京都大学 / 新制・課程博士 / 博士(医学) / 甲第24478号 / 医博第4920号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

BACKGROUND: The adverse renal effects of proton pump inhibitors (PPIs) are increasingly recognized in both the general population and patients with chronic kidney disease. Several pharmacokinetic studies have also raised concerns regarding the interaction between PPIs and immunosuppressive drugs in transplant patients. Whether the adverse effects of PPIs have a clinical significance in kidney transplant recipients remains unclear. We performed this meta-analysis to assess the risk of adverse effects in kidney transplant recipients on PPI compared with those without PPI exposure. AIM: To investigate the risk of acute rejection, graft loss, hypomagnesemia, renal dysfunction, and overall mortality in kidney transplant recipients on PPI compared with those without PPI exposure. METHODS: A systematic review was conducted in MEDLINE, EMBASE, and Cochrane databases from inception through October 2018 to identify studies that evaluated the adverse effects of PPIs in kidney transplant recipients, including biopsy-proven acute rejection, graft loss, hypomagnesemia, renal function, and overall mortality. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO, No. CRD42018115676. RESULTS: Fourteen observational studies with 6786 kidney transplant recipients were enrolled. No significant association was found between PPI exposure and the risk of biopsy-proven acute rejection at ≥ 1 year [pooled odds ratio (OR), 1.25; 95% confidence interval (CI), 0.82-1.91, = 55%], graft loss at 1 year (pooled OR = 1.30, 95%CI: 0.75-2.24, = 0%) or 1-year mortality (pooled OR = 1.53, 95%CI: 0.90-2.58, = 34%). However, PPI exposure was significantly associated with hypomagnesemia (pooled OR = 1.56, 95%CI: 1.19-2.05, = 27%). Funnel plots and Egger regression asymmetry test were performed and showed no publication bias. CONCLUSION: PPI use was not associated with significant risks of higher acute rejection, graft loss, or 1-year mortality. However, the risk of hypomagnesemia was significantly increased with PPI use. Thus, future studies are needed to assess the impact of PPIs on long-term outcomes.

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In this study, a halophilic archaea Halobacterium salinarium TG13 which is isolated from Tuz Lake in Central Anatolia was characterized biochemically and genetically. Halobacterium salinarium DSM3754 and Halobacterium salinarium S9 strains were used as a reference strain through the experiments. In biochemical characterization / total protein profiles of strains was compared by using 1D SDS PAGE. Total protein profile of the isolated strain has shown differences. The SDS-PAGE profile of the purified purple membrane showed only single band by coomassie staining. Molecular weight and pI values of the protein isolated from Halobacterium salinarium TG13 and Halobacterium salinarium S9 were estimated by 2D SDS-PAGE as 22 kD and 5.4, respectively. Photoactivity of purple membrane of the strains was investigated. pH change of the purple membranes were observed upon illumination. This protein might be corresponded to bacteriorhodopsin. In genetical characterization / polymorphism of genomic DNA of strains was scanned with RAPD-PCR. Plasmid DNA profiles of strains was determined to make use of RFLP technique. RAPD-PCR and RFLP analyses have shown that Halobacterium salinarium TG13 is different strain from reference Halobacterium salinarium strains (H.s. S9 and H.s. DSM3754).

Orientador: José Ricardo de Arruda Miranda / Resumo: A via oral de administração de fármacos é a mais utilizada devido a maior aceitação pelo paciente e sua fácil administração. Dentre as estratégias de sistema de liberação de fármacos estão os comprimidos revestidos com polímero pH-dependente, da qual o Eudragit E-100 é um polímero de revestimento protetor solúvel em pH <5, utilizado em formas farmacêuticas sólidas para liberação do fármaco no ambiente gástrico. Para que ocorra a liberação do fármaco é necessário que o comprimido revestido passe por processos que antecedem a absorção, tal como a dissolução do revestimento e desintegração. Sendo assim, se ocorrer mudanças no pH fisiológico o processo de dissolução do revestimento gastrossolúvel pode ser comprometido e consequentemente alterar a biodisponibilidade do fármaco. Diante deste cenário, é de grande importância realizar pesquisas que explorem a influencia do aumento do pH gástrico na biodisponibilidade de um fármaco, contido em comprimido com revestimento pH-dependente administrado concomitantemente. Nesta proposta consiste em empregar a Magnetofarmacocinética (MgPK) para avaliar a influencia da alteração do pH gástrico provocado pelo tratamento com omeprazol no processo de liberação de um fármaco modelo administrado pela via oral em comprimidos revestidos com Eudragit® E-100. Foi produzido um lote de comprimidos magnéticos revestidos com Eudragit® E -100 contendo 500 mg de ferrita e 100 mg de metronidazol. O lote foi avaliado através de testes farmacotécnicos e avalia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The oral route of drug administration is the most used due to the greater acceptance by the patient and its easy administration. Among the drug delivery system strategies are tablets coated with pH-dependent polymer, which aim to improve the stability of the drug, mask taste and odor. Eudragit E-100 is a protective coating polymer soluble at pH <5, used in solid dosage forms to release the drug into the gastric environment. For the drug to release, it is necessary that the coated tablet undergo processes that precede absorption, such as the dissolution of the coating and disintegration. Therefore, if changes in physiological pH occur, the dissolution process of the gas-soluble coating may be compromised and consequently change the bioavailability of the drug. In view of this scenario, it is of great importance to conduct research that explores the influence of the increase in gastric pH on the bioavailability of a drug, contained in a tablet with a pH-dependent coating administered concomitantly. In this proposal, it consists of using Magnetopharmacokinetics (MgPK) to evaluate the influence of gastric pH changes caused by treatment with omeprazole in the process of releasing a model drug administered orally in tablets coated with Eudragit® E-100. Batch of magnetic tablets coated with Eudragit® E-100 containing 100 mg of metronidazole was produced. The batch was evaluated through pharmacotechnical tests and evaluated according to the dissolution profile. For in vivo experiment... (Complete abstract click electronic access below) / Doutor

Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: The rational use of proton pump inhibitors among geriatric patients in the Czech Republic Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Ivana Geletova Introduction: The dynamic process of ageing requires adequate attention at a global level, mainly in the area of providing a proper healthcare. Ageing process is specific by significant involutional changes and is often complicated by higher polymorbidity and polypharmacotherapy. Therefore, it is necessary to eliminate the negative impact of possible drug-related and nondrug-related risk factors and to ensure the rational use of medicines. Proton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drugs in older adults, administered especially for the treatment of gastrointestinal tract (GIT) disorders associated with increased secretion of gastric acid and/or impairment of GIT or as a preventive treatment of potential drug-related and other gastropathies. This diploma thesis focused on evaluating the prevalence of use of PPIs among geriatric patients in acute, ambulatory and pharmacy settings of healthcare in the Czech Republic, in the EUROAGEISM H2020...

Mikrobielle Rhodopsine sind lichtsensitive Membranproteine und agieren als Sensoren, Biokatalysatoren oder Ionentransporter. Die Ionentransporter unterteilen sich in lichtgetriebene Ionenpumpen und in lichtaktivierte Kanalrhodopsine. Besonders die Protonenpumpe Bakteriorhodopsin steht schon lange im Fokus biophysikalischer Untersuchungen. Obwohl die Protonenpumpen seit über 40 Jahren intensiv untersucht werden, ist das Wissen über deren elektrophysiologische Eigenschaften noch immer gering. Aus diesem Grund widmete sich diese Arbeit der elektrophysiologischen Charakterisierung der mikrobiellen Rhodopsine mit dem Fokus auf Protonenpumpen. Hierfür wurden vor allem „Two-Electrode Voltage Clamp“ -Messungen (TEVC) an Oozyten des afrikanischen Krallenfrosches Xenopus leavis durchgeführt. Die Untersuchung verschiedener Protonenpumpen hat gezeigt, dass diese eine unerwartet große Diversität in ihren elektrophysiologischen Eigenschaften aufweisen. Von besonderem Interesse war die Beobachtung, dass einige Protonenpumpen neben Pumpströmen auch passive einwärts gerichtete Photoströme zeigten. Besonders deutlich war der „Pump-Kanal-Dualismus“ bei dem Gloeobacter-Rhodopsin ausgeprägt. Andere Protonenpumpen, wie das Bakteriorhodopsin oder Coccomyxa-Rhodopsin, zeigten keine einwärts gerichteten Photoströme. Das Coccomyxa-Rhodopsin wurde aufgrund seiner hohen Photostrom-Amplituden in Oozyten für eine Mutationsanalyse ausgewählt. Diese Mutationsanalyse verhalf die strukturellen Ursachen für die funktionalen Unterschiede zu identifizieren, welche sowohl zwischen den Protonenpumpen untereinander als auch gegenüber Kanalrhodopsinen beobachtet wurden. Mutationen im Gegenion-Komplex führen zu rein passiven oder inaktiven Transportern. Dagegen übernimmt der extrazelluläre Halbkanal in Protonenpumpe die Aufgabe einen passiven Protonen-Rückfluss während des Pumpzyklus zu verhindern, denn Mutationen in dieser Region verursachen passive Photoströme zusätzlich zum aktiven Pumpstrom. / Microbial rhodopsins are light-sensitive membrane proteins and operate as sensors, enzymes or ion-transporters. The ion transporters are subdivided into light-driven ion pumps and light-gated channels. Biophysical research has put focus on the proton pump bacteriorhodopsin for long time. Despite the fact that light-driven proton pumps are investigated for over 40 years, the knowledge about their electrophysiological properties is surprisingly low. For this reason, this thesis is devoted to the electrophysiological characterization of microbial rhodopsins with special focus on light-driven proton pumps. For this purpose, “Two-Electrode Voltage Clamp”-recordings (TEVC) were primarily performed using oocytes from African clawed frog Xenopus leavis. The investigation of diverse proton pumps has shown that the differences in their electrophysiological behaviors are unexpectedly high. Special interest was laid on proton pumps which show passive inward directed photocurrents when the electrochemical load exceeds a certain level. The dualism of pump and channel activity was particularly pronounced in the proton pump Gloeobacter-rhodopsin. Other proton pumps, for instance bacteriorhodopsin or Coccomyxa-rhodopsin, do not show inward directed photocurrents. Due to high photocurrent amplitudes, the Coccomyxa-rhodopsin was selected for an efficient mutagenesis study. This study allowed the identification of structural key determinants for the differences among proton pumps themselves and for the differences of proton pumps in comparison with light-gated ion channels (channelrhodopsins). Therefore, mutations of the counter-ion-complex cause inactive or purely passive transporters. The extracellular half-channel is the key element in proton pumps which prevents passive proton-backflow during the pump-cycle. Mutations in this region lead to passive leak-currents in overlap with the remaining pump-activity.

Introdução: A Doença do Refluxo Gastroesofágico (DRGE) possui elevada prevalência e morbidade. O tratamento clínico consiste em recomendações quanto ao estilo de vida e, essencialmente, no uso de inibidores da bomba protônica (IBP). A aderência (Ad) dos pacientes com DRGE à prescrição, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. Objetivo: Avaliar a Ad ao tratamento com IBP e possíveis variáveis relacionadas em pacientes com DRGE. Métodos: Estudo transversal e prospectivo com 240 pacientes adultos consecutivos com DRGE erosiva e não-erosiva (ne-DRGE) que haviam recebido dose padrão ou dose dobrada de omeprazol em uso contínuo. Todos os pacientes foram classificados conforme o grau, segundo os achados da endoscopia digestiva alta (EDA) em ne-DRGE (162; 67,5%), classificação endoscópica de Los Angeles (LA) A (48; 20,0%), LA B (21; 8,6%), LA C (1; 0,4%), LA D (1; 0,4%) e Barrett (7; 2,9%). Foi aplicado o questionário de Morisky et al constituído de 4 questões com respostas dicotômicas para avaliar a Ad, classificando-a como baixa (0-2 pontos) e alta ad (3-4 pontos). Foi também aplicado o questionário QS-DRGE para a avaliação dos sintomas, com 10 questões com escores de 0 a 50, conforme a frequência menor ou maior dos sintomas. Os resultados de Ad foram relacionados com os dados sócio-demográficos, polifarmácia (PF) (uso de mais de cinco medicamentos diariamente), comorbidades (CM), tempo de tratamento (TT), escore QS-DRGE, presença de sintomas descrita em prontuário, achados da EDA e conhecimento do paciente sobre a doença. Resultados: (1) 126 pacientes (52,5%) apresentaram alta Ad e 114 (47,5%) baixa Ad; (2) Os pacientes mais jovens (p = 0,002) foram menos aderentes; (3) Pacientes sintomáticos de acordo com relato em prontuário apresentaram maior percentual de baixa Ad e 2 vezes maior probabilidade de ter baixa Ad em relação aos assintomáticos (p = 0,02); (4) Os pacientes casados apresentam probabilidade 2,41 vezes maior de ter baixa Ad do que os viúvos. (5) As demais variáveis estudadas não influenciaram a Ad ao tratamento. Conclusões: Pacientes em uso de IBP em tratamento ambulatorial em hospital terciário em São Paulo apresentaram grande percentual de baixa Ad ao tratamento, sendo esta uma possível causa da falha da terapia com IBP. Idade < 60 anos e estado civil casado podem ser fatores de risco para a baixa Ad / Introduction: The Gastroesophageal Reflux Disease (GERD) is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on lifestyle recommendations and, essentially, in the use of a proton pump inhibitor (PPI). Adherence (Ad) of GERD patients to the prescribed treatment, although critical for therapeutic success, has been little studied. Objective: Assess adherence to the PPI treatment and potential associated variables in patients with GERD. Case studies and Methods: Transversal and prospective study with 240 consecutive adult patients, diagnosed with erosive GERD (e-GERD) and non-erosive GERD (ne-GERD) for whom continuous use of the standard dose or the double dose of omeprazol had been prescribed. Patients were ranked according to the findings of high digestive endoscopy (HDE) in ne-GERD (162; 67.5%); e-GERD: Los Angeles (LA) endoscopic classification A (48; 20.0%), LA B (21; 8.6%), LA C (1; 0.5%), and LA D (1; 0.5%) and Barretts esophagus (7; 2.9%). The Morisky questionnaire, that includes four questions with dicotomic responses to assess Ad, was applied. Ad was classified as low (0-2 points) and high (3-4 points). In addition, the QS-GERD questionnaire was applied to assess symptoms, using 10 questions with score 0 to 50, according to the greater or lesser symptom frequency. Ad results were correlated with personal data (gender and age), demography, polypharmacy (PF), comorbidities (CM), treatment time (TT), QS-GERD scores, symptoms described in the patients record, HDE findings and patient awareness about the disease. Results: (1) 126 patients (52.5%) exhibited high Ad and 114 (47.5%) low Ad; (2) younger patients (p = 0,002) were less compliant; (3) married patients had a 2.41 greater probability to exhibit low Ad as compared to widowers (p = 0.03); (4) patients with symptoms indicated in the patients record exhibited a lower Ad rate and twice greater probability of exhibiting low Ad as compared to asymptomatic patients (p = 0.02); (5) the other variables studied had no influence on treatment adherence. Conclusion: Patients using PPI as out-patients in third care hospital in São Paulo exhibited high rate of reduced treatment adherence, and this may be a potential cause of PPI therapy failure. Age < 60 years and marital status may be risk factors for low adherence

Abstract Aim: The purpose of the study is to show the influence of Proton Pump Inhibitors (PPI in form of esomeprazole) on the bioactivation of dietary nitrate (sodium-nitrate solution) in submaximal exercise, through affecting the gastric pH. Method: Randomized, doubled-blinded, placebo-controlled and crossover study with six subjects (mean ± SD, age 29 ± 5years, height 170 ± 5 centimeters, weight 70 ± 5 Kg, BMI 24,36 ± 1,75 Kg/m2 blood pressure 119/ 77 ± 6 mmHg, 3 male and 3 female). They were tested in two different trials. Every trial consisted of two parts. One part was cycling on 4 different submaximal stages (80W/60RPM, 80W/90RPM, 120W/60RPM, 120W/90RPM) for 5 minutes each, with 90 minutes rest in between. The same protocol was repeated. In the beginning of the resting time a sodium nitrate solution (NaNO3-, 10mg/kg body weight) was ingested. VO2, VCO2, RER, VE, Lactate, Glucose, heart rate and blood pressure were recorded. Venous blood samples were taken. Whether esomeprazole (10mg) or a placebo were taken 24h, 12h and directly before being tested in both trials. Subjects were pleased to have a nitrate poor diet starting when taking the pills. An information sheet was provided. Results: No significant differences were found between the post values and the treatment. Tendencies of a higher oxygen consumption when taking esomeprazole (2,62%) in comparison to placebo (0,11%) were observed. Systolic BP decreased by 3,91% with the placebo while it decreased just 2,04% with esomeprazole after intake. Sex-specific differences occurred in the metabolism of esomeprazole and dietary nitrate. RER showed a significant post nitrate difference between the female and male participants with t=.006 and a significance in predietary nitrate intake. VE in female (40,79 ± 7,20 L/min) and (50,03 ± 10,09 L/min) in male were as well significant (t=.017). Conclusion: Tendencies of effects of PPI are seen in the post-values of VO2 and BP after intake of dietary nitrate. Gender-differences are shown in RER and VE. More research is needed to see the impact of dietary nitrate on the human body under submaximal load.