Perioperative anesthetic management of very long-chain acyl-coenzyme a dehydrogenase deficiency

Very long-chain acyl-coenzyme A dehydrogenase deficiency is a rare disorder of β-oxidation fatty acid metabolism that results in susceptibility to hypoglycemia, liver failure, cardiomyopathy and rhabdomyolysis during catabolic situations. We report the case of a 10-year-old male undergoing a totally implanted central venous catheter placement during hospitalisation for rhabdomyolysis, who was successfully managed with general anesthesia with nitrous oxide, sevoflurane and remifentanil. No hypoglycemia occurred and creatine kinase levels did not increase in the perioperative period. We describe the challenges encountered and the strategies used to avoid further decompensation of the disease due to surgical stress.

“Dad is feeling blue”: what to know about paternal perinatal depression

Introduction

The transition into parenthood is associated with an increased psychopathological vulnerability. Most studies have focused on mothers, although recently, the role of fathers has grown more importance. Paternal perinatal depression (PPD) is an episode of major depressive disorder occurring in new or expectant fathers during the perinatal period. PPD is not widely acknowledged and research are rare.

Objectives

The authors intend to review the literature about PPD, focusing on its prevalence, risk factors, clinical features, treatment and consequences.

Methods

Non-systematic review of the literature through PubMed.

Results

A meta-analysis of PPD estimated a prevalence of 10.4%. Risk factors of PPD are multiple and complex. There are sociodemographic factors, such as marital status, monthly income and social support. Psychological factors, for instance history of depression, maternal prenatal anxiety and maternal depression. Some literature also suggests hormonal changes on men like increase estrogen and lower testosterone levels. PPD can present with symptoms of mood alterations, like irritability and restricted emotions, anxiety, fatigue, insomnia, loss of appetite. Also common are behavioural disturbances such as interpersonal conflicts, impulsivity, violence, avoidance behaviour, and substance abuse. There are no studies to specific treatments to PPD, so the treatment is the same for women, such as antidepressants and psychotherapy. If untreated, PPD can have an adverse influence on the health and wellbeing of the mother and child.

Conclusions

PPD is still underscreened, underdiagnosed and undertreated. It is fundamental identifying risk factors and the development of specific interventions. Further research on PPD is needed.

Disclosure

No significant relationships.

Challenges of ageing in prisons and forensic psychiatric settings

Introduction

There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

Objectives

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Methods

Non-systematic review of the literature.

Results

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

Conclusions

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

Disclosure

No significant relationships.

POS0442 GLPG4399: SELECTIVE SIK3 INHIBITION AS A NOVEL MODE OF ACTION FOR THE TREATMENT OF INFLAMMATORY ARTHRITIC DISEASES (PRECLINICAL)

Background

Salt-inducible kinases (SIKs) is a family of kinases with immunomodulatory function identified using a proprietary adenoviral shRNA knockdown target discovery platform. Moreover, SIK inhibition has previously been shown to have a role in inflammatory signalling.1–3 These findings suggest a therapeutic potential for SIK inhibition in inflammatory indications. A medicinal chemistry effort resulted in the development of a first-in-class, oral, selective SIK3 inhibitor: GLPG4399. This compound may be beneficial in inflammatory diseases such as rheumatoid and psoriatic arthritis which are chronic disorders characterized by impaired joint synovial inflammation.

Objectives

Our research aimed to characterize GLPG4399 and explore its impact in arthritis-relevant inflammatory in vitro phenotypic cell assays, and to evaluate the therapeutic potential of selective SIK3 inhibition in in vivo experimental models of arthritis.

Methods

The selectivity and potency of GLPG4399 was profiled using biochemical and target-based cell assays. The mode of action of selective SIK3 inhibition in inflammation was explored in an in vitro panel of innate (monocytes, macrophages, dendritic cells) and adaptive (B and T lymphocytes) immune phenotypic assays and in a lipopolysaccharide (LPS)-stimulated human whole blood assay by measuring the production of inflammatory cytokines. In vivo target engagement was evaluated in an acute LPS-stimulated cytokine release mouse model by measuring plasma tumour necrosis factor (TNF) α levels. The therapeutic efficacy of GLPG4399 was evaluated in vivo in collagen-induced arthritis (CIA) and IL-23-induced psoriatic arthritis mouse models by assessing disease activity endpoints.

Results

GLPG4399 was shown to be a SIK3 inhibitor with high selectivity against a panel of 370 kinases. The wide effect of SIK3 inhibition on key immune cell types was demonstrated by GLPG4399’s reduction of pro-inflammatory cytokines produced by monocytes, macrophages, dendritic cells, B and T lymphocytes in a panel of in vitro innate and adaptive immune phenotypic assays. The biological activity and target engagement of GLPG4399 was further demonstrated by dose-dependent inhibition of TNFα production in vitro in LPS-stimulated human whole blood and in vivo in the blood of LPS-challenged mice. Oral treatment with GLPG4399 in mice resulted in a significant and dose-dependent improvement of disease activity score in both CIA and the psoriatic arthritis disease model. Moreover, bone erosion in CIA and new bone formation in the psoriatic arthritis disease model were significantly reduced.

Conclusion

Our preclinical findings demonstrate the strong immunomodulatory effect of SIK3 inhibition in arthritis-relevant inflammatory cell assays and highlight the significant preclinical efficacy of GLPG4399 in two experimental arthritis mouse models. The novel mechanisms of action of GLPG4399 represents a promising approach for the treatment of arthritis.

References

[1]Sundberg TB et al. PNAS 2014;111:12468–73.

[2]Lombardi MS et al. J Leukoc Biol 2016;99:711–21.

[3]Wein MN et al. Trends Endocrinol Metab 2018;29:723–35.

Acknowledgements

These studies were funded by Galapagos NV (Mechelen, Belgium). Editorial and publications management support was provided by PharmaGenesis London, London, UK, and funded by Galapagos NV.

Disclosure of Interests

Stephanie Lavazais Employee of: Employee of Galapagos., Anna Pereira-Fernandes Employee of: Employee of Galapagos., Carole Delachaume Employee of: Employee of Galapagos., Catherine Jagerschmidt Employee of: Employee of Galapagos., Michael Drennan Employee of: Employee of Galapagos., Didier Merciris Employee of: Employee of Galapagos., Christophe Peixoto Employee of: Employee of Galapagos., Monica Borgonovi Employee of: Employee of Galapagos., Nicolas Desroy Employee of: Employee of Galapagos., David Amantini Employee of: Employee of Galapagos., Steve De Vos Employee of: Employee of Galapagos., Kris Nys Employee of: Employee of Galapagos.

Physical and rehabilitation medicine intervention in stroke in the acute hospital setting: A cross-sectional study

INTRODUCTION

Stroke represents the main cause of death and disability in Portugal. Resulting functional deficits are widely recognized. This work aims to evaluate the variation in functionality of stroke patients in the acute hospital setting under a rehabilitation program.

MATERIAL AND METHODS

Cross-sectional study of patients admitted to the Neurology department, from January to June 2019, with acute stroke. The variation in functionality was assessed using the Barthel index. Statistical analysis used Student's t-test and Spearman's correlation coefficient, with a p-value≤0.05 as significant.

RESULTS

106 patients with mean age of 63.7±14.2 years and a male predominance (60.4%) were included. Patients started rehabilitation program at 1.37±1.19 days after admission. A gain in functionality between admission and discharge was identified (50.18±32.37 versus 68.73±28.94, p<0.001). A significantly greater increase was observed in patients diagnosed under code stroke protocol (CSP) (p=0.021) and undergoing some type of acute phase treatment (p=0.017). From 90.5% of the patients that pursued rehabilitation after discharge, 40.6% were referred to an inpatient unit on average 12.7±7.0 days after admission.

DISCUSSION

In this study, Physical and Rehabilitation Medicine (PRM) provided early rehabilitation care to stroke patients. According to international evidence this is associated with greater functional gains. The variation in functionality verified during hospitalization demonstrates the importance of PRM in the acute hospital, assessing the rehabilitation needs after hospital discharge and maximizing outpatient rehabilitation. Diagnosis under CSP and undergoing acute treatment were determinants of greater functional improvement.

CONCLUSION

PRM plays a central role in the early management of functional impairment resulting from stroke and in the post-discharge guidance of patients.

Delusional infestation: Two case reports

Introduction

Delusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it.

Objectives

To describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity.

Methods

Two case report and non-systematic review.

Results

We present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia).

Conclusions

DI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first.

Disclosure

No significant relationships.

Substance use disorders in adolescence - a review

Introduction

Substance use disorders in adolescents are a growing problem worldwide. These disorders are often unrecognised, unvalued by families, society and clinicians and as a result underdiagnosed, with serious future consequences if improperly addressed.

Objectives

Updated review of the recent literature on this topic.

Methods

Unsystematic review of the most recent and relevant literature.

Results

Review of neurobiology, risk factors, co-morbidity, differential diagnosis, diagnostic criteria, evaluation and treatment of substance use disorders in adolescence.

Conclusions

Substance use disorder in adolescence includes a variety of behaviours related to the use of alcohol and/or drugs, for instance, inability to control substance use, impairment of function at school, home or work, interpersonal problems and hazardous use of substance. Further knowledge in identifying, early diagnosing and adequate intervention in adolescents’ substance use disorder may have paramount prognostic features.

Disclosure

No significant relationships.

Psychedelics and psychiatric disorders: A emerging role

Introduction

Recently there has been renewal in interest of psychedelic research. Classic psychedelics such as lysergic acid diethylamide (LSD), psilocybin and mescaline act pharmacologically as agonists at the 5-HT2A receptor. The entactogens like methylenedioxymethamphetamine (MDMA), acts as a serotonin, dopamine and noradrenaline agonist. All of these drugs are potential candidates in the treatment of multiple psychiatric illnesses.

Objectives

The authors intend to review the literature on the clinical application of psychedelic drugs in psychiatric disorders.

Methods

Non-systematic review of the literature.

Results

In recent clinical trial the psychedelic is given with psychotherapeutic input. In a supportive setting, psychedelics produced immediate and significant anti-depressant and anxiolytic effects that were endured for several months. Randomized clinical trials support the efficace of psilocybin in the treatment of depression and those with anxiety and depression symptoms provoked by life-threatening cancer. There have also been studies showing efficacy in both alcohol and tobacco dependence. When administered safely LSD can reduce anxiety and have anti-addictive property. Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD. Psychedelics were well-tolerated, few adverse effects have been reported. The most common adverse effects were transient anxiety, short-lived headaches, nausea and mild increases in heart rate and blood pressure, with no persisting adverse effects. Serious adverse events, such as persistent psychosis and suicidality, have not been demonstrated.

Conclusions

Psychedelics appear to be effective in multiple psychiatric disorders and are well-tolerated, although further evidence is required, to better see they therapeutic potential.

Disclosure

No significant relationships.

Psychiatric symptoms in huntington’s disease

Introduction

Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder, that typically manifests in adulthood, clinically characterized by progressive motor, cognitive and psychiatric/behavioural symptoms. Psychiatric symptoms are common in HD. The presentation of these symptoms is highly variable, and their course does not correlate with motor or cognitive disease progression. Psychiatric symptoms often precede motor onset by many years.

Objectives

The authors intend to review the literature the most frequent psychiatric disorders in patients with HD.

Methods

Non-systematic review of the literature.

Results

Psychiatric symptoms have been a core feature of HD. Pre-symptomatic HD patients exhibit a greater prevalence of psychiatric symptoms, particularly affective disorders. This symptoms are presenting symptoms of HD in up to half of all people. In symptomatic HD patients, it is estimated that up to 73–98% of patients will have a major psychiatric disorder or psychiatric symptoms. Psychiatric manifestations in HD include depression, irritability, apathy, anxiety, mania, perseverations, obsessions and psychosis. Cognitive changes include progressive deficits in attention, learning, executive and sensory functions, resulting in dementia. Depression, diagnosed in half of patients with HD, is the most common and earliest symptoms prior to the motor onset. There are likely multiple causes of the psychiatric symptoms, with underlying factors including a combination of neurobiological, cognitive, psychological, social and environmental factors.

Conclusions

Patients with HD have high psychiatric comorbidity, that causes significant functional impairment and affect quality of life. Thus, they require a multidisciplinary approach in the recognition and treatment of psychiatric symptoms.

Eating disorder examination-questionnaire – 7: Construct validity in a sample of portuguese overweight women

Introduction

Although the Eating Disorder Examination Questionnaire (EDEQ; Fairburn et al. 2008) is the most used instrument worldwide for the assessment of eating disorders symptoms, its factorial structure considerably varies, which limits its construct validity. Using exploratory factor analisys in data from a sample of overweight women, our group found a three-factors structure of the EDEQ Portuguese version (Peixoto et al. 2013), Although it was in accordance with other psychometric studies (eg. Peterson et al 2007), it was different from the original matrix. Further investigation regarding its factor structure has been conducted, with studies supporting a modified seven-item-three-factors structure (dietary restraint, shape/weight overvaluation, body dissatisfaction) with improved psychometric properties (Grilo et al. 2013, 2015), including with Portuguese samples (Machado et al. 2018; Santos et al. 2019).

Objectives

To analyze if the EDEQ version composed of seven items and three factors is replicated in a Portuguese sample of overweight women.

Methods

The EDEQ was administered to an outpatient sample of 276 women (Mean age= 43.85±11.89 years; Mean BMI=32.82±5.43 Kg/height²) attending a weight loss treatment consultation in a public hospital.

Results

Confirmatory factor analysis (CFA) revealed an adequate fit of the EDEQ-7 second order model with three dimensions (χ²/df=1.5497; RMSEA=.0452, CFI=.9955, TLI=.9914, GFI=.xxx; p<.001). The EDEQ7 Cronbach’s alphas for the total and its dimensions were α<.70.

Conclusions

Given its good psychometric properties, the overlap of the measurement model with those found with different samples and the reduced number of items, the EDEQ7 will be very useful both in research and clinical settings with/for overweight women.

Pisa syndrome – a case report

Introduction

Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.

Objectives

Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.

Methods

Description of a clinical case by consulting databases of current and scientifically relevant articles.

Results

The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.

Conclusions

Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.

Disclosure

No significant relationships.

The effects of dehydroepiandrosterone on sexual function: a systematic review

OBJECTIVE

Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on people's quality of life, this systematic review was undertaken with the objective of evaluating the effect of DHEA use on aspects of sexual function.

METHOD

An electronic search was conducted in the databases of PubMed, ISI Web of Science and Virtual Health Library (VHL) combining the terms 'DHEA treatment' and 'DHEA use' with terms such as 'sexual dysfunction', 'sexual frequency' and 'libido'. No limits on time and language were imposed. Clinical studies were considered eligible where individuals for any reason made use of DHEA and if they had any aspect of sexual function assessed. Preclinical studies and systematic reviews were considered ineligible.

RESULTS

The search identified 183 references and 38 were considered eligible. DHEA improved aspects such as sexual interest, lubrication, pain, arousal, orgasm and sexual frequency. Its effect was better in populations with sexual dysfunction, especially in perimenopausal and postmenopausal women.

CONCLUSION

Considering the studies currently published, DHEA is effective in improving several aspects of sexual function, but this effect did not reach all the populations studied.

Microdosing of a Carbon-14 Labeled Protein in Healthy Volunteers Accurately Predicts Its Pharmacokinetics at Therapeutic Dosages

Preclinical development of new biological entities (NBEs), such as human protein therapeutics, requires considerable expenditure of time and costs. Poor prediction of pharmacokinetics in humans further reduces net efficiency. In this study, we show for the first time that pharmacokinetic data of NBEs in humans can be successfully obtained early in the drug development process by the use of microdosing in a small group of healthy subjects combined with ultrasensitive accelerator mass spectrometry (AMS). After only minimal preclinical testing, we performed a first-in-human phase 0/phase 1 trial with a human recombinant therapeutic protein (RESCuing Alkaline Phosphatase, human recombinant placental alkaline phosphatase [hRESCAP]) to assess its safety and kinetics. Pharmacokinetic analysis showed dose linearity from microdose (53 μg) [(14) C]-hRESCAP to therapeutic doses (up to 5.3 mg) of the protein in healthy volunteers. This study demonstrates the value of a microdosing approach in a very small cohort for accelerating the clinical development of NBEs.

Muscular dystrophy-related quantitative and chemical changes in adenohypophysis GH-cells in golden retrievers

Duchenne muscular dystrophy (DMD) is a recessive X-linked lethal condition which affects a boy in every 3300 births. It is caused by the absence of dystrophin, a protein occurring especially within the musculoskeletal system and in neurons in specific regions of the central nervous system (CNS). Growth hormone (GH) inhibition is believed to decrease the severity of DMD and could perhaps be used in its treatment. However, the underlying pathological mechanism is not known. The golden retriever muscular dystrophy dog (GRMD) represents an animal model in the study of DMD. In this paper we investigated the morphological aspects of the adenohypophysis as well as the total number and size of GH-granulated cells using design-based stereological methods in a limited number of dystrophic and healthy golden retrievers. GH-cells were larger (32.4%) in dystrophic dogs than in healthy animals (p=0.01) and they occupied a larger portion (62.5%) of the adenohypophysis volume (p=0.01) without changes in either adenohypophysis volume (p=0.893) or total number of GH-granulated cells (p=0.869). With regard to ultrastructure, granulated cells possessed double-layer electron-dense granules which were evenly distributed in the cytosol. Furthermore, these granules in dystrophic animals occupied a larger proportion of GH-granulated cell volume (66.9%; p=0.008) as well as of all GH-cells in the whole pars distalis of adenohypophysis (77.3%; p=0.035), albeit IGF-1 serum concentration was lower in severe cases. This suggests difficulties in the GH secretion that might possibly be associated to dystrophin absence. In contrast to earlier reports, our data suggest that a lower IGF-1 concentration may be more related to a severe, as opposed to a benign, clinical form of muscular dystrophy.

Downstream processing of triple layered rotavirus like particles

Rotavirus like particles (RLPs) constitute a potential vaccine for the prevention of rotavirus disease, responsible for the death of more than half a million children each year. Increasing demands for pre-clinical trials material require the development of reproducible, scaleable and cost-effective purification strategies as alternatives to the traditional laboratory scale CsCl density gradient ultracentrifugation methods commonly used for the purification of these complex particles. Self-assembled virus like particles (VLPs) composed by VP2, VP6 and VP7 rotavirus proteins (VLPs 2/6/7) were produced in 5l scale using the insect cells/baculovirus expression system. A purification process using depth filtration, ultrafiltration and size exclusion chromatography as stepwise unit operations was developed. Removal of non-assembled rotavirus proteins, concurrently formed particles (RLP 2/6), particle aggregates and products of particle degradation due to shear was achieved. Particle stability during storage was studied and assessed using size exclusion chromatography as an analytical tool. Formulations containing either glycerol (10% v/v) or trehalose (0.5 M) were able to maintain 75% of intact triple layered VLPs, at 4 degrees C, up to 4 months. The overall recovery yield was 37% with removal of 95% of host cell proteins and 99% of the host cell DNA, constituting a promising strategy for the downstream processing of other VLPs.

Purification of adenoviral vectors using expanded bed chromatography

The increasing numbers of pre-clinical and clinical trials where recombinant adenoviral vectors are used for gene therapy and vaccination require the development of cost-effective and reproducible large scale purification strategies of the biologically active particles. Alternatives to the traditional laboratory scale CsCl density gradient ultracentrifugation method, such as fixed bed chromatography strategies, have been developed, but the yields of final recovery remain too low due mainly to the capture and concentration steps taking place before and between the chromatographic stages. In this study, a rapid and efficient scale-able purification protocol allowing to obtain concentrated, pure and bioactive adenoviral vectors was developed. This allows efficient levels of binding to the column media and vector purification without centrifugation or filtration steps. Expanded bed chromatography followed by hollow fiber concentration allows the capture of viral particles directly from cellular extracts with high efficiency and vector purification is achieved in less than one working day with a minimal amount of sample handling, thus presenting an improvement over existing processes. The overall process yield reached 32%, representing an eight-fold improvement over results reported previously, while the purity is comparable to that obtained with the CsCl method.

Quantitation of MLV-based retroviral vectors using real-time RT-PCR

Murine leukaemia virus-based vectors quantitation is a time consuming process that can take up to five days. In order to reduce this time a real-time RT-PCR was developed. This method quantifies vectors without an RNA extraction step, using AMV reverse transcriptase and LightCycler technology. Besides a low quantitation time, this method has the advantages of using a plasmid DNA standard curve with good reproducibility, and of having a high sensitivity (3 x 10(2) particles/microl) as well as an excellent intra- and inter-assay reproducibility. Although the method described quantifies vector particles with RNA whether these particles are infectious or not, it is possible to use it to determine infectious particles concentration after the establishment of a correlation between particles with RNA and infectious particles, for a given set of conditions. This method can also be used to study vector stability by comparison of infectious particles, total particles and particles with RNA.

Synthesis of analogues of the O-beta-D-ribofuranosyl nucleoside moiety of liposidomycins. Part 1: contribution of the amino group and the uracil moiety upon the inhibition of MraY

The O-beta-D-ribofuranosyl nucleoside I is the minimal structural entity of liposidomycins maintaining enzyme inhibitory activity. Modifications performed on both the primary amine and the uracil moieties clearly demonstrate their major contribution to the inhibition of the bacterial translocase (MraY).

Structural evidence for ligand specificity in the binding domain of the human androgen receptor. Implications for pathogenic gene mutations

The crystal structures of the human androgen receptor (hAR) and human progesterone receptor ligand-binding domains in complex with the same ligand metribolone (R1881) have been determined. Both three-dimensional structures show the typical nuclear receptor fold. The change of two residues in the ligand-binding pocket between the human progesterone receptor and hAR is most likely the source for the specificity of R1881 to the hAR. The structural implications of the 14 known mutations in the ligand-binding pocket of the hAR ligand-binding domains associated with either prostate cancer or the partial or complete androgen receptor insensitivity syndrome were analyzed. The effects of most of these mutants could be explained on the basis of the crystal structure.