase móvel era composta de uma mistura de 65% de água, 1% de ácido fórmico e 35% de acetonitrilo bombeada a uma taxa de fluxo de 0,5mL/min. O limite de quantificação foi de 0,1ng/ml com linearidade no intervalo de 0,1 a 20ng/mL. O método mostrou precisão intra-ensaio de 0,8 a 5,8% e precisão inter-ensaio de 2,1 a 5,1%. As exatidões intra-ensaio variaram de 95,0 a 105,4%, enquanto a exatidão inter-ensaio variou de 98,2 a 108,2%. Este método de análise foi aplicada em um estudo de biodisponibilidade relativa entre uma formulação teste com 25mg de imipamine contra um comprimido da formulação referência em 35 voluntários de ambos os sexos. Este trabalho descreve três estudos de bioequivalência dos ativos clorpromazina, ondansetrona e imipramina, sendo cada um dos estudos com delineamento aberto, aleatorizado, cruzado de dois períodos. Uma vez que o IC de 90% para as razões de Cmax e ASC ficaram dentro do intervalo de 80-125% em todos os estudos, concluiu-se que as formulações em teste de clorpromazina, ondansetrona e imipramina são bioequivalentes às respectivas formulações de referência no que diz respeito tanto à taxa e extensão como de absorção / Abstract: In the last decade, the evolution of the technical aspects of the Brazilian regulations in the area of medications, based on scientific principles, is unquestionable. The implementation of the specific laws and regulations have contributed to the improvement of manufacturing and quality assurance of medicines in the country, introducing concepts such as pharmaceutical equivalence, bioequivalence and bioavailability. Bioequivalence testing is critical to ensure that the two medications that have proved pharmaceutical equivalence will have the same bioavailability in the body, expressed in terms of the amount of absorbed drug and the speed of absorption using the dosage form provided. Analytical procedures described in this work are in accordance with the requirements of the FDA and ANVISA for the quantitation of drugs in pharmacokinetic studies in humans. Here we describe the first method for the quantitation of chlorpromazine in human plasma using an ultra performance liquid chromatography (UPLC) coupled to an electrospray tandem triple quadrupole mass spectrometer in positive mode (UPLC-ES(+)-MS/MS). The analyte and the internal standard (IS) were extracted from human plasma by a liquid-liquid extraction with diethyl ether/dichloromethane (70/30, v/v) and chromatography was performed isocratically on an Aquity UPLC BEH C18 1.7 ?m (50 mm x 2.1 mm i.d.) operating at 40°C. The mobile phase was a mixture of 65% water+1% formic acid and 35% of acetonitrile at a flow-rate of 0.5 mL/min. The lowest concentration quantified was 0.5ng/mL and a linear calibration curve over the range 0.5-200 ng/mL was obtained, showing intra-assay precisions from 2.4 to 5.8%, and inter-assay precisions from 3.6 to 9.9%. The intra-assay accuracies ranged from 96.9 to 102.5%, while the inter-assay accuracies ranged from 94.1 to 100.3%. This analytical method was applied in a relative bioavailability study in order to compare a test chlorpromazine 100 mg simple dose formulation versus a reference in 57 volunteers of both sexes. The analytical method for quantification of ondansetron in human plasma described here offers advantages over previously reported using HPLC-MS/MS, associated with shorter chromatographic analysis described and low plasma volume for extracting active. Human plasma samples were extracted by liquid-liquid extraction (LLE) using methyl tert-butyl ether and analyzed by LC-ESI-MS/MS. The limit of quantification was 0.2?ng/mL and the method was linear in the range 0.2-60?ng/mL. The intra-assay precisions ranged from 1.6 to 7.7%, while inter-assay precisions ranged from 2.1 to 5.1%. The intra-assay accuracies ranged from 97.5 to 108.2%, and the inter-assay accuracies ranged from 97.3 to 107.0%. The analytical method was applied to evaluate the relative bioavailability of two pharmaceutical formulations containing 8?mg of ondansetron each in 25 healthy volunteers using a randomized, two-period crossover design. In addition, the analytical method for the quantification of imipramine in human plasma described here offers advantages over previously reported using UPLC-MS/MS, HPLC-MS/MS and HPLC-MS, with low limit of quantification associated with shorter chromatographic analysis described in the literature. The analyte and the IS were extracted from human plasma by a liquid¿liquid extraction with diethyl ether/dichloromethane (60/40, V/V) and analyzed by UPLC¿ES+-MS/MS. Chromatography was performed isocratically on an UPLC BEH C18 1.7 Aquity One (100 mm ×2.1 mm i.d.) operating at 40ºC. The mobile phase was a mixture of 65% water + 1% formic acid and 35% of acetonitrile at a flow-rate of 0.5 mL/min. The lowest concentration quantified was 0.1ng/mL and a linear calibration curve over the range 0.1¿20ng/mL was obtained, showing intra-assay precisions from 0.8 to 5.8%, and inter-assay precisions from 2.1 to 5.1%. The intra-assay accuracies ranged from 95.0 to 105.4%, while the inter-assay accuracies ranged from 98.2 to 108.2%. This analytical method was applied in a relative bioavailability study in order to compare a test imipamine 25 mg simple dose formulation versus a reference tablet in 35 volunteers of both sexes. The study was conducted in an open randomized two-period crossover design and with a fourteen days washout period. Since the 90% CI for ASC and Cmax ratios were within the range of 80-125% for all studies, it was concluded that the test formulations of chlorpromazine, imipramine and ondansetron are bioequivalent to the respective reference formulations with respect to both rate and extent of absorption / Doutorado / Clinica Medica / Doutor em Ciências

No description available.

Le virus Chikungunya (CHIKV), arbovirus en pleine ré-émergence, a envahi rapidement de nombreuses zones géographiques du monde. La propagation mondiale de ce virus constitue une menace pour la santé humaine car il n'y a pas de vaccin ou d'agents antiviraux appropriés pour contrôler l'infection virale. La transmission du virus s’effectue lors de la piqure d’un moustique infecté du genre Aedes, qui injecte sa salive contenant le virus dans la peau de l’hôte humain. Afin de contrôler la dissémination du virus, il est primordial de développer des recherches sur l’identification de molécules antivirales et de comprendre les mécanismes moléculaires impliqués dans les interactions hôte-virus et/ou vecteur-virus-hôte. En utilisant différentes stratégies moléculaires et cellulaires, nous avons étudié le potentiel antiviral de l'Imipramine, une molécule déjà commercialisée et qui a la capacité de perturber le transport du cholestérol intracellulaire. Nous avons démontré que cette molécule est capable d'inhiber la réplication du CHIKV dans les fibroblastes cutanés humains. Nous avons mis en évidence que l'Imipramine affectait à la fois les étapes de fusion et de réplication pendant le cycle de réplication du virus. En outre, la molécule a également fortement inhibé la réplication de plusieurs Flavivirus comme le virus Zika (ZIKV), le virus du Nil occidental et le virus de la Dengue. Nous avons également déterminé le profil protéomique global des fibroblastes humains infectés par le CHIKV ou le ZIKV. Cela nous a permis de mettre en évidence les modulations significatives de plusieurs protéines stimulées par l'interféron et de protéines impliquées dans à la défense anti-virale dans les cellules infectées. Plus important encore, nos résultats montrent pour la première fois le rôle de la protéine SAMHD1 dans l'infection des fibroblastes cutanés par les arbovirus. Enfin, compte tenu des fortes interactions entre l’hôte, le vecteur et le CHIKV, l'effet de la salive du moustique Ae. Aegypti sur l'infection virale a été étudié. À notre connaissance, cette étude est la première à montrer l’importance de la salive d’Ae. aegypti sur la facilitation de l’infection du CHIKV, dans des fibroblastes cutanés, à travers la régulation des gènes impliqués dans la réponse interféron de type I. / Chikungunya virus (CHIKV) is a re-emerging mosquito-borne alphavirus that has been spread worldwide. The dissemination of this virus is a threat to human health since there is no approved vaccine or appropriate antiviral agents to control viral infection. The global expansion of the virus is preceded by biting of infected Aedes mosquitos, which injects saliva containing the virus into the skin of the human host. Searching for effective antiviral compounds and understanding of the molecular mechanisms involved in host-virus or vector-virus-host interactions are crucial for controlling viral spread.Using different molecular and cellular strategies, we demonstrated that the FDA approved drug, imipramine, which has the capability to disturb intracellular cholesterol transport inhibits CHIKV replication in human skin fibroblasts. Imipramine was found to affect both the fusion and replication steps of the viral life cycle. Moreover, it also strongly inhibited the replication of several Flaviviridae family members, including Zika, West Nile and Dengue virus. We have also determined the global proteomic profile of Chikungunya and Zika virus infected human skin fibroblasts, and found that several interferon-stimulated proteins and antiviral response proteins are significantly up-regulated in the infected cells. More importantly, our results also provided for the first time a role of SAMHD1 in arbovirus infection of human skin fibroblasts. Finally, we demonstrated that Aedes aegypti saliva enhances CHIKV replication in human skin fibroblasts. To our knowledge, this is the first report showing the importance of Aedes aegypti saliva on promoting CHIKV infection via down regulation of the genes involving type I IFN secretion in the infected human cutaneous cells.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Depressive disorders are among the most frequent psychiatric diseases in the Western world with prevalence between 9% and 18%. Poor compliance and inappropriate antidepressant discontinuation invokes long-term morbidity, and appear linked to hippocampal shrinkage. Despite major advances in pharmacological treatment of the illness over the past 3040 years, currently available agents have distinct shortfalls both in clinical efficacy and in maintenance of response. This implies a greater long-term morbidity with significant impact on the patient, the patient's family as well as economic implications to health care managers and providers. The major reason for this state of affairs is our poor understanding of the neurobiology of depression and hence, of antidepressant (AD) action. AD drugs are thus not addressing the crucial neurobiological target underlying the illness, and new strategies and treatments are urgently needed. In recent years, depression has been associated with disturbances in excitotoxic glutamatergic activity, yet this has not been systematically evaluated. While the role of neurotransmitters such as serotonin, noradrenaline and dopamine has been extensively studied, new evidence suggests a role for the unique neurotransmitter nitric oxide (NO). Nitric oxide (NO), is activated by glutamatergic systems in various limbic and other regions of the brain, and has recently also been implicated in anxiety and affective disorders. Of special interest is the putative role of NO in cellular memory, synaptic plasticity and cell survival, all-important processes in the neuropathology and neurodevelopment of depression. Recent clinical studies have provided evidence of the role of the NO-pathway in depression, while preclinical studies have demonstrated the anxiolytic and antidepressant actions of nitric oxide synthase (NOS)-inhibitors. Moreover, NO interacts with other classical transmitters that have a regulatory role on mood, particularly the monoamines, as well as glutamate and gammaaminobutyric acid (GABA). In the current study the role of the NO-cGMP pathway in AD action was investigated, after chronic imipramine (IMI) and after IMI withdrawal, using a learned helplessness paradigm. Behavioural changes, hippocampal NOS activity and cGMP accumulation was determined together with pharmacological manipulation of the NO-cGMP pathway. Chronic IMI, 15 mg/kg/day intraperitoneal (ip) administration induced a pronounced reduction in swim immobility time in the forced swim test (FST), with no effect on horizontal or vertical locomotor activity. These behavioural changes were accompanied by a significant reduction in NOS enzyme activity and cGMP accumulation. In order to confirm the involvement of the NO-cGMP pathway in the AD action of IMI, chronic (3 weeks) IMI treatment was followed by an acute withdrawal of 7 days. Acute withdrawal, after chronic IMI treatment, resulted in a significant increase in swim immobility time and an increase in NOS enzyme activity and cGMP levels. In fact, NOS activity was raised above that of control, not just higher than the effect of chronic IMI. In order to assess the possible role of the NMDA-NO-cGMP pathway in AD withdrawal, the NMDA receptor antagonist, memantine, and the NOS/guanylyl cyclase (GC) inhibitor, methylene blue (MB), were administered during the 7 day IMI withdrawal period. Memantine (5 mg/kg/d ip), during the 7 day IMI withdrawal period, significantly reversed the increase in immobility time evoked after IMI withdrawal. This was accompanied by a significant reduction in NOS enzyme activity and a tendency to decrease cGMP levels. This data confirms that the antidepressant action of IMI, as well as IMI withdrawal, is associated with actions on the NMDA-GIu-NO-cGMP pathway. Particularly. IMI withdrawal evokes an increase in glutamate activity that is responsible for NOS activation. During the 7 day IMI withdrawal period, MB (15 mg/kg/d ip) also significantly reversed the increased immobility time after IMI withdrawal and was accompanied by a tendency to decrease NOS enzyme activity and cGMP levels in the rat hippocampus, however statistical significance was not reached. Although not emphatic, this data implies a possible role of the NO-cGMP pathway in AD action and AD withdrawal. In order to determine whether the observed IMI withdrawal effects on the NO-cGMP pathway may occur through an initial destabilisation in the serotonergic system, the 5-HT2a/2c receptor antagonist, ritanserin (4 mg/kg/d ip), was administered during the IMI withdrawal period. These studies revealed that antidepressant withdrawal evokes an increase in 5-HT2-mediated activity, and that antidepressant-induced NOS activation after withdrawal has its origin in serotonergic hyperactivity. Clearly, this is supportive of a distinct relationship between the NO and serotonergic system in antidepressant response. On its own, ritanserin was found to increase NOS and cGMP levels, yet during IMI withdrawal this response was lost, suggesting that IMI withdrawal alters the response to a 5-HT2a/2c receptor antagonist, which may have major clinical implications. In conclusion, the AD action of IMI, as well as chronic IMI withdrawal, involves actions on the NO-cGMP pathway. Withdrawal of ADS is associated with a loss of AD efficacy together with an increase in release of NO and cGMP. The NMDA antagonist, memantine, and the NOS/GC inhibitor, MB, reversed these responses therefore suggesting that the NMDA-GIu-NO-cGMP pathway may be a new putative target in understanding the neurobiology of AD action. Finally, NOS activation following withdrawal suggest that inappropriate withdrawal during the treatment of depression may mediate neurodegenerative pathology observed in recurrent depression, possibly by severely increased hippocampal NOS activity which is toxic to neurons. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Depressive disorders are among the most frequent psychiatric diseases in the Western world with prevalence between 9% and 18%. Poor compliance and inappropriate antidepressant discontinuation invokes long-term morbidity, and appear linked to hippocampal shrinkage. Despite major advances in pharmacological treatment of the illness over the past 3040 years, currently available agents have distinct shortfalls both in clinical efficacy and in maintenance of response. This implies a greater long-term morbidity with significant impact on the patient, the patient's family as well as economic implications to health care managers and providers. The major reason for this state of affairs is our poor understanding of the neurobiology of depression and hence, of antidepressant (AD) action. AD drugs are thus not addressing the crucial neurobiological target underlying the illness, and new strategies and treatments are urgently needed. In recent years, depression has been associated with disturbances in excitotoxic glutamatergic activity, yet this has not been systematically evaluated. While the role of neurotransmitters such as serotonin, noradrenaline and dopamine has been extensively studied, new evidence suggests a role for the unique neurotransmitter nitric oxide (NO). Nitric oxide (NO), is activated by glutamatergic systems in various limbic and other regions of the brain, and has recently also been implicated in anxiety and affective disorders. Of special interest is the putative role of NO in cellular memory, synaptic plasticity and cell survival, all-important processes in the neuropathology and neurodevelopment of depression. Recent clinical studies have provided evidence of the role of the NO-pathway in depression, while preclinical studies have demonstrated the anxiolytic and antidepressant actions of nitric oxide synthase (NOS)-inhibitors. Moreover, NO interacts with other classical transmitters that have a regulatory role on mood, particularly the monoamines, as well as glutamate and gammaaminobutyric acid (GABA). In the current study the role of the NO-cGMP pathway in AD action was investigated, after chronic imipramine (IMI) and after IMI withdrawal, using a learned helplessness paradigm. Behavioural changes, hippocampal NOS activity and cGMP accumulation was determined together with pharmacological manipulation of the NO-cGMP pathway. Chronic IMI, 15 mg/kg/day intraperitoneal (ip) administration induced a pronounced reduction in swim immobility time in the forced swim test (FST), with no effect on horizontal or vertical locomotor activity. These behavioural changes were accompanied by a significant reduction in NOS enzyme activity and cGMP accumulation. In order to confirm the involvement of the NO-cGMP pathway in the AD action of IMI, chronic (3 weeks) IMI treatment was followed by an acute withdrawal of 7 days. Acute withdrawal, after chronic IMI treatment, resulted in a significant increase in swim immobility time and an increase in NOS enzyme activity and cGMP levels. In fact, NOS activity was raised above that of control, not just higher than the effect of chronic IMI. In order to assess the possible role of the NMDA-NO-cGMP pathway in AD withdrawal, the NMDA receptor antagonist, memantine, and the NOS/guanylyl cyclase (GC) inhibitor, methylene blue (MB), were administered during the 7 day IMI withdrawal period. Memantine (5 mg/kg/d ip), during the 7 day IMI withdrawal period, significantly reversed the increase in immobility time evoked after IMI withdrawal. This was accompanied by a significant reduction in NOS enzyme activity and a tendency to decrease cGMP levels. This data confirms that the antidepressant action of IMI, as well as IMI withdrawal, is associated with actions on the NMDA-GIu-NO-cGMP pathway. Particularly. IMI withdrawal evokes an increase in glutamate activity that is responsible for NOS activation. During the 7 day IMI withdrawal period, MB (15 mg/kg/d ip) also significantly reversed the increased immobility time after IMI withdrawal and was accompanied by a tendency to decrease NOS enzyme activity and cGMP levels in the rat hippocampus, however statistical significance was not reached. Although not emphatic, this data implies a possible role of the NO-cGMP pathway in AD action and AD withdrawal. In order to determine whether the observed IMI withdrawal effects on the NO-cGMP pathway may occur through an initial destabilisation in the serotonergic system, the 5-HT2a/2c receptor antagonist, ritanserin (4 mg/kg/d ip), was administered during the IMI withdrawal period. These studies revealed that antidepressant withdrawal evokes an increase in 5-HT2-mediated activity, and that antidepressant-induced NOS activation after withdrawal has its origin in serotonergic hyperactivity. Clearly, this is supportive of a distinct relationship between the NO and serotonergic system in antidepressant response. On its own, ritanserin was found to increase NOS and cGMP levels, yet during IMI withdrawal this response was lost, suggesting that IMI withdrawal alters the response to a 5-HT2a/2c receptor antagonist, which may have major clinical implications. In conclusion, the AD action of IMI, as well as chronic IMI withdrawal, involves actions on the NO-cGMP pathway. Withdrawal of ADS is associated with a loss of AD efficacy together with an increase in release of NO and cGMP. The NMDA antagonist, memantine, and the NOS/GC inhibitor, MB, reversed these responses therefore suggesting that the NMDA-GIu-NO-cGMP pathway may be a new putative target in understanding the neurobiology of AD action. Finally, NOS activation following withdrawal suggest that inappropriate withdrawal during the treatment of depression may mediate neurodegenerative pathology observed in recurrent depression, possibly by severely increased hippocampal NOS activity which is toxic to neurons. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Thesis (M. Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Typescript. Bibliography: leaves 68-81.

Submitted by Helmut Patrocinio (hell.kenn@gmail.com) on 2017-12-01T23:57:21Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Josy_Pontes_Disserta??o_2008.pdf: 788256 bytes, checksum: c174c1e17712345ac3019f1561d77074 (MD5) / Approved for entry into archive by Ismael Pereira (ismael@neuro.ufrn.br) on 2017-12-04T12:47:40Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Josy_Pontes_Disserta??o_2008.pdf: 788256 bytes, checksum: c174c1e17712345ac3019f1561d77074 (MD5) / Made available in DSpace on 2017-12-04T12:48:22Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Josy_Pontes_Disserta??o_2008.pdf: 788256 bytes, checksum: c174c1e17712345ac3019f1561d77074 (MD5) Previous issue date: 2008-01-01 / Funda??o de Amparo ? Pesquisa do Estado de S?o Paulo (FAPESP) / Associa??o Fundo de Incentivo ? Psicofarmacologia (AFIP) / Centros de Pesquisa, Inova??o e Difus?o (CEPID) / O papel fisiol?gico das hipocretinas no ciclo sono-vig?lia e principalmente na manuten??o da vig?lia ? bem estabelecido, assim como o seu envolvimento na fisiopatologia da narcolepsia. Pacientes narcol?pticos com baixos n?veis de hipocretina exibem depress?o cl?nica e os pacientes com depress?o maior apresentam diversas altera??es na arquitetura do sono. Devido a essas evid?ncias cl?nicas e ao poss?vel efeito antidepressivo desses neuropept?deos em ratos privados de sono REM, o objetivo desse estudo foi observar se h? altera??es nos n?veis de hipocretina-1 no estado depressivo induzido num modelo animal e ap?s o tratamento com drogas antidepressivas. Foram usados ratos da linhagem Wistar com 3 meses de idade e realizados dois experimentos: no primeiro, os animais foram tratados durante 21 dias com drogas antidepressivas (fluoxetina e imipramina) e no segundo os animais foram submetidos a um protocolo de estresse brando cr?nico utilizado como modelo animal de depress?o e tratados com o antidepressivo tric?clico imipramina. No primeiro experimento observamos que somente os animais tratados com imipramina tiveram os n?veis de hipocretina-1 aumentados. No segundo experimento, os animais submetidos ao modelo animal de depress?o apresentaram n?veis mais baixos de hipocretina, os quais aumentaram ap?s tratamento com imipramina. Esses resultados sugerem que o sistema hipocretin?rgico pode ser um dos fatores envolvidos na fisiopatologia da depress?o e que drogas agonistas de hipocretina podem ter efeito antidepressivo.

A Síndrome da Bexiga Hiperativa (SBH) é caracterizada por urgência urinária com ou sem incontinência, acompanhada de freqüência e noctúria. O tratamento é inicialmente clínico, visando o relaxamento do musculo detrusor com uso de anticolinérgicos e antidepressivos tricíclinos. Os anticolinérgicos reduzem a atividade contrátil do detrusor por bloquear os receptores muscarínicos na junção neuromuscular. A Imipramina é um antidepressivo tricíclico que possui ação anticolinérgica e alfa-adrenérgica indireta, relaxando o detrusor e aumentando a pressão intrauretral, diminuindo os episódios de perda urinária, sendo uma boa alternativa para a Incontinência Urinária Urgência (IUU) e Incontinência Urinária Mista (IUM). OBJETIVOS: Validar a Imipramina como opção para paciente com SBH e verificar a ocorrência e a freqüência dos efeitos adversos. MATERIAIS E MÉTODOS: Ensaio clínico randomizado cruzado com mulheres com mais de 18 anos com queixa de IUU ou IUM atendidas no Ambulatório de Uroginecologia do Hospital de Clínicas de Porto Alegre (HCPA). Para uma melhora de 71% no grupo da imipramina e 16% do grupo dos exercícios perineais, com “p” de 0,05 e um poder de 80%, são necessários 19 pacientes em cada grupo (Epi-Info). Totalizamos um “n” de 38 pacientes, estimando 20% de perdas. RESULTADOS e CONCLUSÕES: 38 mulheres foram randomizadas, sendo 6 pacientes excluídas. 32 pacientes foram submetidas à três meses de tratamento conservador e três meses de uso de Imipramina. Ao final de 6 meses foi realizada a análise estatística. 24 pacientes mantiveram o uso da medicação após o término do estudo. Não houve diferença entre os grupos em relação aos dados demográficos, comorbidades, uso de medicações, cirurgias, distopias genitais, presença de efeitos colaterais com uso da medicação, tempo de suspensão da medicação e Pressão de Perda Urinária (VLPP). Houve diferença estatística em relação à presença de Contrações Não Inibidas (CNI) durante a Avaliação Urodinâmica. Em relação aos questionários, o uso imipramina mostrou uma melhora de 16,8 vezes em relação à alocação quando comparadas com uma melhora de 2,1 vezes do tratamento conservador. Em relação à Percepção Geral da Saúde (PGS), não houve diferença estatística, mas em relação à avaliação do Impacto da Incontinência (II), houve diferença significativa no grupo de realizou tratamento com Imipramina. Demostrou-se uma melhora da perda urinária de 16, 3 vezes quando comparadas ao início da alocação. A análise do escore final mostrou uma significância estatística na interação do grupo com o tipo de tratamento utilizado em determinado momento do tempo. Em conclusão, como única medicação disponível no Sistema Único de Saúde (SUS) para tratar essa patologia podemos passar a utilizá-la, com cautela, como opção terapêutica ao anticolinérgico hoje mais usado, a oxibutinina, uma vez que se mostrou segura em relação aos efeitos colaterais e apresentou significância estatística em relação ao tratamento conservador. Entretanto, acredita-se que mais ensaios clínicos devem ser realizados com um “n” maior de pacientes e, talvez, comparando a imipramina com a oxibutinina, uma vez que é medicação de referência para tal patologia. / Overactive Bladder Syndrome (SBH) is characterized by urinary urgency with or without incontinence, accompanied by frequency and nocturia. Treatment is initially clinical, aimed at relaxing the detrusor muscle with the use of anticholinergics, antispasmodics and antidepressants tricíclinos. Anticholinergics reduce the contractile activity of the detrusor muscle by blocking muscarinic receptors at the neuromuscular junction. Imipramine is a tricyclic antidepressant that has anticholinergic action and alpha-adrenergic indirect, relaxing muscles and increasing detrusor pressure intrauretral, reducing the frequency of urinary leakage, being a good alternative for Urgency Urinary Incontinence (IUU) and mixed urinary incontinence (IUM). OBJECTIVES: To validate Imipramine as an option for patients with SBH and to verify the occurrence and frequency of adverse effects. METHODS: A randomized crossover clinical trial, with women over 18 years with complaints of IUU or IUM treated at the Urogynecology Clinic of Hospital de Clinicas de Porto Alegre (HCPA). For an improvement of 71% in the imipramine group and 16% of perineal exercises, with "p" of 0.05 and a power of 80%, 19 patients are needed in each group (Epi-Info). Totaled an "n" of 38 patients, an estimated 20% loss. RESULTS AND CONCLUSIONS: 38 women were randomized, with 6 patients excluded. 32 patients underwent three months of conservative treatment and three months of use of imipramine. At the end of 6 months was performed statistical analysis. 24 patients maintained their use of medication after the study. There was no difference between groups regarding demographics, comorbidities, medication use, surgery, genital dystopias, presence of side effects with the medication, time of drug discontinuation and urinary loss pressure (VLPP). There was statistical difference in relation to the presence of uninhibited contractions (CNI) during urodynamic evaluation. Regarding the questionnaires, the use of imipramine showed an improvement of 16.8 times over the allocation when compared to a 2.1 times improvement in the conservative treatment. Regarding the General Health Perception (PGS), there was no statistical difference, but in relation to assessing the impact of incontinence (II), there was significant difference in the group treated with imipramine performed. Demonstrated to an improvement in urinary loss of 16, 3 times when compared to the beginning of the allocation. The analysis of the final score showed a statistical significance in the group's interaction with the type of treatment used in a given moment in time. In conclusion, as the only medication available in the Brazilian Public Health System (SUS) to treat this disease that affects a substantial number of women, since it proved to be safe in relation to the side and made statistically significant compared to conservative treatment, we can move to use it with caution, as a therapeutic option for today's most commonly used anticholinergic, oxybutynin. However, it is believed that more trials should be conducted with more patients and perhaps comparing imipramine with oxybutynin, because it is a reference for this pathology.