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Wulkersdorfer B, Bergmann F, Amann L, Fochtmann-Frana A, Al Jalali V, Kurdina E, Lackner E, Wicha SG, Dorn C, Schäfer B, Ihra G, Rath T, Radtke C, Zeitlinger M. Effect of albumin substitution on pharmacokinetics of piperacillin/tazobactam in patients with severe burn injury admitted to the ICU. J Antimicrob Chemother 2024; 79:262-270. [PMID: 38069908 PMCID: PMC10832600 DOI: 10.1093/jac/dkad368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/18/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Pathophysiological changes in severely burned patients alter the pharmacokinetics (PK) of anti-infective agents, potentially leading to subtherapeutic concentrations at the target site. Albumin supplementation, to support fluid resuscitation, may affect pharmacokinetic properties by binding drugs. This study aimed to investigate the PK of piperacillin/tazobactam in burn patients admitted to the ICU before and after albumin substitution as total and unbound concentrations in plasma. PATIENTS AND METHODS Patients admitted to the ICU and scheduled for 4.5 g piperacillin/tazobactam administration and 200 mL of 20% albumin substitution as part of clinical routine were included. Patients underwent IV microdialysis, and simultaneous arterial plasma sampling, at baseline and multiple timepoints after drug administration. PK analysis of total and unbound drug concentrations under steady-state conditions was performed before and after albumin supplementation. RESULTS A total of seven patients with second- to third-degree burns involving 20%-60% of the total body surface were enrolled. Mean (SD) AUC0-8 (h·mg/L) of total piperacillin/tazobactam before and after albumin substitution were 402.1 (242)/53.2 (27) and 521.8 (363)/59.7 (32), respectively. Unbound mean AUC0-8 before and after albumin supplementation were 398.9 (204)/54.5 (25) and 456.4 (439)/64.5 (82), respectively. CONCLUSIONS Albumin supplementation had little impact on the PK of piperacillin/tazobactam. After albumin supplementation, there was a numerical increase in mean AUC0-8 of total and unbound piperacillin/tazobactam, whereas similar Cmax values were observed. Future studies may investigate the effect of albumin supplementation on drugs with a higher plasma protein binding.
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Affiliation(s)
- Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Orthopedic Clinic—SKA Zicksee, Otto-Pohanka-Platz 1, 7161 St.Andrä am Zicksee, Austria
| | - Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Medical University of Vienna, Department of Plastic, Reconstructive, and Aesthetic Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Lisa Amann
- University of Hamburg, Department of Clinical Pharmacology, Institute of Pharmacy, Bundesstrasse 45, 20146 Hamburg, Germany
| | - Alexandra Fochtmann-Frana
- Medical University of Vienna, Department of Plastic, Reconstructive, and Aesthetic Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Elizaveta Kurdina
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Sebastian G Wicha
- University of Hamburg, Department of Clinical Pharmacology, Institute of Pharmacy, Bundesstrasse 45, 20146 Hamburg, Germany
| | - Christoph Dorn
- University of Regensburg, Institute of Pharmacy, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Bruno Schäfer
- Medical University of Vienna, Department of Anesthesiology and General Intensive Care, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gerald Ihra
- Medical University of Vienna, Department of Anesthesiology and General Intensive Care, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Rath
- Medical University of Vienna, Department of Plastic, Reconstructive, and Aesthetic Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christine Radtke
- Medical University of Vienna, Department of Plastic, Reconstructive, and Aesthetic Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Bergmann F, Nussbaumer-Pröll A, Wulkersdorfer B, Eberl S, Ruppitsch W, Lepuschitz S, Zeitlinger M. Antimicrobial activity and pathogen mutation prevention of originator and generics of cefepime, linezolid and piperacillin/tazobactam against clinical isolates of Staphylococcus aureus. J Glob Antimicrob Resist 2023; 34:179-185. [PMID: 37473915 DOI: 10.1016/j.jgar.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Although generic medicinal products are required to have the same qualitative and quantitative composition of the active substance as their reference originator product, patients and health care professionals express concerns about their interchangeability and safety. Therefore, the present study investigated the antimicrobial activity and pathogen mutation prevention of original and generic cefepime, linezolid and piperacillin/tazobactam against Staphylococcus aureus. METHODS Two generic formulations of cefepime, linezolid and piperacillin/tazobactam were tested against their respective originator products. Susceptibility testing was performed with twenty-one clinical isolates of S. aureus and ATCC-29213 using broth microdilution. Time kill curves (TKC) were performed with ATCC-29213 at drug concentrations above and below the respective minimum inhibitory concentrations (MIC). Mutation prevention concentration was determined for each drug formulation against ATCC-29213. All experiments were performed in triplicate. Mutant colonies from mutation prevention concentration (MPC) experiments were genotypically tested by sequence analysis. RESULTS MIC ratios between contiguous originator and generic drugs were similar for each isolate. No visual differences were observed in TKCs between originator and generic substances. The MPC did not differ between different formulations of the same substance. Although sequence analysis of mutant colonies revealed genomic differences compared with the original ATCC-29213, no differences in mutation frequencies were observed between clinical isolates and ATCC-29213 treated with originator or generic substances. CONCLUSIONS Similar antimicrobial activity and pathogen mutation prevention was observed between contiguous substances. These results support the interchangeability of generic and originator drug formulations with the same active ingredient.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria; Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria
| | | | | | - Sabine Eberl
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - Werner Ruppitsch
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Sarah Lepuschitz
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria.
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van Os W, Wulkersdorfer B, Eberl S, Oesterreicher Z, Schwabl P, Reiberger T, Paternostro R, Weber M, Willinger B, Zeitlinger M. Bacterial growth and ceftriaxone activity in individual ascitic fluids in an in vitro model of spontaneous bacterial peritonitis. Front Pharmacol 2023; 14:1124821. [PMID: 37063261 PMCID: PMC10090294 DOI: 10.3389/fphar.2023.1124821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction: The environment of the infection site affects bacterial growth and antibiotic activity. When bacterial growth and antibiotic activity are studied in body fluids, samples of multiple subjects are usually pooled, averaging out potentially relevant differences in composition. The ascitic fluid (AF) environment is frequently associated with spontaneous bacterial peritonitis (SBP) in cirrhotic patients. In this study, bacterial growth and ceftriaxone activity were evaluated in individual AF using an in vitro model of SBP, reflecting the environment and pharmacokinetics at the infection site.Methods: AF was obtained from nine cirrhotic patients with non-infected ascites. Growth of nine bacterial strains (three Escherichia coli, four Staphylococcus aureus, one Enterococcus faecalis, and one Klebsiella pneumoniae) in individual AF was assessed and correlated with biomarkers including potential risk factors for SBP. Ceftriaxone time-kill experiments, in which the pharmacokinetic profile observed in AF following a 1 g intravenous infusion was replicated, were performed with two E. coli and two S. aureus isolates with minimum inhibitory concentrations around the ceftriaxone resistance breakpoint.Results: Significant correlations were found between bacterial growth and AF levels of protein (Spearman’s rank correlation coefficient ρ = −0.35), albumin (ρ = −0.31), and complement C3c (ρ = −0.28), and serum levels of bilirubin (ρ = 0.39) and aspartate aminotransferase (ρ = 0.25). Ceftriaxone was active in AF, even against resistant isolates, generally resulting in ≥2 log reductions in bacterial count within 24 h.Conclusion: Ascites patients may be predisposed to or protected against SBP based on the antimicrobial capacity of their AF. Ceftriaxone at clinical AF concentrations is active in the AF environment.
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Affiliation(s)
- Wisse van Os
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Sabine Eberl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Zoe Oesterreicher
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Schwabl
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Rafael Paternostro
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Department of Microbiology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Markus Zeitlinger,
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Sanz-Codina M, Wicha SG, Wulkersdorfer B, Al Jalali V, Van Os W, Vossen MG, Bauer M, Lackner E, Dorn C, Zeitlinger M. Comparison of ultrafiltration and microdialysis for ceftriaxone protein-binding determination. J Antimicrob Chemother 2023; 78:380-388. [PMID: 36433819 DOI: 10.1093/jac/dkac400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND High protein binding (PB) of antibiotics has an impact on their antimicrobial activity. It has been questioned whether in vitro PB determination can capture the dynamic and concentration-dependent PB of highly bound antibiotics. OBJECTIVES This clinical study compared in vitro ultrafiltration (UF) and in vivo IV microdialysis (MD) methods to determine ceftriaxone PB. METHODS Six healthy male volunteers received a single IV 2 g dose of ceftriaxone. Unbound ceftriaxone plasma concentrations were measured with MD and venous plasma sampling with subsequent UF. Pharmacokinetic parameters were determined using non-compartmental pharmacokinetic analysis. Non-linear mixed-effects modelling was used to quantify the PB. The PTA was estimated. RESULTS The Cmax of ceftriaxone total plasma concentration (297.42 ± 21.0 mg/L) was approximately 5.5-fold higher than for free concentrations obtained with UF (52.83 ± 5.07 mg/L), and only 3.5-fold higher than for free concentrations obtained with MD (81.37 ± 26.93 mg/L). Non-linear, saturable PB binding was confirmed for both UF and MD. Significantly different dissociation constants (Kd) for the albumin/ceftriaxone complex were quantified: in UF it was 23.7 mg/L (95% CI 21.3-26.2) versus 15.9 mg/L (95% CI 13.6-18.6) in MD. Moreover, the estimated number of binding sites (95% CI) per albumin molecule was 0.916 (0.86-0.97) in UF versus 0.548 in MD (0.51-0.59). The PTA obtained with MD was at most 27% higher than with UF. CONCLUSIONS In vitro UF versus in vivo intravasal MD revealed significantly different PB, especially during the distribution phase. The method of PB determination could have an impact on the breakpoint determination and dose optimisation of antibiotics.
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Affiliation(s)
- Maria Sanz-Codina
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | | | - Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Wisse Van Os
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Matthias G Vossen
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Edith Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Al Jalali V, Wasinger G, Rasul S, Grubmueller B, Wulkersdorfer B, Balber T, Mitterhauser M, Simon J, Hacker M, Shariat S, Egger G, Zeitlinger M. Consecutive PSMA and AR PET imaging shows positive correlation to AR and PSMA protein expression in primary hormone naïve prostate cancer. J Nucl Med 2023:jnumed.122.264981. [PMID: 36657982 DOI: 10.2967/jnumed.122.264981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Rationale: The present study set out to investigate if PET imaging can be used as a potential substitute for immunohistochemical analysis of tumor samples in prostate cancer (PC) patients. Correlation between imaging signals of two PET tracers and the corresponding target structures was assessed. The first tracer was [68Ga]Ga-PSMAHBED-CC([68Ga]PSMA), which is already implemented in clinical routine. The second tracer was [18F]-fluoro-5α-dihydrotestosterone([18F]FDHT) which binds to the androgen receptor (AR). The AR is particularly interesting in PC, since the AR expression status and its shift during therapy might directly influence patient care. Methods: This prospective, explorative clinical study included 10 newly diagnosed PC patients. Each patient received a [68Ga]PSMA-PET/MRI- and [18F]FDHT-PET/MRI-scan prior to prostatectomy. Cancer standardized uptake values (SUV) were determined and related to background SUVs. Following prostatectomy, tumor tissue was sampled and AR and prostate-specific membrane antigen (PSMA) expression determined. AR and PSMA expressions were evaluated quantitively with QuPath and additionally with a four-tiered rating system. Correlation between imaging signals and marker expression was statistically assessed. Results: For [18F]FDHT, the SUVmax/SUVbackground ratio showed a significant, strong correlation (P-value=0.019, r=0.72) with AR optical density of the correlating tissue sample. The correlation between PSMA optical density and the [68Ga]PSMA SUVmax/SUVbackground ratio was not significant (P-value=0.061), yet a positive correlation trend could be observed (r=0.61). SUVmax/SUVbackground ratios were higher for [68Ga]PSMA (34.9±24.8) compared to [18F]FDHT (4.8±1.2). In line with this findings, the tumor detection rate of the Ga-PSMA-PET scan was 90%, but only 40% for the [18F]FDHT-PET scan. The four-tiered rating of PSMA staining intensity yielded very homogenous results with values of 3+ for most subjects (90%). The AR staining was rated with 1+ in two patients (20%), with 2+ in four patients (40%) and with 3+ in four patients (40%). Conclusion: [18F]FDHT-PET may be useful for monitoring AR expression and alterations of AR expression during treatment of PC patients. This may facilitate early detection of treatment resistance and allows for adaptation of therapy to prevent cancer progression. [18F]FDHT-PET is inferior to [68Ga]PSMA-PET for primary PC diagnosis, but the correlation between [68Ga]PSMA SUVs and PSMA expression is weaker compared to [18F]FDHT and the AR.
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Affiliation(s)
- Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University Vienna, Austria, Austria
| | | | - Sazan Rasul
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University Vienna, Austria
| | - Bernhard Grubmueller
- Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | | | | | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Austria
| | | | | | - Gerda Egger
- Department of Pathology, Medical University Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Austria, Austria
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6
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Jorda A, Wulkersdorfer B, Schoergenhofer C, Matzneller P, Al Jalali V, Bauer M, Wölfl-Duchek M, Lackner E, Dorn C, Jilma B, Zeitlinger M. Effect of the human endotoxin challenge on tedizolid tissue penetration. Br J Clin Pharmacol 2023; 89:416-420. [PMID: 36223278 PMCID: PMC10092186 DOI: 10.1111/bcp.15564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
The effects of the human endotoxin challenge on tissue pharmacokinetics are unknown. In the present study, we aimed to assess the effect of the endotoxin challenge on interstitial fluid pharmacokinetics of tedizolid in healthy volunteers using intramuscular microdialysis. Eight healthy male subjects were treated with 200 mg of tedizolid phosphate for 6 days. On Day 6, an intravenous bolus of lipopolysaccharide (LPS) (2 ng/kg body weight) was administered. LPS infusion did not affect plasma pharmacokinetics of tedizolid. In contrast, following LPS infusion, median muscle tissue fAUC (0.83 [0.75-1.15] vs. 1.14 [1.11-1.43] mg × h/L, P = .0078) and muscle tissue fCmax (0.15 [0.14-0.19] vs. 0.19 [0.18-0.24] mg/L, P = .0078) were significantly increased by 38% and 24%, respectively. The human endotoxin challenge was associated with increased tissue concentrations of tedizolid, without affecting its plasma concentration-time profile. The human endotoxin challenge combined with microdialysis may be used to investigate the influence of systemic inflammation on tissue pharmacokinetics.
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Affiliation(s)
- Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | | | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Edith Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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7
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Bergmann F, Wulkersdorfer B, Oesterreicher Z, Bauer M, Al Jalali V, Nussbaumer-Pröll A, Wölfl-Duchek M, Jorda A, Lackner E, Reiter B, Stimpfl T, Ballarini N, König F, Zeitlinger M. Comparison of pharmacokinetics and stability of generics of cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs: an intravenous bioequivalence study in healthy volunteers. J Antimicrob Chemother 2022; 77:3086-3092. [PMID: 36039038 DOI: 10.1093/jac/dkac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The efficacy and quality of generic antibacterial drug formulations are often questioned by both healthcare specialists and patients. Therefore, the present study investigated the interchangeability of generic drugs with their originators by comparing bioequivalence parameters and stability data of generic cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs. METHODS In this open-label, randomized, crossover bioequivalence study, three groups of 12 healthy volunteers each received a single intravenous infusion of either 2 g of cefepime or 4.5 g of piperacillin/tazobactam and two generic formulations, or 600 mg of linezolid and one generic formulation. Plasma sampling was performed, with a 5 day washout period between study days. Stability was tested by storing reconstituted generic and originator products according to their own storage specifications and those of the comparator products. All concentrations were measured by LC-MS. RESULTS Similar ratios of generic/originator (90% CI) Cmax were observed for Cefepime-MIP/Maxipime [93.7 (88.4-99.4)], Cefepime Sandoz/Maxipime [95.9 (89.1-103.2)], Linezolid Kabi/Zyvoxid [104.5 (91.1-119.9)], Piperacillin Kabi/Tazobac [95.9 (90.4-101.7)], Piperacillin Aurobindo/Tazobac [99.7 (84.9-104.7)], Tazobactam Kabi/Tazobac [93.4 (87.4-99.8)] and Tazobactam Aurobindo/Tazobac [97.4 (89.7-105.8)]. Accordingly, similar ratios of AUC0-t were observed for Cefepime-MIP/Maxipime [91.1 (87.6-94.8)], Cefepime Sandoz/Maxipime [97.9 (92.5-103.5)], Linezolid Kabi/Zyvoxid [99.7 (93.3-106.6)], Piperacillin Kabi/Tazobac [92.2 (88.3-96.3)], Piperacillin Aurobindo/Tazobac [99.9 (97.0-102.8)], Tazobactam Kabi/Tazobac [91.4 (86.4-96.7)] and Tazobactam Aurobindo/Tazobac [98.8 (94.3-103.6)]. Stable and similar concentrations were measured for all contiguous substances, regardless of storage conditions. CONCLUSIONS Compared with their respective originator drugs, generic cefepime, linezolid and piperacillin/tazobactam met the predetermined bioequivalence criteria. All formulations were stable under the storage conditions of their respective comparators.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zoe Oesterreicher
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Bauer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Wölfl-Duchek
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anselm Jorda
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Birgit Reiter
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Stimpfl
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicolas Ballarini
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Franz König
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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8
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Ngougni Pokem P, Matzneller P, Vervaeke S, Wittebole X, Goeman L, Coessens M, Cottone E, Capron A, Wulkersdorfer B, Wallemacq P, Mouton JW, Muller AE, Zeitlinger M, Laterre PF, Tulkens PM, Van Bambeke F. Binding of temocillin to plasma proteins in vitro and in vivo: the importance of plasma protein levels in different populations and of co-medications. J Antimicrob Chemother 2022; 77:2742-2753. [PMID: 36018077 DOI: 10.1093/jac/dkac286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/28/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Temocillin plasma protein binding (PPB) in healthy individuals is reported to be ∼85% but had not been studied in patients. OBJECTIVES To obtain normative data on temocillin PPB in patients in relation to infection and impact of co-medications widely used in ICU. METHODS Plasma was obtained from healthy individuals (Group #1), non-ICU patients with UTI (Group #2), ICU patients with suspected/confirmed ventriculitis (Group #3) or with sepsis/septic shock (Group #4). Total and unbound temocillin concentrations were measured in spiked samples from temocillin-naive donors (in vitro) or in plasma from temocillin-treated subjects (in vivo). The impact of diluting plasma, using pharmaceutical albumin, or adding drugs potentially competing for PPB was tested in spiked samples. Data were analysed using a modified Hill-Langmuir equation taking ligand depletion into account. RESULTS Temocillin PPB was saturable in all groups, both in vitro and in vivo. Maximal binding capacity (Bmax) was 1.2-2-fold lower in patients. At 20 and 200 mg/L (total concentrations), the unbound fraction reached 12%-29%, 23%-42% and 32%-52% in Groups #2, #3, #4. The unbound fraction was inversely correlated with albumin and C-reactive protein concentrations. Binding to albumin was 2-3-fold lower than in plasma and non-saturable. Drugs with high PPB but active at lower molar concentrations than temocillin caused minimal displacement, while fluconazole (low PPB but similar plasma concentrations to temocillin) increased up to 2-fold its unbound fraction. CONCLUSIONS Temocillin PPB is saturable, 2-4-fold lowered in infected patients in relation to disease severity (ICU admission, hypoalbuminaemia, inflammation) and only partially reproducible with albumin. Competition with other drugs must be considered for therapeutic concentrations to be meaningful.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna Austria
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Xavier Wittebole
- Department of Critical Care Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Lieven Goeman
- Department of Urology, AZ Delta Hospital, Roeselare, Belgium
| | - Marie Coessens
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Eleonora Cottone
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Arnaud Capron
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Pierre Wallemacq
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna Austria
| | - Pierre François Laterre
- Department of Critical Care Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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9
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Oesterreicher Z, Eberl S, Wulkersdorfer B, Matzneller P, Eder C, van Duijn E, Vaes WHJ, Reiter B, Stimpfl T, Jäger W, Nussbaumer-Proell A, Marhofer D, Marhofer P, Langer O, Zeitlinger M. Microdosing as a Potential Tool to Enhance Clinical Development of Novel Antibiotics: A Tissue and Plasma PK Feasibility Study with Ciprofloxacin. Clin Pharmacokinet 2022; 61:697-707. [PMID: 34997559 PMCID: PMC9095552 DOI: 10.1007/s40262-021-01091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
Background and Objective In microdose studies, drug pharmacokinetics is measured in humans after administration of subtherapeutic doses. While previous microdose studies focused primarily on plasma pharmacokinetics, we set out to evaluate the feasibility of microdosing for a pharmacokinetic assessment in subcutaneous tissue and epithelial lining fluid. Methods Healthy subjects received a single intravenous bolus injection of a microdose of [14C]ciprofloxacin (1.1 µg, 7 kBq) with (cohort A, n = 9) or without (cohort B, n = 9) a prior intravenous infusion of a therapeutic dose of unlabeled ciprofloxacin (400 mg). Microdialysis and bronchoalveolar lavage were applied for determination of subcutaneous and intrapulmonary drug concentrations. Microdose [14C]ciprofloxacin was quantified by accelerator mass spectrometry and therapeutic-dose ciprofloxacin by liquid chromatography–tandem mass spectrometry. Results The pharmacokinetics of therapeutic-dose ciprofloxacin (cohort A) in plasma, subcutaneous tissue, and epithelial lining fluid was in accordance with previous data. In plasma and subcutaneous tissue, the dose-adjusted area under the concentration–time curve of microdose ciprofloxacin was similar in cohorts A and B and within an 0.8-fold to 1.1-fold range of the area under the concentration–time curve of therapeutic-dose ciprofloxacin. Penetration of microdose ciprofloxacin into subcutaneous tissue was similar in cohorts A and B and comparable to that of therapeutic-dose ciprofloxacin with subcutaneous tissue-to-plasma area under the concentration–time curve ratios of 0.44, 0.44, and 0.38, respectively. Penetration of microdose ciprofloxacin into epithelial lining fluid was highly variable and failed to predict the epithelial lining fluid penetration of therapeutic-dose ciprofloxacin. Conclusions Our study confirms the feasibility of microdosing for pharmacokinetic measurements in plasma and subcutaneous tissue. Microdosing combined with microdialysis is a potentially useful tool in clinical antimicrobial drug development, but its applicability for the assessment of pulmonary pharmacokinetics with bronchoalveolar lavage requires further studies. Clinical Trial Registration ClinicalTrials.gov NCT03177720 (registered 6 June, 2017). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01091-1.
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Affiliation(s)
- Zoe Oesterreicher
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital of St. Pölten, St. Pölten, Austria
| | - Sabine Eberl
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Beatrix Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Claudia Eder
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | | | - Birgit Reiter
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Alina Nussbaumer-Proell
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniela Marhofer
- Department of Anaesthesia, General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Peter Marhofer
- Department of Anaesthesia, General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria.,Orthopaedic Hospital Speising, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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10
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Hosmann A, Ritscher L, Burgmann H, Al Jalali V, Wulkersdorfer B, Wölfl-Duchek M, Sanz Codina M, Jäger W, Poschner S, Plöchl W, Reinprecht A, Rössler K, Gruber A, Zeitlinger M. Meropenem concentrations in brain tissue of neurointensive care patients exceed CSF levels. J Antimicrob Chemother 2021; 76:2914-2922. [PMID: 34392352 DOI: 10.1093/jac/dkab286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Inadequate antibiotic exposure in cerebral infections might have detrimental effects on clinical outcome. Commonly, antibiotic concentrations within the CSF were used to estimate cerebral target levels. However, the actual pharmacological active unbound drug concentration beyond the blood-brain barrier is unknown. OBJECTIVES To compare meropenem concentrations in blood, CSF and cerebral microdialysate of neurointensive care patients. PATIENTS AND METHODS In 12 patients suffering subarachnoid haemorrhage, 2000 mg of meropenem was administered every 8 h due to an extracerebral infection. Meropenem concentrations were determined in blood, CSF and cerebral microdialysate at steady state (n = 11) and following single-dose administration (n = 5). RESULTS At steady state, the free AUC0-8 was 233.2 ± 42.7 mg·h/L in plasma, 7.8 ± 1.9 mg·h/L in CSF and 26.6 ± 14.0 mg·h/L in brain tissue. The brain tissue penetration ratio (AUCbrain/AUCplasma) was 0.11 ± 0.06, which was more than 3 times higher than in CSF (0.03 ± 0.01), resulting in an AUCCSF/AUCbrain ratio of 0.41 ± 0.16 at steady state. After single-dose administration similar proportions were achieved (AUCbrain/AUCplasma = 0.09 ± 0.08; AUCCSF/AUCplasma = 0.02 ± 0.00). Brain tissue concentrations correlated well with CSF concentrations (R = 0.74, P < 0.001), but only moderately with plasma concentrations (R = 0.51, P < 0.001). Bactericidal thresholds were achieved in both plasma and brain tissue for MIC values ≤16 mg/L. In CSF, bactericidal effects were only reached for MIC values ≤1 mg/L. CONCLUSIONS Meropenem achieves sufficient bactericidal concentrations for the most common bacterial strains of cerebral infections in both plasma and brain tissue, even in non-inflamed brain tissue. CSF concentrations would highly underestimate the target site activity of meropenem beyond the blood-brain barrier.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Lavinia Ritscher
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maria Sanz Codina
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Stefan Poschner
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Walter Plöchl
- Department of Anaesthesia, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Andrea Reinprecht
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Johannes Kepler University, Linz, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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11
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Wulkersdorfer B, Wicha SG, Kurdina E, Carrion Carrera SF, Matzneller P, Al Jalali V, Vossen MG, Riesenhuber S, Lackner E, Dorn C, Zeitlinger M. Protein binding of clindamycin in vivo by means of intravascular microdialysis in healthy volunteers. J Antimicrob Chemother 2021; 76:2106-2113. [PMID: 33970263 DOI: 10.1093/jac/dkab140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The efficacy of an anti-infective drug is influenced by its protein binding (PB), since only the free fraction is active. We hypothesized that PB may vary in vitro and in vivo, and used clindamycin, a drug with high and concentration-dependent PB to investigate this hypothesis. METHODS Six healthy volunteers received a single intravenous infusion of clindamycin 900 mg. Antibiotic plasma concentrations were obtained by blood sampling and unbound drug concentrations were determined by means of in vivo intravascular microdialysis (MD) or in vitro ultrafiltration (UF) for up to 8 h post dosing. Clindamycin was assayed in plasma and MD fluid using a validated HPLC-UV (ultraviolet) method. Non-linear mixed effects modelling in NONMEM® was used to quantify the PB in vivo and in vitro. RESULTS C max was 14.95, 3.39 and 2.32 mg/L and AUC0-8h was 41.78, 5.80 and 6.14 mg·h/L for plasma, ultrafiltrate and microdialysate, respectively. Calculated ratio of AUCunbound/AUCtotal showed values of 13.9%±1.8% and 14.7%±3.1% for UF and microdialysate, respectively. Modelling confirmed non-linear, saturable PB for clindamycin with slightly different median (95% CI) dissociation constants (Kd) for the alpha-1 acid glycoprotein (AAG)-clindamycin complex of 1.16 mg/L (0.91-1.37) in vitro versus 0.85 mg/L (0.58-1.01) in vivo. Moreover, the estimated number of binding sites per AAG molecule was 2.07 (1.79-2.25) in vitro versus 1.66 in vivo (1.41-1.79). CONCLUSIONS Concentration-dependent PB was observed for both investigated methods with slightly lower levels of unbound drug fractions in vitro as compared with in vivo.
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Affiliation(s)
- Beatrix Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Bundesstrasse 45, 20146, Hamburg, Germany
| | - Elizaveta Kurdina
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan F Carrion Carrera
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Service of Rheumatology, Hospital of Silandro (SABES-ASDAA), Via Ospedale, 339028, Silandro-Schlanders, Italy
| | - Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Matthias G Vossen
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sonja Riesenhuber
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Edith Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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12
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Matzneller P, Ngougni Pokem P, Capron A, Lackner E, Wulkersdorfer B, Nussbaumer-Pröll A, Österreicher Z, Duchek M, Van de Velde S, Wallemacq PE, Mouton JW, Van Bambeke F, Zeitlinger M. Single-dose pharmacokinetics of temocillin in plasma and soft tissues of healthy volunteers after intravenous and subcutaneous administration: a randomized crossover microdialysis trial. J Antimicrob Chemother 2021; 75:2650-2656. [PMID: 32433753 DOI: 10.1093/jac/dkaa176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The antibiotic temocillin has recently been rediscovered as a promising therapeutic option against MDR Gram-negative bacteria. However, some aspects of the pharmacokinetic (PK) profile of the drug are still to be elucidated: subcutaneous administration of temocillin might be of interest as an alternative to the intravenous route in selected patients. Similarly, information on the penetration of temocillin into human soft tissues is lacking. OBJECTIVES To investigate the feasibility and plasma PK of subcutaneous dosing as well as soft tissue PK of temocillin after intravenous administration to healthy volunteers. METHODS Eight healthy volunteers received 2 g of temocillin both as intravenous and subcutaneous infusion in a randomized two-period crossover study. Concentration-time profiles of total temocillin in plasma (after both routes) and of unbound temocillin in plasma, muscle and subcutis (only after intravenous dosing) were determined up to 12 h post-dose. RESULTS Subcutaneous dosing caused some infusion site discomfort but resulted in sustained drug concentrations over time with only slightly decreased overall exposure compared with intravenous dosing. Plasma protein binding of temocillin showed concentration-dependent behaviour and was higher than previously reported. Still, unbound drug concentrations in muscle and subcutis determined by microdialysis markedly exceeded those in plasma, suggesting good tissue penetration of temocillin. CONCLUSIONS The subcutaneous administration of temocillin is a valid and feasible alternative to intravenous dosing. With the description of plasma protein binding and soft tissue PK of temocillin in healthy volunteers, this study provides important information that adds to the ongoing characterization of the PK profile of temocillin and might serve as input for PK/PD considerations.
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Affiliation(s)
- Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Université catholique de Louvain, Brussels, Belgium
| | - Arnaud Capron
- Clinical Chemistry Department, Cliniques Universitaires St. Luc, Université catholique de Louvain, Brussels, Belgium
| | - Edith Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | - Alina Nussbaumer-Pröll
- Department of Medicine 1, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Zoe Österreicher
- Department of Medicine 1, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | - Pierre E Wallemacq
- Clinical Chemistry Department, Cliniques Universitaires St. Luc, Université catholique de Louvain, Brussels, Belgium
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Université catholique de Louvain, Brussels, Belgium
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
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13
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Al Jalali V, Wölfl-Duchek M, Taubert M, Matzneller P, Lackner E, Dorn C, Kratzer A, Wulkersdorfer B, Österreicher Z, Zeitlinger M. Plasma and soft tissue pharmacokinetics of ceftolozane/tazobactam in healthy volunteers after single and multiple intravenous infusion: a microdialysis study. J Antimicrob Chemother 2021; 76:2342-2351. [PMID: 34050650 DOI: 10.1093/jac/dkab166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate ceftolozane/tazobactam pharmacokinetics (PK) in plasma and interstitial space fluid (ISF) of muscle and subcutaneous tissue and establish a population PK model. METHODS Eight healthy volunteers received four IV doses of 1000/500 mg ceftolozane/tazobactam q8h in a prospective, open-labelled PK study. ISF concentration-time profiles were determined via in vivo microdialysis up to 8 h post-dose and efficacy of unbound ceftolozane and tazobactam was estimated using the time above MIC (%ƒT>MIC) and time above threshold concentration (%T>CT), respectively. A population PK model was established by merging derived plasma and soft tissue PK data. RESULTS Ceftolozane reached %ƒT>MIC values of 100% in plasma, muscle and subcutaneous ISF for Enterobacteriaceae and 87%, 89% and 87%, respectively, for Pseudomonas aeruginosa. Tazobactam %T>CT was 21%, 22% and 21% in plasma, muscle and subcutaneous ISF, respectively. Plasma protein binding was 6.3% for ceftolozane and 8.0% for tazobactam. Multiple-dose ceftolozane AUC0-8 ISF/plasma ratios were 0.92 ± 0.17 in muscle and 0.88 ± 0.18 in subcutis, and tazobactam ratios were 0.89 ± 0.25 in muscle and 0.87 ± 0.21 in subcutis, suggesting substantial soft tissue penetration. CONCLUSIONS Tazobactam %T>CT values were distinctly below proposed target values, indicating that tazobactam might be underdosed in the investigated drug combination. However, ISF/unbound plasma ratios of ceftolozane and tazobactam support their use in soft tissue infections. A plasma and soft tissue PK model adds important information on the PK profile of ceftolozane/tazobactam. Further investigations in patients suffering from wound infections are needed to confirm these findings.
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Affiliation(s)
- V Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Taubert
- Department of Clinical Pharmacology, University of Cologne, Cologne, Germany
| | - P Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - E Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - A Kratzer
- Hospital Pharmacy, University Hospital Regensburg, Regensburg, Germany
| | - B Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Z Österreicher
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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14
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Zeitlinger M, Bauer M, Reindl-Schwaighofer R, Stoekenbroek RM, Lambert G, Berger-Sieczkowski E, Lagler H, Oesterreicher Z, Wulkersdorfer B, Lührs P, Galabova G, Schwenke C, Mader RM, Medori R, Landlinger C, Kutzelnigg A, Staffler G. A phase I study assessing the safety, tolerability, immunogenicity, and low-density lipoprotein cholesterol-lowering activity of immunotherapeutics targeting PCSK9. Eur J Clin Pharmacol 2021; 77:1473-1484. [PMID: 33969434 PMCID: PMC8440313 DOI: 10.1007/s00228-021-03149-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
Purpose AT04A and AT06A are two AFFITOPE® peptide vaccine candidates being developed for the treatment of hypercholesterolemia by inducing proprotein convertase subtilisin/kexin type 9 (PCSK9)-specific antibodies. This study aimed to investigate safety, tolerability, antibody development, and reduction of low-density lipoprotein cholesterol (LDLc) following four subcutaneous immunizations. Methods This phase I, single-blind, randomized, placebo-controlled study was conducted in a total of 72 healthy subjects with a mean fasting LDLc level at baseline of 117.1 mg/dL (range 77–196 mg/dL). Each cohort enrolled 24 subjects to receive three priming immunizations at weeks 0, 4, and 8 and to receive a single booster immunization at week 60 of either AT04A, AT06A, or placebo. In addition to safety (primary objective), the antigenic peptide- and PCSK9-specific antibody response and the impact on LDLc were evaluated over a period of 90 weeks. Results The most common systemic treatment-related adverse events (AEs) reported were fatigue, headache, and myalgia in 75% of subjects in the AT06A group and 58% and 46% of subjects in the placebo and AT04A groups, respectively. Injection site reactions (ISR) representing 63% of all treatment-emergent adverse events (TEAEs), were transient and mostly of mild or moderate intensity and rarely severe (3%). Both active treatments triggered a robust, long-lasting antibody response towards the antigenic peptides used for immunization that optimally cross-reacted with the target epitope on PCSK9. In the AT04A group, a reduction in serum LDLc was observed with a mean peak reduction of 11.2% and 13.3% from baseline compared to placebo at week 20 and 70 respectively, and over the whole study period, the mean LDLc reduction for the AT04A group vs. placebo was −7.2% (95% CI [−10.4 to −3.9], P < 0.0001). In this group, PCSK9 target epitope titers above 50 were associated with clinically relevant LDLc reductions with an individual maximal decrease of 39%. Conclusions Although both AT04A and AT06 were safe and immunogenic, only AT04A demonstrated significant LDLc-lowering activity, justifying further development. Trial registration EudraCT: 2015-001719-11. ClinicalTrials.gov
Identifier: NCT02508896. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03149-2.
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Affiliation(s)
- Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert M Stoekenbroek
- Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Gilles Lambert
- Laboratoire Inserm, UMR 1188 DéTROI, Université de La Réunion, 2 Rue Maxime Rivière, 97490, Sainte Clotilde, France
| | - Evelyn Berger-Sieczkowski
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Heimo Lagler
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Zoe Oesterreicher
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Beatrix Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Petra Lührs
- AFFiRiS AG, Karl Farkas Gasse 22, 1030, Vienna, Austria
| | - Gergana Galabova
- AFFiRiS AG, Karl Farkas Gasse 22, 1030, Vienna, Austria.,Origenis GmbH, Am Klopferspitz 19a, 82152, Martinsried, Germany
| | | | - Robert M Mader
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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15
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Dorn C, Schießer S, Wulkersdorfer B, Hitzenbichler F, Kees MG, Zeitlinger M. Determination of free clindamycin, flucloxacillin or tedizolid in plasma: Pay attention to physiological conditions when using ultrafiltration. Biomed Chromatogr 2020; 34:e4820. [PMID: 32115736 DOI: 10.1002/bmc.4820] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/15/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
Pharmacokinetic/pharmacodynamic indices of anti-infective drugs should be referenced to free drug concentrations. In the present study, clindamycin, flucloxacillin and tedizolid have been determined in human plasma by HPLC-UV. The drugs were separated isocratically within 3-6 min on a C18 column using mixtures of phosphate buffer-acetonitrile of pH 7.1-7.2. Sample treatment for the determination of total drug concentrations in plasma included extraction/back-extraction (clindamycin) or protein precipitation (flucloxacillin, tedizolid). The free drug concentrations were determined after ultrafiltration. An ultrafiltration device with a membrane consisting of regenerated cellulose proved to be suitable for all drugs. Maintaining a physiological pH was crucial for clindamycin, whereas maintaining body temperature was essential for tedizolid. The methods were applied to the analysis of total and free drug concentrations in clinical samples and were sufficiently sensitive for pharmacokinetic studies and therapeutic drug monitoring.
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Affiliation(s)
- Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Selina Schießer
- Infectious Diseases Unit, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Martin G Kees
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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16
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Hernández Lozano I, Bauer M, Wulkersdorfer B, Traxl A, Philippe C, Weber M, Häusler S, Stieger B, Jäger W, Mairinger S, Wanek T, Hacker M, Zeitlinger M, Langer O. Measurement of Hepatic ABCB1 and ABCG2 Transport Activity with [ 11C]Tariquidar and PET in Humans and Mice. Mol Pharm 2019; 17:316-326. [PMID: 31790256 DOI: 10.1021/acs.molpharmaceut.9b01060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
P-Glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2) in the canalicular membrane of hepatocytes mediate the biliary excretion of drugs and drug metabolites. To measure hepatic ABCB1 and ABCG2 activity, we performed positron emission tomography (PET) scans with the ABCB1/ABCG2 substrate [11C]tariquidar in healthy volunteers and wild-type, Abcb1a/b(-/-), Abcg2(-/-), and Abcb1a/b(-/-)Abcg2(-/-) mice without and with coadministration of unlabeled tariquidar. PET data were analyzed with a three-compartment pharmacokinetic model. [11C]Tariquidar underwent hepatobiliary excretion in both humans and mice, and tariquidar coadministration caused a significant reduction in the rate constant for the transfer of radioactivity from the liver into bile (by -74% in humans and by -62% in wild-type mice), suggesting inhibition of canalicular efflux transporter activity. Radio-thin-layer chromatography analysis revealed that the majority of radioactivity (>87%) in the mouse liver and bile was composed of unmetabolized [11C]tariquidar. PET data in transporter knockout mice revealed that both ABCB1 and ABCG2 mediated biliary excretion of [11C]tariquidar. In vitro experiments indicated that tariquidar is not a substrate of major hepatic basolateral uptake transporters (SLCO1B1, SLCO1B3, SLCO2B1, SLC22A1, and SLC22A3). Our data suggest that [11C]tariquidar can be used to measure hepatic canalicular ABCB1/ABCG2 transport activity without a confounding effect of uptake transporters.
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Affiliation(s)
- Irene Hernández Lozano
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Martin Bauer
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Beatrix Wulkersdorfer
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Alexander Traxl
- Preclinical Molecular Imaging , AIT Austrian Institute of Technology GmbH , Seibersdorf 2444 , Austria
| | - Cécile Philippe
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy , Medical University of Vienna , Vienna 1090 , Austria
| | - Maria Weber
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Stephanie Häusler
- Department of Clinical Pharmacology and Toxicology , University Hospital Zurich, University of Zurich , Zurich 8006 , Switzerland
| | - Bruno Stieger
- Department of Clinical Pharmacology and Toxicology , University Hospital Zurich, University of Zurich , Zurich 8006 , Switzerland
| | - Walter Jäger
- Department of Clinical Pharmacy and Diagnostics , University of Vienna , Vienna 1090 , Austria
| | - Severin Mairinger
- Preclinical Molecular Imaging , AIT Austrian Institute of Technology GmbH , Seibersdorf 2444 , Austria
| | - Thomas Wanek
- Preclinical Molecular Imaging , AIT Austrian Institute of Technology GmbH , Seibersdorf 2444 , Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy , Medical University of Vienna , Vienna 1090 , Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Oliver Langer
- Department of Clinical Pharmacology , Medical University of Vienna , Vienna 1090 , Austria.,Preclinical Molecular Imaging , AIT Austrian Institute of Technology GmbH , Seibersdorf 2444 , Austria.,Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy , Medical University of Vienna , Vienna 1090 , Austria
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17
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Wulkersdorfer B, Bauer M, Karch R, Stefanits H, Philippe C, Weber M, Czech T, Menet MC, Declèves X, Hainfellner JA, Preusser M, Hacker M, Zeitlinger M, Müller M, Langer O. Assessment of brain delivery of a model ABCB1/ABCG2 substrate in patients with non-contrast-enhancing brain tumors with positron emission tomography. EJNMMI Res 2019; 9:110. [PMID: 31832814 PMCID: PMC6908538 DOI: 10.1186/s13550-019-0581-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/04/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2) are two efflux transporters expressed at the blood-brain barrier which effectively restrict the brain distribution of the majority of currently known anticancer drugs. High-grade brain tumors often possess a disrupted blood-brain tumor barrier (BBTB) leading to enhanced accumulation of magnetic resonance imaging contrast agents, and possibly anticancer drugs, as compared to normal brain. In contrast to high-grade brain tumors, considerably less information is available with respect to BBTB integrity in lower grade brain tumors. MATERIALS AND METHODS We performed positron emission tomography imaging with the radiolabeled ABCB1 inhibitor [11C]tariquidar, a prototypical ABCB1/ABCG2 substrate, in seven patients with non-contrast -enhancing brain tumors (WHO grades I-III). In addition, ABCB1 and ABCG2 levels were determined in surgically resected tumor tissue of four patients using quantitative targeted absolute proteomics. RESULTS Brain distribution of [11C]tariquidar was found to be very low across the whole brain and not significantly different between tumor and tumor-free brain tissue. Only one patient showed a small area of enhanced [11C]tariquidar uptake within the brain tumor. ABCG2/ABCB1 ratios in surgically resected tumor tissue (1.4 ± 0.2) were comparable to previously reported ABCG2/ABCB1 ratios in isolated human micro-vessels (1.3), which suggested that no overexpression of ABCB1 or ABCG2 occurred in the investigated tumors. CONCLUSIONS Our data suggest that the investigated brain tumors had an intact BBTB, which is impermeable to anticancer drugs, which are dual ABCB1/ABCG2 substrates. Therefore, effective drugs for antitumor treatment should have high passive permeability and lack ABCB1/ABCG2 substrate affinity. TRIAL REGISTRATION European Union Drug Regulating Authorities Clinical Trials Database (EUDRACT), 2011-004189-13. Registered on 23 February 2012, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2011-004189-13.
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Affiliation(s)
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Karch
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Cécile Philippe
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Marie-Claude Menet
- Inserm, U1144, Paris, France.,Université Paris Descartes, UMR-S 1144, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Xavier Declèves
- Inserm, U1144, Paris, France.,Université Paris Descartes, UMR-S 1144, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Müller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. .,Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria. .,Preclinical Molecular Imaging, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.
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18
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Hernández Lozano I, Karch R, Bauer M, Blaickner M, Matsuda A, Wulkersdorfer B, Hacker M, Zeitlinger M, Langer O. Towards Improved Pharmacokinetic Models for the Analysis of Transporter-Mediated Hepatic Disposition of Drug Molecules with Positron Emission Tomography. AAPS J 2019; 21:61. [PMID: 31037511 PMCID: PMC6488550 DOI: 10.1208/s12248-019-0323-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
Positron emission tomography (PET) imaging with radiolabeled drugs holds great promise to assess the influence of membrane transporters on hepatobiliary clearance of drugs. To exploit the full potential of PET, quantitative pharmacokinetic models are required. In this study, we evaluated the suitability of different compartment models to describe the hepatic disposition of [11C]erlotinib as a small-molecule model drug which undergoes transporter-mediated hepatobiliary excretion. We analyzed two different, previously published data sets in healthy volunteers, in which a baseline [11C]erlotinib PET scan was followed by a second PET scan either after oral intake of unlabeled erlotinib (300 mg) or after intravenous infusion of the prototypical organic anion-transporting polypeptide inhibitor rifampicin (600 mg). We assessed a three-compartment (3C) and a four-compartment (4C) model, in which either a sampled arterial blood input function or a mathematically derived dual input function (DIF), which takes the contribution of the portal vein to the liver blood supply into account, was used. Both models provided acceptable fits of the observed PET data in the liver and extrahepatic bile duct and gall bladder. Changes in model outcome parameters between scans were consistent with the involvement of basolateral hepatocyte uptake and canalicular efflux transporters in the hepatobiliary clearance of [11C]erlotinib. Our results demonstrated that inclusion of a DIF did not lead to substantial improvements in model fits. The models developed in this work represent a step forward in applying PET as a tool to assess the impact of hepatic transporters on drug disposition and their involvement in drug-drug interactions.
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Affiliation(s)
- Irene Hernández Lozano
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Rudolf Karch
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Matthias Blaickner
- Preclinical Molecular Imaging, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Akihiro Matsuda
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Beatrix Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090, Vienna, Austria.
- Preclinical Molecular Imaging, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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19
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Kratzer A, Schießer S, Matzneller P, Wulkersdorfer B, Zeitlinger M, Schlossmann J, Kees F, Dorn C. Determination of total and free ceftolozane and tazobactam in human plasma and interstitial fluid by HPLC-UV. J Pharm Biomed Anal 2019; 163:34-38. [DOI: 10.1016/j.jpba.2018.09.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 11/27/2022]
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20
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Bauer M, Karch R, Wulkersdorfer B, Philippe C, Nics L, Klebermass EM, Weber M, Poschner S, Haslacher H, Jäger W, Tournier N, Wadsak W, Hacker M, Zeitlinger M, Langer O. A Proof-of-Concept Study to Inhibit ABCG2- and ABCB1-Mediated Efflux Transport at the Human Blood-Brain Barrier. J Nucl Med 2018; 60:486-491. [PMID: 30237210 DOI: 10.2967/jnumed.118.216432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/10/2018] [Indexed: 02/06/2023] Open
Abstract
The adenosine triphosphate-binding cassette transporters P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2) are 2 efflux transporters at the blood-brain barrier (BBB) that effectively restrict brain distribution of dual ABCB1/ABCG2 substrate drugs, such as tyrosine kinase inhibitors. Pharmacologic inhibition of ABCB1/ABCG2 may improve the efficacy of dual-substrate drugs for treatment of brain tumors, but no marketed ABCB1/ABCG2 inhibitors are currently available. In the present study, we examined the potential of supratherapeutic-dose oral erlotinib to inhibit ABCB1/ABCG2 activity at the human BBB. Methods: Healthy men underwent 2 consecutive PET scans with 11C-erlotinib: a baseline scan and a second scan either with concurrent intravenous infusion of the ABCB1 inhibitor tariquidar (3.75 mg/min, n = 5) or after oral intake of single ascending doses of erlotinib (300 mg, n = 7; 650 mg, n = 8; or 1,000 mg, n = 2). Results: Although tariquidar administration had no effect on 11C-erlotinib brain distribution, oral erlotinib led, at the 650-mg dose, to significant increases in volume of distribution (23% ± 13%, P = 0.008), influx rate constant of radioactivity from plasma into brain (58% ± 26%, P = 0.008), and area under the brain time-activity curve (78% ± 17%, P = 0.008), presumably because of combined partial saturation of ABCG2 and ABCB1 activity. Inclusion of further subjects into the 1,000-mg dose group was precluded by adverse skin events (rash). Conclusion: Supratherapeutic-dose erlotinib may be used to enhance brain delivery of ABCB1/ABCG2 substrate anticancer drugs, but its clinical applicability for continuous ABCB1/ABCG2 inhibition at the BBB may be limited by safety concerns.
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Affiliation(s)
- Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Karch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Cécile Philippe
- Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Nics
- Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Klebermass
- Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stefan Poschner
- Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Nicolas Tournier
- IMIV, CEA, INSERM, CNRS, Université Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria; and
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Division of Nuclear Medicine, Department of Biomedical Imaging und Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Health and Bioresources, Austrian Institute of Technology GmbH, Seibersdorf, Austria
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21
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Bauer M, Traxl A, Matsuda A, Karch R, Philippe C, Nics L, Klebermass EM, Wulkersdorfer B, Weber M, Poschner S, Tournier N, Jäger W, Wadsak W, Hacker M, Wanek T, Zeitlinger M, Langer O. Effect of Rifampicin on the Distribution of [ 11C]Erlotinib to the Liver, a Translational PET Study in Humans and in Mice. Mol Pharm 2018; 15:4589-4598. [PMID: 30180590 DOI: 10.1021/acs.molpharmaceut.8b00588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Organic anion-transporting polypeptides (OATPs) mediate the uptake of various drugs from blood into the liver in the basolateral membrane of hepatocytes. Positron emission tomography (PET) is a potentially powerful tool to assess the activity of hepatic OATPs in vivo, but its utility critically depends on the availability of transporter-selective probe substrates. We have shown before that among the three OATPs expressed in hepatocytes (OATP1B1, OATP1B3, and OATP2B1), [11C]erlotinib is selectively transported by OATP2B1. In contrast to OATP1B1 and OATP1B3, OATP2B1 has not been thoroughly explored yet, and no specific probe substrates are currently available. To assess if the prototypical OATP inhibitor rifampicin can inhibit liver uptake of [11C]erlotinib in vivo, we performed [11C]erlotinib PET scans in six healthy volunteers without and with intravenous pretreatment with rifampicin (600 mg). In addition, FVB mice underwent [11C]erlotinib PET scans without and with concurrent intravenous infusion of high-dose rifampicin (100 mg/kg). Rifampicin caused a moderate reduction in the liver distribution of [11C]erlotinib in humans, while a more pronounced effect of rifampicin was observed in mice, in which rifampicin plasma concentrations were higher than in humans. In vitro uptake experiments in an OATP2B1-overexpressing cell line indicated that rifampicin inhibited OATP2B1 transport of [11C]erlotinib in a concentration-dependent manner with a half-maximum inhibitory concentration of 72.0 ± 1.4 μM. Our results suggest that rifampicin-inhibitable uptake transporter(s) contributed to the liver distribution of [11C]erlotinib in humans and mice and that [11C]erlotinib PET in combination with rifampicin may be used to measure the activity of this/these uptake transporter(s) in vivo. Furthermore, our data suggest that a standard clinical dose of rifampicin may exert in vivo a moderate inhibitory effect on hepatic OATP2B1.
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Affiliation(s)
| | - Alexander Traxl
- Center for Health & Bioresources , AIT Austrian Institute of Technology GmbH , 2444 Seibersdorf , Austria
| | | | | | | | | | | | | | | | - Stefan Poschner
- Department of Clinical Pharmacy and Diagnostics , University of Vienna , A-1090 Vienna , Austria
| | - Nicolas Tournier
- IMIV, CEA, Inserm, CNRS , Université Paris-Sud, Université Paris Saclay, CEA-SHFJ , 91401 Orsay , France
| | - Walter Jäger
- Department of Clinical Pharmacy and Diagnostics , University of Vienna , A-1090 Vienna , Austria
| | - Wolfgang Wadsak
- Center for Biomarker Research in Medicine - CBmed GmbH , 8010 Graz , Austria
| | | | - Thomas Wanek
- Center for Health & Bioresources , AIT Austrian Institute of Technology GmbH , 2444 Seibersdorf , Austria
| | | | - Oliver Langer
- Center for Health & Bioresources , AIT Austrian Institute of Technology GmbH , 2444 Seibersdorf , Austria
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22
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Pal A, Matzneller P, Gautam A, Österreicher Z, Wulkersdorfer B, Reiter B, Stimpfl T, Zeitlinger M. Target site pharmacokinetics of doxycycline for rosacea in healthy volunteers is independent of the food effect. Br J Clin Pharmacol 2018; 84:2625-2633. [PMID: 30033542 PMCID: PMC6177703 DOI: 10.1111/bcp.13721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022] Open
Abstract
Aims Doxycycline (DFD‐09) oral capsules 40 mg are approved for the treatment of inflammatory lesions of rosacea. Unlike the food‐induced lowering of doxycycline's peak plasma concentration (Cmax), its exposure under fed conditions in the skin, the drug's target site for rosacea, is unknown. The present study explored the effect of food on the dermal pharmacokinetics of doxycycline. Methods The pharmacokinetics of doxycycline in the dermal interstitial fluid (d‐ISF) and plasma of healthy volunteers were assessed in parallel groups under fed (n = 6) and fasting (n = 6) conditions during a 14‐day once‐daily treatment course with doxycycline oral capsules 40 mg (DFD‐09). Sampling of d‐ISF and plasma was performed on days 1, 10 (fasting group d‐ISF only) and 14. Results Twelve subjects were randomized, and 11 analysed. No causally drug‐related adverse events occurred. Dermal doxycycline exposures (Cmax and area under the curve) under the fed state were about 30% lower than under the fasting state at day 1 but were similar at steady state. In analogy to skin, plasma exposure showed no between‐group difference at steady state. Accumulation ratios were higher in the skin than in plasma. Correcting for plasma protein binding (~90%), dermal doxycycline exposure was approximately threefold higher than unbound plasma exposure. Conclusions At steady state, doxycycline concentrations in the skin of fed and fasting healthy volunteers were comparable. Doxycycline's efficacy in rosacea is possibly due to considerable dermal accumulation of unbound doxycycline and is independent of the effect of food.
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Affiliation(s)
- Arindam Pal
- Dr. Reddy's Laboratories Ltd, Hyderabad, India
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Zoe Österreicher
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Birgit Reiter
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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23
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Bauer M, Matsuda A, Wulkersdorfer B, Philippe C, Traxl A, Özvegy-Laczka C, Stanek J, Nics L, Klebermass EM, Poschner S, Jäger W, Patik I, Bakos É, Szakács G, Wadsak W, Hacker M, Zeitlinger M, Langer O. Influence of OATPs on Hepatic Disposition of Erlotinib Measured With Positron Emission Tomography. Clin Pharmacol Ther 2017; 104:139-147. [PMID: 28940241 PMCID: PMC6083370 DOI: 10.1002/cpt.888] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/09/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022]
Abstract
To assess the hepatic disposition of erlotinib, we performed positron emission tomography (PET) scans with [11 C]erlotinib in healthy volunteers without and with oral pretreatment with a therapeutic erlotinib dose (300 mg). Erlotinib pretreatment significantly decreased the liver exposure to [11 C]erlotinib with a concomitant increase in blood exposure, pointing to the involvement of a carrier-mediated hepatic uptake mechanism. Using cell lines overexpressing human organic anion-transporting polypeptides (OATPs) 1B1, 1B3, or 2B1, we show that [11 C]erlotinib is selectively transported by OATP2B1. Our data suggest that at PET microdoses hepatic uptake of [11 C]erlotinib is mediated by OATP2B1, whereas at therapeutic doses OATP2B1 transport is saturated and hepatic uptake occurs mainly by passive diffusion. We propose that [11 C]erlotinib may be used as a hepatic OATP2B1 probe substrate and erlotinib as an OATP2B1 inhibitor in clinical drug-drug interaction studies, allowing the contribution of OATP2B1 to the hepatic uptake of drugs to be revealed.
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Affiliation(s)
- Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Akihiro Matsuda
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Cécile Philippe
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Traxl
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Csilla Özvegy-Laczka
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Johann Stanek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Lukas Nics
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Klebermass
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Poschner
- Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Izabel Patik
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Éva Bakos
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Gergely Szakács
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.,Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
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24
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Staufer K, Dengler M, Huber H, Marculescu R, Stauber R, Lackner C, Dienes HP, Kivaranovic D, Schachner C, Zeitlinger M, Wulkersdorfer B, Rauch P, Prager G, Trauner M, Mikulits W. The non-invasive serum biomarker soluble Axl accurately detects advanced liver fibrosis and cirrhosis. Cell Death Dis 2017; 8:e3135. [PMID: 29072690 PMCID: PMC5680921 DOI: 10.1038/cddis.2017.554] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/28/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023]
Abstract
Soluble Axl (sAxl) was recently shown to be strongly released into the blood during liver fibrogenesis and hepatocellular carcinoma suggesting sAxl as a biomarker of liver diseases. In this study we are the first to evaluate sAxl in human serum in comparison to Enhanced Liver Fibrosis (ELF) test and transient elastography (TE; Fibroscan) for its value to detect significant (F≥2), advanced fibrosis (F≥3), and cirrhosis (F4) in different liver disease etiologies and healthy controls. To properly determine the diagnostic accuracy of sAxl, a test cohort as well as a validation cohort was employed using liver biopsy as a reference method. Most notably, sAxl was confirmed to be an accurate biomarker of liver fibrosis and cirrhosis. Its accuracy was increased, if total serum albumin was added to build a sAxl/albumin ratio. Thereby an AUC of 0.763, 0.776, 0.826, and 0.832 was achieved corresponding to histological fibrosis stages F≥2, F≥3, F4 with liver biopsy as a reference method, and cirrhosis according to imaging techniques, respectively. With a cut-off of 1.29, a sensitivity, specificity, PPV, and NPV of 78.5%, 80.1%, 44%, 94.9% for the detection of cirrhosis was achieved. In comparison, ELF test and TE showed an AUC of 0.910, and 0.934, respectively, for the detection of cirrhosis. However, performance of TE was not possible in 14.4% of patients and both, ELF™ test and TE bear the disadvantage of high costs. In conclusion, the sAxl/albumin ratio is suggested as an accurate biomarker of liver fibrosis and cirrhosis. Due to its easy applicability and low costs it is suitable as screening parameter for significant to advanced liver fibrosis and cirrhosis, especially if TE is not available or not applicable.
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Affiliation(s)
- Katharina Staufer
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mirko Dengler
- Department of Internal Medicine I, Institute of Cancer Research, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Heidemarie Huber
- Department of Internal Medicine I, Institute of Cancer Research, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Rudolf Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Hans-Peter Dienes
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Danijel Kivaranovic
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | - Christian Schachner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Peter Rauch
- Candor Bioscience GmbH, Wangen im Allgäu, Germany
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Mikulits
- Department of Internal Medicine I, Institute of Cancer Research, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
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Wulkersdorfer B, Bauer M, Stefanits H, Karch R, Wadsak W, Hacker M, Czech T, Müller M, Zeitlinger M, Langer O. Investigation of Regional Blood-Brain Barrier Integrity and Cerebral Efflux Transporter Function in Patients with Neuroepithelial Tumors by Means of [ 11 C] Tariquidar Pet. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bauer M, Matsuda A, Wulkersdorfer B, Philippe C, Nics L, Klebermass E, Stanek J, Wadsak W, Hacker M, Zeitlinger M, Langer O. Hepatic Disposition Of [ 11 C] Erlotinib at Micro- and Therapeutic Doses Assessed with Pet Imaging. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bauer M, Wulkersdorfer B, Karch R, Philippe C, Jäger W, Stanek J, Wadsak W, Hacker M, Zeitlinger M, Langer O. Effect of P-glycoprotein inhibition at the blood-brain barrier on brain distribution of (R)-[ 11 C]verapamil in elderly vs. young subjects. Br J Clin Pharmacol 2017; 83:1991-1999. [PMID: 28401570 DOI: 10.1111/bcp.13301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/22/2017] [Accepted: 04/04/2017] [Indexed: 12/21/2022] Open
Abstract
AIMS The efflux transporter P-glycoprotein (ABCB1) acts at the blood-brain barrier (BBB) to restrict the distribution of many different drugs from blood to the brain. Previous data suggest an age-associated decrease in the expression and function of ABCB1 at the BBB. In the present study, we investigated the influence of age on the magnitude of an ABCB1-mediated drug-drug interaction (DDI) at the BBB. METHODS We performed positron emission tomography scans using the model ABCB1 substrate (R)-[11 C]verapamil in five young [26 ± 1 years, (mean ± standard deviation)] and five elderly (68 ± 6 years) healthy male volunteers before and after intravenous administration of a low dose of the ABCB1 inhibitor tariquidar (3 mg kg-1 ). RESULTS In baseline scans, the total distribution volume (VT ) of (R)-[11 C]verapamil in whole-brain grey matter was not significantly different between the elderly (VT = 0.78 ± 0.15) and young (VT = 0.79 ± 0.10) group. After partial (incomplete) ABCB1 inhibition, VT values were significantly higher (P = 0.040) in the elderly (VT = 1.08 ± 0.15) than in the young (VT = 0.80 ± 0.18) group. The percentage increase in (R)-[11 C]verapamil VT following partial ABCB1 inhibition was significantly greater (P = 0.032) in elderly (+40 ± 17%) than in young (+2 ± 17%) volunteers. Tariquidar plasma concentrations were not significantly different between the young (786 ± 178 nmol l-1 ) and elderly (1116 ± 347 nmol l-1 ) group. CONCLUSIONS Our results provide the first direct evidence of an increased risk for ABCB1-mediated DDIs at the BBB in elderly persons, which may have important consequences for pharmacotherapy of the elderly.
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Affiliation(s)
- Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Rudolf Karch
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Cécile Philippe
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Johann Stanek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Centre for Biomarker Research in Medicine - CBmed GmbH, Graz, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging und Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
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Bauer M, Römermann K, Karch R, Wulkersdorfer B, Stanek J, Philippe C, Maier‐Salamon A, Haslacher H, Jungbauer C, Wadsak W, Jäger W, Löscher W, Hacker M, Zeitlinger M, Langer O. Pilot PET Study to Assess the Functional Interplay Between ABCB1 and ABCG2 at the Human Blood-Brain Barrier. Clin Pharmacol Ther 2016; 100:131-41. [PMID: 26940368 PMCID: PMC4979595 DOI: 10.1002/cpt.362] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/20/2016] [Accepted: 02/28/2016] [Indexed: 01/16/2023]
Abstract
ABCB1 and ABCG2 work together at the blood-brain barrier (BBB) to limit brain distribution of dual ABCB1/ABCG2 substrates. In this pilot study we used positron emission tomography (PET) to assess brain distribution of two model ABCB1/ABCG2 substrates ([(11) C]elacridar and [(11) C]tariquidar) in healthy subjects without (c.421CC) or with (c.421CA) the ABCG2 single-nucleotide polymorphism (SNP) c.421C>A. Subjects underwent PET scans under conditions when ABCB1 and ABCG2 were functional and during ABCB1 inhibition with high-dose tariquidar. In contrast to the ABCB1-selective substrate (R)-[(11) C]verapamil, [(11) C]elacridar and [(11) C]tariquidar showed only moderate increases in brain distribution during ABCB1 inhibition. This provides evidence for a functional interplay between ABCB1 and ABCG2 at the human BBB and suggests that both ABCB1 and ABCG2 need to be inhibited to achieve substantial increases in brain distribution of dual ABCB1/ABCG2 substrates. During ABCB1 inhibition c.421CA subjects had significantly higher increases in [(11) C]tariquidar brain distribution than c.421CC subjects, pointing to impaired cerebral ABCG2 function.
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Affiliation(s)
- M Bauer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - K Römermann
- Department of Pharmacology, Toxicology & PharmacyUniversity of Veterinary MedicineHannoverGermany
| | - R Karch
- Center for Medical Statistics, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - B Wulkersdorfer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - J Stanek
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
- Health and Environment DepartmentAIT Austrian Institute of Technology GmbHSeibersdorfAustria
| | - C Philippe
- Department of Biomedical Imaging und Image‐guided Therapy, Division of Nuclear MedicineMedical University of ViennaViennaAustria
| | - A Maier‐Salamon
- Department of Clinical Pharmacy and DiagnosticsUniversity of ViennaViennaAustria
| | - H Haslacher
- Department of Laboratory MedicineMedical University of ViennaViennaAustria
| | - C Jungbauer
- Austrian Red Cross Blood Transfusion ServicesViennaAustria
| | - W Wadsak
- Department of Biomedical Imaging und Image‐guided Therapy, Division of Nuclear MedicineMedical University of ViennaViennaAustria
- Medical Imaging ClusterMedical University of ViennaViennaAustria
| | - W Jäger
- Department of Clinical Pharmacy and DiagnosticsUniversity of ViennaViennaAustria
| | - W Löscher
- Department of Pharmacology, Toxicology & PharmacyUniversity of Veterinary MedicineHannoverGermany
| | - M Hacker
- Department of Biomedical Imaging und Image‐guided Therapy, Division of Nuclear MedicineMedical University of ViennaViennaAustria
- Medical Imaging ClusterMedical University of ViennaViennaAustria
| | - M Zeitlinger
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - O Langer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
- Health and Environment DepartmentAIT Austrian Institute of Technology GmbHSeibersdorfAustria
- Department of Biomedical Imaging und Image‐guided Therapy, Division of Nuclear MedicineMedical University of ViennaViennaAustria
- Medical Imaging ClusterMedical University of ViennaViennaAustria
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Matzneller P, Lackner E, Lagler H, Wulkersdorfer B, Österreicher Z, Zeitlinger M. Single- and Repeated-Dose Pharmacokinetics of Ceftaroline in Plasma and Soft Tissues of Healthy Volunteers for Two Different Dosing Regimens of Ceftaroline Fosamil. Antimicrob Agents Chemother 2016; 60:3617-25. [PMID: 27044549 PMCID: PMC4879389 DOI: 10.1128/aac.00097-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/26/2016] [Indexed: 12/17/2022] Open
Abstract
Ceftaroline fosamil (CPT-F) is currently approved for use for the treatment of complicated skin and soft tissue infections and community-acquired pneumonia at 600 mg twice daily (q12h), but other dosing regimens are under evaluation. To date, very limited data on the soft tissue pharmacokinetics (PK) of the active compound, ceftaroline (CPT), are available. CPT concentrations in the plasma, muscle, and subcutis of 12 male healthy volunteers were measured by microdialysis after single and repeated intravenous administration of 600 mg CPT-F q12h or three times daily (q8h) in two groups of 6 subjects each. Relevant PK and PK/pharmacodynamic (PD) parameters were calculated and compared between groups. In plasma, the area under the concentration-time curve (AUC) from 0 to 24 h for total CPT and the cumulative percentage of the dosing interval during which the free drug concentrations exceeded the MIC (fTMIC) for unbound CPT for the currently established threshold of 1 mg/liter were significantly higher in the group receiving CPT-F q8h. Exposure to free drug in soft tissues was higher in the group receiving CPT-F q8h, but high interindividual variability in relevant PK parameters was observed. The mean ratios of the AUC from time zero to the end of the dosing interval (AUC0-τ) for free CPT in soft tissues and the AUC0-τ for the calculated free fraction in plasma at steady state ranged from 0.66 to 0.75. Administration of CPT-F q8h led to higher levels of drug exposure in all investigated compartments. When MIC values above 1 mg/liter were assumed, the calculated fTMIC after dosing q12h was markedly lower than that after dosing q8h. The clinical implications of these differences are discussed in light of recently completed clinical phase III and PK/PD studies.
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Affiliation(s)
- Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Edith Lackner
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Heimo Lagler
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Zoe Österreicher
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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30
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Langsteger W, Rezaee A, Loidl W, Geinitz HS, Fitz F, Steinmair M, Broinger G, Pallwien-Prettner L, Beheshti M, Imamovic L, Beheshti M, Rendl G, Hackl D, Tsybrovsky O, Steinmair M, Emmanuel K, Moinfar F, Pirich C, Langsteger W, Bytyqi A, Karanikas G, Mayerhöfer M, Koperek O, Niederle B, Hartenbach M, Beyer T, Herrmann K, Czernin J, Rausch I, Rust P, DiFranco MD, Lassen M, Stadlbauer A, Mayerhöfer ME, Hartenbach M, Hacker M, Beyer T, Binzel K, Magnussen R, Wei W, Knopp MU, Flanigan DC, Kaeding C, Knopp MV, Leisser A, Nejabat M, Hartenbach M, Kramer G, Krainer M, Hacker M, Haug A, Lehnert W, Schmidt K, Kimiaei S, Bronzel M, Kluge A, Wright CL, Binzel K, Zhang J, Wuthrick E, Maniawski P, Knopp MV, Blaickner M, Rados E, Huber A, Dulovits M, Kulkarni H, Wiessalla S, Schuchardt C, Baum RP, Knäusl B, Georg D, Bauer M, Wulkersdorfer B, Wadsak W, Philippe C, Haslacher H, Zeitlinger M, Langer O, Bauer M, Feldmann M, Karch R, Wadsak W, Zeitlinger M, Koepp MJ, Asselin MC, Pataraia E, Langer O, Zeilinger M, Philippe C, Dumanic M, Pichler F, Pilz J, Hacker M, Wadsak W, Mitterhauser M, Nics L, Steiner B, Hacker M, Mitterhauser M, Wadsak W, Traxl A, Wanek T, Kryeziu K, Mairinger S, Stanek J, Berger W, Kuntner C, Langer O, Mairinger S, Wanek T, Traxl A, Krohn M, Stanek J, Filip T, Sauberer M, Kuntner C, Pahnke J, Langer O, Svatunek D, Denk C, Wilkovitsch M, Wanek T, Filip T, Kuntner-Hannes C, Fröhlich J, Mikula H, Denk C, Svatunek D, Wanek T, Mairinger S, Stanek J, Filip T, Fröhlich J, Mikula H, Kuntner-Hannes C, Balber T, Singer J, Fazekas J, Rami-Mark C, Berroterán-Infante N, Jensen-Jarolim E, Wadsak W, Hacker M, Viernstein H, Mitterhauser M, Denk C, Svatunek D, Sohr B, Mikula H, Fröhlich J, Wanek T, Kuntner-Hannes C, Filip T, Pfaff S, Philippe C, Mitterhauser M, Hartenbach M, Hacker M, Wadsak W, Wanek T, Halilbasic E, Visentin M, Mairinger S, Stieger B, Kuntner C, Trauner M, Langer O, Lam P, Aistleitner M, Eichinger R, Artner C, Eidherr H, Vraka C, Haug A, Mitterhauser M, Nics L, Hartenbach M, Hacker M, Wadsak W, Kvaternik H, Müller R, Hausberger D, Zink C, Aigner RM, Cossío U, Asensio M, Montes A, Akhtar S, Te Welscher Y, van Nostrum R, Gómez-Vallejo V, Llop J, VandeVyver F, Barclay T, Lippens N, Troch M, Hehenwarter L, Egger B, Holzmannhofer J, Rodrigues-Radischat M, Pirich C, Pötsch N, Rausch I, Wilhelm D, Weber M, Furtner J, Karanikas G, Wöhrer A, Mitterhauser M, Hacker M, Traub-Weidinger T, Cassou-Mounat T, Balogova S, Nataf V, Calzada M, Huchet V, Kerrou K, Devaux JY, Mohty M, Garderet L, Talbot JN, Stanzel S, Pregartner G, Schwarz T, Bjelic-Radisic V, Liegl-Atzwanger B, Aigner R, Stanzel S, Quehenberger F, Aigner RM, Marković AK, Janković M, Jerković VM, Paskaš M, Pupić G, Džodić R, Popović D, Fornito MC, Familiari D, Koranda P, Polzerová H, Metelková I, Henzlová L, Formánek R, Buriánková E, Kamínek M, Thomson WH, Lewis C, Thomson WH, O'Brien J, James G, Notghi A, Huber H, Stelzmüller I, Wunn R, Mandl M, Fellner F, Lamprecht B, Gabriel M, Fornito MC, Leonardi G, Thomson WH, O'Brien J, James G, Hudzietzová J, Sabol J, Fülöp M. 32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016. EJNMMI Res 2016; 6:32. [PMID: 27090254 PMCID: PMC4835428 DOI: 10.1186/s13550-016-0168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/22/2022] Open
Abstract
A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT W Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti A2 F18 Choline PET – CT: an accurate diagnostic tool for the detection of parathyroid adenoma? L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger A3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinoma A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach A4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRI T Beyer, K Herrmann, J Czernin A5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimation I Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T Beyer A6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viability K Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV Knopp A7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapy A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug A8 QDOSE – comprehensive software solution for internal dose assessment Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge A9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolization CL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV Knopp A10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentation M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D Georg A11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidar M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer A12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centres M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O Langer A13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1 M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser A14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracers L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak A15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutations A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer A16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in mice S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer A17 18F labeled azidoglucose derivatives as “click” agents for pretargeted PET imaging D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula A18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-Tetrazines C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes A19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncology T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser A20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click Chemistry C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip A21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactor S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak A22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomography T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer A23 Automated 18F-flumazenil production using chemically resistant disposable cassettes P Lam, M Aistleitner, R Eichinger, C Artner A24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617) H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak A25 68Ga- and 177Lu-labelling of PSMA-617 H Kvaternik, R Müller, D Hausberger, C Zink, RM Aigner A26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation system U Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop A27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differences F VandeVyver, T Barclay, N Lippens, M Troch A28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging – is it a valuable tool to differentiate between low grade and high grade brain tumor? L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich A29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patients N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger A30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot study T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot A31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patients S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner A32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancer S Stanzel, F Quehenberger, RM Aigner A33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphy A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović A34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDG MC Fornito, D Familiari A35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levels P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek A36 Breast Dose from lactation following I131 treatment WH Thomson, C Lewis A37 A new concept for performing SeHCAT studies with the gamma camera WH Thomson, J O’Brien, G James, A Notghi A38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CT H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel A39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD) MC Fornito, G Leonardi A40 Validation of Poisson resampling software WH Thomson, J O’Brien, G James A41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirements J Hudzietzová, J Sabol, M Fülöp
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Affiliation(s)
- W Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - A Rezaee
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - W Loidl
- Prostate Cancer Center Linz, Department of Urology, St Vincent's Hospital, Linz, Austria
| | - H S Geinitz
- Department of Radiation Oncology, St Vincent's Hospital, Linz, Austria
| | - F Fitz
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Steinmair
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Broinger
- Department of Radiology, St Vincent's Hospital, Linz, Austria
| | - L Pallwien-Prettner
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Beheshti
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - L Imamovic
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Beheshti
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Rendl
- Department of Nuclear Medicine and Endocrinology, Paracelsus Private Medical University Salzburg, St Vincent's Hospital, Linz, Austria
| | - D Hackl
- Department of Surgery, St Vincent's Hospital, Linz, Austria
| | - O Tsybrovsky
- Department of Pathology, St Vincent's Hospital, Linz, Austria
| | - M Steinmair
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - K Emmanuel
- Department of Surgery, St Vincent's Hospital, Linz, Austria
| | - F Moinfar
- Department of Pathology, St Vincent's Hospital, Linz, Austria
| | - C Pirich
- Department of Nuclear Medicine and Endocrinology, Paracelsus Private Medical University Salzburg, St Vincent's Hospital, Linz, Austria
| | - W Langsteger
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - A Bytyqi
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Karanikas
- Medical University of Vienna, Division of Nuclear Medicine, Vienna, Austria
| | - M Mayerhöfer
- Medical University of Vienna, Division of General and Pediatric Radiology, Vienna, Austria
| | - O Koperek
- Medical University of Vienna, Institute of Pathology, Vienna, Austria
| | - B Niederle
- Medical University Vienna, Division of Surgical Endocrinology, Vienna, Austria
| | - M Hartenbach
- Medical University of Vienna, Division of Nuclear Medicine, Vienna, Austria
| | - T Beyer
- QIMP, CMPBME, Medical University of Vienna, ᅟ, Austria
| | - K Herrmann
- Department of Nuclear Medicine, University of Würzburg, ᅟ, Germany.,Department of Molecular and Medical Pharmacology, UCLA, ᅟ, USA
| | - J Czernin
- Department of Molecular and Medical Pharmacology, UCLA, ᅟ, USA
| | - I Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - P Rust
- Department of Nutritional Sciences, University of Vienna, ᅟ, Austria
| | - M D DiFranco
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - M Lassen
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - A Stadlbauer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M E Mayerhöfer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - T Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - R Magnussen
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - W Wei
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - M U Knopp
- Sports Medicine, Pepperdine University, Malibu, CA, USA
| | - D C Flanigan
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - C Kaeding
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - A Leisser
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Nejabat
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - G Kramer
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Krainer
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - A Haug
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - Wencke Lehnert
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Karl Schmidt
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Sharok Kimiaei
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Marcus Bronzel
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Andreas Kluge
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - Evan Wuthrick
- Radiation Oncology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Piotr Maniawski
- Clinical Science - Nuclear Medicine, Philips Healthcare, Cleveland, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - M Blaickner
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - E Rados
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - A Huber
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - M Dulovits
- Woogieworks Animation Studio, Perchtoldsdorf, Austria
| | - H Kulkarni
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - S Wiessalla
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - C Schuchardt
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - R P Baum
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - B Knäusl
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, ᅟ, Austria
| | - D Georg
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, ᅟ, Austria
| | - M Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - B Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - M Feldmann
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,University College London, London, UK
| | - R Karch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M J Koepp
- University College London, London, UK
| | - M-C Asselin
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - E Pataraia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Zeilinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Dumanic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - F Pichler
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - J Pilz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - L Nics
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - B Steiner
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - A Traxl
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Thomas Wanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Kushtrim Kryeziu
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Severin Mairinger
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Johann Stanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Kuntner
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Oliver Langer
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - S Mairinger
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Wanek
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - A Traxl
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Krohn
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - J Stanek
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Filip
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sauberer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - C Kuntner
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Pahnke
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - O Langer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - M Wilkovitsch
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Vienna, Austria
| | | | - J Fröhlich
- Austrian Institute of Technology, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - S Mairinger
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - J Stanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - J Fröhlich
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Kuntner-Hannes
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Balber
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - J Singer
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - J Fazekas
- Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - C Rami-Mark
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - N Berroterán-Infante
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - E Jensen-Jarolim
- Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - W Wadsak
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - H Viernstein
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - B Sohr
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - J Fröhlich
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - C Kuntner-Hannes
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - S Pfaff
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Inorganic Chemistry, University of Vienna, ᅟ, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,LBI for Applied Diagnostics, Vienna, Austria
| | - M Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Inorganic Chemistry, University of Vienna, ᅟ, Austria
| | - T Wanek
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - E Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M Visentin
- Department of Clinical Pharmacology and Toxicology, University Hospital, Zurich, Switzerland
| | - S Mairinger
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - B Stieger
- Department of Clinical Pharmacology and Toxicology, University Hospital, Zurich, Switzerland
| | - C Kuntner
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, ᅟ, Austria
| | - P Lam
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - M Aistleitner
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - R Eichinger
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - C Artner
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - H Eidherr
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Vraka
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - A Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,LBI for Applied Diagnostics, Vienna, Austria
| | - L Nics
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - H Kvaternik
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - R Müller
- Seibersdorf Labor GmbH, ᅟ, Austria
| | - D Hausberger
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - C Zink
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - R M Aigner
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - U Cossío
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | - M Asensio
- Engineering Department, Ingeniatrics Tecnologies, P.I. Parque Plata, Camino Mozárabe 41, 41900, Camas-Sevilla, Spain
| | - A Montes
- Engineering Department, Ingeniatrics Tecnologies, P.I. Parque Plata, Camino Mozárabe 41, 41900, Camas-Sevilla, Spain
| | - S Akhtar
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - Y Te Welscher
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - R van Nostrum
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - V Gómez-Vallejo
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | - J Llop
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | | | | | | | - M Troch
- AZ St-Lucas Gent, ᅟ, Belgium
| | - L Hehenwarter
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - B Egger
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - J Holzmannhofer
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - M Rodrigues-Radischat
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - C Pirich
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - I Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - D Wilhelm
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - T Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - T Cassou-Mounat
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France.,Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - S Balogova
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France.,Department of Nuclear Medicine, Comenius university & St. Elisabeth Oncology Institute, Bratislava, Slovakia
| | - V Nataf
- Radiopharmacy, Hôpital Tenon, AP-HP, Paris, France
| | - M Calzada
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France
| | - V Huchet
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - K Kerrou
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - J-Y Devaux
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France
| | - M Mohty
- Hematology, Université Pierre et Marie Curie, Paris, France.,Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs U938, Paris, France
| | - L Garderet
- Hematology, Université Pierre et Marie Curie, Paris, France
| | - J-N Talbot
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - S Stanzel
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - G Pregartner
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, ᅟ, Austria
| | - T Schwarz
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - V Bjelic-Radisic
- Medical University of Graz, Department of Gynecology and Obstetrics, ᅟ, Austria
| | | | - R Aigner
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - S Stanzel
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics, and Documentation, ᅟ, Austria
| | - R M Aigner
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - A Koljević Marković
- Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Milica Janković
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - V Miler Jerković
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - M Paskaš
- National Cancer Research Center Serbia, Innovation Center, University of Belgrade - Faculty of Electrical Engineering, ᅟ, Serbia
| | - G Pupić
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - R Džodić
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - D Popović
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - M C Fornito
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - D Familiari
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - P Koranda
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - H Polzerová
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - I Metelková
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - L Henzlová
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - R Formánek
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - E Buriánková
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Kamínek
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - W H Thomson
- Physics and Nuclear Medicine Department City Hospital, Birmingham, UK
| | - C Lewis
- Maternity Department City Hospital, Birmingham, UK
| | - W H Thomson
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J O'Brien
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - G James
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - A Notghi
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - H Huber
- Institut für Nuklearmedizin und Endokrinologie, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - I Stelzmüller
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - R Wunn
- Zentrales Radiologie-Institut, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M Mandl
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - F Fellner
- Zentrales Radiologie-Institut, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - B Lamprecht
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M Gabriel
- Institut für Nuklearmedizin und Endokrinologie, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M C Fornito
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - G Leonardi
- Heart-Failure Department - Azienda Ospedaliera Universitaria "Policlinico- Vittorio Emanuele", Catania, Italy
| | - W H Thomson
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J O'Brien
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - G James
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J Hudzietzová
- Faculty of Biomedical Engineering, CTU, Prague, Czech Republic
| | - J Sabol
- Faculty of Safety Management, PACR, Prague, Czech Republic
| | - M Fülöp
- Faculty of Public Health, SMU, Bratislava, Slovak Republic
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31
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Wulkersdorfer B, Wanek T, Bauer M, Zeitlinger M, Müller M, Langer O. Using positron emission tomography to study transporter-mediated drug-drug interactions in tissues. Clin Pharmacol Ther 2014; 96:206-13. [PMID: 24682030 PMCID: PMC4153445 DOI: 10.1038/clpt.2014.70] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/21/2014] [Indexed: 01/08/2023]
Abstract
Drug disposition is highly regulated by membrane transporters. Some transporter-mediated drug–drug interactions (DDIs) may not manifest themselves in changes in systemic exposure but rather in changes in tissue exposure of drugs. To better assess the impact of transporter-mediated DDIs in tissues, positron emission tomography (PET)—a noninvasive imaging method—plays an increasingly important role. In this article, we provide examples of how PET can be used to assess transporter-mediated DDIs in different organs.
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Affiliation(s)
- B Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - T Wanek
- Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Müller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - O Langer
- 1] Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria [2] Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
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32
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Frass M, Zagorchev P, Yurukova V, Wulkersdorfer B, Thieves K, Zedtwitz-Liebenstein K, Bursch W, Kaye AD. Two Cases of Fulminant Hepatic Failure from Amanita phalloides Poisoning Treated Additively by Homeopathy. Ochsner J 2014; 14:252-258. [PMID: 24940137 PMCID: PMC4052594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Intoxication with Amanita phalloides is associated with high morbidity and mortality. Treatment therapies include general support, toxin elimination, pharmacotherapy with agents such as the hepatoprotective agent silibinin, and, in extreme states, liver transplantation. Despite these therapeutic interventions, mortality remains relatively high. CASE REPORTS We present reports of 2 patients with severe hepatic failure following intoxication with Amanita phalloides. Both patients were admitted to the intensive care unit; 1 patient suffered from hepatic failure solely, and the second patient experienced severe 5-organ failure. In addition to conventional intensive care treatment, both patients were treated additively with classical homeopathy. The 2 patients survived without any residual pathological sequelae. CONCLUSION Based on the 2 cases, including 1 extreme situation, we suggest that adjunctive homeopathic treatment has a role in the treatment of acute Amanita phalloides-induced toxicity following mushroom poisoning. Additional studies may clarify a more precise dosing regimen, standardization, and better acceptance of homeopathic medicine in the intensive care setting.
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Affiliation(s)
- Michael Frass
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Austria
| | - Petko Zagorchev
- Anesthesiology and Toxicology, Department of Anesthesiology and Critical Care, Hospital for Active Therapy, Shumen, Bulgaria
| | | | - Beatrix Wulkersdorfer
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Austria
| | - Karin Thieves
- Sola Salus, Institute for Homeopathic Research, Geilenkirchen, Germany
| | | | - Willfried Bursch
- Department of Internal Medicine I, Institute of Cancer Research, Medical University of Vienna, Austria
| | - Alan David Kaye
- Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA
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33
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Wulkersdorfer B, Kao KK, Agopian VG, Dunn JC, Wu BM, Stelzner M. Growth Factors Adsorbed on Polyglycolic Acid Mesh Augment Growth of Bioengineered Intestinal Neomucosa. J Surg Res 2011; 169:169-78. [DOI: 10.1016/j.jss.2009.11.719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 10/07/2009] [Accepted: 11/18/2009] [Indexed: 01/18/2023]
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34
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Skokan I, Endler PC, Wulkersdorfer B, Magometschnigg D, Spranger H. Influence of artificial sweetener on human blood glucose concentration. ScientificWorldJournal 2007; 7:1618-21. [PMID: 17982603 PMCID: PMC5900860 DOI: 10.1100/tsw.2007.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Artificial sweeteners, such as saccharin or cyclamic acid are synthetically manufactured sweetenings. Known for their low energetic value they serve especially diabetic and adipose patients as sugar substitutes. It has been hypothesized that the substitution of sugar with artificial sweeteners may induce a decrease of the blood glucose. The aim of this study was to determine the reliability of this hypothesis by comparing the influence of regular table sugar and artificial sweeteners on the blood glucose concentration. In this pilot-study 16 patients were included suffering from adiposity, pre-diabetes and hypertension. In the sense of a cross-over design, three test trials were performed at intervals of several weeks. Each trial was followed by a test free interval. Within one test trial each patient consumed 150 ml test solution (water) that contained either 6 g of table sugar (“Kandisin”) with sweetener free serving as control group. Tests were performed within 1 hr after lunch to ensure conditions comparable to patients having a desert. Every participant had to determine their blood glucose concentration immediately before and 5, 15, 30 and 60 minutes after the intake of the test solution. For statistics an analysis of variance was performed. The data showed no significant changes in the blood glucose concentration. Neither the application of sugar (F4;60 = 1.645; p = .175) nor the consumption of an artificial sweetener (F2.068;31.023 = 1.551; p > .05) caused significant fluctuations in the blood sugar levels. Over a time frame of 60 minutes in the control group a significant decrease of the blood sugar concentration was found (F2.457;36.849 = 4.005; p = .020) as a physiological reaction during lunch digestion.
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Affiliation(s)
- Ilse Skokan
- Interuniversity College for Health and Development Graz, Castle of Seggau, Austria
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35
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Agopian VG, Wulkersdorfer B, Chen DC, Lee J, Stelzner M. Growth factors enhance neomucosal development in tissue-engineered intestine. J Am Coll Surg 2007. [DOI: 10.1016/j.jamcollsurg.2007.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Abstract
The ABO blood group system was discovered by Karl Landsteiner in 1901. Since then, scientists have speculated on an association between different pathologies and the ABO blood group system. The aim of this pilot study was to determine the significance between different blood types of the ABO blood group system and certain pathologies. We included 237 patients with known diagnosis, blood group, sex, and age in the study. As a statistical method, the Chi-square test was chosen. In some cases, a significant association between the blood groups and defined diseases could be determined. Carriers of blood group O suffered from ulcus ventriculi and gastritis (X(2)1 = 78.629, p < 0.001), colitis ulcerosa and duodenitis (X(2)1 = 5.846, p < 0.016), whereas male patients carrying blood group A tended to contract different types of tumours. In patients with intestinal tumours, females with blood group A were more likely to develop the pathology, whereas in males, the blood group O dominated. The development of cholelithiasis was found, above all, in patients with blood group O, which differed from other research where a correlation between this pathology and blood group A was found.
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Affiliation(s)
- Ursula Jesch
- Interuniversity College for Health and Development Graz, Castle of Seggau, Austria.
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37
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Zedtwitz-Liebenstein K, Jaksch P, Wulkersdorfer B, Friehs H, Pempelfort SD, Burgmann H, Frass M. Usefulness of Interleukin-10 Detection in Lung Transplant Patients With Human Cytomegalovirus Infection With Respect to Virus Persistence. Transplantation 2007; 84:268-71. [PMID: 17667821 DOI: 10.1097/01.tp.0000267157.78945.9d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human cytomegalovirus (HCMV) infection in lung transplant patients induces an inflammatory response, including local production of cytokines involved in viral clearance. The aim of this study was to evaluate the potential value of monitoring interleukin (IL)-10 with respect to HCMV persistence in blood and/or bronchoalveolar lavage (BAL). METHODS A quantitative polymerase chain reaction assay was used for HCMV-DNA detection in plasma and BAL. IL-10 was measured with an enzyme-linked immunosorbent assay in blood and with BAL in 101 lung transplant patients. IL-10 levels were correlated with clinical outcome. RESULTS A total of 23 patients of 35 (66%) with detectable HCMV in plasma and/or BAL exhibited increased levels of IL-10 in plasma and/or BAL. Complete clearance of HCMV was observed after 168 (median 130) days in the IL-10-positive group (n=23) in comparison with 87 (median 58) days in the IL-10-negative group (n=12; P<0.024). In the seven HCMV-positive patients with positive IL-10 levels in BAL only, HCMV persisted in BAL for a median of 579 days without signs of systemic infection (positive plasma levels) or clinical symptoms. CONCLUSIONS We show that in lung transplant patients with elevated levels of IL-10 in plasma and/or BAL, HCMV clearance is prolonged because of the influence of anti-inflammatory cytokines.
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38
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Waxenegger I, Endler PC, Wulkersdorfer B, Spranger H. Individual Prognosis Regarding Effectiveness of a Therapeutic Intervention Using Pre-Therapeutic “Kinesiology Muscle Test”. ScientificWorldJournal 2007; 7:1703-7. [PMID: 17982566 PMCID: PMC5900945 DOI: 10.1100/tsw.2007.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Since a therapy's full positive effect and possible adverse effects are individual and not predictable for every single patient, scientists have been searching for methods to predict optimal effects of a therapy. This pilot study investigated the applicability of the “kinesiology muscle test” as a prognostic tool regarding effectiveness in a defined therapeutic procedure. Each of 11 test persons with elevated total cholesterol values received a naturopathic drug supposed to lower cholesterol level on a daily basis for eight consecutive weeks. Prior to treatment the “kinesiology muscle test” was performed, where the patient's ability to maintain a flexed position in a selected joint was evaluated. The resistance created by the patient against the tester's pressure was monitored. Being in touch with healthful or unhealthful chemical substances may, according to the kinesiology literature, increase or decrease this resistance. For testing purposes, the drug was placed onto the patients' skin. The ability of the brachioradial muscle to resist the tester's pressure was determined on a subjective scale (0-100%). The Pearson product-moment correlation coefficient between four variables (total cholesterol value before therapy, total cholesterol value after therapy, difference of total cholesterol values before and after therapy, prior to treatment kinesiology testing) was chosen. A significant correlation between the difference of total cholesterol values before-after and the prior to treatment test was found, as well as a significant correlation between the total cholesterol values after therapy and the prior to treatment kinesiology test.
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Affiliation(s)
- Ingrid Waxenegger
- Interuniversity College for Health and Development Graz, Castle of Seggau, Austria
| | - P. Christian Endler
- Interuniversity College for Health and Development Graz, Castle of Seggau, Austria
| | | | - Heinz Spranger
- Interuniversity College for Health and Development Graz, Castle of Seggau, Austria
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39
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Turkof E, Wulkersdorfer B, Bukaty A. Reconstruction of cavernous nerves by nerve grafts to restore potency: contemporary review of technical principles and basic anatomy. Curr Opin Urol 2006; 16:401-6. [PMID: 17053519 DOI: 10.1097/01.mou.0000250279.52613.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The review discusses the efficacy of reconstructing the neurovascular bundle to regain sexual function if nerve-sparing prostatectomy is unfeasible. RECENT FINDINGS Eleven studies could be found describing the reconstruction of neurovascular bundles. All reconstructive procedures displayed technical inadequacies. The effectiveness of unilateral neurovascular bundle reconstruction remains statistically insignificant when compared with procedures without reconstruction. The efficacy of reconstructing both neurovascular bundles ranges between 0 and 43%. Concerning basic anatomy, the neurovascular bundle contains fibers innervating the cavernous nerves, prostate, rectum, and levator ani muscle. The terms cavernous nerve and neurovascular bundle have often been wrongly considered synonymous. The pelvic splanchnic nerves probably do not join the neurovascular bundle proximal to the bladder/prostate junction but rather at variable distances from 10 to 20 mm distal to it. Therefore, described proximal coaptation sites at the bladder/prostate junction possibly encompass only the hypogastric nerve. SUMMARY Modest clinical results are partly due to inadequate surgical techniques and are mainly due to the anatomical and topographical complexity of the cavernous nerves. Contemporary nerve grafting techniques probably do not allow for the regeneration of all cavernous nerves.
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Affiliation(s)
- Edvin Turkof
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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40
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Rabitsch W, Moser D, Inzunza MR, Niedermayr M, Köstler WJ, Staudinger T, Locker GJ, Schellongowski P, Wulkersdorfer B, Rich JM, Meyer B, Benumof JL, Frass M. Airway Management with Endotracheal Tube versus Combitube® during Parabolic Flights. Anesthesiology 2006; 105:696-702. [PMID: 17006067 DOI: 10.1097/00000542-200610000-00014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background
Training of National Aeronautics and Space Administration space shuttle astronauts revealed difficult airway management with endotracheal tubes (ETTs) under microgravity conditions. The authors performed a randomized comparative study of ETT and Combitube (ETC; Tyco Healthcare, Pleasanton, CA). The aim of the study was to evaluate ease, time of insertion, and success rates during normogravity and parabolic flights using mannequins.
Methods
After normogravity experiments, four flyers performed intubation on a mannequin during the flights. Sixty-two intubation attempts were performed using the ETC (normogravity, 29; microgravity, 33), and 58 intubation attempts were performed using the ETT (each 29 attempts, both conditions). Time to completion of the intubation procedure, success rate, and ease of insertion were recorded.
Results
The ETC performed equally well between normogravity (median, 18 s; range, 17-25 s) and microgravity (median, 18.5 s; range, 17-28 s), whereas the ETT performed significantly slower under microgravity (median, 20 s; range, 17-27 s) as compared with normogravity (median, 18 s; range, 16-22 s; P = 0.019). One hundred nine of 120 (90%) were successful. The ETT and ETC were comparable with respect to successful intubations, under normogravity or microgravity, respectively.
Conclusions
Both the ETC and ETT perform comparably well. Slight differences could be found with respect to time of insertion in favor of the ETC. Because this is the first experiment using the ETC on the KC-135, it is shown that there is enough time to perform the insertion procedure. Because the ETC airway requires less training and is easier to insert than an ETT, it is recommended for further study as an alternative airway to what is currently on the shuttle.
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Affiliation(s)
- Werner Rabitsch
- Department of Internal Medicine I, Intensive Care Unit, Medical University, Vienna, Austria
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41
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Ulrich-Pur H, Hrska F, Krafft P, Friehs H, Wulkersdorfer B, Köstler WJ, Rabitsch W, Staudinger T, Schuster E, Frass M. Comparison of mucosal pressures induced by cuffs of different airway devices. Anesthesiology 2006; 104:933-8. [PMID: 16645443 DOI: 10.1097/00000542-200605000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND High pressures exerted by balloons and cuffs of conventional endotracheal tubes, the Combitube (Tyco Healthcare Nellcor Mallinckrodt, Pleasanton, CA), the EasyTube (Teleflex Ruesch, Kernen, Germany), the Laryngeal Mask Airway (LMA North America, San Diego, CA), the Intubating Laryngeal Mask Airway (Fastrach; LMA North America), the ProSeal (LMA North America), and the Laryngeal Tube (LT; VBM Medizintechnik, Sulz, Germany) may traumatize the pharyngeal mucosa. The aim of this study was to compare pressures exerted on the pharyngeal, tracheal, and esophageal mucosa by different devices designed for securing the patient's airways. METHODS Nineteen fresh cadavers were included. To measure mucosal pressures, microchip sensors were fixed on the anterior, lateral, and posterior surfaces of the proximal balloon and the distal cuff of the investigated devices. Depending on the respective airway device, the cuff volume was increased in 10-ml increments at the proximal balloon starting from 0 to a maximum of 100 ml, and in 2-ml increments at the distal cuff starting from 0 up to 12 ml. RESULTS Tracheal mucosal pressures were significantly higher using the Combitube compared with the endotracheal tube and the EasyTube. Maximal esophageal pressures were significantly higher using the EasyTube compared with the Combitube. Using cuff volumes according to the manufacturers' guidelines, we found the highest pharyngeal pressures with the Intubating Laryngeal Mask Airway versus all other devices. At maximal volumes, the Laryngeal Mask Airway, the Intubating Laryngeal Mask Airway, and the ProSeal induced significantly higher pharyngeal pressures compared with all other devices. Using a pharyngeal cuff volume of 40 ml, the Intubating Laryngeal Mask Airway followed by the Laryngeal Mask Airway exerted significantly higher pressures compared with the other devices. CONCLUSIONS Although some devices exhibit a somewhat higher mucosal pressure when compared with others, the authors believe that the observed differences of the cuff pressures do not suggest a clinically relevant danger, because the investigated devices, except the endotracheal tubes, are not intended for prolonged use.
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Affiliation(s)
- Herbert Ulrich-Pur
- Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University Vienna, Austria
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Rabitsch W, Staudinger T, Koestler WJ, Wulkersdorfer B, Urtubia R, Frass M, Schebesta K, Krafft P. Should there be a change in the teaching of airway management in the medical school curriculum? Resuscitation 2005; 66:245-6. [PMID: 15963622 DOI: 10.1016/j.resuscitation.2005.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 02/17/2005] [Accepted: 02/19/2005] [Indexed: 11/26/2022]
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