The increasing reliance on drugs from natural sources has led to the development of several drugs from traditional plants which are present in abundance in Southern Africa. With the rapid increase of incidence of type 2 diabetes in South Africa with potentially devastating effects on healthcare, the need for alternative therapeutics is a priority. In this study, Schkuhria pinnata (Lam.) Kuntze was investigated for its antidiabetic potential. Initial screening of two different solvent extracts of S. pinnata identified an aqueous extract that lowered blood glucose concentrations in a hyperglycaemic streptozotocin-induced diabetic rat. The classical bioassay approach was followed by using different solvents, drying processes and fractionation in order to produce the most active extract and attempt to isolate an active compound(s). An aqueous freeze dried extract was found to be the most active at stimulating glucose uptake activity in C2C12 and Chang cells. Fractionation of this extract in an attempt to identify the active compound yielded a novel crystalline compound 1 by NMR analysis. Screening for bioactivity of the extract and compound 1 using C2C12 muscle and Chang cells revealed that both extract and compound 1 were biologically active, however the activity of the aqueous extract was more significant overall. A butanone/pentane extract prepared for possible commercialization purposes was also shown to be active in vitro. To establish antidiabetic activity, the aqueous freeze dried extract, butanone/pentane extract and the enriched compound 1 fraction were tested in a streptozotocin (STZ) diabetic rat model showing hypoglycaemic effects for the aqueous freeze dried extract. Messenger RNA and protein studies on C2C12 muscle cells revealed that the aqueous freeze dried extract and compound 1 enhanced insulin receptor, GLUT-4, glycogen synthase, pyruvate kinase and pyruvate carboxylase expression, suggestive of an insulin mimetic mode of action, while the butanone/pentane extract enhanced adenosine monophosphate-activated kinase (AMPK) protein expression by a non-insulin dependent mechanism. A pharmacokinetic study (PK) established bioavailability of compound 1 following oral administration of the extracts, but not from the compound 1 enriched fraction. From this study, the traditional use of S. pinnata has been scientifically validated as having antidiabetic properties. In vitro and in vivo bioassays, confirmed that an aqueous freeze dried extract which was prepared as per the traditional method had the most promising antidiabetic iii activity. Compound 1 isolated from an active fraction was proven to be almost as effective as the parent extract in in vitro studies. This compound could therefore be the major active ingredient responsible for the uptake of glucose in cells and the hypoglycaemic activity in vivo. In this study, the antidiabetic activities together with the mechanism of action of S. pinnata extracts and compound 1 were elucidated. The highlight of the study was the identification of a bioactive novel chemical entity (NCE) compound 1 (identified as 2-(2-{[(2E)-4-hydroxy2-(hydroxymethyl)but-2-enoyl]oxy}-4,7-dimethyl-1,2,3,4-tetrahydronaphthalen-1-yl)prop-2- enoic acid) isolated from an active fraction of S. pinnata that was proven to be almost as effective as the parent extract in in vitro studies. This compound could therefore be the major active ingredient responsible for the uptake of glucose in cells and the hypoglycaemic activity in vivo. The cellular mechanism of action of the S. pinnata extracts and compound 1 demonstrated both insulin mimetic and non-insulin dependent mechanisms (AMPK) in C2C12 muscle cells. Further research in the form of preclinical and clinical trials need to be undertaken to make this extract or biologically active compound available as a herbal remedy or nutraceutical therapeutic for diabetes. To achieve this; safety, efficacy and mode of action studies will have to be established. The synthesis of compound 1 and/or analogues should also be investigated as an antidiabetic drug candidate.

Dynamic contrast enhanced MR imaging (DCE-MRI) has commonly been used to investigate disruptions in microvascular capillary permeability in pathologies such as tumours, and in brain diseases such as multiple sclerosis. This imaging technique involves intravenous injection of a contrast agent, which can modulate MR signal contrast, while frequently acquiring images (i.e. every few seconds) as the agent perfuses through the tissue of interest. Microvascular permeability, and other parameters such as blood volume and flow (perfusion) can be quantified through application of a pharmacokinetic model on the data acquired from the MRI scan. The model requires input from both the biological (e.g. pharmacokinetic rate constants) as well as physical (i.e. scanner settings) parameters. As there are a great many variables and different biophysical models (e.g. high blood flow, high permeability tissues, etc.) there needs to be considerations made for situations where the permeability may be only slightly different from normal. In the brain the blood-brain barrier (BBB) is a highly selective barrier that restricts most bulk diffusion/permeability of solutes. Changes in BBB permeability is likely only subtle in diseases such as depression or bipolar disorder, especially when compared against hypervascular-hypermemeable cancers that are void of a BBB altogether. The problem is however, to decide which model of BBB permeability is best suited for differentiating subtle changes. Thus the intention of this project was to investigate multiple pharmacokinetic models for the tracking of MRI contrast agent in regions of the brain with an intact BBB. In the brain, where there is strict regulation of molecules passing through the microvasculature into the extracellular space, and where more subtle disruptions might be of interest, different assumptions may be necessary. Four models were investigated: the Tofts model, the modified Tofts model, the two-compartment exchange model, and the uptake model. Scans of eight healthy subjects were analyzed, and permeability was quantified using each model. The accuracy of each model, quantified by the R\textsuperscript{2} value, were compared. Analysis found that the Tofts model performed significantly worse than the modified Tofts and Uptake models when fitting regions of the brain with a blood-brain barrier, with a p-value of 0.006. The analysis did not reveal any significant difference between the modified Tofts, Uptake or 2CX models, although perhaps it was obscured due to the limited number of data points. Further investigation is needed to determine any differences between the three top-performing models. / Thesis / Master of Applied Science (MASc)

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No description available.

No description available.

In clinical experiments, the evolution of a product concentration in tissue over time is often under study. Different products and tissues may be considered. For instance, one could analyse the evolution of drug concentration in plasma over time, by performing successive blood sampling from the subjects participating to the clinical study. One could also observe the evolution of radioactivity uptakes in different regions of the brain during a PET scan (Positron Emission Tomography). The global objective of this thesis is the modelling of such evolutions, which will be called, generically, pharmacokinetic curves (PK curves). Some clinical measures of interest are derived from PK curves. For instance, when analysing the evolution of drug concentration in plasma, PK parameters such as the area under the curve (AUC), the maximal concentration (Cmax) and the time at which it occurs (tmax) are usually reported. In a PET study, one could measure Receptor Occupancy (RO) in some regions of the brain, i.e. the percentage of specific receptors to which the drug is bound. Such clinical measures may be badly estimated if the PK curves are noisy. Our objective is to provide statistical tools to get better estimations of the clinical measures of interest from appropriately smoothed PK curves. Plenty of literature addresses the problem of PK curves fitting using parametric models. It usually relies on a compartmental approach to describe the kinetic of the product under study. The use of parametric models to fit PK curves can lead to problems in some specific cases. Firstly, the estimation procedures rely on algorithms which convergence can be hard to attain with sparse and/or noisy data. Secondly, it may be difficult to choose the adequate underlying compartmental model, especially when a new drug is under study and its kinetic is not well known. The method that we advocate to fit such PK curves is based on Bayesian Penalized splines (P-splines): it provides good results both in terms of PK curves fitting and clinical measures estimations. It avoids the difficult choice of a compartmental model and is more robust than parametric models to a small sample size or a low signal to noise ratio. Working in a Bayesian context provides several advantages: prior information can be injected, models can easily be generalized and extended to hierarchical settings, and uncertainty for associated clinical parameters are straightforwardly derived from credible intervals obtained by MCMC methods. These are major advantages over traditional frequentist approaches.

Tumors have several important hallmarks; anomalous and heterogeneous behaviors of their vascular structures, and high angiogenesis and neovascularization. Tumor tissue presents high blood flow (F) and extraction ratio (E) of contrast molecules. Consequently there is growing interest in non invasive methods for characterizing changes in tumor vasculature. Toft's model has been extensively used in the past in order to calculate Ktrans maps which take into consideration both F and E. However, in this thesis we argue that for accurate tumor characterization we need a model able to compute both F and E in tissue plasma. This project has been developed as part of a larger project, working toward building a Clinical Decision Support System (CDSS): an interactive expert computer software, that helps doctors and other health professionals make decisions regarding patient treatment progress. Using the Gamma Capillary Transit Time (GCTT) pharmacokinetic model we calculate F and E separately in a more realistic framework; unlike other models it takes into account the heterogeneity of the tumor, which depends on parameter a-1. a-1 is the width of the distribution of the capillary transit times within a tissue voxel. In more detail, a-1 expresses the heterogeneity of tissue microcirculation and microvasculature. We studied 9 patients pathologically diagnosed with glioblastoma multiforme (GBM), a common malignant type of brain tumor. Several physiological parameters including the blood flow and extraction ratio distributions were calculated for each patient. Then we investigated if these parameters can characterize early the patients' responsiveness to current treatment; we assessed the classification potential based on the actual therapy outcome. To this end, we present a novel analysis framework which exploits the new parameter a-1 and organizes each voxel into four sub-region. Our results indicate that early characterization of response based on GCCT can be significantly improved by focusing on tumor voxels from a specific sub-region.

O citalopram (CITA), inibidor seletivo da recaptação da serotonina, é disponível na clínica como mistura racêmica dos enantiômeros (+)-(S) e (-)-(R) ou como enantiômero puro (+)-(S)-CITA. O CITA é metabolizado pelo CYP2C19, CYP2D6 e CYP3A ao desmetilcitalopram (DCITA) e pelo CYP2D6 ao didesmetilcitalopram. O estudo investiga a influência de inibidores enzimáticos no metabolismo enantiosseletivo do CITA em ratos e em voluntários sadios. Os ratos machos Wistar (n=6 para cada grupo) foram tratados com dose única de 20 mg/Kg de CITA (grupo controle) ou pré-tratados com 80 mg/Kg de quinidina (grupo quinidina), 10 mg/Kg de fluvoxamina (grupo fluvoxamina) ou 50 mg/Kg de cetoconazol (grupo cetoconazol). As amostras de sangue foram colhidas dos ratos até 20 h após a administração do CITA. Os voluntários sadios fenotipados como metabolizadores extensivos (EM) do CYP2C19 (omeprazol como fármaco marcador), EM do CYP2D6 (debrisoquina como fármaco marcador) e com atividade normal do CYP3A (midazolam como fármaco marcador) receberam dose única p.o. de 20 mg de CITA racêmico associado ou não ao omeprazol (20 mg/dia durante 18 dias). Os enantiômeros do CITA e do DCITA foram analisados no sistema LC-MS/MS, com a coluna quiral Chiralcel OD-R e fase móvel constituída por acetonitrila:metanol:água (30:30:40 v/v/v) contendo 0,05 % de dietilamina. O método foi linear no intervalo de concentrações de 0,1 20 ng de cada enantiômero do CITA e DCITA/mL de plasma humano e de de 0,1 500 ng de cada enantiômero do CITA e DCITA/mL de plasma de rato. Os coeficientes de variação obtidos nos estudos da precisão e a inexatidão foram inferiores a 15 % para plasma humano e plasma de ratos. A disposição cinética do CITA é enantiosseletiva nos ratos dos grupos controle (razão de AUCS/R de 0,4), quinidina (razão de AUCS/R de 0,5) e cetoconazol (razão de AUCS/R de 0,8). A inibição do CYP2D pela quinidina resultou em inibição do metabolismo do CITA e do DCITA de maneira não enantiosseletiva. A inibição do CYP2C pela fluvoxamina e do CYP3A pelo cetoconazol resultou em inibição somente do metabolismo do (+)-(S)-CITA. A disposição cinética do CITA em voluntários sadios é enantiosseletiva na ausência de tratamento com o omeprazol com observação de maior proporção plasmática do enantiômero (-)-(R)-CITA. A razão de AUCS/R obtida para o CITA foi de 0,56 e para o metabólito DCITA foi de 1,06. A administração de CITA racêmico a voluntários sadios em tratamento com o omeprazol exibe perda da enantiosseletividade na farmacocinética do CITA. A razão de AUCS/R foi de 0,96 para o CITA e de 0,92 para o DCITA. A administração de omeprazol em doses múltiplas a voluntários sadios inibe de maneira enantiosseletiva o metabolismo do eutômero (+)-(S)-CITA com aumento das concentrações plasmáticas em aproximadamente 140%. / Citalopram (CITA), a selective serotonin reuptake inhibitor, is available for clinical use as a racemic mixture of the (+)-(S) and (-)-(R) enantiomers or as the pure (+)-(S)-CITA enantiomer. CITA is metabolized by CYP2C19, CYP2D6 and CYP3A to demethylcitalopram (DCITA) and by CYP2D6 to didemethylcitalopram. The present study investigated the influence of enzyme inhibitors on the enantioselective metabolism of CITA in rats and healthy volunteers. Male Wistar rats (n=6 for each group) received a single dose of 20 mg/kg CITA (control group) or were pretreated with 80 mg/kg quinidine (quinidine group), 10 mg/kg fluvoxamine (fluvoxamine group), or 50 mg/kg ketoconazole (ketoconazole group). Blood samples were collected from the animals up to 20 h after the administration of CITA. Healthy volunteers phenotyped as extensive metabolizers of CYP2C19 (omeprazole as marker drug) and of CYP2D6 (debrisoquine as marker drug) and those with normal CYP3A activity (midazolam as marker drug) received a single oral dose of 20 mg racemic CITA combined or not with omeprazole (20 mg/day for 18 days). The CITA and DCITA enantiomers were analyzed by LC-MS/MS using a Chiralcel OD-R chiral column and a mobile phase of acetonitrile:methanol:water (30:30:40, v/v/v) containing 0.05% diethylamine. The method was linear in the concentration range of 0.1-20 ng of each CITA and DCITA enantiomer/mL human plasma and of 0.1-500 ng of each CITA and DCITA enantiomer/mL rat plasma. Accuracy and precision were below the acceptance limits of 15% for human and rat plasma. The kinetic disposition of CITA was enantioselective in rats of the control (AUCS/R ratio = 0.4), quinidine (AUCS/R ratio = 0.5) and ketoconazole (AUCS/R ratio = 0.8) groups. The inhibition of CYP2D by quinidine resulted in the non-enantioselective inhibition of the metabolism of CITA and DCITA. The inhibition of CYP2C by fluvoxamine and of CYP3A by ketoconazole only inhibited the metabolism of (+)-(S)-CITA. The kinetic disposition of CITA in healthy volunteers was enantioselective in the absence of treatment with omeprazole, with the observation of a higher plasma proportion of the (-)-(R)-CITA enantiomer. The AUCS/R ratio was 0.56 for CITA and 1.06 for the DCITA metabolite. The administration of racemic CITA to healthy volunteers treated with omeprazole showed a loss of enantioselectivity in the pharmacokinetics of CITA. The AUCS/R ratio was 0.96 for CITA and 0.92 for DCITA. The administration of multiple doses of omeprazole to healthy volunteers enantioselectively inhibited the metabolism of the (+)-(S)-CITA eutomer, with an approximately 140% increase of plasma concentrations

Objetivos: O objetivo deste trabalho foi desenvolver modelo farmacocinético (popPK) populacional para descrever simultaneamente as concentrações das fluoroquinolonas (levofloxacino – LEV e ciprofloxacino – CIP) no plasma, pulmão e próstata na presença e ausência do inibidor da P-gp tariquidar (TAR) visando determinar a contribuição desse transportador de efluxo na distribuição tecidual desses antimicrobianos. Método: Para alcançar este objetivo as seguintes etapas foram realizadas: i) foi validado o método analítico de HPLC-fluorescência para quantificação de CIP em amostras de plasma e microdialisado; ii) foram estabelecidas as condições para microdiálise para o CIP e as taxas de recuperação in vitro, por diálise e retrodiálise, e em tecido pulmonar e prostático in vivo por retrodiálise; iii) foi avaliada a farmacocinética do LEV após administração a ratos Wistar via i.v. bolus e por nebulização intratraqueal na dose de 7mg/kg na ausência e após administração prévia de TAR (15 mg/Kg i.v.); iv) foi desenvolvido um modelo popPK para prever as concentrações do LEV simultaneamente no plasma, pulmão e próstata após administração intravenosa e intratraqueal na presença e ausência do TAR; v) foi desenvolvido o modelo popPK para descrever as concentrações de CIP simultaneamente no plasma, pulmão e próstata após administração a ratos Wistar da dose de 7 mg/kg i.v. bolus na presença e ausência de TAR (15 mg/kg i.v.); vi) Para ambos os fármacos os dados foram avaliados por análise não-compartimental e modelados por modelo de quatro compartimentos modificado, com ajuda do software NONMEN®. Resultados e Conclusões. i) Método analítico foi desenvolvido e validado com sucesso para quantificação de CIP em HPLC/fluorescência mostrando-se linear na faixa de 10–2000 ng/mL em plasma e 5–1000 ng/mL em microdialisado com coeficientes de determinação (r2) superiores a 0,99. Os valores obtidos de erro padrão relativo para ensaios de precisão intra e inter-dia foram entre 8,8 e 6,0 %, para microdialisado entre 11,1 e 7,4 % para plasma, respectivamente. Os valores de exatidão foram 86,1% entre 114.3% para microdialisado e 85,6% entre 108,2% para plasma; ii) A avaliação do CIP por microdiálise mostrou recuperação concentração independente (0,25 - 1,5 μg/mL). Além disso, não houve diferença entre as recuperações obtidas por diálise e retrodiálise para o mesmo fluxo. No fluxo selecionado para os experimentos (1,5 μL/min) as recuperações médias por diálise e retrodiálise foram 23,0 ± 2,8% e 22,8 ± 1,6 %, respectivamente. A recuperação relativa das sondas in vivo foi de 11,3 ± 1,9 e 13,1 ± 2,7 % para pulmão e próstata, respectivamente; iii) A análise dos perfis plasmáticos e teciduais LEV após dose intravenosa do grupo controle (sem TAR) mostrou boa penetração tecidual na próstata (ƒT = 0,68) e no pulmão (ƒT = 0,69). Para a mesma via de administração, o grupo TAR mostrou uma penetração praticamente inalterada para o pulmão (ƒT = 0,81) e um aumento de mais de 2 vezes na penetração prostática (ƒT= 1,64). Na dose intratraqueal houve um aumento significativo na biodisponibilidade para o grupo TAR (F = 0,86) em relação ao controle (F = 0,4). Nessa via de administração foi detectado um aumento significativo na exposição (ASC) do pulmão ao LEV no grupo TAR demonstrando que o transporte por efluxo no pulmão é mais relevante quando o fármaco é administrado pela via intratraqueal; iv) Para o LEV, o modelo popPK de quatro compartimentos foi capaz de descrever simultaneamente os dados no plasma, pulmão e próstata na presença e ausência do TAR. Além disso, o modelo para administração intravenosa foi estendido e adaptado para administração intratraqueal. Foi possível analisar o impacto do transporte por efluxo sobre a penetração tecidual do LEV por diferentes vias de administração utilizando o modelo popPK; v) A avaliação do perfil farmacocinético plasmático do CIP após administração intravenosa, na presença e ausência de TAR, demonstrou diferença significativa entre todos os parâmetros calculados por análise não-compartimental, exceto para a constante de velocidade de eliminação (= 0,05). Em relação à penetração tecidual do CIP na próstata e pulmão, não houve alteração significativa nos parâmetros de eliminação e exposição tecidual do fármaco na presença do inibidor de efluxo TAR ( = 0,05), demonstrando que o transporte por efluxo possui papel minoritário no processo de distribuição do fármaco para os tecidos estudados. O modelo popPK de quatro compartimentos foi capaz de descrever as concentrações plasmáticas totais, livres no pulmão e próstata em presença e ausência de TAR, simultaneamente; vi) O modelo popPK desenvolvido permitiu o estudo mais profundo do processo de distribuição do LEV e do CIP no pulmão e próstata. / Objectives: The aim of this study was to develop a population pharmacokinetic model (popPK) able to simultaneously describe fluoroquinolones (levofloxacin – LEV and ciprofloxacin – CIP) concentrations in plasma, lung and prostate in the presence and absence of the inhibitor of P-gp tariquidar (TAR) to determine the contribution of this efflux transporter on the tissue distribution of these antimicrobials. Methods: To achieve this goal the following steps were taken: i) An analytical method by HPLC-fluorescence was developed and validated for CIP analysis in plasma and microdialysate samples; ii) microdialysis conditions were established for CIP including determination of in vitro relative recovery by dialysis and retrodialysis. The relative recovery was also determined in vivo, in lung and prostate, by retrodialysis; iii) LEV pharmacokinetics was evaluated after intravenous (i.v.) bolus and intratracheal (i.t.) administration of 7 mg/kg dose alone and following TAR administration (15 mg/kg i.v.) to Wistar rats; iv) a popPK model was developed to describe and predict LEV concentrations in plasma, lung and prostate following i.v. and i.t. dosing with and without TAR co-administration; v) the popPK model developed was used to describe CIP concentrations in plasma, lung and prostate after i.v. bolus administration of 7 mg/kg in presence and absence of TAR; vi) For both drugs non-compartmental analysis was performed besides data modeling by four compartment model using NONMEN®. Results and Conclusions i) The analytical method was developed and successfully validated for quantification of CIP by HPLC/fluorescence. The method was linear in the range of 10-2000 ng/mL in plasma and 5-1000 ng/mL in tissues microdialysate samples with coefficients of determination (r2) higher than 0.99. The relative standard error (RSD) obtained for intra and inter-day precision were lower than 8.8% and 6.0% for microdialysate and lower than 11.1 and 7.4% for plasma, respectively. The accuracy was 86.1% to 114.3% for microdialysate and 85.6 to 108.2 % for plasma samples; ii) the evaluation of CIP microdialysis probes relative recovery in vitro showed that the recovery was concentration independent (0.25 to 1.5 μg/mL). In addition, there was no statistical difference between the recoveries determined by dialysis and retrodialysis at the same flow rate. Using the selected flow rate (1.5 μL/min) the recoveries by dialysis and retrodialysis were 23.0 ± 2.8% and 22.8 ± 1.6%, respectively. CIP relative recoveries in vivo by retrodialysis were 11.3 ± 1.9 and 13.1 ± 2.7% for lung and prostate, respectively; iii) the analysis of LEV plasma and tissues concentration-time profiles after i.v. dosing showed a good tissue penetration of LEV in the prostate (ƒT = 0.68) and lung (ƒT = 0.69). For the same route of administration, TAR group showed virtually the same penetration into lung (ƒT = 0.81) and an increase of over 2 fold in drug levels in prostate (ƒT = 1.64). For the i.t. dose, there was a significant increase on LEV bioavailability for TAR group (F = 0.86) compared to control (F = 0.4). Furthermore, a significant increase was detected on lung exposure to LEV for TAR group indicating that efflux transport in the lung is more relevant when the drug is administered by the i.t. route; iv) For LEV, a four compartment model was able to describe the data simultaneously in plasma, lung and prostate in the presence and absence of TAR. Moreover, the intravenous model was extended to adapt the intratracheal dosing route. The popPK model allowed to analyze the impact of efflux transport on tissue LEV penetration of different routes of administration; v) the evaluation of plasma CIP profiles after i.v. dosing with and without TAR showed a significant difference in all parameters determined by non-compartmental analysis in the TAR group, except the elimination rate constant (α = 0.05). The CIP tissue penetration in prostate and lung, no significant difference was observed in tissues exposure and elimination rate when TAR was present demonstrating that efflux transporter play a minor role on CIP distribution to tissues investigated (α = 0.05). The popPK model with four compartments was able to describe CIP concentrations in plasma, lung and prostate in the presence and absence of TAR, simultaneously; vi) the popPK model developed allowed a more detailed investigation of LEV and CIP distribution process in lung and prostate.

Le choc septique est défini par une hypotension persistante malgré un remplissage vasculaire adéquat en présence d’une réponse inflammatoire systémique suite à une infection. Il est responsable de 10% des admissions en réanimation et malgré des progrès thérapeutiques constants, la mortalité liée au sepsis varie entre 30% et 60% dans les cas de choc septique. Dans 50% des cas, le choc septique est associé à une insuffisance surrénale relative ce qui diminue la probabilité de survie des patients. Les patients sont alors traités avec de l’hydrocortisone et de la fludrocortisone, mais ce traitement est très controversé. Pour la première fois, nous avons pu mettre au point et valider une technique de quantification de la fludrocortisone plasmatique après une prise de 50 μg. Cette technique a pu ensuite être utilisée pour l’obtention de l’étude pharmacocinétique/pharmacodynamique de la fludrocortisone chez le volontaire sain et le patient septique avec insuffisance surrénale relative. Enfin, nous avons étudié la distribution et l’élimination de cette molécule chez la souris saine et deux modèles de sepsis. Les paramètres pharmacocinétiques montrent que la demi-vie de la fludrocortisone est d’environ 1 h, avec un délai d’absorption d’environ 50 minutes. Nos travaux ont permis de mettre en évidence qu’il existe deux populations de patients : les absorbants et les non-absorbants la fludrocortisone, qui représentent 30 % des patients testés, ce qui pourrait être à l’origine de la controverse sur les effets bénéfiques de cette molécule sur la survie des patients. Cependant nous n’avons pu mettre en évidence aucun effet hémodynamique de cette molécule sur les patients septiques. / The septic shock is defined by persistent hypotension despite fluid resuscitation with systemic inflammation due to infection. This is the cause of 10% of the admission in intensive care unit. Despite steady progress in therapeutics, the mortality of patients with sepsis varies between 30% to 60% for a septic shock. In 50%, the septic shock is associated to relative adrenal insufficiency which decrease survival probability of the patients. The patients receive hydrocortisone and fludrocortisone but this treatment is still controversial. For the first time, we developped and validated a quantification method of low concentration fludrocortisone in plasma. This method were used for the pharmacokinetic/pharmacodynamic study of fludrocortisone in healthy volunteers and patients with septic shock associated with relative adrenal insufficiency. Then we studied the distribution and elimination of this molecule in two mice models of sepsis. The pharmacokinetic parameters show that the half-life of fludrocortisone is about 1h and the delay of absorption is about 50min. Our study shows two groups of patients : absorbent patients and non-absorbent patients which have no detectable fludrocortisone concentrations in plasma. This population represents 30% of the population. This could be the reason of the controversial results. No hemodynamic effetc were found in patients with septic shock due to fludrocortisone after low-dosage administration.