In vivo confocal microscopic study of corneal innervation in Sjögren's Syndrome with or without small fiber neuropathy

PURPOSE

To study changes in the subbasal nerve plexus by In vivo confocal microscopy (IVCM) in Sjögren's Syndrome (SS) with or without associated Small Fiber Neuropathy (SFN), in order to prevent diagnostic delay.

METHODS

Seventy-one patients with SS, including 19 with associated SFN, 20 healthy volunteers and 20 patients with Meibomian gland dysfunction (MGD) were included in this retrospective case-control study. IVCM was used to investigate subbasal nerve plexus density and morphology.

RESULTS

Corneal sensitivity as evaluated with the Cochet-Bonnet aesthesiometer was significantly reduced in the SS group versus the control group (P = 0.026) and the MGD group (P = 0.037). The number of inflammatory cells was significantly increased in the SS group to 86.2 ± 82.1 cells/mm² compared to the control group (P < 0.001). The density of the subbasal nerve plexus was significantly reduced to 16.7 ± 6.5 mm/mm² in the SS group compared to the control group (P < 0.005) and the MGD group (P = 0.042). The tortuosity of the nerves in the SS group was significantly increased compared to the control group (P < 0.001) and the MGD group (P = 0.025). The average number of subbasal nerve plexus neuromas was significantly increased in the SS group compared to the control group (P = 0.001), with a significant increase in the average number of neuromas in SS patients with associated SFN compared to SS patients without SFN (P = 0.008).

CONCLUSION

IVCM can be useful to detect corneal nerve changes in SS patients and may allow earlier diagnosis of the disease and to consider new therapeutic approaches.

[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products]

OBJECTIVES

To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products.

METHODS

Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H₁); all initiations under biosimilars and continuation therapy with the princeps (H₂) or all patients are treated with biosimilars (H₃).

RESULTS

The annual savings are estimated at 237,000 € with the H₁ hypothesis. In the case of H₂, the expected savings would be 376,200 € per year. In the case of H₃, savings for the community could reach almost 1,282,800 € per year.

CONCLUSION

The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H₁ and H₂ hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations.

Peripheral and central H1 histamine receptor occupancy by levocetirizine, a non-sedating antihistamine; a time course study in the guinea pig

BACKGROUND AND PURPOSE

The H(1) receptor occupancy (H1RO) in brain is an indicator of central side effects of antihistamines. Here, we determined the kinetics of central and peripheral H1RO by levocetirizine in relation to its brain and plasma concentration, and investigated the role of the blood-brain barrier in any delay in brain H1RO.

EXPERIMENTAL APPROACH

Concentration-time profiles in plasma and brain were obtained after 0.1 and 1 mg kg(-1) oral doses of levocetirizine in guinea pigs. H1RO in brain was measured ex vivo using [3H]-mepyramine and, in the periphery, by measuring the degree of inhibition of histamine-induced contractions of isolated guinea pig ileum.

KEY RESULTS

The concentration-time profile of levocetirizine indicated lower levels (partition coefficient, K(p)=0.06-0.08), higher t(max) (2-4 h vs 1-1.5 h) and longer terminal half-life (4-5.6 h vs 2.1-2.8 h) in brain than plasma. The H1RO at 0.1 and 1 mg kg(-1) were 75% and 97%, respectively, at 1 hr in the periphery and, in the brain, were <20% and 28-67% respectively, at all time points studied. Brain H1RO vs plasma concentrations profile showed a delay, but not when compared to brain concentrations.

CONCLUSIONS AND IMPLICATIONS

This study demonstrates an effective peripheral antihistamine effect of levocetirizine without central adverse effects at the dose close to human therapeutic dose. The slow increase in H1RO in the brain with time was caused by slow blood-brain barrier transport of levocetirizine. This demonstrates the importance of measuring time course of brain H1RO in relation to brain concentrations of drugs.

Arylsulfonamides as a new class of cannabinoid CB1 receptor ligands: Identification of a lead and initial SAR studies

High-throughput screening of the UCB sample collection identified the piperidinyl-sulfonyl benzoic ester 1 as a novel agonist for CB(1) receptor with nanomolar affinity. We report here the pharmacological profile of compound 1 as well as preliminary biological activities in pain model. Diverse close analogs of 1 were purchased and the structure-affinity relationships among this novel class are discussed.

Contractile properties of various histaprodifen derivatives in guinea pig isolated ileum and trachea

We characterized the histamine H(1) receptor agonism of various histaprodifen derivatives in guinea pig isolated ileum and trachea in comparison with histamine. Based on their affinity (calculated pK(A) values for ileum and trachea, respectively), the compounds were ranked as follows: suprahistaprodifen (8.31/8.08) > N(alpha)-(4-phenylbutyl)histaprodifen (7.22/5.93) >or= histamine (5.79/5.19) approximately methylhistaprodifen (5.57/6.07). Based on their efficacy (calculated tau values for ileum and trachea, respectively), the compounds were ranked as follows: methylhistaprodifen (37.67/2.50) > histamine (5.64/1.80) > suprahistaprodifen (1.63/1.42) >or= N(alpha)-(4-phenylbutyl)histaprodifen (0.083/1.54). In the ileum, histamine and methylhistaprodifen showed a high histamine H(1) receptor reserve while suprahistaprodifen and N(alpha)-(4-phenylbutyl)histaprodifen are devoid of any histamine H(1 )receptor reserve. On the trachea, no histamine H(1 )receptor reserve was demonstrable with the four tested agonists. The kinetic of contraction/relaxation of the ileum was faster with histamine and methylhistaprodifen than with suprahistaprodifen and N(alpha)-(4-phenylbutyl)histaprodifen. Histamine contracted the trachea faster than histaprodifen derivatives. Levocetirizine antagonized contractions induced by histamine and histaprodifen derivatives in both tissues. The differences observed in the calculated pA(2) (7.60-8.29) and/or pD'(2) values (6.28-7.90) depending on the tissue and/or the agonist are discussed.

Effect of levocetirizine on the contraction induced by histamine on isolated rabbit bronchioles from precision-cut lung slices

The present experiments were designed to study the effects of levocetirizine (a potent selective histamine H(1) antagonist) on the contraction induced by histamine on isolated rabbit bronchioles using the precision-cut lung slice technology. Histamine induced a concentration-dependent contraction of isolated rabbit bronchioles (pD(2) value of 5.6). Mepyramine (0.01-1 micromol/l) induced a shift to the right without any decrease in the concentration-response curve to histamine (pA(2) value of 8.2). Levocetirizine (0.03-0.1 micromol/l) induced both a shift to the right and a decrease in the maximal amplitude of the concentration-response curve to histamine (pA(2) and pD'(2) values of 7.9 and 7.0, respectively). The difference between both compounds could be explained in terms of the difference in the dissociation rate from the histamine H(1) receptor coupled to a putative low receptor reserve present in the rabbit bronchioles.

[Allergy to ragweed in the Rhone-Alpes and consumption of anti-allergics]

AIMS

To measure evolution and cost consumption of anti-allergic medicines during ragweed pollen-period, geographic trend in the locations of anti-allergic consumers. Ragweed is highly spread in Rhone Alps.

METHODS

We measured the ratio: number of boxes of anti-allergic medicines per one thousand patients between 6 and 64 years, refunded by twelve local health offices in the Rhone Alps area. We obtained statistical mapping for consumers of triamcinolone, we analysed in the relation to weakly ragweed pollen figures.

RESULTS

Four geographic areas showed high increases of antihistaminic consumption from the middle of august to the end of september during the four years studied. A threefold increase of consumption of antihistaminic medicines, anti-allergic eye-drops and anti-allergic nasals topics was observed during ragweed pollen-period (week 33 to week 40). Antihistaminic consumption ratios increased in relation with ragweed pollen-period This study demonstrated that the anti-allergic medicines consumption reflected the image of ragweed allergy. This sanitary feature is easily obtained from the refunded databases of Medical Insurance.

[Consumption of allergy medicines in 2000 and 2001: data from 12 Primary Medical Insurance Offices (CPAM) in the Rhône-Alpes region]

OBJECTIVES

Comparison of the annual consumption of different classes of antiallergy medicines in the Rhône-Alpes region and as a function of the pollen calendar.

MATERIAL AND METHODS

Exhaustive review, over all the beneficiaries of the general system of social security aged from 6 to 65 years, of the number of weekly supplies: non-cholinergic oral antihistamines (antiH1), anti-allergy nasal sprays, anti-allergy eye lotions, delayed release injectable orticosteroids. In the twelve Primary Offices of Medical Assurance of the Rhône-Alpes region for the years 2000 and 2001. The results are expressed as the number of units (boxes)/100 beneficiaries.

RESULTS

The principal reports are: Consumptions vary in a parallel way between the different regions with a south > north and plain > mountain gradient between the different therapeutic classes (per os > local administration); a fluctuation closely linked to the presence of allergizing pollens: ragweed is responsible for high consumption in all the departments except the two Savoie. The observed peak of pollinization of birch in 2001 was associated with a peak of deliveries. These data confirm the value of data of medicines consumption both economically and medically.

Discovery of orally bioavailable NK1 receptor antagonists

Benzyloxyphenethylpiperazines are a new class of high affinity NK1 receptor antagonists. Oral bioavailability and selectivity can be fine tuned by the nature of the substituents on the basic nitrogen atom. Addition of substituents with a carboxylic acid group led to very selective and orally active NK1 antagonists free of interaction with L-type calcium channels.

A new series of M3 muscarinic antagonists based on the 4-amino-piperidine scaffold

A series of 4-amino-piperidine containing molecules have been synthesized and structure-affinity relationship toward the M3-muscarinic receptor has been investigated. Chemical modulations provided molecules with K(i) for the human M3-R up to 1 nM with variable selectivity (3- to 40-fold) over the human M2-R. Compounds 2 (pA(2)=8.3, 8.6) demonstrates in vitro on guinea pig bladder and ileal strips potent anticholinergic properties and tissue selectivity.

[Type 2 Diabetes and Short Form 36-items Health Survey]

OBJECTIVES

This study explores the quality of life in patients with type 2 diabetes with the French Short Form 36-items Health Survey which involves eight health concepts: physical functioning, body pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy and general health perceptions.

MATERIAL AND METHODS

The French SF 36 was proposed to 282 diabetic patients, 70 years of age and under, randomly selected from the database of Social Security healthcare office in Lyon (total: 4 644 patients). 160 healthy controls, matched for age and sex, were enrolled. 12 questionaires were not analysed because of linguistic difficulties.

RESULTS

The data show that quality of life is altered into T2D compared with the control population in all 8 dimensions of SF-36 items Health Survey.

CONCLUSIONS

Quality of life is an interesting element to take into account for practitioners during management of diabetic patients, that could prove useful in order to obtain a better compliance of the patients.

Effects of irbesartan (SR47436/BMS-186295) on angiotensin II-induced pressor responses in the pithed rat: potential mechanisms of action

The effects of two new non-peptide angiotensin receptor antagonists, irbesartan (SR 47436/BMS-186295, (2-n-butyl-4-spirocyclopentane-1-[((2'-tetrazol-5-yl)bipheny l-4-yl)methyl]2 - imidazolin-5-one) and SR 47155A (2-n-butyl-4-spirocyclopentane-1-[((2'-carboxy)biphenyl-4-yl)methy l]2- imidazolin-5-one, trifluoroacetate), on angiotensin II-induced pressor responses were studied in the pithed rat in comparison to losartan, EXP 3174 and [Sar1,Val5,Ala8]angiotensin II. SR 47155A (1-10 mg/kg i.v.) and losartan (1-10 mg/kg i.v.) shifted dose dependently the dose-response curve of angiotensin II to the right without affecting the maximal response. SR 47436 (0.3-10 mg/kg i.v.), EXP 3174 (0.03-1 mg/kg i.v.) and [Sar1,Val5,Ala8]angiotensin II (0.03-1 mg/kg i.v.) induced, at least at high doses, a non-parallel shift to the right of the angiotensin II dose-response curve and this was associated with a reduction of the maximal response. During a 70 min period, the effect of [Sar1,Val5,Ala8]angiotensin II (1 mg/kg i.v.) on the angiotensin II (0.3 microgram/kg i.v.)-induced pressor response was shown to be reversible, the effect of SR 47155A (10 mg/kg i.v.) was partially reversible and the effect of SR 47436 (3 mg/kg i.v.), EXP 3174 (1 mg/kg i.v.) or losartan (6 mg/kg i.v.) was not reversed at the end of this 70 min period. Administration of SR 47155A (10 mg/kg i.v.) before SR 47436 (1-10 mg/kg i.v.) reversed the reduced angiotensin II-maximal response induced by SR 47436. Administration of SR 47436 (10 mg/kg i.v.) before SR 47155A (1-10 mg/kg i.v.) prevented the full development of the pressor response as observed in the absence of SR 47436. In the pithed rat, SR 47436 (30 mg/kg i.v.) and losartan (30 mg/kg i.v.) reduced the change in diastolic blood pressure induced by electrical stimulation of the spinal cord only at low stimulation rates. Taken together these results indicate that SR 47436, under in vivo conditions, is a potent non-peptide angiotensin receptor antagonist. The type of antagonism (partially insurmountable but selective) can be explained by different theoretical models which are discussed.

In vitro characterization of a novel Ca2+ entry blocker: SR 33805

In this study, SR 33805 was shown to inhibit competitively [3H]fantofarone binding to cardiac sarcolemmal membranes. In contrast, SR 33805 was shown to inhibit allosterically [3H](+)-PN200-110, [3H](-)-D888 and cis-(+)-[3H]diltiazem binding. In isolated rabbit atrial preparations, SR 33805 was shown to be the least potent of fantofarone, nifedipine, verapamil and diltiazem in terms of both negative chronotropic and inotropic responses (IC50's 6 and 12 microM, respectively). In superfused rat aortic strips, SR 33805 like other Ca2+ channel antagonists, caused a significant inhibition of both K(+)-induced 45Ca2+ influx and contractile responses. In addition this agent was shown to antagonize Ca(2+)-induced contractions in K(+)-depolarized aorta with a pA2, value of 8.39 +/- 0.02. In femoral, renal and basilar arteries, SR 33805 was equiactive to the other Ca2+ channel antagonists studied in antagonizing K(+)-induced contractions (IC50 approximately 40 nM), but unlike the reference Ca2+ channel antagonists, was equiactive in antagonizing serotonin-induced contractions (IC50 approximately 250 nM). This suggests that the effects of SR 33805 depend mainly on membrane potential. In conclusion, SR 33805 is a potent Ca2+ channel antagonist which, unlike fantofarone, verapamil and diltiazem, is highly selective for vascular smooth muscle and devoid of any potent negative inotropic actions.

Biochemical and pharmacological properties of SR 49059, a new, potent, nonpeptide antagonist of rat and human vasopressin V1a receptors

SR 49059, a new potent and selective orally active, nonpeptide vasopressin (AVP) antagonist has been characterized in several in vitro and in vivo models. SR 49059 showed high affinity for V1a receptors from rat liver (Ki = 1.6 +/- 0.2) and human platelets, adrenals, and myometrium (Ki ranging from 1.1 to 6.3 nM). The previously described nonpeptide V1 antagonist, OPC-21268, was almost inactive in human tissues at concentrations up to 100 microM. SR 49059 exhibited much lower affinity (two orders of magnitude or more) for AVP V2 (bovine and human), V1b (human), and oxytocin (rat and human) receptors and had no measurable affinity for a great number of other receptors. In vitro, AVP-induced contraction of rat caudal artery was competitively antagonized by SR 49059 (pA2 = 9.42). Furthermore, SR 49059 inhibited AVP-induced human platelet aggregation with an IC50 value of 3.7 +/- 0.4 nM, while OPC-21268 was inactive up to 20 microM. In vivo, SR 49059 inhibited the pressor response to exogenous AVP in pithed rats (intravenous) and in conscious normotensive rats (intravenous and per os) with a long duration of action (> 8 h at 10 mg/kg p.o). In all the biological assays used, SR 49059 was devoid of any intrinsic agonistic activity. Thus, SR 49059 is the most potent and selective nonpeptide AVP V1a antagonist described so far, with marked affinity, selectivity, and efficacy toward both animal and human receptors. With this original profile, SR 49059 constitutes a powerful tool for exploring the therapeutical usefulness of a selective V1a antagonist.

SR 33557, a novel calcium entry blocker. I. In vitro isolated tissue studies

The effects of SR 33557 on isolated cardiovascular preparations were compared to those of nifedipine, verapamil and diltiazem. In rat aortic strips, SR 33557, like nifedipine, verapamil and diltiazem, caused a significant and simultaneous inhibition of potassium-induced 45Ca++ influx and contractile responses (nifedipine greater than SR 33557 greater than verapamil greater than diltiazem). SR 33557 also antagonized Ca(++)-induced contractions in K(+)-depolarized aorta preparations (pA2:9.08 +/- 0.03) and is the first calcium channel antagonist, structurally not related to 1,4-dihydropyridines, to inhibit competitively contractions induced by BAY K8644. In spike-generating vascular smooth muscle (rat portal vein), contractures evoked by noradrenaline (4 microM) or KCl (100 mM) were reduced by all four antagonists, the pharmacological potency being nifedipine greater than SR 33557 greater than verapamil greater than diltiazem. Unlike SR 33557, nifedipine, verapamil and diltiazem showed a parallel enhancement of frequency of spontaneous contractions in rat portal vein in spite of a concentration-related reduction in amplitude. By using rabbit atrial preparations, spontaneous right atrial rate and electrically stimulated (120/min) basal contractions of left atria were used as indices of chronotropy and inotropy. The potency series for negative chronotropic effects was nifedipine greater than SR 33557 greater than verapamil greater than diltiazem. For negative inotropic effects the potency order was verapamil greater than nifedipine greater than SR 33557 greater than diltiazem, respectively. Thus, SR 33557 should depress heart rate to a greater extent than ventricular contractility. These results suggest that SR 33557 is a potent calcium entry blocker that (unlike verapamil and diltiazem) is particularly selective for vascular smooth muscle and devoid of any potent negative inotropic actions.