La mambaquarétine-1 (MQ-1), une toxine du mamba vert, est le tout premier peptide Kunitz à bloquer sélectivement l’activité du récepteur de type 2 à la vasopressine (V2R). Celui-ci contrôle la concentration finale des urines dans le rein. Impliqué dans plusieurs pathologies, son inhibition est actuellement considérée comme la meilleure stratégie thérapeutique dans le traitement de la polykystose rénale, une maladie génétique héréditaire. L’étude pharmacodynamique de MQ-1 sur des rats sains a confirmé son activité in vivo qui se traduit par un effet aquarétique dépendant de la dose. L’effet maximum est atteint 2 heures après injection intrapéritonéale et disparait avec un temps de demi-vie biologique variant de 1 à 4 heures selon la dose. L’administration quotidienne d’une faible dose a montré une accumulation de l’effet les trois premiers jours, avant un plateau, suggérant une activité résiduelle au-delà de 24 heures. Le criblage des trois autres venins de mambas ainsi qu’une analyse comparée des séquences peptidiques les plus proches dans les bases de données ont révélé l’existence d’un groupe phylogénétique de onze toxines Kunitz antagonistes de V2R. Une approche innovante, combinant tests de liaison de variants de MQ-1 et modélisation du complexe MQ-1-V2R, a permis de décrypter une partie du pharmacophore de la toxine. Les deux partenaires partagent une importante complémentarité ionique impliquant plusieurs boucles extracellulaires du récepteur, et une région hydrophobe de MQ-1 interagit au cœur de V2R à proximité de son site orthostérique supposé. Enfin, une première collaboration avec une industrie pharmaceutique a mis en évidence les points critiques à approfondir pour aboutir au développement thérapeutique de MQ-1. / Mambaquaretin-1 (MQ-1), a green mamba toxin, is the very first Kunitz peptide to selectively hinder the vasopressin type 2 receptor (V2R) activation. This receptor controls the final concentration of urine in kidneys. Involved in a number of pathologies, its inhibition is currently considered as the best therapeutic strategy in the treatment of polycystic kidney disease, a hereditary genetic disease. Pharmacodynamic study of MQ-1 carried out on healthy rats confirmed its in vivo activity which consists in inducing a dose-dependent aquaretic effect. Maximum effect is reached 2 hours after an intraperitoneal injection and disappears in a biological half-life ranging from 1 to 4 hours according to the dose. The daily injection of small quantities pointed to a cumulative effect over the first three days, leading to a plateau, which suggests a residual activity exceeding 24 hours. The screening of the three other mamba venoms along with a comparative analysis of the closest peptide sequences reported in databases revealed the existence of a phylogenetic group of eleven V2R antagonist Kunitz toxins. An innovative approach combining binding assays on MQ-1 variants and the modelling of the MQ-1-V2R complex has led to a partial deciphering of the pharmacophore of the toxin. The two partners share a significant ionic complementarity involving a number of extracellular loops of the receptor, and a hydrophobic region of MQ-1 interacts within V2R in the vicinity of its supposed orthosteric site. Lastly, a collaboration initiated with a pharmaceutical company brought out the need for the closer scrutiny of some crucial points to succeed in a therapeutic development of MQ-1.

No description available.

No description available.

Glioblastomas are highly vascular brain tumors that are characterized as heterogeneous, comprised of an anatomically and functionally irregular blood brain barrier (BBB) that contributes to variable drug distribution and possibly associated pharmacodynamics (PD) responses. Standard pharmacokinetic (PK) approaches that are based on whole tumor homogenates and accordingly averaged drug concentrations are limited in their ability to depict regional variations in drug concentrations, and could lead to faulty assessments of drug distribution and activity. Given the paucity of quantitative information on intratumoral PK/PD variability of anticancer drugs, the goal of this project was to characterize the regional PK and PD properties of gefitinib, an EGFR inhibitor, in brain tumors, in the context of biological characteristics, and use the information to develop mechanistic PK/PD models that may be valuable to understand why some anticancer drugs are inactive. Towards this end, in vitro cytotoxicity assays and pilot in vivo studies were first conducted and identified U87VIII mutant cell line as a gefitinib sensitive orthotopic brain tumor model with suitable growth characteristics to allow for immunohistochemical (IHC) analysis of tumor biological characteristics for further studies. Subsequently, in vitro PD studies identified phosphorylated-ERK1/2 (pERK) as a PD marker for this cell line. Thereafter, to set up a framework to obtain intratumoral PK/PD information in vivo, a novel tumor sectioning protocol was devised and sensitive and robust PK (LC-MS/MS) and PD (Meso Scale Discovery, MSD, electrochemiluminescence-based assay) methods were developed to enable the use of minimal amounts of tumor samples to assess the intratumoral PK and PD characteristics of gefitinib. Mice bearing orthotopic U87VIII mutant tumors were administered gefitinib at doses of 150 mg/kg and 50 mg/kg orally (p.o.), followed by collection of plasma and tumor samples at various time points, based on a serial sacrifice study design. Serial tumor sections were obtained in four distinct regions according to the aforementioned protocol for PK, PD and IHC measurements. An IHC index called microvessel pericyte index (MPI), a measure of BBB integrity, reflected the variability in gefitinib brain tumor concentrations, and was used to bin the data to generate three intratumoral PK/PD data sets. These data sets were then used to develop a set of hybrid physiologically based PK/PD models accounting for variable BBB permeability within the tumor. Each model consisted of a forcing function describing plasma concentration profile, a tissue compartment to represent the drug disposition within the tumor, and target-response compartments for the PD model. The intratumoral variation in the PKs of gefitinib was accurately described by the MPI classifications and ranged about 2-fold, and was responsible for the associated PD variability. In summary, using a novel tumor sectioning protocol and sensitive analytical methods in an orthotopic glioblastoma (GBM) model, the intratumoral variability of gefitinib PK/PD could be binned according to BBB integrity and enabled the development of a mechanistic hybrid physiologically based PK/PD models, which provides a means to assess the influence of tumor heterogeneity on drug response. / Pharmaceutical Sciences

No / PURPOSE: AQ4N is a novel bioreductive prodrug under clinical investigation. Preclinical evidence shows that AQ4N penetrates deeply within tumors and undergoes selective activation to form AQ4, a potent topoisomerase II inhibitor, in hypoxic regions of solid tumors. This proof-of-principle, phase I study evaluated the activation, hypoxic selectivity, and safety of AQ4N in patients with advanced solid tumors. EXPERIMENTAL DESIGN: Thirty-two patients with cancer (8 glioblastoma, 9 bladder, 8 head and neck, 6 breast, and 1 cervix) received a single 200 mg/m(2) dose of AQ4N before elective surgery. AQ4 and AQ4N levels in 95 tissues (tumor, healthy tissue) were assessed by liquid chromatography-tandem mass spectrometry. Tissue sections were also analyzed for AQ4 fluorescence using confocal microscopy, and for expression of the hypoxia-regulated glucose transporter, Glut-1. RESULTS: Activated AQ4 was detected in all tumor samples with highest levels present in glioblastoma (mean 1.2 microg/g) and head and neck (mean 0.65 microg/g) tumors; 22 of 32 patients had tumor AQ4 concentrations > or = 0.2 microg/g, levels previously shown to be active in preclinical studies. In 24 of 30 tumor samples, AQ4 was detected at higher concentrations than in adjacent normal tissue (tumor to normal ratio range 1.1-63.6); distant skin samples contained very low concentrations of AQ4 (mean 0.037 microg/g). Microscopic evaluation of tumor sections revealed that AQ4 colocalized within regions of Glut-1+ hypoxic cells. CONCLUSIONS: AQ4N was activated selectively in hypoxic regions in human solid tumors. Intratumoral concentrations of AQ4 exceeded those required for activity in animal models and support the evaluation of AQ4N as a novel tumor-targeting agent in future clinical studies.

<p dir="ltr">Torsades de pointes (TdP) is a life-threatening polymorphic ventricular tachycardia associated with QT interval prolongation. Female sex and age > 65 years are risk factors for QT prolongation and TdP, possibly due to the effect of sex hormones. Progesterone shortens QT interval, while estrogen lengthens QT interval in females. Preclinical and clinical evidence indicates that progesterone has protective effects against drug-induced QT interval prolongation. J-Tpeak (JTp) and Tpeak-Tend (Tpe) intervals are biomarkers of early and late repolarization. Population pharmacokinetic/pharmacodynamic (PK/PD) models can be used to describe exposure-response relationships and identify sources of variability. In this study, data were pooled from four clinical trials with similar study design investigating the effect of progesterone on ibutilide-induced ventricular repolarization lengthening in healthy premenopausal women during menses or ovulation phase and healthy postmenopausal women. A nonlinear mixed effect model of ibutilide - QTc interval was first developed with preliminary data from 33 subjects. The model was then updated with new data from a total of 52 subjects, assessing the effect of progesterone on drug-induced QTc interval lengthening and identifying sources of variability through covariate analysis. Finally, two PK/PD models of ibutilide - baseline corrected JTpc (ΔJTpc) interval and Tpe (ΔTpe) interval were developed to assess the effect of progestogen on ibutilide-induced early and late repolarization lengthening. Progesterone showed protective effect against ibutilide-induced QTc interval lengthening, mainly through the shortening of pre-ibutilide baseline QTc interval. Body weight, age, race, hypertension, electrocardiogram (ECG) type and estradiol concentration were not significant covariates. Progesterone attenuates ibutilide-induced lengthening of late ventricular repolarization but did not show significant effect on ibutilide-induced early repolarization lengthening. Higher estradiol concentration was related to higher ibutilide-induced early repolarization lengthening. Black race was related to lower ibutilide-induced late repolarization lengthening.</p>

Malaria is the most important parasitic disease in man and it kills approximately 2,000 people each day. Pregnant women are especially vulnerable to malaria with increased incidence and mortality rates. There are indications that pregnancy alters the pharmacokinetic properties of many antimalarial drugs. This is worrisome as lower drug exposures might result in lowered efficacy and lower drug exposures can also accelerate the development and spread of resistant parasites. The aim of this research was to study the pharmacokinetics and pharmacodynamics of the most commonly used drugs for the treatment of uncomplicated Plasmodium falciparum malaria during the second and third trimester of pregnancy using a pharmacometric approach. This thesis presents a number of important findings that increase the current knowledge of antimalarial drug pharmacology and that may have an impact in terms of drug efficacy and resistance. (1) Lower lumefantrine plasma concentrations at day 7 were evident in pregnant women compared to that in non-pregnant patients. Subsequent in-silico simulations with the final pharmacokinetic-pharmacodynamic lumefantrine/desbutyl-lumefantrine model showed a decreased treatment failure rate after a proposed extended artemether-lumefantrine treatment. (2) Dihydroartemisinin exposure (after intravenous and oral administration of artesunate) was lower during pregnancy compared to that in women 3 months post-partum (same women without malaria). Consecutive in-silico simulations with the final model showed that the underexposure of dihydroartemisinin during pregnancy could be compensated by a 25% dose increase. (3) Artemether/dihydroartemisinin exposure in pregnant women was also lower compared to literature values in non-pregnant patients. This further supports the urgent need for a study in pregnant women with a non-pregnant control group. (4) Quinine pharmacokinetics was not affected by pregnancy trimester within the study population and a study with a non-pregnant control group is needed to evaluate the absolute effects of pregnancy. (5) Finally, a data-dependent power calculation methodology using the log likelihood ratio test was successfully used for sample size calculations of mixed pharmacokinetic study designs (i.e. sparsely and densely sampled patients). Such sample size calculations can contribute to a better design of future pharmacokinetic studies. In conclusion, this thesis showed lower exposures for drugs used to treat uncomplicated Plasmodium falciparum malaria during the second and third trimester of pregnancy. More pharmacokinetic studies in pregnant women with a non-pregnant control group are urgently needed to confirm the current findings and to enable an evidence-based dose optimisation. The data-dependent power calculation methodology using the log likelihood ratio test can contribute to an effective design of these future pharmacokinetic studies.

Natural products are teeming with potential therapeutic agents. One group of compounds, polyphenols, from plants, exhibit anti-cancer, anti-inflammatory and anti-oxidant activities. Four polyphenolic compounds and their enantiomers were investigated in this thesis; the stilbene, 3-methoxypterostilbene, a structural analog of resveratrol, and the chiral prenylflavonoids from hops (Humulus lupulus L.); 8-prenylnaringenin, 6-prenylnaringenin and isoxanthohumol. A high performance liquid chromatography method for 3-methoxypterostilbene and enantiospecific liquid chromatography-mass spectrometry assays for the three prenylflavonoids were developed and validated. The methods allowed for quantification of these four polyphenols in biological samples and plant-based materials. Content analysis studies of 3-methoxypterostilbene and the three prenylflavonoids in traditional Chinese medicinal plants and hops-containing nutraceuticals were carried out, respectively. The pharmacokinetics of these four compounds were delineated through intravenous and oral administration in rats. 3-Methoxypterostilbene demonstrated greater bioavailability in rats than reported values for resveratrol. Enantiomeric differences in disposition parameters were observed for the three prenylflavonoids along with differences between compounds despite only small structural differences. The in vitro pharmacodynamics of these four compounds were elucidated including anti-oxidant, anti-inflammatory, anti-diabetic and cytochrome P450 modulation activities. All four compounds demonstrated a range of bioactivities related to chronic diseases and potential drug-botanical interactions. Further studies of polyphenols, especially clinical studies, are needed along with enantiospecific study when applicable to continue delineating the importance of bioactivity, pharmacokinetics and safety. Natural products are further developed into nutraceuticals and sold over-the-counter for both human and veterinary use but are not currently required to demonstrate efficacy prior to marketing. In the final section of this thesis, Phycox®, a multi-component veterinary nutraceutical for joint health was investigated for pharmacological activity in an in vitro model of canine osteoarthritis along with select constituents. A pilot single-dose pharmacokinetic study in dogs was also undertaken. Two liquid chromatography tandem mass spectrometry methods were developed and validated to detect constituents in serum. In vitro study results indicated that Phycox® was able to reduce inflammatory mediators similar to the NSAID, carprofen, and acute pharmacokinetic results revealed that detectable concentrations of glucosamine were evident in serum. It is suggested that further clinical studies of Phycox® are warranted to optimize its usage. / May 2016

Tuberculosis (TB) is the world’s most deadly infectious disease and causes enormous public health problems. The comorbidity with HIV and the rise of multidrug-resistant TB strains impede successful therapy through drug-drug interactions and the lack of efficient second-line treatments. The aim of this thesis was to support the improvement of anti-TB therapy through development of pharmacometric models, specifically focusing on the novel drug bedaquiline, pharmacokinetic interactions and methods for pooled population analyses. A population pharmacokinetic model of bedaquiline and its metabolite M2, linked to semi-mechanistic models of body weight and albumin concentrations, was developed and used for exposure-response analysis. Treatment response was quantified by measurements of mycobacterial load and early bedaquiline exposure was found to significantly impact the half-life of bacterial clearance. The analysis represents the first successful characterization of a concentration-effect relationship for bedaquiline. Single-dose Phase I studies investigating potential interactions between bedaquiline and efavirenz, nevirapine, ritonavir-boosted lopinavir, rifampicin and rifapentine were analyzed with a model-based approach. Substantial effects were detected in several cases and dose-adjustments mitigating the impact were suggested after simulations. The interaction effects of nevirapine and ritonavir-boosted lopinavir were also confirmed in patients with multidrug-resistant TB on long-term treatment combining the antiretrovirals and bedaquiline. Furthermore, the outcomes from model-based analysis were compared to results from conventional non-compartmental analysis in a simulation study. Non-compartmental analysis was found to consistently underpredict the interaction effect when most of the concentration-time profile was not observed, as commonly is the case for compounds with very long terminal half-life such as bedaquiline. To facilitate pooled analyses of individual patient data from multiple sources a structured development procedure was outlined and a fast diagnostic tool for extensions of the stochastic model components was developed. Pooled analyses of nevirapine and rifabutin pharmacokinetics were performed; the latter generating comprehensive dosing recommendations for combined administration of rifabutin and antiretroviral protease inhibitors. The work presented in this thesis demonstrates the usefulness of pharmacometric techniques to improve treatment of TB and especially contributes evidence to inform optimized dosing regimens of new and old anti-TB drugs in various clinical contexts.

Malgré les progrès évidents sur la compréhension de la carcinogénèse, l’incidence des cancers est toujours en augmentation. C’est pourquoi les besoins en nouveaux traitements sont importants. Notre travail de thèse a porté sur l’évaluation pharmacologique d’une nouvelle molécule anticancéreuse, l’OTX015. Cette petite molécule de synthèse a la propriété d’inhiber les protéines bromodomaines (famille des BET) qui jouent un rôle clé dans les mécanismes épigénétiques et dont la dérégulation favorise l’apparition de cancers en particulier des hémopathies malignes. Des études précliniques in vitro sur plusieurs lignées cellulaires d’hémopathies malignes et in vivo sur des souris xénogreffées ont permis de mettre en évidence les propriétés antitumorales de l’OTX015. Une méthode de dosage des concentrations plasmatiques d’OTX015 par UPLC-MS/MS a été développée et validée afin d’évaluer sa pharmacocinétique chez les patients inclus dans un protocole d’escalade de doses de phase I. Dans un premier temps, la PK de l’OTX015 a été modélisée par une approche de population et dans un second temps un modèle PK-PD a été construit pour pouvoir évaluer le profil de la tolérance (nombreuses thrombopénies) de cette nouvelle molécule. / Despite obvious progress in carcinogenesis understanding, the incidence of cancer is still increasing. Therefore, the need of new treatments remains important. Our thesis focused on the pharmacological evaluation of a new anticancer drug, OTX015. This small synthetic molecule inhibits the bromodomain proteins (BET) that play a key role in epigenetic mechanisms. Downregulation of BRDs promotes cancer occurrence including hematological malignancies. Preclinical evidences obtained from in vitro and in vivo studies in xenograft mice, suggest that OTX015 has antitumor properties. An ultra-performance liquid chromatography with tandem mass spectrometry detection method was developed and validated in order to measure OTX015 plasma concentrations. Its pharmacokinetics in patients enrolled in a phase I dose-escalation study was then evaluated. The OTX015 PK parameters were estimated by a population approach and PK-PD modeling was developed in order to evaluate the tolerance and safety (thrombocytopenia) of this new drug.