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Aguiar RPD, Newman-Tancredi A, Prickaerts J, Oliveira RMWD. The 5-HT 1A receptor as a serotonergic target for neuroprotection in cerebral ischemia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110210. [PMID: 33333136 DOI: 10.1016/j.pnpbp.2020.110210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Cerebral ischemia due to stroke or cardiac arrest greatly affects daily functioning and the quality of life of patients and has a high socioeconomic impact due to the surge in their prevalence. Advances in the identification of an effective pharmacotherapy to promote neuroprotection and recovery after a cerebral ischemic insult are, however, limited. The serotonin 1A (5-HT1A) receptor has been implicated in the regulation of several brain functions, including mood, emotions, memory, and neuroplasticity, all of which are deleteriously affected by cerebral ischemia. This review focuses on the specific roles and mechanisms of 5-HT1A receptors in neuroprotection in experimental models of cerebral ischemia. We present experimental evidence that 5-HT1A receptor agonists can prevent neuronal damage and promote functional recovery induced by focal and transient global ischemia in rodents. However, indiscriminate activation of pre-and postsynaptic by non-biased 5-HT1A receptor agonists may be a limiting factor in the anti-ischemic clinical efficacy of these compounds since 5-HT1A receptors in different brain regions can mediate diverging or even contradictory responses. Current insights are presented into the 'biased' 5-HT1A post-synaptic heteroreceptor agonist NLX-101 (also known as F15599), a compound that preferentially and potently stimulates postsynaptic cortical pyramidal neurons without inhibiting firing of serotoninergic neurons, as a potential strategy providing neuroprotection in cerebral ischemic conditions.
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Affiliation(s)
- Rafael Pazinatto de Aguiar
- Department of Pharmacology and Therapeutics, State University of Maringá, Av. Colombo, 5790, CEP 87020-900, Maringá, Paraná, Brazil
| | | | - Jos Prickaerts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rúbia Maria Weffort de Oliveira
- Department of Pharmacology and Therapeutics, State University of Maringá, Av. Colombo, 5790, CEP 87020-900, Maringá, Paraná, Brazil.
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Nik Ramli NN, Omar N, Husin A, Ismail Z, Siran R. Preconditioning effect of (S)-3,5-dihydroxyphenylglycine on ischemic injury in middle cerebral artery occluded Sprague-Dawley rats. Neurosci Lett 2015; 588:137-41. [PMID: 25562631 DOI: 10.1016/j.neulet.2014.12.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 10/24/2022]
Abstract
Glutamate receptors are the integral cellular components associated with excitotoxicity mechanism induced by the ischemic cascade events. Therefore the glutamate receptors have become the major molecular targets of neuroprotective agents in stroke researches. Recent studies have demonstrated that a Group I metabotropic glutamate receptor agonist, (S)-3,5-dihydroxyphenylglycine ((S)-3,5-DHPG) preconditioning elicits neuroprotection in the hippocampal slice cultures exposed to toxic level of N-methyl-d-aspartate (NMDA). We further investigated the preconditioning effects of (S)-3,5-DHPG on acute ischemic stroke rats. One 10 or 100μM of (S)-3,5-DHPG was administered intrathecally to Sprague-Dawley adult male rats, 2h prior to induction of acute ischemic stroke by middle cerebral artery occlusion (MCAO). After 24h, neurological deficits were evaluated by modified stroke severity scores and grid-walking test. All rats were sacrificed and infarct volumes were determined by 2,3,5-triphenyltetrazolium chloride staining. The serum level of neuron-specific enolase (NSE) of each rat was analyzed by enzyme-linked immunosorbent assay (ELISA). One and 10μM of (S)-3,5-DHPG preconditioning in the stroke rats showed significant improvements in motor impairment (P<0.01), reduction in the infarct volume (P<0.01) and reduction in the NSE serum level (P<0.01) compared to the control stroke rats. We conclude that 1 and 10μM (S)-3,5-DHPG preconditioning induced protective effects against acute ischemic insult in vivo.
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Affiliation(s)
- Nik Nasihah Nik Ramli
- Institute of Medical Molecular Biotechnology, Universiti Teknologi MARA, 47000 Selangor, Malaysia
| | - Nursyazwani Omar
- Institute of Medical Molecular Biotechnology, Universiti Teknologi MARA, 47000 Selangor, Malaysia
| | - Andrean Husin
- Faculty of Dentistry, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia; Brain and Neuroscience Communities of Research, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia
| | - Zalina Ismail
- Brain Research and Information Network, Centre for Neurocognitive Sciences, Universiti Sains Malaysia, 16150 Kelantan, Malaysia
| | - Rosfaiizah Siran
- Brain and Neuroscience Communities of Research, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia.
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Grupke S, Hall J, Dobbs M, Bix GJ, Fraser JF. Understanding history, and not repeating it. Neuroprotection for acute ischemic stroke: from review to preview. Clin Neurol Neurosurg 2014; 129:1-9. [PMID: 25497127 DOI: 10.1016/j.clineuro.2014.11.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 11/07/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neuroprotection for ischemic stroke is a growing field, built upon the elucidation of the biochemical pathways of ischemia first studied in the 1970s. Beginning in the early 1990s, means by which to pharmacologically intervene and counteract these pathways have been sought, though with little clinical success. Through a comprehensive review of translations from laboratory to clinic, we aim to evaluate individual mechanisms of action, while highlighting potential barriers to success that will guide future research. METHODS The MEDLINE database and The Internet Stroke Center clinical trials registry were queried for trials involving the use of neuroprotective agents in acute ischemic stroke in human subjects. For the purpose of the review, neuroprotective agents refer to medications used to preserve or protect the potentially ischemic tissue after an acute stroke, excluding treatments designed to re-establish perfusion. This excludes mechanical or pharmacological thrombolytics, anti-thrombic medications, or anti-platelet therapies. RESULTS This review summarizes previously trialed neuroprotective agents, including but not limited to glutamate neurotransmission blockers, anti-oxidants, GABA agonists, leukocyte migration blockers, various small cation channel modulators, narcotic antagonists, and phospholipid membrane stabilizers. We outline key biochemical steps in ischemic injury that are the proposed areas of intervention. The agents, time to administration of therapeutic agent, follow-up, and trial results are reported. DISCUSSION Stroke trials in humans are burdened with a marked heterogeneity of the patient population that is not seen in animal studies. Also, trials to date have included patients that are likely treated at a time outside of the window of efficacy for neuroprotective drugs, and have not effectively combined thrombolysis with neuroprotection. Through an evaluation of the accomplishments and failures in neuroprotection research, we propose new methodologies, agents, and techniques that may provide new routes for success.
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Affiliation(s)
- Stephen Grupke
- Department of Neurosurgery, University of Kentucky, Lexington, USA
| | - Jason Hall
- Department of Neurosurgery, University of Kentucky, Lexington, USA
| | - Michael Dobbs
- Department of Neurology, University of Kentucky, Lexington, USA
| | - Gregory J Bix
- Department of Neurology, University of Kentucky, Lexington, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, USA
| | - Justin F Fraser
- Department of Neurosurgery, University of Kentucky, Lexington, USA; Department of Neurology, University of Kentucky, Lexington, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, USA; Department of Radiology, University of Kentucky, Lexington, USA.
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Gonzales NR, Grotta JC. Pharmacologic Modification of Acute Cerebral Ischemia. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guenther U, Wrigge H, Theuerkauf N, Boettcher MF, Wensing G, Zinserling J, Putensen C, Hoeft A. Repinotan, a selective 5-HT1A-R-agonist, antagonizes morphine-induced ventilatory depression in anesthetized rats. Anesth Analg 2010; 111:901-7. [PMID: 20802053 DOI: 10.1213/ane.0b013e3181eac011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Spontaneous breathing during mechanical ventilation improves arterial oxygenation and cardiovascular function, but is depressed by opioids during critical care. Opioid-induced ventilatory depression was shown to be counteracted in anesthetized rats by serotonin(1A)-receptor (5-HT(1A)-R)-agonist 8-OH-DPAT, which cannot be applied to humans. Repinotan hydrochloride is a selective 5-HT(1A)-R-agonist already investigated in humans, but the effects on ventilation and nociception are unknown. In this study, we sought to establish (a) the effects of repinotan on spontaneous breathing and nociception, and (b) the interaction with the standard opiate morphine. METHODS The dose-dependent effects of repinotan, given alone or in combination with morphine, on spontaneous minute ventilation (MV) and nociceptive tail-flick reflex latencies (TFLs) were measured simultaneously in spontaneously breathing anesthetized rats. An additional series with NaCl 0.9% and the 5-HT(1A)-R-antagonist WAY 100 135 served as controls. RESULTS (a) Repinotan dose-dependently activated spontaneous breathing (MV, mean [95% confidence interval]; 53% [29%-77%]) of pretreatment level) and suppressed nociception (TLF, 91% maximum possible effect [68%-114%]) with higher doses of repinotan (2-200 μg/kg). On the contrary, nociception was enhanced with a small dose of repinotan (0.2 μg/kg; TFL, -47% maximum possible effect [-95% to 2%]). Effects were prevented by 5-HT(1A)-antagonist WAY 100 135. (B) Morphine-induced depression of ventilation (MV, -72% [-100% to -44%]) was reversed by repinotan (20 μg/kg), which returned spontaneous ventilation to pretreatment levels (MV, 18% [-40% to 77%]). The morphine-induced complete depression of nociception was sustained throughout repinotan and NaCl 0.9% administration. Despite a mild decrease in mean arterial blood pressure, there were no serious cardiovascular side effects from repinotan. CONCLUSIONS The 5-HT(1A)-R-agonist repinotan activates spontaneous breathing in anesthetized rats even in morphine-induced ventilatory depression. The potency of 5-HT(1A)-R-agonists to stimulate spontaneous breathing and their antinociceptive effects should be researched further.
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Affiliation(s)
- U Guenther
- University Hospital of Bonn, Clinic of Anaesthesiology and Intensive Care Medicine, Bonn, Germany.
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Teal P, Davis S, Hacke W, Kaste M, Lyden PD, Fierus M. A Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Efficacy, Safety, Tolerability, and Pharmacokinetic/Pharmacodynamic Effects of a Targeted Exposure of Intravenous Repinotan in Patients With Acute Ischemic Stroke. Stroke 2009; 40:3518-25. [DOI: 10.1161/strokeaha.109.551382] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Teal
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
| | - Stephen Davis
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
| | - Werner Hacke
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
| | - Markku Kaste
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
| | - Patrick D. Lyden
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
| | - Monika Fierus
- From the University of British Columbia (P.T.), Vancouver, British Columbia, Canada; University of Melbourne (S.D.), Melbourne, Australia; the University of Heidelberg (W.H.), Heidelberg, Germany; the University of Helsinki (M.K.), Helsinki, Finland; the Veterans Administration Medical Center and University of California School of Medicine (P.D.L.), San Diego, Calif; and Bayer HealthCare AG (M.F.), Leverkusen, Germany
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Ashioti M, Beech JS, Lowe AS, Bernanos M, McCreary A, Modo MM, Williams SCR. Neither in vivo MRI nor behavioural assessment indicate therapeutic efficacy for a novel 5HT(1A) agonist in rat models of ischaemic stroke. BMC Neurosci 2009; 10:82. [PMID: 19607699 PMCID: PMC2720976 DOI: 10.1186/1471-2202-10-82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 07/16/2009] [Indexed: 02/01/2023] Open
Abstract
Background 5HT1A agonists have previously been shown to promote recovery in animal models of stroke using ex vivo outcome measures which have raised the hopes for a potential clinical implementation. The purpose of this study was to evaluate the potential neuroprotective properties of a novel 5HT1A agonist DU123015 in 2 different models of transient focal ischaemic stroke of varying severities using both in vivo neuroimaging and behavioural techniques as primary outcome measures. For these studies, the NMDA receptor antagonist MK-801 was also utilized as a positive control to further assess the effectiveness of the stroke models and techniques used. Results In contrast to MK-801, no significant therapeutic effect of DU123015 on lesion volume in either the distal MCAo or intraluminal thread model of stroke was found. MK-801 significantly reduced lesion volume in both models; the mild distal MCAo condition (60 min ischaemia) and the intraluminal thread model, although it had no significant impact upon the lesion size in the severe distal MCAo condition (120 min ischaemia). These therapeutic effects on lesion size were mirrored on a behavioural test for sensory neglect and neurological deficit score in the intraluminal thread model. Conclusion This study highlights the need for a thorough experimental design to test novel neuroprotective compounds in experimental stroke investigations incorporating: a positive reference compound, different models of focal ischaemia, varying the duration of ischaemia, and objective in vivo assessments within a single study. This procedure will help us to minimise the translation of less efficacious compounds.
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Affiliation(s)
- Maria Ashioti
- Institute of Psychiatry, Kings College London, Denmark Hill, UK.
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Meller E. 5-HT1A receptor-mediated apoptosis: death by JNK? BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2007; 1773:691-3. [PMID: 17346815 PMCID: PMC1950678 DOI: 10.1016/j.bbamcr.2007.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 01/02/2007] [Accepted: 01/02/2007] [Indexed: 11/22/2022]
Abstract
There is growing interest in the potential use of 5-HT(1A) receptor agonists as neuroprotective agents in stroke and traumatic brain injury. However, a new study using a recombinant 5-HT(1A) receptor cell line suggests that these agonists may promote as well as inhibit apoptotic responses. Because heterologously expressed receptors may couple promiscuously to inappropriate signal transduction pathways, the results should be interpreted with caution.
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Affiliation(s)
- Emanuel Meller
- Millhauser Laboratories, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Ferro JM, Dávalos A. Other Neuroprotective Therapies on Trial in Acute Stroke. Cerebrovasc Dis 2006; 21 Suppl 2:127-30. [PMID: 16651823 DOI: 10.1159/000091712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
New neuroprotective agents on trial may potentially offer benefit to stroke patients without the associated hemorrhagic risk of thrombolytic therapy. Clinical investigation of these drugs has been designed to obtain the highest probability of success, or concentrates on the salvageable ischemic brain and use infarct growth on MRI as a surrogate end-point. Nine substances in 10 trials are currently being tested in three therapeutical strategies in patients with acute ischemic stroke. These strategies focus on: (1) the optimal management of serum glucose with the infusion of glucose, insulin and potassium to induce and maintain euglycemia; (2) the modulation of the inflammatory response with recombinant human interferon-beta(1a), and (3) interfering with the ischemic cascade using magnesium, albumin, the metal iron chelator DP-b99, the AMPA receptor antagonist zonampanel, the serotonin agonists repinotan and piclozotan, the free radical scavenger cerovive, and the membrane modulator citicoline. Future directions should develop neuroprotective compounds that are safe and well tolerated, are effective in a broad range of patients and can be used with or without rt-PA.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal.
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Rogalewski A, Schneider A, Ringelstein EB, Schäbitz WR. Toward a Multimodal Neuroprotective Treatment of Stroke. Stroke 2006; 37:1129-36. [PMID: 16527996 DOI: 10.1161/01.str.0000209330.73175.34] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke remains a common medical problem with importance attributable to the demographic changes in industrialized societies.
Summary of Review—
After years of setbacks, acute stroke therapy has finally emerged, including thrombolysis with tissue plasminogen activator (t-PA). However, t-PA treatment is limited by a narrow time window and side effects, so that only 3% of all stroke patients receive thrombolysis. Unimodal targeting of key events in stroke pathophysiology was not effective in providing long-term benefits, leading to negative results in previous clinical neuroprotective stroke trials. A successful future stroke therapy should approach multiple pathophysiological mechanisms besides revascularization at once, including reduction of t-PA–related side effects, prevention of cell death, stimulation of neuroregeneration, and plasticity.
Conclusions—
Strategies targeting these processes include multiple combination therapies as well as treatment with multimodal drugs that interact with these mechanisms. Here, we review such combination approaches, and outline how this concept could be developed into future stroke treatment.
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Tanigawa T, Heinig R, Kuroki Y, Higuchi S. Evaluation of Interethnic Differences in Repinotan Pharmacokinetics by Using Population Approach. Drug Metab Pharmacokinet 2006; 21:61-9. [PMID: 16547395 DOI: 10.2133/dmpk.21.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Repinotan is a selective full serotonin receptor agonist at the 5-HT1A subtype which has been studied in phase I and II studies involving over 500 healthy subjects and patients. Repinotan is primarily metabolized by CYP2D6 which is known to be subject to polymorphism and ethnic differences in its quantitative and qualitative expression pattern. In order to investigate the effect of ethnicity on repinotan pharmacokinetics (PK) between a Caucasian and Japanese population and to explain PK variability, this population PK evaluation was conducted. A population PK model was established based on the data of 1314 blood samples from 241 patients from 3 Phase II studies. This analysis has characterized the repinotan PK, with particular attention to ethnicity. Using the MIXTURE subroutine of NONMEM, evidence was provided for different CL groups. Repinotan plasma levels in the 'High CL' subgroup, which comprised the majority of patients, did not show relevant differences between a Japanese and Caucasian population. In the 'Low CL' subgroup, Japanese and Caucasian populations were different. These findings are consistent with the published literature, which reports ethnic differences in the distribution of CYP2D6 activity. The finding of a greater percentage of patients with intermediate CL in the Japanese population falling between poor and extensive metabolizers is consistent with the distribution pattern of CYP2D6 in the Japanese population. The results of this evaluation can be used to assist in designing future trials.
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