Synthesis and Structure-Affinity Relationships of Spirocyclic Benzopyrans with Exocyclic Amino Moiety

σ1 and/or σ2 receptors play a crucial role in pathological conditions such as pain, neurodegenerative disorders, and cancer. A set of spirocyclic cyclohexanes with diverse O-heterocycles and amino moieties (general structure III) was prepared and pharmacologically evaluated. In structure-activity relationships studies, the σ1 receptor affinity and σ1:σ2 selectivity were correlated with the stereochemistry, the kind and substitution pattern of the O-heterocycle, and the substituents at the exocyclic amino moiety. cis-configured 2-benzopyran cis-11b bearing a methoxy group and a tertiary cyclohexylmethylamino moiety showed the highest σ1 affinity ( Ki = 1.9 nM) of this series of compounds. In a Ca2+ influx assay, cis-11b behaved as a σ1 antagonist. cis-11b reveals high selectivity over σ2 and opioid receptors. The interactions of the novel σ1 ligands were analyzed on the molecular level using the recently reported X-ray crystal structure of the σ1 receptor protein. The protonated amino moiety forms a persistent salt bridge with E172. The spiro[benzopyran-1,1'-cyclohexane] scaffold and the cyclohexylmethyl moiety occupy two hydrophobic pockets. Exchange of the N-cyclohexylmethyl moiety by a benzyl group led unexpectedly to potent and selective μ-opioid receptor ligands.

Rigidity versus Flexibility: Is This an Issue in σ1 Receptor Ligand Affinity and Activity?

Stereoisomeric 2,5-diazabicyclo[2.2.2]octanes 14 and 15 were prepared in a chiral-pool synthesis starting from (S)- or (R)-aspartate. The key step in the synthesis was a Dieckmann-analogous cyclization of (dioxopiperazinyl)acetates 8, which involved trapping of the intermediate hemiketal anion with Me3SiCl. The σ1 affinity was tested using membrane preparations from animal (guinea pig) and human origin. The binding of bicyclic compounds was analyzed by molecular dynamics simulations based on a 3D homology model of the σ1 receptor. The good correlation between Ki values observed in the σ1 assays and calculated free binding energy, coupled with the identification of four crucial ligand/receptor interactions, allowed the formulation of structure-affinity relationships. In an in vitro antitumor assay with seven human tumor cell lines, the bicyclic compounds inhibited selectively the growth of the cell line A427, which is due to induction of apoptosis. In this assay, the compounds behave like the known σ1 receptor antagonist haloperidol.

The sigma enigma: in vitro/in silico site-directed mutagenesis studies unveil σ1 receptor ligand binding

The σ1 receptor is an integral membrane protein that shares no homology with other receptor systems, has no unequivocally identified natural ligands, but appears to play critical roles in a wide variety of cell functions. While the number of reports of the possible functions of the σ1 receptor is increasing, almost no information about the three-dimensional structure of the receptor and/or possible modes of interaction of the σ1 protein with its ligands have been described. Here we performed an in vitro/in silico investigation to analyze the molecular interactions of the σ1 receptor with its prototypical agonist (+)-pentazocine. Accordingly, 23 mutant σ1 isoforms were generated, and their interactions with (+)-pentazocine were determined experimentally. All direct and/or indirect effects exerted by the mutant residues on the receptor-agonist interactions were reproduced and rationalized in silico, thus shining new light on the three-dimensional structure of the σ1 receptor and its ligand binding site.

Structure of the σ1 receptor and its ligand binding site

The exact 3D structure of the enigmatic σ1 receptor is unknown, as the crystal structure of this protein has not been solved so far. Many efforts have been devoted to unveiling the structure of the σ1 receptor and specifically its binding site, which include photoaffinity labeling, site directed mutagenesis, and homology modeling. The aim of the present miniperspective is to give a short overview of all results that contribute to the current knowledge of the σ1 receptor and its ligand binding site.

Characterization of ligand binding to the σ(1) receptor in a human tumor cell line (RPMI 8226) and establishment of a competitive receptor binding assay

The standard assay for the determination of σ(1) receptor affinities of novel compounds is a competitive binding assay using [(3)H]-(+)-pentazocine as radioligand and membrane preparations from guinea pig brain. Herein, a novel competitive binding assay was developed employing the hematopoietic cell line of human multiple myeloma (RPMI 8226), which expresses a large amount of the human σ(1) receptor. Membrane fragments of RPMI 8226 cells were prepared and characterized. A Western blot analysis confirmed the high density of σ(1) receptors in this cell line. Assay conditions were carefully optimized leading to an incubation period of 120 min, an incubation temperature of 37°C, and receptor material for each well was prepared from 300,000 cells. It was shown that a large excess (10 μM) of (+)-pentazocine, haloperidol, and di-o-tolylguanidine provided the same results during determination of the nonspecific binding. Saturation experiments with the radioligand [(3)H]-(+)-pentazocine led to a K(d)-value of 36±0.3 nM and a B(max)-value of 477±7 fmol/mg protein. These data resulted in approximately 122,000 σ(1) binding sites per cell. The assay was validated by using six known σ(1) ligands and eight σ(1) ligands prepared in our lab. The K(i)-values determined with RPMI 8226-derived receptor material are in good accordance with the K(i)-values obtained with guinea pig brain membrane preparations. Compared with guinea pig brain preparations, the RPMI 8226-derived receptor material represents a better standardized receptor material with a high density of human σ(1) receptors.

An extended association screen in multiple sclerosis using 202 microsatellite markers targeting apoptosis-related genes does not reveal new predisposing factors

Apoptosis, the programmed death of cells, plays a distinct role in the etiopathogenesis of Multiple sclerosis (MS), a common disease of the central nervous system with complex genetic background. Yet, it is not clear whether the impact of apoptosis is due to altered apoptotic behaviour caused by variations of apoptosis-related genes. Instead, apoptosis in MS may also represent a secondary response to cellular stress during acute inflammation in the central nervous system. Here, we screened 202 apoptosis-related genes for association by genotyping 202 microsatellite markers in initially 160 MS patients and 160 controls, both divided in 4 sets of pooled DNA samples, respectively. When applying Bonferroni correction, no significant differences in allele frequencies were detected between MS patients and controls. Nevertheless, we chose 7 markers for retyping in individual DNA samples, thereby eliminating 6 markers from the list of candidates. The remaining candidate, the ERBB3 gene microsatellite, was genotyped in additional 245 MS patients and controls. No association of the ERBB3 marker with the disease was detected in these additional cohorts. In consequence, we did not find further evidence for apoptosis-related genes as predisposition factors in MS.

A review of natural CO2 accumulations in Europe as analogues for geological sequestration

Natural geological accumulations of carbon dioxide occur widely throughout Europe, often close to population centres. Some of these CO2 deposits leak, whereas others are sealed. Understanding these deposits is critical for selecting and designing underground storage sites for anthropogenic CO2. To provide confidence that the potential risks of geological CO2 storage are understood, geologists are required to predict how CO2 may behave once stored underground. Natural CO2 accumulations provide a unique opportunity to study long-term geochemical and geomechanical processes that may occur following geological storage of anthropogenic CO2. In addition, natural CO2 springs and gas vents can provide information on the mechanisms of gas migration and the potential effects of CO2 leakage to the surface. This paper provides a description of some natural, European CO2 occurrences.

CO2 accumulations occur in many basins across Europe. In addition, volcanic areas and seismically active areas allow CO2-rich fluids to migrate to the near surface. Many of these occur in areas that have been populated for hundreds and thousands of years.

Stratigraphic traps have allowed CO2 to accumulate below evaporite, limestone and mudstone caprocks. Comparisons between reservoir sandstone and equivalent nearby sandstones that contain no CO2 indicate that reservoir sandstones may experience increased secondary porosity development through feldspar dissolution. Where fracture reactivation allows CO2-rich fluids to migrate, limited self-sealing may take place through calcite precipitation. Gas migration experiments indicate that, due to geochemical interactions, fine-grained seals would be able to trap smaller volumes of CO2 compared to, for example CH4. In natural systems most leakage from depth occurs along fractures and is typically extremely localized on a metre-scale.

Polymorphism in the peroxisome proliferator-activated receptor alpha gene influences the risk for Alzheimer's disease

The peroxisome proliferator-activated receptor alpha (PPAR-alpha) is a member of the steroid hormone super family of ligand-inducible transcription factors, involved in glucose and lipid metabolism. We screened for polymorphisms in the PPAR-alpha gene and detected two known polymorphisms located in exon 5 and intron 7. These polymorphisms were investigated for their possible association with Alzheimer's disease (AD) and for their effect in carriers of an insulin gene (INS) polymorphism. The PPAR-alpha C --> G polymorphism in exon 5 (L162V) was associated with AD, in that the V-allele was more frequent in AD patients than in healthy subjects. Further data analysis revealed that carriers of an PPAR-alpha L162V V-allele and an INS-1 allele presented with an increased risk for AD. Cerebrospinal fluid amyloid-beta levels were influenced by PPAR-alpha L162V genotype. These results suggest, that PPAR-alpha polymorphism may be a risk factor for AD.

[Paradoxical cerebral embolism during fibrinolysis therapy in deep vein thrombosis and pulmonary embolism]

A 37-year-old woman with increasing dyspnoea over several months suddenly developed severe ortho- and tachypnoea as well as cyanosis of the lips and acrocyanosis. Pulmonary angiography revealed massive bilateral pulmonary emboli with a systolic pulmonary artery pressure of 75 mm Hg. Phlebography demonstrated a thrombotic occlusion of the deep veins of the left leg extending to the distal femoral vein. Thrombolysis treatment was started via an indwelling pulmonary artery catheter (500,000 IU urokinase and 10,000 IU heparin as bolus, then 1 mill. IU urokinase and 1,000 IU heparin per hour). After two hours an incomplete left-sided paresis occurred (involving ocular and facial muscles, dysarthria, left arm and left leg) and the thrombolytic infusion was stopped. But cerebral computed tomography (CT) did not demonstrate any intracerebral haemorrhage. The heparin infusion was restarted (partial thromboplastin time between 70 and 90 s). CT examinations during the next few days showed the development of an ischaemic infarction in the distribution of the right medial cerebral artery. Angiography demonstrated occlusion of the right internal carotid artery. The diagnosis of a paradoxical embolus was supported by easy cardiac catheter passage through a patent foramen ovale. Subsequent pulmonary angiography demonstrated a thrombus-free pulmonary arterial circulation with a normal pulmonary arterial pressure. There was gradual and extensive regression of the incomplete hemiparesis.

[Ventricular late potentials in athletes]

Ventricular late potentials detected by signal averaging have a high predictive value for the origin of malignant ventricular tachyarrhythmias in patients with coronary artery disease. We examined 35 male sportsmen aged from 22 to 33 years. Clinical examination, ECG at rest, echocardiography and signal averaging were performed. In nine of the 35 sportsmen (26%) ventricular late potentials were detected. In a control group of 20 nonsportsmen none had late potentials. The nine sportsmen with late potentials all had electrocardiographical and echocardiographical signs of left-ventricular hypertrophy. Of the 26 sportsmen without ventricular late potentials five had left-ventricular hypertrophy. Ventricular late potentials are not rare in sportsmen. They seem always to appear together with left-ventricular hypertrophy.

Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction

Prolonged external cardiac massage is often regarded as a contraindication for thrombolytic therapy because of the risk of fatal hemorrhage. The influence of cardiopulmonary resuscitation on complications of thrombolytic bleeding was assessed analyzing data of all patients with myocardial infarction admitted to our clinic during the 10-year period between 1978 and 1987. From the total of 2,147 patients with acute myocardial infarction, 590 received thrombolytic therapy (intracoronary in 229, intravenous in 400). Of these, 43 patients underwent prolonged cardiopulmonary resuscitation and received thrombolysis within a time interval of less than 24 hours. In 21 patients, resuscitation was performed within a short period of time (5 minutes to 20 hours) after thrombolysis (10 intracoronary, 10 intravenous, 1 intravenous + intracoronary) had been initiated; 9 of these patients survived (43%). In the other 22 patients, thrombolytic therapy was initiated during ongoing resuscitation (n = 6: intravenous in 5, intravenous + intracoronary in 1) or in the early phase (10 to 120 minutes) after successful resuscitation (n = 16: intracoronary in 10, intravenous in 4, intravenous + intracoronary in 2). From this group, 14 patients survived (in-hospital mortality 36%). The mean duration of cardiopulmonary resuscitation was 36 +/- 32 minutes (range 4 to 120). Autopsy studies were performed in 16 of 20 decreased patients. Bleeding complications occurred in 8 of 43 patients. No case of bleeding was directly related to cardiocompression despite the often traumatic procedure with rib fractures verified in 17 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiofrequency catheter ablation in recurrent ventricular tachycardia

Catheter ablation by radiofrequency energy was carried out in 10 patients with one type of recurrent monomorphic sustained ventricular tachycardia resistant to medical antiarrhythmic management. Electrophysiological studies before ablation included activation and pace-mapping. In all patients, the origin of the tachycardia was localized in the left ventricle: in the septum in six, at the posterolateral wall in three and anterobasal in one. The earliest onset of endocardial activation preceding the QRS complex during ventricular tachycardia ranged between -45 and -90 ms. Transcatheter ablation was performed with a bipolar or quadripolar catheter using a radiofrequency generator (HAT 100, Osypka). No complications occurred during the ablation procedure. Thereafter, in all patients, the clinical tachycardia was no longer inducible by programmed stimulation. During a follow-up period of 22 to 32 months including eight patients, the tachycardia recurred in two; one of these patients subsequently died suddenly. A third patient had one episode of a new type of sustained ventricular tachycardia some hours after catheter ablation. In the remaining patients, there was no recurrence of symptomatic tachycardia under maintenance of the antiarrhythmic management which, prior to ablation had been ineffective. Thus, our preliminary results suggest that radiofrequency catheter ablation might be beneficial for these high risk patients.

[Effect of thrombolytic therapy in acute myocardial infarct on incidence of ventricular late potentials]

The aim of thrombolytic therapy for acute myocardial infarction is reperfusion of the infarction-related vessel. Ventricular late potentials detected by signal averaging have been demonstrated to be related to slow and inhomogeneous conduction within damaged cardiac tissue. In 75 patients with first myocardial infarction the effect of thrombolysis on ventricular late potentials was studied. Reperfusion of the infarction-related vessel could be demonstrated by coronary angiography in 53 (71%) patients. In 22 patients (29%) there was no reperfusion. In the 53 patients with successful thrombolysis the incidence of late potentials was significantly lower (9%) than in the 22 patients without reperfusion (50%). The lower incidence of late potentials may demonstrate improved ventricular electrical stability.

Prevalence of late ventricular potentials in hypertensive patients

Late ventricular potentials detected by signal averaging are used for predicting ventricular arrhythmias and sudden cardiac death in patients with coronary artery disease. We studied the prevalence of signal-averaged late ventricular potentials in 37 male patients (mean age of 56 years) with angiographically normal coronary arteries. Seventeen patients were hypertensive (group A) and 20 patients were normotensive (group B). In group A, 5 of 17 patients (29%) had late ventricular potentials. In group B, only 1 of 20 patients (5%) had late potentials (p less than 0.05). Late ventricular potentials detected by signal averaging are more common in hypertensive patients than in healthy controls. Whether late ventricular potentials can be used to predict malignant ventricular arrhythmias or sudden cardiac death in hypertensive patients will have to be investigated in further studies.

[Perforation of an automatic implantable cardioverter-defibrillator into the peritoneal cavity]

The automatic, implantable cardioverter-defibrillator is a new therapy for life-threatening ventricular tachyarrhythmias that are resistant to other therapy. Only a few complications, such as infections, lead defects, and interactions with pacemakers have been reported. We report on a patient whose AICD-generator perforated into the peritoneal cavity.

Hemodynamic effects of nebivolol at rest and on exertion in patients with heart failure

Nebivolol is a novel B-1-adrenoceptor-blocking drug with an unusual hemodynamic profile unlike classical B-blockers. In dogs and in healthy volunteers it decreases blood pressure and heart rate but improves left ventricular function. The authors studied 10 male patients with coronary artery disease and heart failure (ejection fraction mean = 46%). A Swan-Ganz catheter was placed into the pulmonary artery, and the mean blood pressure, the heart rate, the pulmonary artery pressure, the pulmonary wedge pressure, the right atrial pressure, the cardiac output, and the stroke volume were measured at rest and on exertion before and after seven days' treatment with oral nebivolol (5 mg/day). While the blood pressure and the heart rate decreased significantly, the pulmonary artery and wedge pressures, as well as the right atrial pressure and the cardiac output, did not change during treatment. The stroke volume increased significantly. The maintained cardiac output cannot be explained by any changes in preload or afterload; instead a positive inotropic mechanism must be assumed. Unlike other B-blockers it seems to be possible to treat patients with heart failure with nebivolol without causing the hemodynamic situation to deteriorate.

[Coronary angioplasty with the implantation of a vascular support (stent)]

Coronary angiography in a 55-year-old man with coronary heart disease and typical physical activity-induced angina revealed a subtotal stenosis in the middle third of the right coronary artery while left ventricular function was normal. Percutaneous transluminal coronary angioplasty (PTCA) was performed in January 1989, achieving a residual stenosis of less than 50%. However, restenosis of more than 90% developed within six months, necessitating another PTCA, followed immediately by implantation of a metal (Palmaz-Schatz) stent in the stenotic area. No stenosis was demonstrable afterwards. Maintenance medication with anticoagulants (phenprocoumon) and platelet-function inhibitors (aspirin and dipyridamole) was instituted and repeat angiography three months later demonstrated good dilatation results without any restenosis.

[Ventricular arrhythmia and late potentials in patients with hypertrophic cardiomyopathy]

Holter monitoring (48 h) and registration of signal-averaged late potentials (method of Simson, high pass filter 40 Hz) were performed in outpatiens with hypertrophic cardiomyopathy. A prevalence of spontaneous ventricular arrhythmias could be determined in 51 patients; the results of 45 patients not taking antiarrhythmic drugs are presented here. 96% of these showed ventricular premature beats, 76% had multiform extrasystoles, 27% showed pairs of ectopic beats and 20% had runs of ventricular tachycardia (more than 3 QRS complexes). Absolute counts of premature beats were low in most patients, but important interindividual differences could be observed: M = 34 extrasystoles/24 h (0-4943). Ventricular tachycardias were of short duration (maximum 11 QRS) with heart rate ranging from 120 to 200/min. All patients were asymptomatic during tachycardia. Signal-averaged late potentials could be registered in 30 patients, 28 of them without antiarrhythmic drug therapy. Mean QRS duration (QRSdur) was 108 +/- 12 ms, mean duration of low amplitude signals (less than 40 microV) in the terminal portion of the QRS (LAdur) was 27 +/- 13 ms, and mean amplitude of the last 40 ms of the filtered QRS (LAamp) was 65 +/- 43 microV. A patient was considered to show late potentials if two of the following criteria were present: QRSdur greater than 120 ms, LAdur greater than or equal to 40 ms, LAamp less than 20 microV. This was found in four patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of long-term treatment with ketanserin on blood pressure, pulmonary artery pressure, and cardiac output in patients with heart failure

Ketanserin is a selective serotonin2-receptor blocker and by this mechanism decreases peripheral resistance and blood pressure in hypertensives. We examined the hemodynamic effects of ketanserin during long-term treatment in patients with heart failure. Five male patients with coronary artery disease and heart failure (NYHA classes II-III) were treated with ketanserin (80 mg daily) for 12 months. Before treatment, after 4 weeks, and after 12 months treatment, a Swan-Ganz catheter was placed into the pulmonary artery and pulmonary wedge pressure, cardiac output, mean arterial pressure, and heart rate were measured at rest and on exertion. The pulmonary wedge pressure at rest decreased from 8 mmHg before to 6 mmHg after 4 weeks and 12 months treatment; on exertion, it decreased from 31 mmHg before treatment to 24 mmHg after 4 weeks treatment and to 21 mmHg after 12 months treatment. The mean arterial pressure also decreased at rest and on exertion after 4 weeks treatment as well as after 12 months treatment. Cardiac output increased slightly and heart rate was unaltered. No serious side effects occurred. Ketanserin could become an alternative vasodilator drug in the treatment of patients with heart failure.