Chez les animaux de laboratoire, même si les anesthésiques par inhalation sont généralement plus sécuritaires que les injectables, leur utilité est souvent restreinte lorsqu’un protocole expérimental exige une autre approche. Des combinaisons d’anesthésiques contenant de la kétamine sont considérées comme l’option de choix pour les anesthésies injectables chez les rats. Le vieillissement entraîne des changements dégénératifs au niveau de la structure et la fonction des organes, modifiant souvent à la pharmacocinétique des drogues. Ce projet porte sur l’évaluation des changements pharmacodynamiques (physiologiques, biochimiques et histologiques) et pharmacocinétiques, lors d’une combinaison anesthésique de kétamine-­‐xylazine chez le rat Sprague-­‐Dawley vieillissant. Une anesthésie à la kétamine-­‐xylazine fut induite chez des rats Sprague-­‐Dawley de différents âges. Afin d’évaluer l’effet du vieillissement sur le métabolisme des deux drogues, des prélèvements sanguins périodiques pour l’analyse de la pharmacocinétique ainsi que des mesures des paramètres physiologiques, biochimiques et une histopathologie furent effectués. Le vieillissement a causé certaines modifications notamment en produisant une diminution de la saturation d’oxygène, une baisse marquée de la fréquence cardiaque et respiratoire, une hypoalbuminémie ainsi qu’une augmentation de la durée d’anesthésie. Les paramètres pharmacocinétiques de la kétamine et de la xylazine furent grandement affectés par le vieillissement causant une augmentation progressive significative de l’aire sous la courbe (AUC) et du temps de demi-­‐vie, ainsi qu’une diminution de la clairance. À la lumière de ces résultats, les doses de kétamine et de xylazine doivent être adaptées chez les rats vieillissants pour permettre une anesthésie de durée raisonnable et un réveil sans complications. / In laboratory animals, even if inhalation anesthetics are generally safer than injecting, their usefulness is often restrained when an experimental design does not allow it. For this reason, ketamine combinations are considered the option of choice for injecting anesthesia in rats. Aging brings degenerative changes in the structure and function of the organs, often affecting the pharmacokinetics of drugs. This project focuses on the evaluation of physiological, pharmacokinetic, biochemical and histological changes during a ketamine-­‐xylazine anesthetic combination in aging Sprague-­‐Dawley rats. Anesthesia with ketamine-­‐xylazine was induced in Sprague-­‐Dawley rats of different ages. To assess the effect of aging on the metabolism of both drugs, periodic blood samples for pharmacokinetic analysis and measurements of physiological, biochemical and histological parameters were performed. Aging have made some changes for example a decrease in oxygen saturation, a sharp drop in heart and respiratory rate, hypoalbuminemia and an increase in the duration of anesthesia. The pharmacokinetic parameters of ketamine and xylazine were greatly affected in older animals, causing a significant increase in the area Under the curve (AUC) and the half-­‐life time, and a decrease in clearance. In the light of these results, dosage of ketamine and xylazine must be adapted in aging rats to allow a short anesthesia and an awakening without complications.

Dans mes travaux de thèse, je me suis intéressé à la fonction de la barrière hémato-encéphalique (BHE) et son impact dans le développement de médicaments à visée du système nerveux central (SNC). Cependant, plusieurs obstacles limitant le processus de développement de nouveaux médicaments ont été identifiés. Parmi eux, une faible biodisponibilité cérébrale est reconnue pour être un facteur limitant majeur. Malgré ce constat, la biodisponibilité et la pharmacodynamie cérébrales sont souvent inconnues ou globalement négligées durant le processus de développement des médicaments. Actuellement, 3 méthodes permettent d'explorer la pharmacocinétique cérébrale in vivo, à savoir l'analyse du liquide céphalorachidien, la tomographie par émission de positron et la microdialyse cérébrale. Chaque approche présente certaines contraintes, la première fournit des informations restreintes, la seconde est coûteuse et limitée à une utilisation principalement académique, la troisième est souvent réalisée sur des modèles rongeurs rendant la transposabilité des données à l’homme complexe. Le projet de recherche réalisé s’est articulé autour de cette problématique et a suivi deux axes de développement. Le premier s’est orienté sur l’étude du passage dans le contexte particulier de la maladie de Parkinson. Le second aborde le manque de modèles pertinents utilisables lors du développement d’un nouveau médicament et présente une solution possible, la microdialyse intracérébrale sur macaque vigile. Les études en lien avec la maladie de Parkinson ont mis en évidence que premièrement, les statines sont inefficace dans le traitement des dyskinésies lévodopa induites chez les patients parkinsoniens. Cet échec peut être en partie explicable par une biodisponibilité cérébrale insuffisante du principe actif. Deuxièmement, la fonction de BHE est modifiée sur le modèle de référence de la maladie de Parkinson, le macaque traité au 1-méthyle 4-phényl 1,2,3,6-tétrahydro pyridine (MPTP). Le travail réalisé selon le second axe démontre la faisabilité de l’échantillonnage du liquide extracellulaire cérébral sur macaque vigile par microdialyse. / While working on my thesis, I focused on the function of the blood-brain barrier (BBB) and its impact in drug development to target the central nervous system (CNS). However, several obstacles that slow down the process of developing new successful drugs have been identified. Among several factors, the poor brain bioavailability is acknowledged as a primary limiting factor. Despite this statement, both brain bioavailability and brain pharmacodynamic are either unknown or globally overlooked during the drug development process. Currently, 3 methods allow exploring in vivo brain pharmacokinetic: cerebral spinal fluid sampling analysis, Positron Emission Tomography imaging and brain microdialysis. Each approach has its own constraints, the first provides restricted information, the second is expensive and limited to a mainly academic use, and the third is often carried out on rodent models making the transferability of data in complex man. The research project is focused on this issue and followed two paths of development. The first is focused on the study of the crossing in the particular context of Parkinson's disease. The second addresses the lack of appropriate model used in the development of a new drug and presents a possible solution, intracerebral microdialysis in awake macaque. Studies linked with Parkinson's disease show that statins has proved ineffective in the treatment of levodopa-induced dyskinesia in parkinsonian patients. This failure can be explained in part by insufficient brain bioavailability of the active compound. Secondly, in macaques treated with 1-methyl 4-phenyl 1,2,3,6-tetrahydro pyridine (MPTP), the gold standard model of Parkinson's disease, the BBB is modified. The work done along the second axis shows the feasibility of sampling brain extracellular fluid by microdialysis in awake macaque.

Les pneumopathies acquises sous ventilation mécanique (PAVM) sont responsables d'une mortalité élevée. La nébulisation d'antibiotiques permet d'améliorer l'efficacité de leur traitement. Pour autant, aucune donnée pharmacocinétique portant sur la colistine et la gentamicine ne permet de recommander un schéma posologique particulier.Nous avons comparé les propriétés pharmacocinétiques plasmatique et intra-pulmonaire de la colistine (administrée sous forme de prodrogue, le colistiméthate sodique ou CMS) et de la gentamicine selon le mode d'administration (nébulisation ou perfusion intraveineuse) chez des patients de réanimation présentant une PAVM.Les concentrations intra-pulmonaires de colistine et de gentamicine étaient, respectivement, de 10 à 40 et 50 à 70 fois supérieures, après nébulisation, à celles retrouvées après administration d'une même dose par voie intraveineuse. La nébulisation permettrait également de limiter le risque de toxicité systémique avec une biodisponibilité inférieure à 10%.En assurant de fortes concentrations intra-pulmonaires et un faible passage systémique, la nébulisation de CMS et de gentamicine pourrait être une bonne alternative à leur administration intraveineuse dans le traitement des PAVM. / Ventilator-associated pneumonia (VAP) is associated with high mortality. Nebulization of antibiotics improves outcome of patient with VAP. However, pharmacokinetic data concerning colistin and gentamicin allowing for optimal dosing regimen recommendation are lacking.We compared systemic and pulmonary concentrations of colistin (administered as an inactive prodrug, colistin methanesulfonate or CMS) and gentamicin according to the route of administration (nebulization and intravenous infusion) in critically ill patients with VAP.Intra-pulmonary concentrations of colistin and gentamicin were 10 to 40-fold and 50 to 70-fold much higher after nebulization than after the same dose by intravenous route, respectively. Nebulization has also the theoretical potential advantage to improve patients' safety in relation to the colistin biodisponibility lower than 10%.With high intra-pulmonary concentrations and very low systemic absorption, CMS and gentamicin nebulization may be good alternatives to intravenous infusion for VAP treatment.

A mistura triterpênica ¤ e ß- amirinas é comumente encontrada em quantidades significativas em espécies do gênero Protium (Burseraceae) e possuem reconhecidas atividades anti-inflamatória, hepatoprotetora, gastroprotetora e analgésica, dentre outras. Entretanto, pouco se sabe sobre sua farmacocinética e metabolismo. Neste sentido, esta tese teve o objetivo de desenvolver metodologias bioanalíticas para determinar a farmacocinética e a eliminação de ? e ?-amirinas isoladas de P. spruceanum bem como avaliar o metabolismo in vitro destes triterpenos. A mistura de ¤ e ß-amirinas foi isolada em grau de pureza cromatográfica acima de 99%. Foi desenvolvida e caracterizada uma nanoemulsão do tipo O/A contendo ¤ e ß-amirinas a fim de viabilizar a administração por vias oral e endovenosa e realizar os estudos de disposição cinética dessas substâncias em camundongos. O tamanho médio das partículas da nanoemulsão foi de 103,5 ± 0,44 nm, com porcentagem de encapsulação de acima de 99%. Os estudos de liberação in vitro mostraram baixa taxa de liberação após 24 horas. A avaliação da disposição cinética de ? e ?-amirinas em camundongos mostrou que após administração oral a suspensão de CMC não foi absorvida, entretanto a nanoemulsão contendo as substancias foi absorvida e a biodisponibilidade oral de ¤ e ß-amirinas foi de 1,03 ± 0,08 e 1,56 ± 0,24%, respectivamente. O Vd foi elevado e a T1/2 foi de 2,61±0,15 e 2,57±0,07 horas, respectivamente. O ClB mostrou-se elevado, comparado ao ClR. Após administração oral da nanoemulsão, praticamente toda a mistura foi eliminada inalterada nas fezes devido a baixa absorção. Entretanto, após administração endovenosa cerca de 50% da mistura foi eliminada inalterada pela via biliar. Estudos de eliminação renal de ¤ e ß-amirinas mostraram que apenas cerca de 0,2% das substâncias foram eliminadas por via renal após administração endovenosa. O fenômeno Flip-Flop ocorreu para a via extravascular utilizada. Os resultados da eliminação parcial e de baixa liberação in vitro sugerem que após administração endovenosa da nanoemulsão pode ocorrer acúmulo extravascular dos compostos, corroborando com altos Vd. As reações biomiméticas de oxidação de ¤ e ß-amirinas mostraram baixa taxa degradação. Apenas um metabólito putativo foi encontrado, entretanto, não foi possível observá-lo nas matrizes biológicas analisadas. / The triterpene mixture of ¤ and ß-amyrins is generally found in significative amounts in Protium species (Burseraceae). They have known biological activities as anti-inflammatory, hepatoprotective, gastroprotective and antinociceptive effects among others. However, their pharmacokinetics and metabolism are practically unknown. The purpose of this thesis was to develop bioanalytical methodologies to perform pharmacokinetic and elimination studies of ¤ and ß-amyrins from P. spruceanum as well as to evaluate in vitro metabolism of these triterpenes. The mixture ¤ and ß-amyrins was isolated with chromatography purity above 99%. One ¤ and ß-amyrins loaded O/W nanoemulsion was developed and characterized to enable the intravenous and oral administration and to performed pharmacokinetic studies of these compounds in mice. The average particle size was 103.5 ± 0.44 nm and the encapsulation efficiency was higher than 99%. In vitro release study demonstrated low release rater after 24 hours. The pharmacokinetics studies of ? and ?-amyrins indicated CMC suspension was not absorbed, however ¤ and ß-amyrins loaded O/W nanoemulsion was poorly absorved and bioavailability was 1.03 ± 0.08 and 1.56 ± 0.24% respectively. The Vd was high and T1/2 was 2.61 ± 0.15 e 2.57± 0.07 hours respectively. The ClB was high compared to ClR. After oral administration almost all ¤ and ß-amyrins were eliminated unchanged in faeces due to low absorption. However, after intravenous administration about 50% was excluded unchanged by biliar excretion pathway. Studies of ¤ and ß-amyrins renal elimination directed only 0.2 % were removed unchanged by renal pathway after intravenous administration. The Flip-Flop phenomenon was happen when ¤ and ß- amyrins was dispensed by extravascular via. The partial biliar excretion in vivo and low release rate in vitro suggests ¤ and ß-amyrins could be stored after nanoemulsion intravenous administration confirming high Vd. The biomimetic reactions of oxidation of ¤ and ß-amyrins showed low degradation rate and only one metabolite was found however it was not detected in biological samples.

Le système nerveux central est un organe privilégié et protégé, notamment grâce à l’existence des barrières histologiques entre le sang et les tissus nerveux. La barrière-hémato encéphalique (BHE) et la barrière hémato-rétinienne (BHR) séparent respectivement le parenchyme cérébral et la rétine des composés contenus dans l’espace vasculaire, grâce à l’expression de jonctions serrées et de transporteurs membranaires permettant une régulation spécifique des échanges entre le sang et le parenchyme nerveux. Ce travail a porté sur l’étude d’un nouveau transporteur de cations organiques mis en évidence fonctionnellement à la BHE de la souris. Ce transporteur appartenant très probablement à la superfamille des solute carrier (SLC), fonctionne comme un antiport proton. Actuellement, sa présence ne peut être démontrée que de façon fonctionnelle car son identité moléculaire est encore inconnue. Cet antiport proton constitue un nouvel acteur de la perméabilité cérébrale et ouvre une nouvelle voie d’accès au cerveau. Nous nous sommes tout d’abord attachés à approfondir les connaissances fonctionnelles de ce transporteur en étudiant de nouveaux substrats et tissus d’expression. Le transport cérébral de psychotropes a été étudié in vivo par la technique de perfusion carotidienne in situ chez la souris et in vitro grâce à une lignée de cellules endothéliales cérébrales humaines immortalisées (hCMEC/D3). Nous avons démontré que la haute perméabilité cérébrale de la cocaïne fait intervenir à la fois une diffusion passive et surtout une diffusion médiée par un antiport proton. La vitesse d’entrée des substances d’abus dans le cerveau est associée à un plus fort risque d’addiction et fait de ce transporteur un nouvel acteur critique de la régulation du passage cérébral. En effet, d’autres substances comme la nicotine et certaines amphétamines comme le MDPV et l'ecstasy sont également des substrats de cet antiport. Ce transporteur apparaît comme une cible pharmacologique potentielle dans la prise en charge de toxicomanies. Malgré la diversité chimique et pharmacologique d’interactions des composés avec cet antiport, les concentrations nécessaires pour l’inhiber dépassent celles retrouvées dans le sang. Pour aider l’identification d’inhibiteurs sélectifs et efficaces nous avons développé un modèle pharmacophorique d’inhibiteurs du transporteur à partir de données générées in vitro et de l’approche FLAPpharm. Ce modèle semble prédictif de nouveaux composés pouvant constituer de meilleurs inhibiteurs de ce transporteur. L’étude des échanges in vivo au niveau du tissu nerveux nous a menés à étudier l’impact de transporteurs ABC et de l’antiport-proton au niveau cérébral et rétinien à l’aide de substances spécifiques ou de substrats mixtes comme le vérapamil. L’antiport proton est fonctionnel au niveau de la BHR et transporte notamment la clonidine, le DPH et le vérapamil. Cependant, dans le cas d’un substrat mixte P-gp et SLC (ex : vérapamil), ce transport d’influx n’est visible à la BHE que lorsque la P-gp est neutralisée. Au contraire, à la BHR l’influx lié à cet SLC est visible naturellement. L’impact de la P-gp à la BHR étant 6.3-fois plus faible ce processus est probablement moins masqué. Cette étude illustre la difficulté actuelle de prédire l’impact fonctionnel d’un transporteur pour des substrats multi-spécifiques et l’existence d’une priorisation du transport. Enfin, nous avons essayé d’identifier l’antiport proton au niveau moléculaire par une méthode de photo-activation à l’aide d’un composé adapté. Cette méthode s’est avérée efficace pour fixer une molécule sur le transporteur, permettant par la suite de l’isoler plus facilement. En conclusion, ce travail a permis de mettre en évidence l’importance de l’antiport proton dans la distribution cérébrale de psychotropes et d’ouvrir de nouvelles perspectives dans l’addiction et la compréhension du transport de substrats multi-spécifiques. / The central nervous system is a privilege organ protected by histological barriers between the blood and the nervous tissue. The blood-brain barrier (BBB) and the blood-retinal barrier (BRB) separate cerebral parenchyma and retina from the circulating blood and both express tight junctions and membrane transporters, allowing a precise regulation of the exchanges between the blood and nervous tissues. We studied a new cationic transporter functionally evidenced at the mouse BBB. This molecularly unknown transporter belong to the solute carrier super family (SLC) and is a proton antiporter. It could constitute a new actor in the cerebral permeability and may be a new brain access pathway. First, we worked on the functional identification studying new substrates and new localization. Psychotropic brain transport was studied in vivo by brain in situ perfusion on mouse and in vitro with human immortalized endothelial cells (hCMEC/D3). We showed that cocaine brain entry depends on passive diffusion but also mainly on a proton antiporter. Brain entry rate of drugs of abuse is associated with modulation of addiction liability, making this transporter a new component of brain entry of cocaine, and also nicotine and some amphetamines such as ecstasy and MDPV. This proton antiporter appears to be a new potential target in addiction. Various chemical entities interact with this transporter; however concentrations used to inhibit the transporter are much higher than the one possibly found in the blood. In order to help find or design new selective and potent inhibitors, we developed a pharmacophore model of the proton antiporter inhibitors using in vitro data and the FLAPpharm approach. The model predicts well new possible inhibitors of this transporter. We also studied the impact of the ABC transporters and the proton antiporter at the BBB and the BRB using specific or multi-specific substrates such as verapamil. The proton antiporter is functionally expressed at the BRB and transports clonidine, DPH and verapamil. However, for the multi-specific (P-gp and SLC) compound verapamil, influx transport by the proton antiporter is visible at the BBB only when P-gp efflux is neutralized. On the contrary, at the BRB, the proton antiporter influx is always visible. This is certainly due to the lower impact (by 6.3 fold) of P-gp at the BRB compared to the BBB. These results show the difficulty to predict the functional impact of a transporter for multi-specific compounds and a probable transport prioritization. Finally we worked on the molecular identification of the proton antiporter using a photolabeling method. This work evidenced the importance of the proton antiporter in the brain distribution of psychotropic and drugs of abuse and opened toward new perspectives in addiction and transport comprehension.

<p style="text-align: justify;">Reverzno-faznom tečnom hromatografijom pod visokim pritiskom primenom dva sistema<br />rastvarača ispitano je pona&scaron;anje i hromatografska lipofilnost prirodnih stiril laktona 7-(+)-<br />goniofufurona, 7-epi-(+)-goniofufurona, krasalaktona B i C i dvadeset njihovih<br />novosintetizovanih derivata i analoga. U ranijim ispitivanjima pokazalo se da ova jedinjenja<br />imaju veliki biolo&scaron;ki potencijal jer pokazuju zapaženu citotoksičnost prema vi&scaron;e humanih<br />tumorskih ćelijskih linija. Hromatografsko pona&scaron;anje jedinjenja uglavnom je u skladu sa<br />njihovom strukturom. Ustanovljene su linearne veze između hromatografskih retencionih<br />konstanti i većine in silico parametara lipofilnosti. Primenom hemometrijske QSRR analize<br />utvrđeni su veoma dobri multi linearni regresioni prediktivni modeli kvantitativne zavisnosti<br />između eksperimentalno dobijene hromatografske retencione konstante, koja defini&scaron;e<br />retenciju jedinjenja u čistoj vodi i in silico molekulskih deskriptora odnosno strukture<br />jedinjenja. Lipofilnost jedinjenja ima najveći uticaj na njihove farmakokinetičke, tj. ADME<br />(apsorpcija, distribucija, metabolizam, eliminacija) osobine. Definisani su i statistički<br />potvrđeni najbolji multi linearni regresioni modeli zavisnosti farmakokinetičkih parametara<br />stiril laktona i od drugih molekulskih deskriptora. In vitro citotoksična aktivnost jedinjenja<br />evaluirana je prema četiri nove humane maligne ćelijske linije: kancer prostate (PC3), kancer debelog creva (HT-29), melanom (Hs294T), adenokancer pluća (A549). Najaktivnije<br />novosintetizovano jedinjenje je triciklični 4-fluorocinamatni analog, koji ispoljava<br />nanomolarnu aktivnost (IC₅₀ 2,1 nM) prema ćelijama melanoma i aktivniji je preko 2250 puta od komercijalnog antitumorskog agensa doksorubicina (DOX). SAR analizom utvrđena je zavisnost između strukture i biolo&scaron;ke aktivnosti jedinjenja. Molekulskim dokingom ispitana je veza stiril laktona i ciljanog proteina značajnog za kancer prostate. Jedinjenja sa visokom inhibitornom aktivno&scaron;ću prema ćelijama kancera prostate imaju visok doking skor i mogu graditi koordinativno-kovalentnu vezu sa Fe²+jonom prisutnim u aktivnom centru enzima. 3D-QSAR analizom, koja je izvedena metodama komparativnih polja CoMFA i CoMSIA, formiran je značajan prediktivni model između hemijske strukture i biolo&scaron;ke aktivnosti stiril laktona.</p> / <p>The behavior and the chromatographic lipophilicity natural styryl lactone 7-(+)-<br />goniofufurone, 7-epi-(+)-goniofufurone, crassalactones B and C and twenty of their newly<br />synthesized derivatives and analogs were examined using reverse-phase high performance liquid chromatography in the two solvent systems. In previous studies it has been shown that these compounds have great biological potential toward several human tumor cell lines. Chromatographic behavior of the compounds is generally in accordance with their structure. The relationships between the chromatographic retention constants and the majority of their in silico lipophilicity parameters are linear. The application of chemometric QSRR analysis determined very good multiple linear regression predictive models of quantitative correlation between experimentally obtained chromatographic retention constant, which determines the retention of the compound in pure water and in silico molecular descriptors, i.e. the structure of the compound. The lipophilicity of the compounds has a major influence on their pharmacokinetics, i.e. ADME (absorption, distribution, metabolism, elimination) properties. The best multi-linear regression models depending on the pharmacokinetic parameters of styryl lactone and other molecular descriptors have been defined and statistically validated. In vitro cytotoxic activity of the compounds was evaluated according to four novel human malignant cell lines: prostate cancer (PC3), colon cancer (HT-29), melanoma (Hs294T), lung adenocarcinom (A549). The most active compound was tricyclic 4-fluorocinnamic analog, which exhibits a nanomolar activity (IC50 2,1 nM) toward melanoma cells. This compound is over 2250 times more active than commercial antitumor agent doxorubicin (DOX). SAR analysis has revealed a correlation between the structure and the biological activity of the compounds. Using the molecular docking the relationship of the styryl lactone and the target protein important for prostate cancer was examined. The compounds with high inhibitory activity against prostate cancer cells have a high docking score and are capable to form a coordinative-covalent bond with a Fe2+ ion present in the active centre of the enzyme. 3DQSAR analysis, which was performed by methods of comparative CoMFA and CoMSIA fields, has formed a good predictive model between chemical structure and biological activity of the styryl lactone.</p>

L’exposition au bisphénol A (BPA) au cours du développement fœtal est suspectée d’être impliquée dans l’initiation d’effets biologiques. Dans ce contexte, l’objectif de cette thèse est d’évaluer l’exposition humaine fœtale au BPA. Une étude pharmacocinétique (PK) réalisée sur le modèle du fœtus ovin a montré que le BPA glucuronide (BPAG), métabolite majeur du BPA piégé dans le compartiment fœtal, est lentement éliminé via sa réactivation en BPA. A partir de ces données PK, le développement d’un modèle PK humanisé a permis de prédire des concentrations plasmatiques fœtales de BPAG maintenues autour de 40ng/L chez le fœtus humain en fin de grossesse, soit environ 1000 fois supérieures aux concentrations en BPA correspondantes. Une analyse protéomique de tissus fœtaux ovins a montré qu’une même dose molaire de BPAG ou de BPA affecte des voies physiologiques similaires, suggérant que l’hydrolyse du BPAG pourrait exposer les tissus à des concentrations en BPA compatibles avec l’expression d’un effet biologique. L’ensemble de ces résultats indique que les concentrations de BPAG dans le sang de cordon constituent un marqueur pertinent de l’exposition fœtale au BPA et qu’elles doivent être prises en compte dans l’évaluation du risque / Prenatal exposure to bisphenol A (BPA) is suspected to induce adverse effects later in life. In this context, the goal of this thesis was to evaluate the human fetal exposure to BPA. Using a pharmacokinetic (PK) approach, we showed that BPA glucuronide (BPAG), the main metabolite of BPA that remains trapped in the fetal compartment, is slowly eliminated through its back conversion into BPA. A humanized PK model developed from these data predicted steady BPAG fetal plasma concentrations of 40ng/L in late pregnancy, i.e. about 1000 folds higher than corresponding BPA concentrations. A proteomic analysis of fetal tissues has shown that equimolar BPAG or BPA fetal exposures trigger similar physiological shifts in the ovine model, suggesting that BPAG hydrolysis might expose fetal tissues to BPA at levels of functional significance. It is concluded that BPAG levels in human cord blood are relevant indicators of fetal exposure to BPA during late pregnancy and should be taken into account for risk assessment

A Agência Nacional de Vigilância Sanitária (ANVISA) não exige a realização de ensaios de bioequivalência utilizando métodos enantiosseletivos de quantificação de fármacos para o registro de medicamentos genéricos ou similares contendo fármacos racêmicos. Porém, existe a possibilidade das diferenças de concentrações plasmáticas dos enantiômeros entre o medicamento referência e os genéricos e/ou similares comercializados no Brasil serem maiores que as estabelecidas pelos limites de bioequivalência. Esse estudo teve a finalidade de investigar a influência da velocidade de liberação do fármaco metoprolol, a partir da forma farmacêutica, sobre o processo de absorção do fármaco total e de seus enantiômeros por meio da avaliação das concentrações plasmáticas de metoprolol total, (S)-metoprolol e (R)-metoprolol, e da relação entre as concentrações dos enantiômeros (S/R) após a administração oral de medicamentos contendo mistura racêmica deste fármaco. Para isso, foi realizado ensaio de biodisponibilidade in vivo, em um grupo de 20 voluntários saudáveis, de acordo com procedimentos éticos estabelecidos internacionalmente. Foram empregados três esquemas de administração do metoprolol, com a finalidade de simular diferentes velocidades de liberação do fármaco a partir da forma farmacêutica, na Fase 1 foi administrado uma dose única de 100 mg de metoprolol em solução, na Fase 2 e Fase 3 essa mesma dose foi particionada em duas e cinco administrações, respectivamente, com intervalo de 30 minutos entre elas. Foram coletadas amostras de sangue, e estas foram analisadas utilizando método convencional e método quiral para quantificação do metoprolol total e seus enantiômeros, respectivamente, utilizando cromatografia líquida de alta eficiência, com detector de fluorescência. Os parâmetros farmacocinéticos de ASC0-t, Cmáx e Tmáx foram utilizados para comparação entre as três velocidades de liberação do fármaco a partir da forma farmacêutica. A análise farmacocinética para o fámaco (R,S) metoprolol e seus enantiômeros e a comparação entre seus parâmetros farmacocinéticos obtidos após administração oral do metoprolol, indicam uma cinética enantioseletiva para o metoprolol, que pode ter ocorrido devido a uma biotransformação pré-sistêmica dose-dependente, ou a uma inibição do metabolismo do (S)-metoprolol pela forma (R)-metoprolol. / ANVISA, brazilian regulatory agency for drug products, does not require the use of enantioselective bioanalytical methods in bioequivalence assays of generic and similar drug products containing racemic drugs. Therefore, it is possible that two formulations are bioequivalent based on plasmatic concentration of total drug, but are not bioequivalent on the basis of the comparison of the data of the stereoisomers. The objective of this study was to investigate the influence of the release rate of metoprolol from the dosage form on its absorption process and on its enantiomers\' absorption process by measuring plasmatic concentrations of total metoprolol, (S)-metoprolol and (R)-metoprolol after oral administration of drug products containing racemic metoprolol. An in vivo bioavailability study was conducted in a group of 20 healthy volunteers, according to national and international guidelines for biomedical research, in which the administration rate of metoprolol was varied. In Phase 1 a single dose of 100 mg metoprolol was administered in solution, in Phase 2 and Phase 3 the same dose was partitioned into two and five administrations, respectively, with an interval of 30 minutes between them. Blood samples were collected, and these were analyzed using the conventional method and chiral method for quantification of (R,S)-metoprolol and for its enantiomers, using high performance liquid chromatography with fluorescence detection. The pharmacokinetic parameters AUC0-t, Cmax and Tmax were used for comparisons between three different drug release rates. Pharmacokinetic analysis for (R, S) metoprolol and its enantiomers and comparison of their pharmacokinetic parameters obtained after oral administration of metoprolol, to indicate an enantioselective kinetic, which may be due to a biotransformation pre-systemic dose dependent or the inhibition of metabolism of the (S)-form for metoprolol (R)-metoprolol.

Introdução: Em pacientes críticos, como os grandes queimados, todos os parâmetros farmacocinéticos (absorção, distribuição, metabolismo e excreção) de muitas classes de drogas, incluindo antimicrobianos, estão alterados. Devido à forte associação entre a terapia antimicrobiana adequada em pacientes com queimaduras e mortalidade, intervenções como o monitoramento terapêutico de drogas podem ser uteis para otimizar a concentração sérica desses agentes em diferentes estágios do estado hiperdinâmico. Portanto, é possível melhorar desfecho clínico e sobrevivência além de reduzir o desenvolvimento de resistência. O objetivo deste estudo foi analisar o impacto em mortalidade de uma estratégia de ajuste de dose de acordo com o monitoramento terapêutico e modelagem farmacocinética/farmacodinâmica em pacientes de uma Unidade de Terapia Intensiva (UTI) para Queimados. Métodos: Um estudo comparativo, retrospectivo, foi conduzido entre pacientes admitidos com pneumonia, infecção em queimadura, infecção de corrente sanguínea e/ou infecção do trato urinário associados à assistência à saúde em uma UTI para Queimados do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Estes pacientes foram divididos em dois grupos: aqueles admitidos de maio de 2005 a outubro de 2008 que receberam antibioticoterapia em regime de dose convencional proposto pelo Grupo de Controle de Infecção Hospitalar do HC-FMUSP e aqueles admitidos de novembro de 2008 a junho de 2011 que receberam terapia antimicrobiana com dose ajustada de acordo com o monitoramento plasmático e modelagem farmacocinética. Características gerais dos dois grupos foram analisadas e desfechos clínicos (melhora dos sinais e sintomas da infecção), mortalidade em 14 dias e mortalidade hospitalar foram comparados. Resultados: 63 pacientes admitidos na UTI de Queimados apresentaram os critérios de inclusão para o grupo de tratamento convencional e 77 para o grupo de tratamento monitorado. Comparando dois grupos homogêneos em suas características gerais, houve diferenças quanto ao número de desbridamentos realizados e história de alcoolismo e uso de drogas ilícitas, mais frequentes no grupo de tratamento monitorado. Melhora clínica ocorreu em 56% dos pacientes sob regime monitorado e a mortalidade hospitalar foi similar entre os grupos. Pertencer a um dos grupos de tratamento não afetou o prognóstico. Na análise multivariada final, variáveis significativamente associadas com mortalidade hospitalar foram superfície corporal queimada maior que 30%, idade mais avançada e sexo masculino. Conclusão: Nosso estudo demonstrou que a estratégia de monitoramento terapêutico de antimicrobianos não alterou prognóstico de pacientes queimados. Acreditamos que são necessários mais estudos para embasar esta estratégia / Introduction: In critical patients, such as burn patients, pharmacokinetic parameters (absorption, distribution, metabolism and excretion) of many classes of drugs, including antibiotics, are altered. The aim of this study was to compare two groups of burned patients under treatment for healthcare associated infections with and without therapeutic drug monitoring (TDM) based on PK/PD modeling. Methods: A comparative study was conducted with patients with healthcare-associated pneumonia, burn infection, bloodstream infection and urinary tract infection in the Burn Intensive Care Unit (ICU) of a tertiary-care hospital. These patients were divided into two groups: 1) those admitted from May 2005 to October 2008 who received conventional antimicrobial dose regimen; and 2) those admitted from November 2008 to June, 2011 who received antibiotics with doses adjusted according to plasma monitoring and pharmacokinetics modeling. General characteristics of the groups were analyzed and clinical outcomes, 14-day and in-hospital mortality. Results: 63 patients formed the conventional treatment group and 77 the monitored treatment group. The groups were very homogeneous. Improvement occurred in 56% of the patients under monitored treatment and the in-hospital mortality was similar between groups. In the final multivariate models, variables significantly associated with in-hospital mortality were total burn surface area (TBSA) > 30%, older age and male sex. Treatment group did not affect the prognosis. Conclusions: TDM for antimicrobial treatment did not alter the prognosis of burn patients. More trials are needed to support the use of TDM to optimize treatment in burn patients

A Agência Nacional de Vigilância Sanitária (ANVISA) não exige a realização de ensaios de bioequivalência utilizando métodos enantiosseletivos de quantificação de fármacos para o registro de medicamentos genéricos ou similares contendo fármacos racêmicos. Porém, existe a possibilidade das diferenças de concentrações plasmáticas dos enantiômeros entre o medicamento referência e os genéricos e/ou similares comercializados no Brasil serem maiores que as estabelecidas pelos limites de bioequivalência. Esse estudo teve a finalidade de investigar a influência da velocidade de liberação do fármaco metoprolol, a partir da forma farmacêutica, sobre o processo de absorção do fármaco total e de seus enantiômeros por meio da avaliação das concentrações plasmáticas de metoprolol total, (S)-metoprolol e (R)-metoprolol, e da relação entre as concentrações dos enantiômeros (S/R) após a administração oral de medicamentos contendo mistura racêmica deste fármaco. Para isso, foi realizado ensaio de biodisponibilidade in vivo, em um grupo de 20 voluntários saudáveis, de acordo com procedimentos éticos estabelecidos internacionalmente. Foram empregados três esquemas de administração do metoprolol, com a finalidade de simular diferentes velocidades de liberação do fármaco a partir da forma farmacêutica, na Fase 1 foi administrado uma dose única de 100 mg de metoprolol em solução, na Fase 2 e Fase 3 essa mesma dose foi particionada em duas e cinco administrações, respectivamente, com intervalo de 30 minutos entre elas. Foram coletadas amostras de sangue, e estas foram analisadas utilizando método convencional e método quiral para quantificação do metoprolol total e seus enantiômeros, respectivamente, utilizando cromatografia líquida de alta eficiência, com detector de fluorescência. Os parâmetros farmacocinéticos de ASC0-t, Cmáx e Tmáx foram utilizados para comparação entre as três velocidades de liberação do fármaco a partir da forma farmacêutica. A análise farmacocinética para o fámaco (R,S) metoprolol e seus enantiômeros e a comparação entre seus parâmetros farmacocinéticos obtidos após administração oral do metoprolol, indicam uma cinética enantioseletiva para o metoprolol, que pode ter ocorrido devido a uma biotransformação pré-sistêmica dose-dependente, ou a uma inibição do metabolismo do (S)-metoprolol pela forma (R)-metoprolol. / ANVISA, brazilian regulatory agency for drug products, does not require the use of enantioselective bioanalytical methods in bioequivalence assays of generic and similar drug products containing racemic drugs. Therefore, it is possible that two formulations are bioequivalent based on plasmatic concentration of total drug, but are not bioequivalent on the basis of the comparison of the data of the stereoisomers. The objective of this study was to investigate the influence of the release rate of metoprolol from the dosage form on its absorption process and on its enantiomers\' absorption process by measuring plasmatic concentrations of total metoprolol, (S)-metoprolol and (R)-metoprolol after oral administration of drug products containing racemic metoprolol. An in vivo bioavailability study was conducted in a group of 20 healthy volunteers, according to national and international guidelines for biomedical research, in which the administration rate of metoprolol was varied. In Phase 1 a single dose of 100 mg metoprolol was administered in solution, in Phase 2 and Phase 3 the same dose was partitioned into two and five administrations, respectively, with an interval of 30 minutes between them. Blood samples were collected, and these were analyzed using the conventional method and chiral method for quantification of (R,S)-metoprolol and for its enantiomers, using high performance liquid chromatography with fluorescence detection. The pharmacokinetic parameters AUC0-t, Cmax and Tmax were used for comparisons between three different drug release rates. Pharmacokinetic analysis for (R, S) metoprolol and its enantiomers and comparison of their pharmacokinetic parameters obtained after oral administration of metoprolol, to indicate an enantioselective kinetic, which may be due to a biotransformation pre-systemic dose dependent or the inhibition of metabolism of the (S)-form for metoprolol (R)-metoprolol.