Made available in DSpace on 2015-07-22T20:49:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-09-24. Added 1 bitstream(s) on 2015-08-11T03:25:34Z : No. of bitstreams: 1 Publico-017.pdf: 1297043 bytes, checksum: 1c07f97bbf8c4bb508620341eee9116b (MD5) / Associação Fundo de Incentivo à Psicofarmacologia (AFIP) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Justificativa: Drogas colinérgicas como 0 donepezil aumentam a disponibilidade de acetilcolina (ACh) e consequentemente melhoram a cognção em uma variedade de disfunções clínicas. Contudo, não há consenso quanta ao potencial nootrópico agudo desta droga quando administrada a voluntários jovens sadios. Em estudos que investigaram os efeitos agudos do donepezil a avaliação cognitiva foi feita antes que 0 pica de concentração plasmático fosse atingido. Portanto, a falta de resultados consistentes pode refletir concentações subótimas e/ou variáveis de ACh. Objetivo: avaliar 0 curso temporal dos efeitos cognitivos de uma dose oral aguda do donepezil em voluntários jovens sadios. Método: Este foi um estudo duplo cego, controlado por placebo, em grupos paralelos de tratamento que avaliou os efeitos agudos de 5 mg de donepezil por via oral em voluntários sadios jovens. Os sujeitos foram testados duas vezes após a ingestão do donepezil: aos 90 min. (tempo que coincide com as testagens prévias na literatura) e aos 210 min. (tempo que coincide com 0 pica de concentração plasmático teórico do donepezil). A bateria de testes incluiu tarefas que avaliam domínios cognitivos sensíveis a manipulações colinérgicas: processamento visuospacial, memória episódica, e subcomponentes de memória operacional, além de avaliações do humor. Resultados: a maior parte de efeitos do donepezil foi observada em ambos os tempos de testagem e incluíram melhora do humor, recordação tardia de uma história, recordação (imediata e tardia) de objetos, de posições espaciais estáticas e integração da identidade de objetos com as suas posições espaciais. Contudo, a melhora de desempenho na medida de funcionamento do executivo central (digit span ordem inversa) ocorreu apenas aos 210 min. Conclusão: os efeitos cognitivos benéficos do donepezil após administração aguda foram observados em vários domínios cognitivos em voluntários jovens sadios, mas 0 seu potencial nootrópico completo e mais claramente encontrado próximo ao pico de concentração plasmático esta droga. / Rationale: Drugs such as donepezil that increase the availability of acetylcholine (Ach) are known to improve cognition. However, there is no consensus as to the acute nootropic potential of this drug when administered to young, healthy volunteers. In the studies that have investigated this issue donepezil effects were evaluated before peak-plasma concentration was reached. Hence, lack of consistent results may reflect performance at suboptimal and/or variable concentrations of ACh. Objective: To evaluate the time course of cognitive effects of an acute oral dose of donepezil in young, healthy volunteers. Methods: This was a double-blind, placebo controlled, parallel group study of cognitive effects of acute oral donepezil (5 mg). Subjects were tested twice after donepezil ingestion: 90 min (time that coincides with previous testing in the literature) and 210 min. (theoretical peak-plasma concentration). The test battery included tasks that tap cognitive domains that have been shown to be sensitive to ACh manipulations: visuospatial processing, episodic memory, and subcomponents of working memory, in addition to evaluations of mood. Results: Most of donepezil’s effects were observed at both testing times and included improvement in mood, long-term recall of prose, objects recall, recall of static spatial locations and integration of objects with their locations. However, improvement of performance in the central executive measure (backward digit span) occurred only at 210 min. Conclusion: positive cognitive effects of acute donepezil can be observed in various cognitive domains in young, healthy volunteers but its full nootropic potential is more clearly found close to peak-plasma concentration. / TEDE / BV UNIFESP: Teses e dissertações

A Doença de Alzheimer (DA) é uma desordem neurodegenerativa progressiva que causa comprometimento cognitivo e demência. O diagnóstico é baseado em parâmetros clínicos, mas sua confirmação é post-mortem, após avaliação patológica durante a autópsia. Os tratamentos disponíveis para a DA são os inibidores da colinesterase (IChEs) e os antagonistas de receptores de N-metil-D-aspartato (NMDA), sendo que os IChEs compõe o principal grupo. Diversos estudos tem mostrado um efeito neuroprotetor dos IChEs, levando a alterações na patogênese da DA. Avaliar e mensurar essas alterações são papeis atribuídos aos biomarcadores. Neste sentido podemos destacar a fosfolipase A2 (PLA2), a principal responsável pelo metabolismo de fosfolípides de membrana, e que tem sido achada diminuída na DA, assim como a glicogênio sintase-quinase (GSK), responsável pela fosforilação da proteína Tau, que é um dos processos alterados na DA. O objetivo deste trabalho foi avaliar o efeito do tratamento com IChE sobre a atividade da PLA2 e expressão da GSK3B em plaquetas de 30 pacientes com DA após 3 e 6 meses de tratamento. Como grupo controle foram investigados 42 individuos idosos sem doença neurodegenerativa. Encontramos nos pacientes com DA antes do tratamento uma diminuição da atividade da iPLA2 quando comparada ao grupo controle. Após três e seis meses de tratamento a PLA2 aumentou, voltando ao nível dos controles. Os pacientes que apresentaram um aumento maior da iPLA2 apos 3 meses de tratamento apresentaram melhora cognitiva mais marcante após seis meses de tratamento, avaliado pelo CAMCOG. Apos 6 meses de tratamento encontramos um inativação da GSK3B, medida por um aumento em sua forma fosforilada. Nossos resultados sugerem que o donepezil apresenta propriedades modificadoras na doença de Alzheimer, e ainda que a medida da atividade da iPLA2 poderia ser usada como marcador de resposta terapêutica ao donepezil e, possivelmente, a outros IChEs, na doença de Alzheimer / Alzheimer\'s disease (AD) is a progressive neurodegenerative disorder that causes dementia and cognitive impairment. The Diagnosis is based on clinical parameters, but confirmation is post-mortem after pathologic evaluation during autopsy. The treatments available for AD are cholinesterase inhibitors (IChEs) and N-methyl-D-aspartate (NMDA) antagonists. The main group comprises the IChEs. Several studies have shown a neuroprotective effect of IChEs, leading to alterations in the pathogenesis of AD. Evaluate and measure these changes are assigned to biomarkers. In this regard we can highlight the phospholipase A2 (PLA2) the main enzyme in membrane phospholipids metabolism and that has been found decreased in AD as well as Glycogen Synthase kinase (GSK), a major responsible for tau phosphorylation which is one processes altered in AD. The objective of this study was to evaluate the effect of treatment with IChE on PLA2 activity and GSK3B expression in platelet of 30 AD patients after 3 and 6 months of treatment. The control group comprised 42 elderly individuals without neurodegenerative disease The results obtained were a decreased iPLA2 activity in patients with AD before treatment as compared to controls. After 3 and 6 months of treatment, we observed a significant increase in iPLA2 activity, restoring enzymatic activity similar to that observed among control. The patients who showed higher iPLA2 activity in the first three months were those showing cognitive improvement after six months of treatment, measured by CAMCOG. After 6 months of treatment a GSK3B inactivation were found, measured by an increase in its phosphorylated form. Our results suggest that donepezil present modifying properties in Alzheimer disease and that iPLA2 activity measurement could be used as a marker of therapeutic response to donepezil and possibly other IChEs in Alzheimer\'s disease

A Doença de Alzheimer (DA) é uma desordem neurodegenerativa progressiva que causa comprometimento cognitivo e demência. O diagnóstico é baseado em parâmetros clínicos, mas sua confirmação é post-mortem, após avaliação patológica durante a autópsia. Os tratamentos disponíveis para a DA são os inibidores da colinesterase (IChEs) e os antagonistas de receptores de N-metil-D-aspartato (NMDA), sendo que os IChEs compõe o principal grupo. Diversos estudos tem mostrado um efeito neuroprotetor dos IChEs, levando a alterações na patogênese da DA. Avaliar e mensurar essas alterações são papeis atribuídos aos biomarcadores. Neste sentido podemos destacar a fosfolipase A2 (PLA2), a principal responsável pelo metabolismo de fosfolípides de membrana, e que tem sido achada diminuída na DA, assim como a glicogênio sintase-quinase (GSK), responsável pela fosforilação da proteína Tau, que é um dos processos alterados na DA. O objetivo deste trabalho foi avaliar o efeito do tratamento com IChE sobre a atividade da PLA2 e expressão da GSK3B em plaquetas de 30 pacientes com DA após 3 e 6 meses de tratamento. Como grupo controle foram investigados 42 individuos idosos sem doença neurodegenerativa. Encontramos nos pacientes com DA antes do tratamento uma diminuição da atividade da iPLA2 quando comparada ao grupo controle. Após três e seis meses de tratamento a PLA2 aumentou, voltando ao nível dos controles. Os pacientes que apresentaram um aumento maior da iPLA2 apos 3 meses de tratamento apresentaram melhora cognitiva mais marcante após seis meses de tratamento, avaliado pelo CAMCOG. Apos 6 meses de tratamento encontramos um inativação da GSK3B, medida por um aumento em sua forma fosforilada. Nossos resultados sugerem que o donepezil apresenta propriedades modificadoras na doença de Alzheimer, e ainda que a medida da atividade da iPLA2 poderia ser usada como marcador de resposta terapêutica ao donepezil e, possivelmente, a outros IChEs, na doença de Alzheimer / Alzheimer\'s disease (AD) is a progressive neurodegenerative disorder that causes dementia and cognitive impairment. The Diagnosis is based on clinical parameters, but confirmation is post-mortem after pathologic evaluation during autopsy. The treatments available for AD are cholinesterase inhibitors (IChEs) and N-methyl-D-aspartate (NMDA) antagonists. The main group comprises the IChEs. Several studies have shown a neuroprotective effect of IChEs, leading to alterations in the pathogenesis of AD. Evaluate and measure these changes are assigned to biomarkers. In this regard we can highlight the phospholipase A2 (PLA2) the main enzyme in membrane phospholipids metabolism and that has been found decreased in AD as well as Glycogen Synthase kinase (GSK), a major responsible for tau phosphorylation which is one processes altered in AD. The objective of this study was to evaluate the effect of treatment with IChE on PLA2 activity and GSK3B expression in platelet of 30 AD patients after 3 and 6 months of treatment. The control group comprised 42 elderly individuals without neurodegenerative disease The results obtained were a decreased iPLA2 activity in patients with AD before treatment as compared to controls. After 3 and 6 months of treatment, we observed a significant increase in iPLA2 activity, restoring enzymatic activity similar to that observed among control. The patients who showed higher iPLA2 activity in the first three months were those showing cognitive improvement after six months of treatment, measured by CAMCOG. After 6 months of treatment a GSK3B inactivation were found, measured by an increase in its phosphorylated form. Our results suggest that donepezil present modifying properties in Alzheimer disease and that iPLA2 activity measurement could be used as a marker of therapeutic response to donepezil and possibly other IChEs in Alzheimer\'s disease

La maladie d’Alzheimer (MA) est une maladie neurodégénérative complexe caractérisée par une perte progressive de la mémoire et de la cognition. C’est la première cause de démence chez le sujet âgé et affecte environs 4.6 millions de personnes par an, selon un rapport de l’association « Alzheimer’s disease International », le nombre de patients pourrait s’élever à 135.5 millions en 2050. Du fait de sa complexité, la MA reste incurable et seuls 4 médicaments aux vertus palliatives dont 3 visant à inhiber l’acétylcholinestérase (AChE) ont reçu une autorisation de mise sur le marché à ce jour. L’approche multi-cible parait particulièrement adaptée du fait du grand nombre de cibles potentielles de la pathologie, et du caractère multifactoriel de la maladie. Cette approche consiste à associer sur une seule molécule, plusieurs pharmacophores afin qu’ils puissent agir simultanément sur différentes cibles impliquées dans le processus neurodégénératif. Dans ce contexte, en parallèle de la resynthèse d’un ligand multi-cible conjugué alliant un inhibiteur d’AChE (IAChE) et un antioxydant, deux nouvelles familles de ligands multi-cibles conjuguées, combinant un IAChE et un agoniste des récepteurs nicotiniques α7 (α7 nAChR) ont été conçues et leur synthèse abordée. Dans le cas de la première famille, le fragment ivastigmine a été choisi pour sa capacité à inhiber de manière pseudo-irréversible l’AChE et a été conjugué à un motif quinuclidine, un puissant agoniste des α7 nAChRs impliqués dans la MA. En combinant ces deux fragments, il a été observé que les propriétés biologiques in vitro de chaque pharmacophore étaient améliorées. La structure de la seconde famille est basée sur le Donepezil, un IAChE réversible de plus forte affinité, combiné au même motif quinuclidine que dans la série précédente. Si des intermédiaires avancés ont été obtenus, un ou deux étapes restent à finaliser pour finaliser la synthèse de cette troisième famille de MTDL. / Alzheimer’s disease (AD) is a complex neurodegenerative disease characterised by a progressive loss of memory and cognition. Nowadays, 4.6 million new patients are identified every year and according to the “Alzheimer’s diseases International” association, the number of patients could reach 135.5 million in 2050. Due to its complexity, AD remains uncurable and only 4 palliative drugs, of which 3 are acetylcholinesterase (AChE) inhibitors (AChEI), have been approved by FDA to date. AD being a multifactorial illness, with many potential targets involved in the pathology, the MTDL approach seems promising. This strategy associates in one single molecule, different pharmacophores (at least) acting on different targets involved in this CNS-related disorder. In this context, in parallel with the upscaled synthesis of a conjugated MTDL combining an AChEI inhibitor and an antioxidant, two new families of conjugated MTDLs associating an AChEI and a α7 nicotinic receptor (α7 nAChR) agonist have been investigated. The structure of the first family was based on a Rivastigmine scaffold, known to be a pseudo-irreversible AChE inhibitor, and a quinuclidine fragment, a potent α7 nAChR agonist. By combining these two fragments, it was brought to light that the in vitro biological properties were improved on both targets. The second family was based on a donepezil fragment, a more potent AChEI, and the same quinuclidine fragment than in the first family. Advanced intermediates have been obtained, and two last steps remain to be achieved for the completion of this third MTDL series.

O uso de fungos na biotransformação estereosseletiva de fármacos pode constituirse em uma excelente alternativa à síntese assimétrica para obtenção de metabólitos, bem como aos estudos de biotransformação in vivo e in vitro convencionais. Neste trabalho foram empregados fungos isolados de órgãos internos de plantas, classificados como endofíticos, fungos fitopatógenos, bem como, fungos adquiridos de coleções de micro-organismos. Esses fungos foram empregados no estudo da biotransformação estereosseletiva dos fármacos midodrina, bufuralol e donepezila. Estes fármacos foram selecionados por produzirem metabólitos ativos nos processos de biotransformação em humanos. Para o monitoramento da formação dos metabólitos dos fármacos foi necessário desenvolver e validar métodos analíticos com características adequadas para essa aplicação. Para determinação enantiosseletiva da midodrina e seu metabólito empregou-se a eletroforese capilar, enquanto que para a determinação aquiral empregou-se a cromatografia líquida de alta eficiência. Para avaliar a biotransformação estereosseletiva do bufuralol e donepezila foram desenvolvidos métodos empregando a cromatografia líquida de alta eficiência. Os dados referentes ao estudo de cada fármaco são apresentados em quatro capítulos. O primeiro capítulo apresenta os resultados obtidos no desenvolvimento de um método empregando a eletroforese capilar para a determinação enantiosseletiva de midodrina e seu metabólito desglimidodrina (DMAE) em meio de cultura Czapek. As análises foram realizadas em capilar de sílica de 50 ?m de diâmetro interno e com comprimento efetivo de 40 cm, utilizando 30 mmol L-1 de trimetil- -ciclodextrina dissolvida em solução de acetato de sódio 70 mmol L-1, pH 5, como tampão de análise. A técnica de preparação das amostras empregada foi a extração líquidolíquido. O método foi validado, mostrando linearidade na faixa de concentração de 100 - 12000 ng mL-1, com coeficientes de correlação linear 0.9975. Os resultados de precisão e exatidão foram inferiores a 15% e a robustez do método foi avaliada através de um planejamento fatorial fracionário. O método foi aplicado em um estudo de biotransformação usando fungos endofíticos. Foram avaliados oito fungos com destaque para o fungo Papulaspora immersa Hotson (SS13) que biotransformou 21,3% da (+)-midodrina em (+)-DMAE e 2,4% da (-)-midodrina em (-)-DMAE, em 72 h de biotransformação, apresentando um excesso enantiomérico de 79,7%. O segundo capítulo apresenta os resultados obtidos no desenvolvimento de um método cromatográfico para a determinação de midodrina e DMAE em meio de cultura Czapek-Dox. As análises foram realizadas no modo reverso de eluição empregando uma coluna Lichrospher 100 RP 18 e fase móvel composta por acetonitrila:ácido fórmico 40 mmol L-1 (60:40, v/v), vazão de 1,4 mL min-1 e detecção em 290 nm. O preparo de amostras empregado foi a extração líquido-líquido, usando acetato de etila como solvente extrator. O método foi validado na faixa de concentração de 0,4 a 40 ?g mL-1, com coeficientes de correlação linear superiores ii a 0,9997. Este método foi aplicado em um estudo de biotransformação da midodrina empregando o fungo endofítico Papulaspora immersa e duas linhagens do fitopatógeno Botrytis cinerea (UCA 992 e 2100). Entre os fungos estudados, o Botrytis cinerea 2100, em condição de agitação, apresentou o maior percentual de biotransformação da midodrina em DMAE (42,2% em 48 h). Além disso, nos cromatogramas referentes a biotransformação em condição estática, pelos fungos Papulaspora immersa e Botrytis cinerea 2100, foi observada a presença de picos adicionais não observados nos controles realizados. Estes fungos foram submetidos à biotransformação em escala ampliada, em condição estática, a partir das quais foram isolados DMAE de ambos os fungos e um derivado desaminado da midodrina (Botrytis cinerea 2100). No terceiro capítulo são apresentados os resultados obtidos com o desenvolvimento de um método para a determinação estereosseletiva do bufuralol e seus metabólitos 1'-oxobufuralol e 1'-hidroxibufuralol em meio Czapek, usando a coluna Chiralcel OD-H no modo normal de eluição. As demais condições cromatográficas empregadas foram: fase móvel constituída por hexano:isopropanol:metanol (97,5:2,0:0,5; v/v/v) acrescidos de 0,5% de dietilamina, vazão 1,5 mL min-1 e detecção no UV em 248 e 273 nm. A microextração em fase líquida com membrana cilíndrica oca em três fases foi usada como procedimento de preparação das amostras. As condições empregadas na extração foram: fase doadora em pH 13 ajustado com NaOH 2 mol L-1, n-octanol como solvente orgânico, fase aceptora constituída por ácido acético 0,2 mol L-1, tempo de extração de 30 min e velocidade de agitação de 1750 rpm. Os valores de recuperação do método ficaram na faixa de 50 - 69%. O método foi aplicado em um estudo piloto de biotransformação com cinco espécies de fungos endofíticos. Nenhum dos fungos estudados biotransformou o bufuralol em 1'-oxobufuralol e/ou 1'-hidroxibufuralol e, devido a isso, o método desenvolvido não foi validado. O quarto capítulo mostra os resultados obtidos com o desenvolvimento de um método empregando a cromatografia líquida de alta eficiência na determinação enantiosseletiva da donepezila, 5-O-desmetil donepezila e 6-O-desmetil donepezila em meio de cultura Czapek. As análises foram realizadas na coluna Chiralpak AD-H no modo normal de eluição. As demais condições cromatográficas empregadas foram: fase móvel constituída por hexano:etanol:metanol (75:20:5, v/v/v) acrescido de 0,3% de trietilamina, vazão 1,5 mL min-1 e detecção no UV em 270 nm. A técnica de preparação das amostras foi a extração líquido-líquido e o solvente extrator foi o acetato de etila. O método descrito foi validado, mostrando linearidade na faixa de concentração de 100 - 10000 ng mL-1 para os enantiômeros da donepezila (r 0,9985) e 100 - 5000 ng mL-1 para os enantiômeros da 5-O-desmetil donepezila e 6- O-desmetil donepezila (r 0,9951). Os valores de recuperação foram superiores a 90% para todos os analitos. O método foi aplicado em um estudo de biotransformação usando fungos. Foram avaliados cinco fungos endofíticos e os fungos Cunninghamella elegans ATCC 10028B e Beauveria bassiana ATCC 7159. Os fungos endofíticos não desmetilaram a donepezila nas condições estudadas, entretanto, esta reação foi catalisada pelo fungo B. bassiana que biotransformou predominantemente 8,3% da donepezila em (-)-(R)-5-O-desmetil donepezila (ee, 60,6%), enquanto que o fungo C. elegans apresentou biotransformação enantiosseletiva da donepezila em (-)-(R)-6-O-desmetil donepezila (ee, 100%) com um rendimento de 15,1%. Os dados aqui apresentados demonstram que biotransformações com fungos são uma importante alternativa para mimetizar a biotransformação em mamíferos e para a obtenção de metabólitos de fármacos, especialmente na forma de enantiômeros puros. / Drug biotransformations using fungi are considered an alternative approach to the asymmetric synthesis and conventional in vivo and in vitro metabolism studies. In this work, endophytic fungi isolated from health internal plant organs, phythophatogenic fungi and fungi purchased from ATCC were used to study the stereoselective biotransformation of midodrine, bufuralol and donepezil drugs. These drugs were selected because the biotrasformation process in humans results in active metabolites. To evaluate the metabolite formation during the biotransformation study, suitable analytical methods were required. The midodrine biotransformation was evaluated under chiral and achiral conditions. For the enantiosselective determination of midodrine, a capillary electrophoresis method was used, whereas the achiral determination of this drug and its metabolite was carried out by liquid chromatography. The determination of the other drugs was performed by chiral liquid chromatography.The results of each studied drug are presented in four chapters. In the first chapter, a capillary electrophoresis method was described for the stereoselective determination of midodrine and desglymidodrine (DMAE) in Czapek culture medium to be applied to a stereoselective biotransformation study employing endophytic fungi. The electrophoretic analyses were performed using an uncoated fused-silica capillary and 70 mmol L-1 sodium acetate buffer solution (pH 5.0) containing 30 mmol L-1 heptakis (2, 3, 6-tri-O-methyl)--CD as running electrolyte. The applied voltage and temperature used were 15 kV and 15°C, respectively. The UV detector was set at 200 nm. The sample preparation was carried out by liquid- liquid extraction using ethyl acetate as extractor solvent. The method was linear over the concentration range of 100 -12000 ng mL-1 for each enantiomer of midodrine and DMAE (r 0.9975). Within-day and between-day precision and accuracy evaluated by RSDs and relative errors, respectively, were lower than 15% for all analytes. The method proved to be robust by a fractional factorial design evaluation. The validated method was used to assess the midodrine biotransformation to DMAE by eight endophytic fungi. The fungus Papulaspora immersa (SS13) showed the best biotransformation results. It biotransformed 21.3% of (+)-midodrine to (+)-DMAE and 2.4% of (-)-midodrine to (-)-DMAE, after 72 hours. The observed enantiomeric excess was 79.7%. The second chapter describes the optimization and validation of a method for the determination of midodrine and DMAE in Czapek-Dox culture medium. The analyses were carried out under reverse elution mode using a Lichrospher 100 RP 18 column and acetonitrile: formic acid solution 40 mmol L-1 (60:40, v/v), as mobile phase, at a flow rate of 1.4 mL min-1 and UV detection at 290 nm. The sample preparation was carried out by liquid-liquid extraction using ethyl acetate as extractor solvent. The method was linear over the concentration range of 0.4 - 40 ?g mL-1 for each analyte (r 0.9997). This method was applied to evaluate the biotransformation of midodrine by the endophyte Papulaspora immersa and two Botrytis cinerea strains (UCA 992 and 2100). Among the studied fungi, Botrytis v cinerea 2100, at shaken condition, showed the higher percentual of DMAE formation (42.2%, at 48 hours). Moreover, the chromatograms obtained for the biotransformation under static condition, showed additional peaks not detected at performed controls, for both Papulaspora immersa and Botrytis cinerea 2100. Further biotransformation experiments were carried out at large scale on static condition. In addition to DMAE, a deaminated midodrine derivative was isolated from Botrytis cinerea 2100. In the third chapter, a three-phase hollow-fiber liquid-phase microextraction (HF-LPME) method was used for the sample preparation of bufuralol and its metabolites 1'-oxobufuralol and 1'- hydroxybufuralol in Czapek culture medium. The analysis was carried out by chiral liquid chromatography using a Chiralcel OD-H column with hexane: isopropanol:methanol (97.5:2.0:0.5, v/v/v) plus 0.5% diethylamine as the mobile phase, and UV detection at 248 and 273 nm. The HF-LPME optimized conditions involved the use of n-octanol as the organic solvent, 0.2 mol L-1 acetic acid as the acceptor phase, donor phase pH adjusted to 13, sample agitation at 1750 rpm and extraction for 30 min. By using this extraction procedure, the recovery rates were in the range of 50-69%. The method was used to assess the biotransformation of bufuralol using five endophytic fungi strains. None of the studied fungi biotransformed bufuralol to 1'-oxobufuralol and / or 1'- hidroxybufuralol and because of this, the method developed was not validated. In the fourth chapter a chiral liquid chromatography method was described for the stereoselective determination of donepezil, 5-O-desmethyl donepezil, and 6-Odesmethyl donepezil in Czapek culture medium to be applied to a stereoselective biotransformation study employing fungi. The analysis was carried out using a Chiralpak AD-H column with hexane:ethanol:methanol (75:20:5, v/v/v) plus 0.3% triethylamine as the mobile phase at a flow rate of 1.5 mL min-1 and UV detection at 270 nm. The sample preparation was carried out by liquid-liquid extraction using ethyl acetate as extractor solvent. The method was linear over the concentration range of 100 -10000 ng mL-1 for each enantiomer of donepezil (r 0.9985) and of 100 - 5000 ng mL-1 for each enantiomer of 5-O-desmethyl donepezil and 6-Odesmethyl donepezil (r 0.9951). Within-day and between-day precision and accuracy evaluated by RSDs and relative errors, respectively, were lower than 15% for all analytes. The recoveries were higher that 90% for all analytes. The validated method was used to assess the donepezil biotransformation by five endophytes and by Cunninghamella elegans ATCC 10028B e Beauveria bassiana ATCC 7159 fungi. The endophytic fungi do not demethylate donepezil at the studied conditions. On the other hand, Beauveria bassiana ATCC 7159 biotransformed 8.3% of donepezil to (-)- (R)-5-O-desmethyl donepezil (ee, 60.6%), while Cunninghamella elegans ATCC 10028B biotransformed 15.1% of donepezil to (-)-(R)-6-O-desmethyl donepezil (ee, 100%). The data presented here show that the biotransformations with fungi are an important alternative to mimetize biotransformations in mammals and to obtain drug metabolites, especially as pure enantiomers.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

Η υδροχλωρική δονεπεζίλη (Donepezil.HCl, DPZ) είναι ένα φάρμακο που λαμβάνεται για τη θεραπεία της νόσου Altzheimer. Δρα ως ανασολέας της ακετυλοχοληστερινάσης, ενός ενζύμου υπεύθυνου για την καταστροφή του νευροδιαβιβαστή ακετυλοχολίνη, αυξάνοντας το ποσό της ακετυλοχολίνης στον εγκέφαλο. Παρουσιάζει διάφορες κρυσταλλικές μορφές, συμπεριλαμβανομένων δύο ένυδρων, καθώς και μια άμορφη φάση. Τα δισκία Υδροχλωρικής Δονεπεζίλης λαμβάνονται από το στόμα και μπορεί να αποθηκευθούν για κάποιο χρονικό διάστημα πριν χρησιμοποιηθούν. Τα δισκία DPZ ισχύος 10 mg περιέχουν 3.6 % API, ενώ στις περιπτώσεις όπου λαμβάνει χώρα πολυμορφική μετατροπή, η επιμέρους περιεκτικότητα κάθε πολυμόρφου είναι ακόμα μικρότερη. Η ταυτοποίηση και ποσοτική ανάλυση των πολυμόρφων ή ένυδρων μορφών είναι δυνατή μόνο με τη χρήση περίθλασης ακτίνων Χ και δονητικών φασματοσκοπικών τεχνικών. Λόγω του μικρού ποσοστού της δραστικής ουσίας στα δισκία και της πιθανής παρουσίας περισσοτέρων του ενός πολυμόρφου αλλά και του μεγάλου σχετικά ορίου ανίχνευσης αυτών των τεχνικών η ταυτοποίηση και ποσοτική ανάλυση είναι μια αναλυτική πρόκληση. Στην παρούσα εργασία έγινε προσπάθεια ταυτοποίησης των κρυσταλλικών μορφών του DPZ σε δισκία και έλεγχος της σταθερότητάς τους μετά από διάφορες διαδικασίες παρασκευής των δισκίων, καθώς και μετά από αποθήκευση σε διάφορες συνθήκες υγρασίας και θερμοκρασίας, χρησιμοποιώντας τις πειραματικές τεχνικές XRD, FT-IR και FT-Raman. Παρατηρήθηκε ότι η προέλευση του API, οι συνθήκες αποθήκευσης και κυρίως η μέθοδος παρασκευής των δισκίων επηρεάζουν τη σταθερότητα των φαρμακευτικών σκευασμάτων. Με στόχο τη διερεύνηση της δυνατότητας ανάπτυξης ποσοτικών αναλυτικών μεθόδων προσδιορισμού των πολυμόρφων Ι και ΙΙΙ του DPZ σε δισκία, οι παραπάνω τεχνικές χρησιμοποιήθηκαν για τον υπολογισμό των ορίων ανίχνευσης των δύο πολυμόρφων (0.35% κ.β. για το πολύμορφο Ι και 0.44 % κ.β. για το πολύμορφο ΙΙΙ με την τεχνική Raman, 0.95% κ.β. για το πολύμορφο Ι και 1.3 % κ.β. για το πολύμορφο ΙΙΙ με την τεχνική XRD, 1.2% κ.β. για τη μορφή Ι και 1.0 % κ.β. για τη μορφή ΙΙΙ με την τεχνική IR, όπως προέκυψαν μετά από στατιστική επεξεργασία των πειραματικών δεδομένων των διαφόρων τεχνικών), καθώς και για τον ποσοτικό τους προσδιορισμό. Η τεχνική Raman φαίνεται να μπορεί χρησιμοποιηθεί για ποσοτική ανάλυση των πολυμόρφων Ι και ΙΙΙ του DPZ σε δισκία, ενώ επιπλέον η ποσοτική μέθοδος που παρουσιάσθηκε εδώ είναι απλή και μη καταστροφική για τα δείγματα. Η μέθοδος XRD μπορεί πιθανόν να χρησιμοποιηθεί για την ποσοτική ανάλυση δισκίων DPZ, με μεγαλύτερο όμως σφάλμα σε σύγκριση με την τεχνική Raman, ενώ η μέθοδος FT-IR ATR, παρέχει τα λιγότερο καλά ποσοτικά αποτελέσματα, ακόμα και στην περίπτωση που το δισκίο περιέχει αποκλειστικά το ένα από τα δύο πολύμορφα. Τέλος, με στόχο την ερμηνεία των φασμάτων δόνησης που καταγράφησαν στην παρούσα εργασία, υπολογίστηκαν η σταθερή δομή του μορίου της Δονεπεζίλης και της ένυδρης Δονεπεζίλης (με ένα μόριο νερού ανά μόριο Δονεπεζίλης) και τα φάσματα δόνησης (IR και Raman) με τις μεθόδους Hartree-Fock ab-initio και DFT (Density Functional Theory) και χρήση του υπολογιστικού πακέτου Gaussian09. / Donepezil hydrochloride (DPZ) is a medication used to treat Altzheimer’s disease. It acts as an inhibitor of acetylcholisterinase, an enzyme responsible for the destruction of the neurotransmitter acetylcholine, thus increasing the level of acetylcholine in the brain. As most of the pharmaceutical solids, DPZ exhibits polymorphism. Donepezil hydrochloride has different crystalline forms, including two hydrates, as well as an amorphous phase. DPZ is available for oral administration in tablets which can be stored for some time before use. In the present study, an effort was made to identify the crystal form of DPZ in tablets, as well as to test its stability against time, temperature and humidity, after various manufacturing processes, using XRD, FT-IR and FT-Raman techniques. The data showed that the origin of the API, the storing conditions and mainly the manufacturing process of the tablets affect the stability of the API. Quantitative determination of polymorphs I and III of DPZ in tablets was also attempted using the above experimental methods. Calibration models were constructed and applied in DPZ tablets. The detection limits of polymorphs I and III of DPZ for each technique, derived after statistical treatment of the experimental data, were calculated. Raman spectroscopy exhibited the lower detection limit (0.35 weigh % for polymorph Ι and 0.44 % weigh % for polymorph ΙΙΙ) compared with XRD (0.95% weigh % for polymorph Ι and 1.3 % weigh % for polymorph ΙΙΙ) and IR spectroscopy (1.2% weigh % for polymorph Ι and 1.0 % weigh % for polymorph ΙΙΙ). The data suggest that Raman spectroscopy could be applied to quantify polymorphs I and III in DPZ tablets; moreover, the Raman quantitative method presented in this work is simple and non-destructive for the tablets. The application of the X ray diffraction method for the quantitative analysis of polymorphs I and III in tablets yielded larger errors compared with Raman spectroscopy, while the FT-IR ATR technique yielded poor quantitative results, even in the case that only one polymorph was present in DPZ tablets. Finaly, in order to facilitate the assignment of the vibrational spectra recorded in this study, the optimized structure and the vibrational spectra (IR and Raman) of Donepezil and Donepezil hydrate (Donepezil:H20 = 1:1) molecules were calculated at the Hartree-Fock and DFT (Density Functional Theory) level of theory using the Gaussian 09 program package. The weigh % of the API in the tablets containing 10 mg of DPZ is 3.6 %. In cases where two or more polymorphs are present, the weigh % of each polymorphic form is lower. The difficulty in the identification and quantification of the crystal phase of DPZ is stemming from the small percentage of the API in the tablets, the considerable overlapping of DPZ XRPD patterns and IR and Raman spectra of the polymorphs and the excipients and the availability of various polymorphs.

Cholinesterase inhibitors (ChEIs) are the first line pharmacotherapy for the symptoms of Alzheimer’s disease (AD). Though ChEIs offer modest cognitive benefits in early AD, literature addressing their continued use in severe AD is scarce. This study assessed the safety of discontinuing ChEIs in institutionalized moderate-severe AD patients. Twenty-six patients were randomized, double-blind to ChEI continuation or placebo for 8-weeks. Vitals, weight (kg) and adverse events (AEs) were monitored biweekly. Chi-square test revealed no significant association between semi-blinded treatment allocation and AE occurrence (χ²=(1,26)=0.99, p=0.32). Groups showed no differences on clinically significant weight loss (χ²=(1,26) =1.9, p=0.17), mean weight loss (F=.531, p= .473), pulse rate (F=.624, p=.437), or side effects (F=.224, p=.640). Preliminary results suggest that either ChEIs are well tolerated or that these drugs are no longer providing therapeutic benefit. Study completion (recruitment of 60 patients and unblinding) will generate more comprehensive data for determination of safe ChEI discontinuation guidelines.

Cholinesterase inhibitors (ChEIs) are the first line pharmacotherapy for the symptoms of Alzheimer’s disease (AD). Though ChEIs offer modest cognitive benefits in early AD, literature addressing their continued use in severe AD is scarce. This study assessed the safety of discontinuing ChEIs in institutionalized moderate-severe AD patients. Twenty-six patients were randomized, double-blind to ChEI continuation or placebo for 8-weeks. Vitals, weight (kg) and adverse events (AEs) were monitored biweekly. Chi-square test revealed no significant association between semi-blinded treatment allocation and AE occurrence (χ²=(1,26)=0.99, p=0.32). Groups showed no differences on clinically significant weight loss (χ²=(1,26) =1.9, p=0.17), mean weight loss (F=.531, p= .473), pulse rate (F=.624, p=.437), or side effects (F=.224, p=.640). Preliminary results suggest that either ChEIs are well tolerated or that these drugs are no longer providing therapeutic benefit. Study completion (recruitment of 60 patients and unblinding) will generate more comprehensive data for determination of safe ChEI discontinuation guidelines.

Background: Dementia leads to progressive cognitive and functional decline. Population aging is a concern, and the healthcare system must refocus its limited resources to keep up with service demands. Three cholinesterase inhibitors (ChEIs) – donepezil, galantamine and rivastigmine – have been approved for the treatment of dementia and are covered under Ontario’s formulary plan, but there has been little research regarding their economic impact. Methods: The purpose of this study was to describe the patterns of use of ChEIs, and to assess associated health resource utilization and costs to Ontario’s healthcare system. Anonymized patient-level data from seven provincial administrative databases were linked at the Institute for Clinical and Evaluative Sciences at Queen’s University. First-time users of ChEIs aged 66 years and older were identified between April 1st, 2004 and March 31st, 2009, and were followed until treatment discontinuation or up to one year following their index date. Health resource use was classified into six care categories: prescription drugs, physicians, long-term care, home care nursing, emergency department, and hospitalizations. Chi-square, Kruskal-Wallis ANOVA and linear regression were employed to compare resource use between users of the three ChEIs. Results: In the cohort (N=40,057), the majority were prescribed donepezil (n=24,347), were female (60.5%) and had at least one other co-morbid disease. The odds of discontinuation were 1.47 (1.36, 1.60) and 1.26 (1.17, 136), higher for rivastigmine users than galantamine and donepezil users, respectively. Between 2005 and 2008, overall healthcare costs increased from $95.2 million to $106.1 million. Prescription drugs comprised 33% of all healthcare costs. ChEIs accounted for half of all prescription drug costs. Overall mean annual healthcare system cost per patient was $12,679.47 ($12,510.86, $12,848.08). Predictors of overall healthcare costs included long-term care, co-morbidity status, hospitalization and hip fractures. Conclusions: Prescription drugs account for a substantial proportion of healthcare costs for patients with dementia, and the amount attributable to ChEIs alone is significant. Knowing the health service utilization patterns for dementia patients can help healthcare professionals and decision-makers plan patient care and timely resource allocation. The results stress the utility of administrative databases and the need for further research for this disease. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-11-01 15:49:58.417