My graduate work focused on the syntheses and pharmacology of species-selective aryl methylcarbamate acetylcholinesterase inhibitors to combat the malaria-transmitting mosquito, Anopheles gambiae. We identified six novel carbamates that demonstrated levels of target selectivity exceeding our project milestone of 100-fold. Among the C2-substituted phenylcarbamates examined (class II), 2'-(2- ethylbutoxy)phenyl N-methylcarbamate (9bd*) was extraordinarily selective (570-fold ± 72). The high level of selectivity observed for many of the class II carbamates was attributed to a helical displacement within the active site of An. gambiae acetylcholinesterase, able to accommodate carbamates with larger C2-substituted secondary β-branching side chains. Conversely, this type of side chain forms unfavorable interactions within the active site of human acetylcholinesterase. The C3-substituted carbamates (class I), such as terbam (9c), were less selective than many of the class II carbamates; however, class I carbamates related to terbam (9c) were highly toxic to An. gambiae. In particular, the contact toxicity measured for 9c (LC₅₀ = 0.037 mg/mL) was equal to the commonly used agricultural insecticide, propoxur (9a, LC₅₀ = 0.037 mg/mL). In total, seventy aryl carbamates were screened for their inhibition potency and contact toxicity towards An. gambiae. The common final step in all of these syntheses was the carbamoylation of a phenol, which normally proceeded in a 70 to 90% yield. Thirty seven novel carbamates are reported out of the seventy two prepared. Although sixteen of the phenols were commercially available, the others were prepared with known and adapted synthetic methodologies. The emerging structure-activity relationships led us to focus on the synthesis of 3-tert-alkylphenols (Class I) and 2-alkoxy or 2-alkylthio-substituted phenols (Class II). Three methods particularly stand out: First, we applied the methods of Tanaka to prepare 3-tert-alkylphenols wherein a methyl group was replaced by a trifluoromethyl group. Second, we adapted the methods of Tanaka to prepare 3-tert-alkylphenols that lack fluorine substitution. This method is competitive with the little known method of Reetz to convert aryl ketones to the corresponding 1,1-dimethylalkyl group and allows one to access electron rich tert-alkyl-substituted aromatics that are not accessible by the Friedel-Crafts alkylation (Friedel-Crafts restricted). Third, we found a convenient and high-yielding method for selective S-alkylation of 2-mercaptophenol. In addition to the synthesis of carbamates, the preparation of one hundred three intermediates, phenols, and electron rich tert-alkyl arenes are reported. / Ph. D.

Trypanosoma cruzi é um protozoário flagelado que ao infectar seres humanos causa a doença de Chagas, uma doença tropical negligenciada que afeta milhões de pessoas no mundo todo. As fumarato hidratases (FH), ou fumarases, são enzimas que catalisam a reação estéreo-específica reversível de hidratação do fumarato em S-malato, e foram recentemente consideradas essenciais para a viabilidade do parasito Trypanosoma brucei, sugerindo seu potencial como alvo macromolecular para o desenvolvimento de novos fármacos tripanocidas. O presente trabalho visou à caracterização funcional, bioquímica, biofísica e estrutural das fumarases de T. cruzi (TcFHs) e humana (HsFH) de forma a avaliar o papel das TcFHs para o parasito Trypanosoma cruzi, mapear o mecanismo de ação e identificar as diferenças entre TcFHs e a enzima humana de forma a serem exploradas no planejamento de inibidores seletivos às fumarases do parasito. Análise das sequências mostrou que TcFHs pertencem à classe I das fumarases (enzimas diméricas dependentes de ferro) e não são homólogas à HsFH que pertence a classe II (tetraméricas independentes de ferro). Estudos de localização celular confirmaram a existência de duas fumarases em T. cruzi, uma citosólica (TcFHc) e uma mitocondrial (TcFHm), e experimentos de nocaute gênico sugeriram que essas enzimas são essências para o parasito. A caracterização cinética das enzimas TcFHc, TcFHm e HsFH mostrou que as fumarases de T. cruzi são sensíveis ao oxigênio enquanto a enzima humana se mantém ativa em condições aeróbicas. Estudos de ressonância eletrônica paramagnética mostraram a presença de um cluster de ferro-enxofre, sensível a oxidação por oxigênio, envolvido no mecanismo enzimático das enzimas TcFHs. Modelos estruturais das TcFHs, construídos por homologia à estrutura cristalográfica da fumarase de Leishmania major, foram comparados à estrutura cristalográfica obtida para a fumarase humana e as diferenças entre as duas estruturas foram utilizadas no planejamento de ligantes seletivos às fumarases do parasito. O ligante planejado inibiu a fumarase citosólica de T. cruzi na faixa de 1 ?M e não apresentou efeito na atividade da enzima humana. Testes in vivo demonstraram o efeito tripanocida do inibidor provavelmente por interferir na produção de ATP pela mitocôndria do T. cruzi. Os resultados obtidos com o desenvolvimento desse projeto apresentam uma proposta inovadora no desenvolvimento de novas terapias contra a doença de Chagas, o uso da enzima fumarase como alvo macromolecular, assim como apresenta um inibidor potente e seletivo para a enzima do parasito a ser utilizado como protótipo no desenvolvimento de fármacos contra Trypanosoma cruzi. A síntese de moléculas análogas ao inibidor de forma a melhorar suas propriedades farmacológicas encontra-se em andamento / Trypanosoma cruzi is a flagellate protozoan parasite that infects humans and causes Chagas disease, a tropical neglected disease that affects millions of people worldwide. Fumarate hydratases (FH), or fumarases, are enzymes responsible for the reversible stereo-specific hydration of fumarate into S-malate, and were recently considered to be essential to Trypanosoma brucei viability, suggesting, therefore, a potential role for FHs as macromolecular targets to the drug development against trypanosomatids. The present work focused on the functional, biochemical, biophysical and structural characterization of T. cruzi fumarases (TcFHs) and human fumarase (HsFH) to evaluate TcFHs role for T. cruzi, map the reaction mechanism and identify and exploit differences between the parasite and host enzymes in order to design selective inhibitors to the parasite enzyme. Sequence analysis revealed that TcFHs belong to class I fumarases (dimeric and iron-sulfur containing enzymes) and are not homologous to HsFH which belongs to class II fumarases (tetrameric iron independent enzymes). Cellular sub-localization studies confirmed the presence of a cytosolic and a mitochondrial fumarases in T. cruzi and gene knockout experiments suggested TcFHs are essential to the parasite. The kinetic characterization showed that TcFHs activity is highly sensitive to oxygen whereas HsFH activity remained stable in aerobic conditions. Electron paramagnetic experiments further revealed the presence of an iron-sulfur cluster highly sensitive to oxidation and involved in the catalytic mechanism in both TcFHm and TcFHc. TcFHs structural models, built by homology modeling using the Leishmania major fumarase crystal structure as template, were compared to the HsFH crystal structure and the differences were used to design a selective ligand to the parasite fumarases. The designed ligand showed to inhibit TcFHc with an IC50 of 1 ?M and showed no effect on the human fumarase activity. In vivo assays using T. cruzi epimastigotes demonstrated the trypanocidal effect of the designed inhibitor probably caused by stalling ATP production. The results obtained with the development of this project represent an innovative proposal on the development of new therapies against Chagas disease, the use of fumarase enzyme as a macromolecular target, as well as present a potent and selective inhibitor to the parasite enzyme to be further used as a prototype in the development of drugs against Chagas disease. The synthesis of inhibitor analogues with optimized pharmacological properties are currently in progress.

Trypanosoma cruzi é um protozoário flagelado que ao infectar seres humanos causa a doença de Chagas, uma doença tropical negligenciada que afeta milhões de pessoas no mundo todo. As fumarato hidratases (FH), ou fumarases, são enzimas que catalisam a reação estéreo-específica reversível de hidratação do fumarato em S-malato, e foram recentemente consideradas essenciais para a viabilidade do parasito Trypanosoma brucei, sugerindo seu potencial como alvo macromolecular para o desenvolvimento de novos fármacos tripanocidas. O presente trabalho visou à caracterização funcional, bioquímica, biofísica e estrutural das fumarases de T. cruzi (TcFHs) e humana (HsFH) de forma a avaliar o papel das TcFHs para o parasito Trypanosoma cruzi, mapear o mecanismo de ação e identificar as diferenças entre TcFHs e a enzima humana de forma a serem exploradas no planejamento de inibidores seletivos às fumarases do parasito. Análise das sequências mostrou que TcFHs pertencem à classe I das fumarases (enzimas diméricas dependentes de ferro) e não são homólogas à HsFH que pertence a classe II (tetraméricas independentes de ferro). Estudos de localização celular confirmaram a existência de duas fumarases em T. cruzi, uma citosólica (TcFHc) e uma mitocondrial (TcFHm), e experimentos de nocaute gênico sugeriram que essas enzimas são essências para o parasito. A caracterização cinética das enzimas TcFHc, TcFHm e HsFH mostrou que as fumarases de T. cruzi são sensíveis ao oxigênio enquanto a enzima humana se mantém ativa em condições aeróbicas. Estudos de ressonância eletrônica paramagnética mostraram a presença de um cluster de ferro-enxofre, sensível a oxidação por oxigênio, envolvido no mecanismo enzimático das enzimas TcFHs. Modelos estruturais das TcFHs, construídos por homologia à estrutura cristalográfica da fumarase de Leishmania major, foram comparados à estrutura cristalográfica obtida para a fumarase humana e as diferenças entre as duas estruturas foram utilizadas no planejamento de ligantes seletivos às fumarases do parasito. O ligante planejado inibiu a fumarase citosólica de T. cruzi na faixa de 1 ?M e não apresentou efeito na atividade da enzima humana. Testes in vivo demonstraram o efeito tripanocida do inibidor provavelmente por interferir na produção de ATP pela mitocôndria do T. cruzi. Os resultados obtidos com o desenvolvimento desse projeto apresentam uma proposta inovadora no desenvolvimento de novas terapias contra a doença de Chagas, o uso da enzima fumarase como alvo macromolecular, assim como apresenta um inibidor potente e seletivo para a enzima do parasito a ser utilizado como protótipo no desenvolvimento de fármacos contra Trypanosoma cruzi. A síntese de moléculas análogas ao inibidor de forma a melhorar suas propriedades farmacológicas encontra-se em andamento / Trypanosoma cruzi is a flagellate protozoan parasite that infects humans and causes Chagas disease, a tropical neglected disease that affects millions of people worldwide. Fumarate hydratases (FH), or fumarases, are enzymes responsible for the reversible stereo-specific hydration of fumarate into S-malate, and were recently considered to be essential to Trypanosoma brucei viability, suggesting, therefore, a potential role for FHs as macromolecular targets to the drug development against trypanosomatids. The present work focused on the functional, biochemical, biophysical and structural characterization of T. cruzi fumarases (TcFHs) and human fumarase (HsFH) to evaluate TcFHs role for T. cruzi, map the reaction mechanism and identify and exploit differences between the parasite and host enzymes in order to design selective inhibitors to the parasite enzyme. Sequence analysis revealed that TcFHs belong to class I fumarases (dimeric and iron-sulfur containing enzymes) and are not homologous to HsFH which belongs to class II fumarases (tetrameric iron independent enzymes). Cellular sub-localization studies confirmed the presence of a cytosolic and a mitochondrial fumarases in T. cruzi and gene knockout experiments suggested TcFHs are essential to the parasite. The kinetic characterization showed that TcFHs activity is highly sensitive to oxygen whereas HsFH activity remained stable in aerobic conditions. Electron paramagnetic experiments further revealed the presence of an iron-sulfur cluster highly sensitive to oxidation and involved in the catalytic mechanism in both TcFHm and TcFHc. TcFHs structural models, built by homology modeling using the Leishmania major fumarase crystal structure as template, were compared to the HsFH crystal structure and the differences were used to design a selective ligand to the parasite fumarases. The designed ligand showed to inhibit TcFHc with an IC50 of 1 ?M and showed no effect on the human fumarase activity. In vivo assays using T. cruzi epimastigotes demonstrated the trypanocidal effect of the designed inhibitor probably caused by stalling ATP production. The results obtained with the development of this project represent an innovative proposal on the development of new therapies against Chagas disease, the use of fumarase enzyme as a macromolecular target, as well as present a potent and selective inhibitor to the parasite enzyme to be further used as a prototype in the development of drugs against Chagas disease. The synthesis of inhibitor analogues with optimized pharmacological properties are currently in progress.

Malaria is one of the deadliest diseases known to mankind. In 2010, 219 million cases were reported, and 666,000 deaths were attributed to this disease. In the past, pyrethroid-treated mosquito nets have shown efficacy in reducing malaria transmission in many malaria endemic regions. However, an upsurge in the mosquito population that is resistant to pyrethroids threatens to compromise the efficacy of pyrethroid-treated bed nets. In an effort to develop another class of insecticide with a different mode of action, we have explored three classes of five membered heterocyclic carbamates (isoxazol-3-yl, pyrazol-5-yl, and pyrazol-4-yl), and 3-oxoisoxazole- 2(3H)-carboxamide as acetylcholinesterase inhibitors (AChE) targeting wild type (G3) and resistant (Akron) malaria mosquito Anopheles gambiae (Ag). Isoxazole carboxamide and carbamates were obtained regioselectively through judicious use of two different protocols. The final products were characterized and identified using ¹H and ¹³C NMR, and mass spectroscopy. In addition, the carboxamide structure was confirmed using X-ray diffraction. Several of the novel carbamates and carboxamides evaluated exhibited excellent toxicity towards susceptible G3 and resistant Akron strain An. gambiae (48f LC₅₀ G3 = 41 μg/mL, LC₅₀ Akron = 58 μg/mL, and 47i LC₅₀ G3 = 38 μg/mL, LC₅₀ Akron = 40 μg/mL). Hence, achieving the resistance- breaking goal. On the contrary, the commercial aryl methylcarbamates currently approved for indoor residual sprays (IRS) showed no potency towards the resistant strain An. gambiae (LC₅₀ G3 = 16-42 μg/mL, and LC₅₀ Akron >5,000 μg/mL). Further, we observed low toxicological cross-resistance ratios (RR) for the toxic isoxazol-3-yl and pyrazol-4-yl carbamates, and 3- oxoisoxazole-2(3H)-carboxamides (RR = 0.5-2.0). Amongst the commercial AChE inhibitors approved for IRS, only aldicarb exhibited such low RR (RR = 0.5), whereas the RR for commercial aryl methylcarbamates exceed 130-fold. The low RR observed for these novel heterocyclic inhibitors would certainly be favorable for a new anticholinesterase-based mosquitocide targeting both the susceptible and resistant strain mosquitoes. Although the overall selectivity (Ag vs human) did not exceed 24-fold, the heterocyclic carbamates and carboxamides synthesized by the author showed appreciable inhibition of resistant AChE (G119S) in comparison to commercial aryl carbamates, which showed no inhibition at all. During the course of this project, the isoxazol-3-yl and pyrazol-5-yl methylcarbamates proved to be unstable, and thus could not be isolated. The synthesis of pyrazol-4-yl methylcarbamates using N-methylcarbamoyl chloride proved particularly challenging due to the formation of by-products called allophanates. The similar Rf of the by-product and the desired final product made the isolation laborious and time-consuming. We have successfully overcome this problem by employing a new protocol, where triphosgene served as the carbonylating agent and N-methylamine in THF was used as the amine source. In addition, we have also developed another one-pot protocol for a safer synthesis of pyrazol-4-yl methylcarbamates utilizing 1,1- carbonyldiimidazole (CDI), and N-methylamine hydrogen chloride salt. With the pyrazol-4-yl core, apart from achieving excellent toxicity towards both strains of An. gambiae, we have also achieved excellent AgAChE vs hAChE selectivity (Ag vs h >100-fold). Due to our continued interest in developing this core, we have devised a convenient, scalable, no-column approach for the synthesis an intermediate 103 that can be utilized to synthesize these compounds more efficiently. / Ph. D.

O uso de fármacos durante a lactação é uma prática comum; porém, os tratamentos farmacológicos impõem grandes dúvidas tanto aos profissionais quanto às nutrizes sobre a segurança do uso destes durante este período. A amamentação é uma forma de vínculo entre mãe e bebê e está associada a diversos benefícios nutricionais, imunológicos, cognitivos, psicoafetivos, econômicos e sociais. A depressão é um problema clínico importante durante o período pós-parto, e a vulnerabilidade para o início ou recorrência de sintomas depressivos aumenta a possibilidade de uso de psicofármacos enquanto ocorre a lactação. Os antidepressivos inibidores seletivos da recaptação da serotonina são comumente prescritos para o tratamento destes quadros depressivos, entre eles fluoxetina, sertralina, citalopram e paroxetina, sendo que a maioria destes é excretada no leite materno e há grande variabilidade na quantidade de analitos que pode ser recebida pelo lactente. Bupropiona é um fármaco antidepressivo utilizado para o tratamento do tabagismo e quadros depressivos e tem sua excreção ao leite materno relatada em literatura. Métodos bioanalíticos para determinação da excreção de fármacos antidepressivos foram desenvolvidos e validados por cromatografia líquida acoplada a espectrômetro de massas e cromatografia líquida com detecção ultravioleta. Estes métodos demonstraram serem seletivos, lineares, precisos e exatos, com limites de quantificação de 5 ng/mL (fluoxetina, citalopram e bupropiona) e 20 ng/mL (sertralina e paroxetina) para método por LC-MS e de 200 ng/mL para todos os analitos no método por CLAE-UV. As amostras de leite materno foram coletadas em Banco de Leite de mães que declararam utilizar fluoxetina ou sertralina ou paroxetina e analisados. Os dados de concentração encontrados para os fármacos referidos estão dentro da faixa encontrada em literatura confirmando sua excreção no leite materno. Paroxetina apresentou valores abaixo do limite de quantificação. Das concentrações encontradas no leite materno, foram estimadas as doses absolutas e relativas no lactante, sendo que os resultados demonstraram baixos valores em relação a estas estimativas, podendo os fármacos analisados ser considerados seguros para manutenção do uso durante a lactação. Foi também detectada nas análises por LC-MS a presença de norfluoxetina, metabólito da fluoxetina, confirmando sua excreção nesta matriz. / The use of medications during lactation is a common practice; however pharmacological treatments impose serious doubts to both, professionals and nursing mothers, about the safety of drugs use during this period. Breastfeeding is a natural form of bonding between mother and baby and it is associated with many nutritional, immunological, cognitive, psychoemotional, social and economic benefits. Depression is a major clinical problem during the postpartum period and the vulnerability to onset or recurrence of depressive symptoms increases the possibility of psychotropic drug use during lactation. Selective inhibitors of serotonin reuptake are commonly prescribed for the treatment of depressive disorders, including fluoxetine, sertraline, citalopram and paroxetine. Most of these drugs are excreted in breast milk and there is great variability in the amount of analytes that can be received by the infant. Bupropion is an antidepressant used for tabagism treatment and for depression symptoms; it is also described in literature its excretion into breast milk. Bioanalytical methods for determining the excretion of antidepressants were developed and validated by liquid chromatography coupled to mass spectrometry and liquid chromatography with ultraviolet detection. These methods proved to be selective, linear, precise and accurate with quantification limits of 5 ng/mL (fluoxetine, citalopram e bupropion) and 20 ng/mL (sertraline e paroxetine) for LC-MS method and 200 ng/mL for all analytes in the CLAE-UV method. Human milk samples were collected in milk banks from mothers to which the antidepressants fluoxetine or sertraline or paroxetine were administered, and the concentrations in this matrix were verified. Found concentrations were within the range described in the literature confirming their excretion in the breast milk. Paroxetine presented values less than limit of quantification. From the found concentrations, the absolute and relative doses in nursing were estimated. The results showed low values for these estimates and so the analyzed drugs can be considered safe to continue use during lactation. The presence of norfluoxetine, a metabolite of fluoxetine, was also detected by LC-MS, confirming its excretion in this matrix.

O uso de fármacos durante a lactação é uma prática comum; porém, os tratamentos farmacológicos impõem grandes dúvidas tanto aos profissionais quanto às nutrizes sobre a segurança do uso destes durante este período. A amamentação é uma forma de vínculo entre mãe e bebê e está associada a diversos benefícios nutricionais, imunológicos, cognitivos, psicoafetivos, econômicos e sociais. A depressão é um problema clínico importante durante o período pós-parto, e a vulnerabilidade para o início ou recorrência de sintomas depressivos aumenta a possibilidade de uso de psicofármacos enquanto ocorre a lactação. Os antidepressivos inibidores seletivos da recaptação da serotonina são comumente prescritos para o tratamento destes quadros depressivos, entre eles fluoxetina, sertralina, citalopram e paroxetina, sendo que a maioria destes é excretada no leite materno e há grande variabilidade na quantidade de analitos que pode ser recebida pelo lactente. Bupropiona é um fármaco antidepressivo utilizado para o tratamento do tabagismo e quadros depressivos e tem sua excreção ao leite materno relatada em literatura. Métodos bioanalíticos para determinação da excreção de fármacos antidepressivos foram desenvolvidos e validados por cromatografia líquida acoplada a espectrômetro de massas e cromatografia líquida com detecção ultravioleta. Estes métodos demonstraram serem seletivos, lineares, precisos e exatos, com limites de quantificação de 5 ng/mL (fluoxetina, citalopram e bupropiona) e 20 ng/mL (sertralina e paroxetina) para método por LC-MS e de 200 ng/mL para todos os analitos no método por CLAE-UV. As amostras de leite materno foram coletadas em Banco de Leite de mães que declararam utilizar fluoxetina ou sertralina ou paroxetina e analisados. Os dados de concentração encontrados para os fármacos referidos estão dentro da faixa encontrada em literatura confirmando sua excreção no leite materno. Paroxetina apresentou valores abaixo do limite de quantificação. Das concentrações encontradas no leite materno, foram estimadas as doses absolutas e relativas no lactante, sendo que os resultados demonstraram baixos valores em relação a estas estimativas, podendo os fármacos analisados ser considerados seguros para manutenção do uso durante a lactação. Foi também detectada nas análises por LC-MS a presença de norfluoxetina, metabólito da fluoxetina, confirmando sua excreção nesta matriz. / The use of medications during lactation is a common practice; however pharmacological treatments impose serious doubts to both, professionals and nursing mothers, about the safety of drugs use during this period. Breastfeeding is a natural form of bonding between mother and baby and it is associated with many nutritional, immunological, cognitive, psychoemotional, social and economic benefits. Depression is a major clinical problem during the postpartum period and the vulnerability to onset or recurrence of depressive symptoms increases the possibility of psychotropic drug use during lactation. Selective inhibitors of serotonin reuptake are commonly prescribed for the treatment of depressive disorders, including fluoxetine, sertraline, citalopram and paroxetine. Most of these drugs are excreted in breast milk and there is great variability in the amount of analytes that can be received by the infant. Bupropion is an antidepressant used for tabagism treatment and for depression symptoms; it is also described in literature its excretion into breast milk. Bioanalytical methods for determining the excretion of antidepressants were developed and validated by liquid chromatography coupled to mass spectrometry and liquid chromatography with ultraviolet detection. These methods proved to be selective, linear, precise and accurate with quantification limits of 5 ng/mL (fluoxetine, citalopram e bupropion) and 20 ng/mL (sertraline e paroxetine) for LC-MS method and 200 ng/mL for all analytes in the CLAE-UV method. Human milk samples were collected in milk banks from mothers to which the antidepressants fluoxetine or sertraline or paroxetine were administered, and the concentrations in this matrix were verified. Found concentrations were within the range described in the literature confirming their excretion in the breast milk. Paroxetine presented values less than limit of quantification. From the found concentrations, the absolute and relative doses in nursing were estimated. The results showed low values for these estimates and so the analyzed drugs can be considered safe to continue use during lactation. The presence of norfluoxetine, a metabolite of fluoxetine, was also detected by LC-MS, confirming its excretion in this matrix.

O uso de fármacos durante a lactação é uma prática comum; porém, os tratamentos farmacológicos impõem grandes dúvidas tanto aos profissionais quanto às nutrizes sobre a segurança do uso destes durante este período. A amamentação é uma forma de vínculo entre mãe e bebê e está associada a diversos benefícios nutricionais, imunológicos, cognitivos, psicoafetivos, econômicos e sociais. A depressão é um problema clínico importante durante o período pós-parto, e a vulnerabilidade para o início ou recorrência de sintomas depressivos aumenta a possibilidade de uso de psicofármacos enquanto ocorre a lactação. Os antidepressivos inibidores seletivos da recaptação da serotonina são comumente prescritos para o tratamento destes quadros depressivos, entre eles fluoxetina, sertralina, citalopram e paroxetina, sendo que a maioria destes é excretada no leite materno e há grande variabilidade na quantidade de analitos que pode ser recebida pelo lactente. Bupropiona é um fármaco antidepressivo utilizado para o tratamento do tabagismo e quadros depressivos e tem sua excreção ao leite materno relatada em literatura. Métodos bioanalíticos para determinação da excreção de fármacos antidepressivos foram desenvolvidos e validados por cromatografia líquida acoplada a espectrômetro de massas e cromatografia líquida com detecção ultravioleta. Estes métodos demonstraram serem seletivos, lineares, precisos e exatos, com limites de quantificação de 5 ng/mL (fluoxetina, citalopram e bupropiona) e 20 ng/mL (sertralina e paroxetina) para método por LC-MS e de 200 ng/mL para todos os analitos no método por CLAE-UV. As amostras de leite materno foram coletadas em Banco de Leite de mães que declararam utilizar fluoxetina ou sertralina ou paroxetina e analisados. Os dados de concentração encontrados para os fármacos referidos estão dentro da faixa encontrada em literatura confirmando sua excreção no leite materno. Paroxetina apresentou valores abaixo do limite de quantificação. Das concentrações encontradas no leite materno, foram estimadas as doses absolutas e relativas no lactante, sendo que os resultados demonstraram baixos valores em relação a estas estimativas, podendo os fármacos analisados ser considerados seguros para manutenção do uso durante a lactação. Foi também detectada nas análises por LC-MS a presença de norfluoxetina, metabólito da fluoxetina, confirmando sua excreção nesta matriz. / The use of medications during lactation is a common practice; however pharmacological treatments impose serious doubts to both, professionals and nursing mothers, about the safety of drugs use during this period. Breastfeeding is a natural form of bonding between mother and baby and it is associated with many nutritional, immunological, cognitive, psychoemotional, social and economic benefits. Depression is a major clinical problem during the postpartum period and the vulnerability to onset or recurrence of depressive symptoms increases the possibility of psychotropic drug use during lactation. Selective inhibitors of serotonin reuptake are commonly prescribed for the treatment of depressive disorders, including fluoxetine, sertraline, citalopram and paroxetine. Most of these drugs are excreted in breast milk and there is great variability in the amount of analytes that can be received by the infant. Bupropion is an antidepressant used for tabagism treatment and for depression symptoms; it is also described in literature its excretion into breast milk. Bioanalytical methods for determining the excretion of antidepressants were developed and validated by liquid chromatography coupled to mass spectrometry and liquid chromatography with ultraviolet detection. These methods proved to be selective, linear, precise and accurate with quantification limits of 5 ng/mL (fluoxetine, citalopram e bupropion) and 20 ng/mL (sertraline e paroxetine) for LC-MS method and 200 ng/mL for all analytes in the CLAE-UV method. Human milk samples were collected in milk banks from mothers to which the antidepressants fluoxetine or sertraline or paroxetine were administered, and the concentrations in this matrix were verified. Found concentrations were within the range described in the literature confirming their excretion in the breast milk. Paroxetine presented values less than limit of quantification. From the found concentrations, the absolute and relative doses in nursing were estimated. The results showed low values for these estimates and so the analyzed drugs can be considered safe to continue use during lactation. The presence of norfluoxetine, a metabolite of fluoxetine, was also detected by LC-MS, confirming its excretion in this matrix.

What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk. Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib. Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379–2·378), placebo (OR: 1·655: 95% CI: 1·029–2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146–4·053), and COXIBs (OR: 1·800, 95% CI: 1·217–2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396–0·857) and (OR: 0·609, 95% CI: 0·375–0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027–2·155) and (OR: 1·933, 95% CI: 1·052–3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410–0·887), (OR: 0·517, 95% CI: 0·287–0·929), and (OR: 0·509, 95% CI: 0·280–0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313–1·981), (OR: 1·572, 95% CI: 1·123–2·201) and (OR: 1·838, 95% CI: 1·323–2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658–0·986) and (OR: 0·557, 95% CI: 0.404–0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data. What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.

What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk. Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib. Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379-2·378), placebo (OR: 1·655: 95% CI: 1·029-2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146-4·053), and COXIBs (OR: 1·800, 95% CI: 1·217-2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396-0·857) and (OR: 0·609, 95% CI: 0·375-0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027-2·155) and (OR: 1·933, 95% CI: 1·052-3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410-0·887), (OR: 0·517, 95% CI: 0·287-0·929), and (OR: 0·509, 95% CI: 0·280-0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313-1·981), (OR: 1·572, 95% CI: 1·123-2·201) and (OR: 1·838, 95% CI: 1·323-2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658-0·986) and (OR: 0·557, 95% CI: 0.404-0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data. What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.