Die antiangioneogenetischen Effekte in-vitro und in-vivo in Kombination mit der selektiven Inhibition der TNFalpha Produktion durch Thalidomid läßt dieses Medikament als geeignete Therapie für Krankheitszustände erscheinen, bei denen die TNFalpha Toxizität eine pathogenetische Rolle spielt, die Immunität jedoch intakt bleiben muß. Ziel dieser Monographie waren Untersuchungen der Wirkungen von Thalidomid in vitro, in vivo und klinische Studien. In einer prospektiv-randomisierten, doppel-blind Studie an 70 Patienten mit kleinzelligem Bronchialkarzinom konnte die Verlängerung der Überlebenszeit durch die additive Therapie mit Thalidomid in Kombination mit einer Standardpolychemotherapie und Strahlentherapie nachgewiesen werden. Vor dem additiven Einsatz des Angioneogenesehemmers Thalidomid in der Chirurgie muß unbedingt sichergestellt sein, daß die Therapie mit Thalidomid nicht zu einer erhöhten postoperativen Morbidität und Letalität führt. Durch in-vitro Untersuchungen konnte eine Proliferationshemmung von Kaninchenendothelzellen durch metabolisiertes Thalidomid bewiesen werden. In einer randomisierten Studie an New Zealand White Kaninchen konnte gezeigt werden, daß die intraperitoneale Gabe von Thalidomid den Berstungsdruck von Kolonanastomosen im Kaninchenmodell im Vergleich zu einer Kontrollgruppe nicht erniedrigt. Darüberhinaus zeigte sich in diesem Tiermodell, daß die Rate an postoperativen Verwachsungen durch die intraperitoneale Gabe von Thalidomid signifikant vermindert wird. Das Medikament könnte eine Rolle in der additiven Therapie von Patienten mit einem kleinzelligen Bronchialkarzinom spielen. Darüberhinaus wird die Heilung von Kolonanastomosen nicht durch die intraperitoneale Gabe von Thalidomid negativ beeinflusst. Somit könnte ein Einsatz in der perioperativen Therapie bei der Resektion gastrointestinaler Karzinome in der Zukunft erwogen werden. / The proven antiangiogenic effects in vivo and in vitro in combination with a selective inhibition of the tnf alpha production seem to predestine thalidomide as an agens for diseases with a pathological elevated tnf alpha level. The theses of this monography were in vitro, in vivo and clinical effects of thalidomide. In a prospective randomized placebo controlled study on 70 patients with proven small cell lung cancer the additive treatment with oral thalidomide lead to a significant prolonged survival in combination with radio chemotherapy. Considering the treatment of thalidomide in combination with surgical therapy of patients it is essential to prove that this treatment does not lead to a higher postoperative morbidity of the patients. In an in vitro assay we could prove the antiproliferative effect of metabolized thalidomide in rabbit endothelial cells. We were than able to demonstrate that intraperitoneal administered thalidomide does not impair anastomotic healing of colonic anastomoses in a New Zealand white rabbit model compared to a control group. In addition to this significant less postoperative adhesions were found in the thalidomide group. In conclusion did the additive treatment with thalidomide in patients with small cell lung cancer lead to a prolonged survival. The antiangiogenic treatment with thalidomide in a perioperative setting does not impair the healing of colonic anastomoses in a rabbit model and may be possible in patients undergoing gastrointestinal resections in the future.

In den letzten Jahren erfuhr Thalidomid auf Grund seiner antiinflammatorischen, immunmodulatorischen und antiangiogenetischen Eigenschaften eine "Renaissance". Bei ophthalmologischen Erkrankungen, die durch Gefäßproliferation gekennzeichnet sind, wie bei der diabetischen Retinopathie und der altersbedingten Makuladegeneration (33) oder bei immunpathologische Erkrankungen wie die Uveitis (44) liegen Berichte zu günstigen Effekten vor. Aufgrund der erheblichen Nebenwirkungen bei der systemischen Verabreichung wurde der Versuch einer topischen Applikation angestrebt. Dieser Applikationsweg ist limitiert durch die schlechte Wasserlöslichkeit und hydrolytische Instabilität bei der Formulierung von wässrigen Augentropfen. Zur Erhöhung der intraokularen Bioverfügbarkeit von Thalidomid wurden Cyclodextrine, speziell HP-ß-CD, als Vehikel zur Verbesserung der physiko-chemischen Eigenschaften verwendet. Die experimentelle Arbeit wurde an 21 pigmentierten Kaninchen durchgeführt, die mit Thalidomid-HP-ß-CD haltigen Augentropfen oder mit einer Thalidomidsuspension behandelt wurden. Nach einer Einwirkungszeit von 30, 60, oder 240 Minuten wurden die Augen enukleiert, präpariert und eingefroren. Anschließend wurde mittels HPLC die jeweilige Thalidomid-Konzentration ermittelt. Unsere Arbeit hat signifikante (p / Background: Thalidomide, which has been rediscovered as an angiogenic, immunmodulatory and anti-inflammatory agent might be a treatment option for several eye diseases. The systemic application causes severe side effects. The water-insolubility and hydrolytic instability of thalidomide limits its ocular bioavailability during local application. Hydroxypropyl-ß-cyclodextrin (HP-ß-CD) is a cyclodextrin derivative, which has the ability to form inclusion complexes with lipophilic drugs increasing their stability and solubility. Methods: 21 pigmented male rabbits were treated with 5x50 mul 0,04 % thalidomide/12,5% HP-ß-CD (THA-CD) or 0,04 % thalidomide suspension (THA-SP). 30, 60 or 240 minutes post instillation the animals were sacrificed and the eyes were enucleated. The thalidomide concentrations where determined using HPLC. Results: A significant (p

The expanding therapeutic use of thalidomide (TD) remains limited by its species-specific teratogenicity in humans and rabbits, but not rodents. The R and S isomers of TD may be selectively responsible for its respective therapeutic and teratogenic effects, but rapid in vivo racemization makes this impossible to confirm. Fluorothalidomide (FTD), a fluorinated TD analogue with stable, non-racemizing isomers, may serve as a model compound for determining stereoselective effects. In vivo, FTD was undetectable in plasma, suggesting rapid breakdown, as confirmed in vitro, where FTD hydrolyzed up to 22-fold faster than TD. Unlike TD, FTD in pregnant rabbits and mice was highly toxic and lethal to both dams and fetuses. In rabbit embryo culture, FTD initiated optic (eye) vesicle and hindbrain but not classic limb bud embryopathies. Chemical instability, potent general toxicity and absence of limb bud embryopathies make FTD an unsuitable stereoselective model for TD teratogenesis. TD teratogenesis may involve its bioactivation by embryonic prostaglandin H synthases (PHSs) to a free radical intermediate that increases embryopathic reactive oxygen species (ROS) formation. However, the teratogenic potential of rapidly formed TD hydrolysis products and the determinants of species-specific teratogenesis are unclear. For some teratogens, mouse strains that are resistant in vivo are susceptible in embryo culture, suggesting maternal and/or placental determinants of risk. However, TD and two hydrolysis products, 2-phthalimidoglutaramic acid (PGMA) and 2-phthalimidoglutaraic acid (PGA), were non-embryopathic in CD-1 mouse embryo culture. Also, mice deficient in oxoguanine glycosylase 1 (OGG1), which repairs oxidatively damaged DNA, were resistant to TD embryopathies in culture and in vivo. Therefore, murine resistance to TD teratogenesis is dependent on embryonic factors, rather than maternal/placental determinants or increased DNA repair. In contrast, rabbit embryos exposed in culture to TD, PGMA and PGA exhibited head/brain, otic (ear) vesicle and classic limb bud embryopathies, validating the first mammalian embryo culture model for TD teratogenesis and providing the first evidence of a teratogenic role for TD hydrolysis products. Pretreatment with eicosatetraynoic acid (ETYA), a dual PHS/lipoxygenase inhibitor, or phenylbutylnitrone (PBN), a free radical spin trapping agent, completely blocked TD, PGMA and PGA-initiated embryopathies, implicating a PHS-dependent, ROS-mediated embryopathic mechanism.

The expanding therapeutic use of thalidomide (TD) remains limited by its species-specific teratogenicity in humans and rabbits, but not rodents. The R and S isomers of TD may be selectively responsible for its respective therapeutic and teratogenic effects, but rapid in vivo racemization makes this impossible to confirm. Fluorothalidomide (FTD), a fluorinated TD analogue with stable, non-racemizing isomers, may serve as a model compound for determining stereoselective effects. In vivo, FTD was undetectable in plasma, suggesting rapid breakdown, as confirmed in vitro, where FTD hydrolyzed up to 22-fold faster than TD. Unlike TD, FTD in pregnant rabbits and mice was highly toxic and lethal to both dams and fetuses. In rabbit embryo culture, FTD initiated optic (eye) vesicle and hindbrain but not classic limb bud embryopathies. Chemical instability, potent general toxicity and absence of limb bud embryopathies make FTD an unsuitable stereoselective model for TD teratogenesis. TD teratogenesis may involve its bioactivation by embryonic prostaglandin H synthases (PHSs) to a free radical intermediate that increases embryopathic reactive oxygen species (ROS) formation. However, the teratogenic potential of rapidly formed TD hydrolysis products and the determinants of species-specific teratogenesis are unclear. For some teratogens, mouse strains that are resistant in vivo are susceptible in embryo culture, suggesting maternal and/or placental determinants of risk. However, TD and two hydrolysis products, 2-phthalimidoglutaramic acid (PGMA) and 2-phthalimidoglutaraic acid (PGA), were non-embryopathic in CD-1 mouse embryo culture. Also, mice deficient in oxoguanine glycosylase 1 (OGG1), which repairs oxidatively damaged DNA, were resistant to TD embryopathies in culture and in vivo. Therefore, murine resistance to TD teratogenesis is dependent on embryonic factors, rather than maternal/placental determinants or increased DNA repair. In contrast, rabbit embryos exposed in culture to TD, PGMA and PGA exhibited head/brain, otic (ear) vesicle and classic limb bud embryopathies, validating the first mammalian embryo culture model for TD teratogenesis and providing the first evidence of a teratogenic role for TD hydrolysis products. Pretreatment with eicosatetraynoic acid (ETYA), a dual PHS/lipoxygenase inhibitor, or phenylbutylnitrone (PBN), a free radical spin trapping agent, completely blocked TD, PGMA and PGA-initiated embryopathies, implicating a PHS-dependent, ROS-mediated embryopathic mechanism.

[pt] No presente trabalho foram desenvolvidas duas metodologias analíticas para a determinação de talidomida, um composto de reconhecida importância farmacológica. As metodologias espectrofluorimétrica e voltamétrica desenvolvidas foram comparadas em termos de desempenho analítico.As características fluorescentes e eletroquímicas da talidomida foram estudadas para que se encontrassem condições experimentais que fornecessem máximo sinal fluorescente do analito em solução na temperatura ambiente e possibilidade de pré-concentração do analito no eletrodo de mercúrio.Nas condições experimentais otimizadas para a talidomida, limites de detecção compreendidos entre 10-6 e 10-9 g L-1 foram obtidos para o método espectrofluorimétrico e voltamétrico, respectivamente. Faixas lineares dinâmicas entre 2 e 4 ordens de grandeza foram alcançadas dependendo do método e do interferente presente na amostra. Esses parâmetros de mérito se mostraram adequados para o problema proposto. O possível efeito interferente de substâncias geralmente usadas em associação com o analito foi estudado, e estratégias para minimização das interferências foram desenvolvidas. Enquanto a tetraciclina não interferiu no método espectrofluorimétrico, o uso combinado de meio ácido e irradiação UV da amostra foi necessária para permitir a quantificação do analito em presença de sulfanilamida. Na voltametria, as interferências da tetraciclina e da sulfanilamida puderam ser compensadas pelo uso da quantificação pelo método de adição do analito. Nas determinações dos fluídos biológicos, o uso da extração em coluna de sílica C18 mostrou-se bastante eficiente na separação do analito dos interferentes da matriz para o método espectrofluorimétrico e para o voltamétrico, no caso do soro sangüíneo. Para a urina, apenas a clarificação da amostra com sulfato de amônio foi suficiente no caso da determinação voltamétrica.Os métodos desenvolvidos foram testados na dosagem de talidomida presente em uma formulação comercial e em amostras de urina e soro sangüíneo enriquecidas com o analito. Para tal, utilizaram-se os procedimentos de curva de calibração (espectrofluorimetria) e método da adição do analito (voltametria). Em todos os casos, as recuperações obtidas estiveram compreendidas na faixa de 96,5 a 107,6 %, dentro da faixa de recuperação estabelecida pela Farmacopéia dos Estados Unidos da América. / [en] In the present work two analytical methodologies were developed aiming the determination of thalidomide, an important pharmacological compound. The developed spectrofluorimetric and the voltammetric based analytical methodologies were compared in terms of analytical performance. The thalidomide fluorescent and the electrochemical characteristics were studied in order to find experimental conditions for maximum fluorescence in solution and at room temperature and to allow analyte pre- concentration on the mercury electrode. Using the optimized experimental conditions, limits of detection between 10-6 to 10-9 g L-1 were achieved respectively for the spectrofluorimetric method and for the voltammetric method. Dynamic linear ranges between 2 and 4 orders of magnitude were obtained depending on the method utilized and the interferent substances present in the sample. Those parameters of merit were suitable for this proposed analytical problem. The potential interference effect from substances usually used in association with thalidomide, were studied and strategies for the minimization of such interferences were developed. While no interference in the spectrofluorimetric method was observed for tetracycline, the combined use of acidic medium and UV irradiation of the samples was necessary to allow the analyte determination in the presence of sulfanilamide. For the voltammetric method, interferences from tetracycline and sulfanilamide could be compensated by quantifying thalidomide using the analyte addition method. For the determination in biological fluids, the use a solid-liquid extraction on a C18 column was found to be very effective for the analyte separation and elimination of matrix interferences for the spectrofluorimetric method and for the voltammetric method developed for blood serum. For urine samples, a clean-up step using ammonium sulfate was found to be sufficient for the voltammetric determination of thalidomide. The developed methodologies were tested by determining the thalidomide content in a commercial pharmaceutical formulation and in analyte spiked biological fluids using calibration curves (spectrofluorimetric) and analyte addition method (voltammetric). In all cases, the recoveries were between the 96,5 and 107,6 %, within the recovery range considered adequate according to the United States Pharmacopoeia.