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Silva L, Pacheco T, Araújo E, Duarte RJ, Ribeiro-Vaz I, Ferreira-da-Silva R. Unveiling the future: precision pharmacovigilance in the era of personalized medicine. Int J Clin Pharm 2024:10.1007/s11096-024-01709-x. [PMID: 38416349 DOI: 10.1007/s11096-024-01709-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
In the era of personalized medicine, pharmacovigilance faces new challenges and opportunities, demanding a shift from traditional approaches. This article delves into the evolving landscape of drug safety monitoring in the context of personalized treatments. We aim to provide a succinct reflection on the intersection of tailored therapeutic strategies and vigilant pharmacovigilance practices. We discuss the integration of pharmacogenetics in enhancing drug safety, illustrating how genetic profiling aids in predicting drug responses and adverse reactions. Emphasizing the importance of phase IV-post-marketing surveillance, we explore the limitations of pre-marketing trials and the necessity for a comprehensive approach to drug safety. The article discusses the pivotal role of pharmacogenetics in pre-exposure risk management and the redefinition of pharmacoepidemiological methods for post-exposure surveillance. We highlight the significance of integrating patient-specific genetic profiles in creating personalized medication leaflets and the use of advanced computational methods in data analysis. Additionally, we examine the ethical, privacy, and data security challenges inherent in precision medicine, emphasizing their implications for patient consent and data management.
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Affiliation(s)
- Lurdes Silva
- Faculty of Pharmacy of the University of Porto, Porto, Portugal
| | - Teresa Pacheco
- Faculty of Pharmacy of the University of Porto, Porto, Portugal
| | - Emília Araújo
- Palliative Care Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Center for Health Technology and Services Research, Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Porto, Portugal
| | | | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research, Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Porto, Portugal
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Renato Ferreira-da-Silva
- Center for Health Technology and Services Research, Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Porto, Portugal.
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine of the University of Porto, Porto, Portugal.
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Rebelo SD, Ferreira T, Pacheco T, Silva SL, Tornada A. Good Syndrome in a Young Woman: An Unusual Presentation. Cureus 2024; 16:e52705. [PMID: 38384652 PMCID: PMC10879946 DOI: 10.7759/cureus.52705] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Good Syndrome is a rare disease that comprises the presence of a thymoma, immunodeficiency, and recurrent opportunistic infections. We report the case of a young woman who was diagnosed with Good Syndrome, who had a long-term history of recurrent infections, often due to atypical agents, and who also had a previous history of immunodeficiency and a B1 thymoma invading the large vessels, lung, and pericardium (Masaoka stage IV). She underwent surgical resection of the mediastinal mass, requiring vena cava superior reconstruction due to the extent of invasion, followed by adjuvant radiotherapy and immunoglobulin G supplementation. Despite relative stability in the subsequent years, without serious infections, after three years she had a thymoma recurrence requiring a new therapeutic approach. This case highlights the importance of a thorough investigation of the underlying causes of recurrent infections, which may be the result of an immunodeficiency secondary to malignancy. In young patients, early diagnosis is crucial to avoid disease progression and to reduce mortality rates. To achieve such outcomes, a multidisciplinary team and a comprehensive therapeutic strategy are necessary.
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Affiliation(s)
- Sandra D Rebelo
- Serviço de Medicina Interna, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Tiago Ferreira
- Serviço de Medicina Interna, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Teresa Pacheco
- Serviço de Oncologia Médica, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
- Serviço de Oncologia Médica, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
- Serviço de Oncologia Médica, Instituto de Medicina Molecular João Lobo Antunes, Lisbon, PRT
| | - Susana L Silva
- Serviço de Imunoalergologia, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
- Serviço de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
- Serviço de Imunoalergologia, Instituto de Medicina Molecular João Lobo Antunes, Lisbon, PRT
| | - Ana Tornada
- Serviço de Medicina Interna, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
- Serviço de Medicina Interna, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PRT
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Lambert K, Almeida A, Mukherjee N, Goldstein N, Birlea S, Webb S, Koch P, Koster M, Norris D, Pacheco T, Shellman Y. 840 Aberrant differentiation as a novel mechanism for lentigines and hair graying. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.916] [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: 10/27/2022]
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Martínez-Alés G, Angora R, Barrigón ML, Román-Mazuecos E, Jiménez-Sola E, Villoria L, Sánchez-Castro P, López-Castromán J, Casado I, Pacheco T, Rodríguez-Vega B, Navío M, Bravo-Ortiz MF, Baca-García E. A Real-World Effectiveness Study Comparing a Priority Appointment, an Enhanced Contact Intervention, and a Psychotherapeutic Program Following Attempted Suicide. J Clin Psychiatry 2019; 80. [PMID: 30817098 DOI: 10.4088/jcp.18m12416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness of 3 real-practice preventive programs aimed at lowering the relapse risk following a suicide attempt: a single priority appointment with an outpatient psychiatrist, an enhanced contact intervention, and an individual psychotherapy program. METHODS This observational study was conducted in a sample of 1,492 suicide attempters from 3 catchment areas in Madrid, Spain, between 2013 and 2017. Relapse was defined as an emergency department return after a new attempt within a 1-year follow-up. Kaplan-Meier survival functions were obtained by intervention, and Cox proportional hazard regression models were used to estimate unadjusted and adjusted risks of relapse by intervention. Sex- and age-stratified analyses were also conducted. Covariates were age, sex, history of suicide attempts, history of psychiatric disorders, main ICD-10 psychiatric diagnostic groups, medical comorbidities, and family support. RESULTS A total of 133 subjects (8.9%) relapsed. The psychotherapy group had a lower presence of known risk factors for suicide attempt. Individual psychotherapy and enhanced contact were more effective than a single priority appointment at reducing suicide reattempt, with a 40% lower relapse risk in adjusted models. Results did not differ after sex and age stratification. CONCLUSIONS In a naturalistic clinical setting, patients exposed to individual psychotherapy or an enhanced contact intervention had a similar, lower relapse risk than the single priority appointment group.
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Affiliation(s)
- Gonzalo Martínez-Alés
- La Paz University Hospital, Psychiatry, Paseo de la Castellana 261, 28036 Madrid, Spain. .,La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | | | | | | | | | - Lucía Villoria
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Isabel Casado
- SAMUR-Civil Citizen Protection Emergency Service, Madrid, Spain
| | - Teresa Pacheco
- SAMUR-Civil Citizen Protection Emergency Service, Madrid, Spain
| | - Beatriz Rodríguez-Vega
- La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | | | - María Fe Bravo-Ortiz
- La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
| | - Enrique Baca-García
- Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain.,Fundación Jiménez Díaz University Hospital, Madrid, Spain.,Universidad Católica del Maule, Talca, Chile
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Mansinho A, Ferreira A, Casimiro S, Alho I, Vendrell I, Costa A, Sousa R, Abreu C, Pulido C, Macedo D, Pacheco T, Correia L, Costa L. Levels of circulating fibroblast growth factor (FGF) 23 and prognosis of cancer patients with bone metastasis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.173] [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: 11/13/2022] Open
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Machado D, Antunes J, Simões A, Perdigão J, Couto I, McCusker M, Martins M, Portugal I, Pacheco T, Batista J, Toscano C, Viveiros M. Contribution of efflux to colistin heteroresistance in a multidrug resistant Acinetobacter baumannii clinical isolate. J Med Microbiol 2018; 67:740-749. [DOI: 10.1099/jmm.0.000741] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Diana Machado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Jéssica Antunes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Ana Simões
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
- Present address: Instituto Nacional de Investigação Agrária e Veterinária, I.P, Lisboa, Portugal
| | - João Perdigão
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Couto
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Matthew McCusker
- School of Food Science and Environmental Health, College of Sciences and Health, Dublin Institute of Technology, Dublin, Ireland
| | - Marta Martins
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Isabel Portugal
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pacheco
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Judite Batista
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Cristina Toscano
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
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Ferreira A, Alho I, Vendrell I, Melo M, Brás R, Costa AL, Sousa AR, Mansinho A, Abreu C, Pulido C, Macedo D, Pacheco T, Correia L, Costa L, Casimiro S. The prognostic role of RANK SNP rs34945627 in breast cancer patients with bone metastases. Oncotarget 2018; 7:41380-41389. [PMID: 27191503 PMCID: PMC5173066 DOI: 10.18632/oncotarget.9356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/02/2016] [Accepted: 03/31/2016] [Indexed: 01/10/2023] Open
Abstract
Receptor activator of NF-kB (RANK) pathway regulates bone remodeling and is involved in breast cancer (BC) progression. Genetic polymorphisms affecting RANK-ligand (RANKL) and osteoprotegerin (OPG) have been previously associated with BC risk and bone metastasis (BM)-free survival, respectively. In this study we conducted a retrospective analysis of the association of five missense RANK SNPs with clinical characteristics and outcomes in BC patients with BM. SNP rs34945627 had an allelic frequency of 12.5% in BC patients, compared to 1.2% in the control group (P = 0.005). SNP rs34945627 was not associated with any clinicopathological characteristics, but patients presenting SNP rs34945627 had decreased disease-free survival (DFS) (log-rank P = 0.039, adjusted HR 2.29, 95% CI 1.04–5.08, P = 0.041), and overall survival (OS) (log-rank P = 0.019, adjusted HR 4.32, 95% CI 1.55–12.04, P = 0.005). No differences were observed regarding bone disease-free survival (log-rank P = 0.190, adjusted HR 1.68, 95% CI 0.78–3.66, P = 0.187), time to first skeletal-related event (log-rank P = 0.753, adjusted HR 1.28, 95% CI 1.42–3.84; P = 0.665), or time to bone progression (log-rank P = 0.618, adjusted HR 0.511, 95% CI 0.17–1.51; P = 0.233). Our analysis shows that RANK SNP rs34945627 has a high allelic frequency in patients with BC and BM, and is associated with decreased DFS and OS.
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Affiliation(s)
- Arlindo Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Irina Alho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Vendrell
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Marta Melo
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Raquel Brás
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Lúcia Costa
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ana Rita Sousa
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - André Mansinho
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Catarina Abreu
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Catarina Pulido
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Daniela Macedo
- Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Teresa Pacheco
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Lurdes Correia
- Pathology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luis Costa
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Sandra Casimiro
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Querfeld C, Foss F, Porcu P, Kim Y, Pacheco T, Haverkos B, Halwani A, DeSimone J, William B, Pinter-Brown L, Seto A, Ruckman J, Landry M, Jackson A, Dickinson B, Sanseverino M, Rodman D, Rubin P, Marshall W. PH 1 TRIAL EVALUATING MRG-106, A MICRORNA-155 INHIBITOR, ADMINISTERED BY INTRATUMORAL, SUBCUTANEOUS, OR INTRAVENOUS DELIVERY IN CUTANEOUS T-CELL LYMPHOMA (CTCL) PATIENTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - F.M. Foss
- Hematology and Bone Marrow Transplantation; Yale Cancer Center; Woodbridge USA
| | - P. Porcu
- Hematologic Malignancies and Hematopoietic Stem Cell Transplantation; Sidney Kimmel Cancer Center at Jefferson; Philadelphia USA
| | - Y.H. Kim
- Dermatology; Stanford Cancer Institute; Stanford USA
| | - T. Pacheco
- Dermatology; University of Colorado School of Medicine; Aurora USA
| | - B. Haverkos
- Blood Cancer & BMT; University of Colorado School of Medicine; Aurora USA
| | - A.S. Halwani
- Hematology and Hematologic Malignancies; Huntsman Cancer Institute at the University of Utah; Salt Lake City USA
| | - J. DeSimone
- Melanoma and Skin Cancer Center; Inova Schar Cancer Institute; Fairfax USA
| | - B. William
- Hematology; The Ohio State University Comprehensive Cancer Center; Columbus USA
| | - L. Pinter-Brown
- Hematology/Oncology; University of California; Irvine Orange USA
| | - A. Seto
- R&D, miRagen Therapeutics; Boulder USA
| | | | - M. Landry
- R&D, miRagen Therapeutics; Boulder USA
| | | | | | | | - D. Rodman
- R&D, miRagen Therapeutics; Boulder USA
| | - P. Rubin
- R&D, miRagen Therapeutics; Boulder USA
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Lambert K, Backos D, Norris D, Spritz R, Artinger K, Pacheco T, Shellman Y. 407 Mutation in SASH1 causes human skin hyperpigmentation. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.441] [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: 10/21/2022]
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Tato-Costa J, Casimiro S, Pacheco T, Pires R, Fernandes A, Alho I, Pereira P, Costa P, Castelo HB, Ferreira J, Costa L. Therapy-Induced Cellular Senescence Induces Epithelial-to-Mesenchymal Transition and Increases Invasiveness in Rectal Cancer. Clin Colorectal Cancer 2015; 15:170-178.e3. [PMID: 26603055 DOI: 10.1016/j.clcc.2015.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/17/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION DNA damaging agents and ionizing radiation used in the therapy of human cancers can induce senescence of cancer cells. Senescent cells exhibit a secretory phenotype (senescence-associated secretome [SAS]) that can affect cancer cell behavior and, eventually, clinical prognosis. We assessed the effects of the SAS on the induction of epithelial-to-mesenchymal transition (EMT) in vitro and in clinical samples from patients with rectal cancer who had undergone neoadjuvant chemoradiotherapy (CRT). MATERIALS AND METHODS Colorectal cancer cells (HCT 116) were induced into senescence by exposure to either 5-fluorouracil (5-FU) or doxorubicin. The senescent state was confirmed by staining for senescence-associated β-galactosidase (SA-β-Gal). The paracrine effects of SASs were assessed on proliferating HCT 116 cells. The quantified parameters were cell proliferation, invasive capacity, and induction of EMT. Senescence and EMT in clinical samples were assessed by the expression levels (reverse transcriptase-quantitative polymerase chain reaction) of genes related to senescence and EMT after laser-assisted microdissection of cancer cell clusters that stained either positive or negative for SA-β-Gal. RESULTS We have shown that cultured colon cancer cells induced into senescence by exposure to 5-FU exhibit a SAS capable of paracrine induction of EMT in colon and rectal cancer cell lines and increased cell invasion in vitro. Using laser-assisted microdissection, we found that in rectal cancer samples from patients treated with neoadjuvant CRT, tumor cell niches enriched for senescent cells bookmark regions of increased mRNA expression levels of EMT-related proteins (Slug, Snail, vimentin) compared with the nearby senescent-null tumor cell niches. CONCLUSION We have provided, first-hand, strongly suggestive evidence that senescent cancer cells emerging in the context of neoadjuvant CRT for rectal cancer influenced the tumor microenvironment by promoting EMT by way of short-range interactions.
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Affiliation(s)
- Joana Tato-Costa
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Sandra Casimiro
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Teresa Pacheco
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Ricardo Pires
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal; Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Afonso Fernandes
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Irina Alho
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Pedro Pereira
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Paulo Costa
- Surgery Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Henrique Bicha Castelo
- Surgery Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - João Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Luís Costa
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal; Oncology Division, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
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Silveira CJC, Amaral J, Gorayeb RP, Cabral J, Pacheco T. Fungal meningoencephalitis caused by Alternaria: a clinical case. Clin Drug Investig 2013; 33 Suppl 1:S27-31. [DOI: 10.1007/s40261-012-0016-2] [Citation(s) in RCA: 3] [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: 11/30/2022]
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Ferreira AC, Chambel L, Tenreiro T, Cardoso R, Flor L, Dias IT, Pacheco T, Garin-Bastuji B, Le Flèche P, Vergnaud G, Tenreiro R, de Sá MIC. MLVA16 typing of Portuguese human and animal Brucella melitensis and Brucella abortus isolates. PLoS One 2012; 7:e42514. [PMID: 22905141 PMCID: PMC3419166 DOI: 10.1371/journal.pone.0042514] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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: 06/20/2012] [Accepted: 07/06/2012] [Indexed: 12/30/2022] Open
Abstract
To investigate the epidemiological relationship of isolates from different Portuguese geographical regions and to assess the diversity among isolates, the MLVA16Orsay assay (panels 1, 2A and 2B) was performed with a collection of 126 Brucella melitensis (46 human and 80 animal isolates) and 157 B. abortus field isolates, seven vaccine strains and the representative reference strains of each species. The MLVA16Orsay showed a similar high discriminatory power (HGDI 0.972 and 0.902) for both species but panel 1 and 2A markers displayed higher diversity (HGDI 0.693) in B. abortus compared to B. melitensis isolates (HGDI 0.342). The B. melitensis population belong to the “Americas” (17%) and “East Mediterranean” (83%) groups. No isolate belonged to the “West Mediterranean” group. Eighty-five percent of the human isolates (39 in 46) fit in the “East-Mediterranean” group where a single lineage known as MLVA11 genotype 116 is responsible for the vast majority of Brucella infections in humans. B. abortus isolates formed a consistent group with bv1 and bv3 isolates in different clusters. Four MLVA11 genotypes were observed for the first time in isolates from S. Jorge and Terceira islands from Azores. From the collection of isolates analysed in this study we conclude that MLVA16Orsay provided a clear view of Brucella spp. population, confirming epidemiological linkage in outbreak investigations. In particular, it suggests recent and ongoing colonisation of Portugal with one B. melitensis lineage usually associated with East Mediterranean countries.
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Affiliation(s)
- Ana Cristina Ferreira
- Laboratório Nacional de Investigação Veterinária, Instituto Nacional de Recursos Biológicos, IP, Lisboa, Portugal.
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Martins M, Viveiros M, Couto I, Costa SS, Pacheco T, Fanning S, Pagès JM, Amaral L. Identification of efflux pump-mediated multidrug-resistant bacteria by the ethidium bromide-agar cartwheel method. In Vivo 2011; 25:171-178. [PMID: 21471531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIM Bacterial multidrug resistance may be mediated by the overexpression of efflux pumps. Conventional evaluation of efflux activity using efflux pump substrates, such as ethidium bromide, requires specialised instrumentation. The agar-based method, previously reported, has been modified to evaluate as many as twelve bacterial strains and has been termed the ethidium bromide-agar cartwheel method. MATERIALS AND METHODS Agar plates containing different concentrations of ethidium bromide were swabbed with bacterial cultures. The cell efflux capacity increased with increasing ethidium bromide concentration, which produced fluorescence of the bacterial mass. RESULTS The method was shown to be useful for the detection of efflux activity among multidrug-resistant Gram-negative and Gram-positive clinical isolates, as confirmed by the determination of minimum inhibitory concentration for several antibiotics in the presence of known efflux pump inhibitors. CONCLUSION This method may be adapted to the clinical laboratory for the presumptive identification of multidrug-resistant isolates that overexpress efflux pump systems.
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Affiliation(s)
- Marta Martins
- Unit of Mycobacteriology and UPMM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT/UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
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Kristiansen MM, Leandro C, Ordway D, Martins M, Viveiros M, Pacheco T, Molnar J, Kristiansen JE, Amaral L. Thioridazine reduces resistance of methicillin-resistant staphylococcus aureus by inhibiting a reserpine-sensitive efflux pump. In Vivo 2006; 20:361-6. [PMID: 16724671] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Previous studies suggested that the phenothiazine chlorpromazine (CPZ) could reverse or reduce the antibiotic resistance of bacteria. In some areas of the world, the majority of Staphylococcus aureus isolates are now resistant to methicillin, prompting this study to see whether such resistance can be altered by phenothiazine thioridazine (TZ), an agent with equal antibacterial activity, which is free of the severe side-effects associated with chronic administration of CPZ. The results indicated that, whereas methicillin-sensitive strains of Staphylococcus aureus (MSSA) were not rendered more susceptible to oxacillin, resistance to oxacillin by highly-resistant strains (MRSA) could be significantly reduced by sub-inhibitory concentrations of TZ. Reserpine, an inhibitor of efflux pumps, was also shown to reduce the resistance of MRSA strains to oxacillin in a concentration-dependent manner. The phenothiazines have been shown, by others, to inhibit the efflux pumps of bacteria and the mechanism by which MRSA are rendered more susceptible to oxacillin in the presence of TZ is believed to be due to a similar efflux pump.
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Affiliation(s)
- Malthe M Kristiansen
- Unit of Mycobacteriology, UPMM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 96, 1349-008 Lisboa, Portugal
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15
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Viveiros M, Leandro C, Rodrigues L, Almeida J, Bettencourt R, Couto I, Carrilho L, Diogo J, Fonseca A, Lito L, Lopes J, Pacheco T, Pessanha M, Quirim J, Sancho L, Salfinger M, Amaral L. Direct application of the INNO-LiPA Rif.TB line-probe assay for rapid identification of Mycobacterium tuberculosis complex strains and detection of rifampin resistance in 360 smear-positive respiratory specimens from an area of high incidence of multidrug-resistant tuberculosis. J Clin Microbiol 2005; 43:4880-4. [PMID: 16145166 PMCID: PMC1234138 DOI: 10.1128/jcm.43.9.4880-4884.2005] [Citation(s) in RCA: 48] [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: 11/20/2022] Open
Abstract
The INNO-LiPA Rif.TB assay for the identification of Mycobacterium tuberculosis complex strains and the detection of rifampin (RIF) resistance has been evaluated with 360 smear-positive respiratory specimens from an area of high incidence of multidrug-resistant tuberculosis (MDR-TB). The sensitivity when compared to conventional identification/culture methods was 82.2%, and the specificity was 66.7%; the sensitivity and specificity were 100.0% and 96.9%, respectively, for the detection of RIF resistance. This assay has the potential to provide rapid information that is essential for the effective management of MDR-TB.
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Affiliation(s)
- Miguel Viveiros
- Unidade de Micobacterias do Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
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16
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Weber M, Johnson K, Osgood M, Trotter J, Hartmann N, Starzl T, Pacheco T. 419 HISTORICAL CLINICAL EXPERIENCE OF SKIN CANCER DEVELOPMENT IN LONG TERM ORGAN TRANSPLANT RECIPIENTS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.418] [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: 11/18/2022]
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17
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Martins M, Bleiss W, Marko A, Ordway D, Viveiros M, Leandro C, Pacheco T, Molnar J, Kristiansen JE, Amaral L. Clinical concentrations of thioridazine enhance the killing of intracellular methicillin-resistant Staphylococcus aureus: an in vivo, ex vivo and electron microscopy study. In Vivo 2004; 18:787-94. [PMID: 15646821] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Chlorpromazine (CPZ) is concentrated by human macrophages where it kills intracellular mycobacteria when the concentration outside the macrophage is sub-clinical. We have previously demonstrated that thioridazine (TZ), a much milder phenothiazine, has similar activity and kills intracellular methicillin-susceptible S. aureus at sub-clinical concentrations. We have extended this latter study to include methicillin-resistant S. aureus (MRSA) and show that TZ kills intracellular MRSA at clinically relevant concentrations. The ultrastructure of MRSA exposed to in vitro concentrations of TZ just below its MIC and that of MRSA phagocytosed by macrophages previously exposed to a clinically relevant concentration of TZ was also studied. TZ inhibits the replication of phagocytosed MRSA, affecting the structure of the cell envelope, resulting in lysis of the bacterium 6 hours post-phagocytosis. These ultrastructural changes are identical to those produced in vitro by a TZ concentration that is just below the MIC. Because macrophage intracellular MRSA is not killed by the macrophage and its intracellular location protects it from antibiotics that are unable to reach that site, recurrent infections which result may be successfully managed with the use of TZ.
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Affiliation(s)
- Marta Martins
- Unit of Mycobacteriology, UPMM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-019 Lisboa, Portugal
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18
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Kristiansen MM, Leandro C, Ordway D, Martins M, Viveiros M, Pacheco T, Kristiansen JE, Amaral L. Phenothiazines alter resistance of methicillin-resistant strains of Staphylococcus aureus (MRSA) to oxacillin in vitro. Int J Antimicrob Agents 2004; 22:250-3. [PMID: 13678829 DOI: 10.1016/s0924-8579(03)00200-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [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: 11/22/2022]
Abstract
Mechanisms of antibiotic resistance of bacteria include efflux pumps which extrude the antibiotic prior to reaching its target. Phenothiazines inhibit the activity of some efflux pumps thereby altering the susceptibility of bacteria. This study demonstrated that chlorpromazine and thioridazine reduce the susceptibility of methicillin-resistant strains (MRSA) but not that of methicillin-susceptible Staphylococcus aureus (MSSA) strains to oxacillin (MIC of oxacillin reduced from >500 to 10 mg/l). Reserpine, an inhibitor of antibiotic efflux pumps also reduced the resistance of MRSA strains to oxacillin suggesting the presence of an efflux pump that contributes to antibiotic resistance of MRSA strains.
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Affiliation(s)
- Malthe M Kristiansen
- Unit of Mycobacteriology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 96, 1349-008 Lisbon, Portugal
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19
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Messias A, Araújo C, Lino S, Pacheco T, Masinho K, Ordway D, Ventura FA. [Cavitated pulmonary condensation by Rhodococcus equi, in an HIV seropositive individual]. ACTA MEDICA PORT 2000; 13:329-35. [PMID: 11234501] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The first clinical case described in Portugal of a human infection by Rhodococcus equi in a 35 year-old HIV1 seropositive i.v. drug user is presented. The patient was admitted to hospital due to clinical and radiological suspicion of tuberculosis. While in hospital, a Rhodococcus equi cavitated lung infection was diagnosed. By applying a triple antibiotic therapy with erythromycin, rifampin and teicoplanin along with surgical excision of the lower lobe of the right lung, we were able to clinically resolve the pulmonary infection. A brief review of Rhodococcus equi infections, especially those associated to HIV1 infected individuals is also presented with particular emphasis on the therapeutic approach.
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Affiliation(s)
- A Messias
- Serviço de Doenças Infecciosas, Parasitárias e de Medicina Tropical, Hospital Egas Moniz, Lisboa
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20
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Rodrigues G, Corredoura A, Moraes M, Oliveira L, Niza Pinheiro M, Da Graça JP, Viveiros M, Brum L, Pacheco T, Aguiar P, Abecasis P. Estudo da resposta aos antibacilares em doentes com infecção VIH. Revista Portuguesa de Pneumologia 2000. [DOI: 10.1016/s0873-2159(15)30879-5] [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: 11/16/2022] Open
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21
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Viveiros M, Pinheiro S, Moreira P, Pacheco T, Brum L. Evaluation of a commercial ligase chain reaction assay for the diagnosis of pulmonary and extra-pulmonary tuberculosis. Int J Tuberc Lung Dis 1999; 3:508-14. [PMID: 10383064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
SETTING Egas Moniz Hospital, Lisbon, Portugal. OBJECTIVE To evaluate the Ligase Chain Reaction (LCx) Mycobacterium tuberculosis Assay for the direct detection of M. tuberculosis complex in respiratory specimens after smear observation, and its suitability for non-respiratory clinical specimens. DESIGN Analysis of 156 specimens collected from 123 patients with pulmonary tuberculosis and/or extrapulmonary involvement. RESULTS Among 93 pulmonary secretions and 63 extra-pulmonary samples and after resolution of discrepancies based on clinical and laboratory findings, two pulmonary samples from a patient with a diagnosis of sarcoidosis, four samples of cerebrospinal and one of seminal fluid were considered as false positives. Two tissue biopsy samples, one pericardial effusion and one pulmonary secretion from patients strongly suspected of having tuberculosis were considered as false negatives for the assay, without inhibition of amplification. All specimens yielding M. avium on culture were LCx negative. CONCLUSION The LCx Mycobacterium tuberculosis Assay was found to be useful for the rapid identification of M. tuberculosis complex in all types of specimens. It revealed a high specificity both in pulmonary and extrapulmonary products, and a sensitivity of 97% for the pulmonary secretions and of 75% for the extra-pulmonary specimens, independently of the bacilloscopy results.
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Affiliation(s)
- M Viveiros
- Departamento de Microbiologia e Centro de Malaria e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal.
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22
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Pacheco T, Oliveira L, Viana M, Rodrigues F, Gil A, da Rocha JP, de Abreu MC. Diagnóstico da estrongiloidíase num exame de rotina da expectoração com coloração pela técnica de Ziehi-Neelsen. Revista Portuguesa de Pneumologia 1999. [DOI: 10.1016/s0873-2159(15)30952-1] [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: 11/29/2022] Open
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23
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Metter EJ, Conwit R, Metter B, Pacheco T, Tobin J. The relationship of peripheral motor nerve conduction velocity to age-associated loss of grip strength. Aging (Milano) 1998; 10:471-8. [PMID: 10078317 DOI: 10.1007/bf03340161] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Age-associated loss of muscle strength is attributed to decreasing muscle mass. Both strength and mass are dependent on peripheral innervation. However, the association between nerve function and age-associated strength loss has not been studied directly. The median nerve contribution to grip strength was estimated using nerve conduction velocity (NCV). Grip strength and NCV were measured in 197 male participants of the Baltimore Longitudinal Study of Aging (age 59.0 +/- 13.9 years). Multiple regression and path analyses were used separately to examine the association between median NCV and grip strength. Grip strength showed a negative quadratic relationship with increasing age (r2 = 0.32, p < 0.001) with a major change in slope occurring after 64.7 years of age. Median NCV (r2 = 0.14, p < 0.001) declined linearly with age. Median NCV significantly contributed to grip strength (p < 0.001) while controlling for forearm muscle mass (forearm circumference), self-reported 24-hour caloric expenditures, and age. The median nerve has an independent contribution to age-associated levels of muscle strength. The level of the effect was smaller than what could be attributed to forearm muscle mass or age.
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Affiliation(s)
- E J Metter
- National Institute on Aging, Gerontology Research Center, Baltimore, MD 21224, USA
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24
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Velasco F, Velasco M, Pacheco T, Márquez I. Comparative effects of topical perfusions of pentylenetetrazol in the mesencephalon and cerebral cortex of cats. Exp Neurol 1985; 87:533-43. [PMID: 3972053 DOI: 10.1016/0014-4886(85)90182-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Push-pull perfusions of pentylenetetrazol (PTZ) were carried out in the mesencephalon and cerebral cortex (orbitofrontal, motor, and suprasylvian) of "encéphale isolé" cats, while EEG recordings from motor cortices and EMG of facial muscles were obtained. There were significant differences between perfusions in the mesencephalic reticular formation (MRF) and in the cerebral cortex: (i) EEG spikes not accompanied by muscular contractions occurred during perfusion of cerebral cortex (motor cortex included), but never with perfusions in MRF. (ii) In some instances muscular tonic and clonic contractions occurred in the absence of EEG spikes when perfusing the mesencephalon, but never with cortical perfusions. (iii) Both MRF and cortical perfusions induced EEG spikes accompanied by myoclonic seizures; however, muscular seizures were practically of the same amplitude in both sides after perfusion of the MRF and were predominant in the contralateral side after cortical perfusions. In addition, significantly less perfusion time (total dose) of PTZ was needed to induce such events in the MRF than in the cerebral cortex. (iv) Generalized seizures induced by cortical perfusions showed a clear predominance of contractions in the muscles contralateral to the perfusion site, whereas perfusions in the MRF induced generalized seizures indistinguishable from those produced by i.v. administration of PTZ. Results suggest that PTZ generalized seizures, closely resembling the so called "primary generalized seizures," result from activation of the MRF, whereas PTZ acting in the cerebral cortex produces a model of focal convulsions that may become secondarily generalized.
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