Toward Elucidating the Physiological Impacts of Residual Stresses in the Colorectum

Irritable bowel syndrome afflicts 10-20% of the global population, causing visceral pain with increased sensitivity to colorectal distension and normal bowel movements. Understanding and predicting these biomechanics will further advance our understanding of visceral pain and complement the existing literature on visceral neurophysiology. We recently performed a series of experiments at three longitudinal segments (colonic, intermediate, and rectal) of the distal 30 mm of colorectums of mice. We also established and fitted constitutive models addressing mechanical heterogeneity in both the through-thickness and longitudinal directions of the colorectum. Afferent nerve endings, strategically located within the submucosa, are likely nociceptors that detect concentrations of mechanical stresses to evoke the perception of pain from the viscera. In this study, we aim to: (1) establish and validate a method for incorporating residual stresses into models of colorectums, (2) predict the effects of residual stresses on the intratissue mechanics within the colorectum, and (3) establish intratissue distributions of stretches and stresses within the colorectum in vivo. To these ends we developed two-layered, composite finite element models of the colorectum based on our experimental evidence and validated our approaches against independent experimental data. We included layer- and segment-specific residual stretches/stresses in our simulations via the prestrain algorithm built into the finite element software febio. Our models and modeling approaches allow researchers to predict both organ and intratissue biomechanics of the colorectum and may facilitate better understanding of the underlying mechanical mechanisms of visceral pain.

Magnetic Resonance Imaging-based biomechanical simulation of cartilage: A systematic review

MRI-based mathematical and computational modeling studies can contribute to a better understanding of the mechanisms governing cartilage's mechanical performance and cartilage disease. In addition, distinct modeling of cartilage is needed to optimize artificial cartilage production. These studies have opened up the prospect of further deepening our understanding of cartilage function. Furthermore, these studies reveal the initiation of an engineering-level approach to how cartilage disease affects material properties and cartilage function. Aimed at researchers in the field of MRI-based cartilage simulation, research articles pertinent to MRI-based cartilage modeling were identified, reviewed, and summarized systematically. Various MRI applications for cartilage modeling are highlighted, and the limitations of different constitutive models used are addressed. In addition, the clinical application of simulations and studied diseases are discussed. The paper's quality, based on the developed questionnaire, was assessed, and out of 79 reviewed papers, 34 papers were determined as high-quality. Due to the lack of the best constitutive models for various clinical conditions, researchers may consider the effect of constitutive material models on the cartilage disease simulation. In the future, research groups may incorporate various aspects of machine learning into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification, such as gait analysis.

Computational Modeling of Mouse Colorectum Capturing Longitudinal and Through-thickness Biomechanical Heterogeneity

Mechanotransduction, the encoding of local mechanical stresses and strains at sensory endings into neural action potentials at the viscera, plays a critical role in evoking visceral pain, e.g., in the distal colon and rectum (colorectum). The wall of the colorectum is structurally heterogeneous, including two major composites: the inner consists of muscular and submucosal layers, and the outer consists of circular muscular, intermuscular, longitudinal muscular, and serosal layers. In fact the colorectum presents biomechanical heterogenity across both the longitudinal and through-thickness directions thus highlighting the differential roles of sensory nerve endings within different regions of the colorectum in visceral mechanotransduction. We determined constitutive models and model parameters for individual layers of the colorectum from three longitudinal locations (colonic, intermediate, and distal) using nonlinear optimization to fit our experimental results from biaxial extension tests on layer-separated colorectal tissues (mouse model, 7×7 mm2, Siri et al., Am. J. Physiol. Gastrointest. Liver Physiol. 316, G473-G481 and 317, G349-G358), and quantified the thicknesses of the layers. In this study we also quantified the residual stretches stemming from separating colorectal specimens into inner and outer composites and we completed new pressure-diameter mechanical testing to provide an additional validation case. We implemented the constitutive equations and created two-layered, 3-D finite element models using FEBio (University of Utah), and incorporated the residual stretches. We validated the modeling framework by comparing FE-predicted results for both biaxial extension testing of bulk specimens of colorectum and pressure-diameter testing of bulk segments against corresponding experimental results independent of those used in our model fitting. We present the first theoretical framework to simulate the biomechanics of distal colorectum, including both longitudinal and through-thickness heterogeneity, based on constitutive modeling of biaxial extension tests of colon tissues from mice. Our constitutive models and modeling framework facilitate analyses of both fundamental questions (e.g., the impact of organ/tissue biomechanics on mechanotransduction of the sensory nerve endings, structure-function relationships, and growth and remodeling in health and disease) and specific applications (e.g., device design, minimally invasive surgery, and biomedical research).

A multi-layered model of human skin elucidates mechanisms of wrinkling in the forehead

Skin wrinkling, especially in the facial area, is a prominent sign of aging and is a growing area of research aimed at developing cosmetics and dermatological treatments. To better understand and treat undesirable skin wrinkles, it is vitally important to elucidate the underlying mechanisms of skin wrinkling, a largely mechanical process. Human skin, a multi-layer composite, has six mechanically distinct layers: from the outermost inward they are the stratum corneum, viable epidermis, dermal-epidermal-junction, papillary dermis, reticular dermis, and hypodermis. To better address the through-thickness hierarchy, and the development of wrinkling within this complicated hierarchy, we established a six-layered model of human skin realized with finite element modeling, by leveraging available morphological and biomechanical data on human skin of the forehead. Exercising our new model we aimed to quantify the effects of three potential mechanisms of wrinkle formation: (1) skin compression due to muscle contraction (dynamic wrinkles); (2) age-related volumetric tissue loss (static wrinkles); and (3) the combined effects of both mechanisms. Since hydration of the stratum corneum significantly affects its stiffness we also aimed to quantify the influence its hydration with these three potential mechanisms of wrinkle formation. Our six-layered skin model, combined with the proposed wrinkling mechanisms, successfully predicts the formation of dynamic and static wrinkles in the forehead consistent with the experimental literature. We observed three wrinkling modes in the forehead where the deepest wrinkles could reach to the reticular dermis. With further refinement our new six-layered model of human skin can be applied to study other region-specific wrinkle types such as the "crow's feet" and the nasolabial folds.

A multi-layered computational model for wrinkling of human skin predicts aging effects

The development and progression of wrinkles from young to aged human skin relates to both structural and mechanical changes induced by aging. Here we aim to better understand the interaction of skin's layered morphology with dynamic wrinkles predicted in young and aged skin. First, we compare the predictions of wrinkling from 3-D finite element models of human skin including two to six distinct and anatomically motivated layers. Second, we perform parametric analyses using our six-layered model to determine how age-related changes in the architecture of human skin affect dynamic surface wrinkling. Specifically, we consider the following aging-related changes in the morphology of skin: flattening of the dermal-epidermal junction (DEJ) interface; thinning of both the viable epidermis (VE) and the reticular dermis (RD); and thickening of the papillary dermis (PD). We use skin compression to model dynamic, expressional wrinkles due to muscle contraction, and volumetric tissue loss to model effects of aging in wrinkling simulations. Our results highlight the role of skin's multi-layered structure in the modeling of wrinkling formation. Our six-layered model, consisting of all of the mechanical layers, predicts deep wrinkles with better fidelity than models including fewer layers. From our parametric study, applying our six-layered model, we conclude that: (1) the relative thicknesses of the layers in the epidermis or dermis significantly influences surface wrinkling in skin; and, (2) flattening of the DEJ with aging enhances surface wrinkling. Thinning of VE increases the relative stiffness of the epidermis and thus enhances dynamic wrinkling, while thickening of PD or thinning of RD has the same effect by reducing the equivalent stiffness of the substrate. Consequently, strategies to minimize wrinkling could maintain the undulating morphology of the DEJ, thereby delaying dynamic wrinkling and delaying the propagation of buckling into the deeper dermis or hypodermis. Additional strategies to minimize wrinkling could target preventing the VE and RD from thinning or preventing the PD from thickening.

Through-thickness patterns of shear strain evolve in early osteoarthritis

OBJECTIVE

Given the structural changes associated with the progression of Osteoarthritis (OA), we hypothesized that patterns of through-thickness, large-strain shear evolve with early-stage OA. We therefore aimed to determine whether and how patterns of shear strains change during early-stage OA to 1) gain insight into the progression of OA by quantifying changes in local deformations; 2) gauge the potential of patterns in shear strain to serve as image-based biomarkers of early-stage OA; and 3) provide high-resolution, through-thickness data for proposing, fitting, and validating constitutive models for cartilage.

DESIGN

We completed displacement-driven, large-strain shear tests (5, 10, 15%) on 44 specimens of variably advanced osteoarthritic human articular cartilage as determined by both Osteoarthritis Research Society International (OARSI) grade and PLM-CO score. We recorded the through-thickness deformations with a stereo-camera system and processed these data using digital image correlation (DIC) to determine full-thickness patterns of strains and relative zonal recruitments, i.e., the average shear strain in a through-thickness zone weighted by its relative thickness and normalized by the applied strain.

RESULTS

We observed three general shapes for the curves of averaged through-thickness, Green-Lagrange shear strains during progression of OA. We also observed that during the progression of OA only the deep zone is recruited differently under shear in a statistically significant way.

CONCLUSIONS

We propose that changes in through-thickness patterns of shear strain could provide sensitive biomarkers for early clinical detection of OA. The relative zonal recruitment of the deep zone decreases with progressing OA (OARSI grade) and microstructural remodeling (PLM-CO score), which do not consistently affect recruitment of the superficial and middle zones.

The evolving large-strain shear responses of progressively osteoarthritic human cartilage

OBJECTIVE

The composition and structure of articular cartilage evolves during the development and progression of osteoarthritis (OA) resulting in changing mechanical responses. We aimed to assess the evolution of the intrinsic, large-strain mechanics of human articular cartilage-governed by collagen and proteoglycan and their interactions-during the progression of OA.

DESIGN

We completed quasi-static, large-strain shear tests on 64 specimens from ten donors undergoing total knee arthroplasty (TKA), and quantified the corresponding state of OA (OARSI grade), structural integrity (PLM score), and composition (glycosaminoglycan and collagen content).

RESULTS

We observed nonlinear stress-strain relationships with distinct hystereses for all magnitudes of applied strain where stiffnesses, nonlinearities, and hystereses all reduced as OA advanced. We found a reduction in energy dissipation density up to 80% in severely degenerated (OARSI grade 4, OA-4) vs normal (OA-1) cartilage, and more importantly, we found that even cartilage with a normal appearance in structure and composition (OA-1) dissipated 50% less energy than healthy (control) load-bearing cartilage (HL₀). Changes in stresses and stiffnesses were in general less pronounced and did not allow us to distinguish between healthy load-bearing controls and very early-stage OA (OA-1), or to distinguish consistently among different levels of degeneration, i.e., OARSI grades.

CONCLUSIONS

Our results suggest that reductions in energy dissipation density can be detected by bulk-tissue testing, and that these reductions precede visible signs of degeneration. We highlight the potential of energy dissipation, as opposed to stress- or stiffness-based measures, as a marker to diagnose early-stage OA.

GPGPU-based explicit finite element computations for applications in biomechanics: the performance of material models, element technologies, and hardware generations

Finite element (FE) simulations are increasingly valuable in assessing and improving the performance of biomedical devices and procedures. Due to high computational demands such simulations may become difficult or even infeasible, especially when considering nearly incompressible and anisotropic material models prevalent in analyses of soft tissues. Implementations of GPGPU-based explicit FEs predominantly cover isotropic materials, e.g. the neo-Hookean model. To elucidate the computational expense of anisotropic materials, we implement the Gasser-Ogden-Holzapfel dispersed, fiber-reinforced model and compare solution times against the neo-Hookean model. Implementations of GPGPU-based explicit FEs conventionally rely on single-point (under) integration. To elucidate the expense of full and selective-reduced integration (more reliable) we implement both and compare corresponding solution times against those generated using underintegration. To better understand the advancement of hardware, we compare results generated using representative Nvidia GPGPUs from three recent generations: Fermi (C2075), Kepler (K20c), and Maxwell (GTX980). We explore scaling by solving the same boundary value problem (an extension-inflation test on a segment of human aorta) with progressively larger FE meshes. Our results demonstrate substantial improvements in simulation speeds relative to two benchmark FE codes (up to 300[Formula: see text] while maintaining accuracy), and thus open many avenues to novel applications in biomechanics and medicine.

Low-energy impact of human cartilage: predictors for microcracking the network of collagen

OBJECTIVE

We aimed to determine the minimum mechanical impact to cause microstructural damage in the network of collagen (microcracking) within human cartilage and hypothesized that energies below 0.1 J or 1 mJ/mm³ would suffice.

DESIGN

We completed 108 low-energy impact tests (0.05, 0.07, or 0.09 J; 0.75 or 1.0 m/s²) using healthy cartilage specimens from six male donors (30.2 ± 8.8 yrs old). Before and after impact we acquired, imaging the second harmonic generation (SHG), ten images from each specimen (50 μm depth, 5 μm step size), resulting in 2160 images. We quantified both the presence and morphology of microcracks. We then correlated test parameters (predictors) impact energy/energy dissipation density, nominal stress/stress rate, and strain/strain rate to microcracking and tested for significance. Where predictors significantly correlated with microstructural outcomes we fitted binary logistic regression plots with 95% confidence intervals (CIs).

RESULTS

No specimens presented visible damage following impact. We found that impact energy/energy dissipation density and nominal stress/stress rate were significant (P < 0.05) predictors of microcracking while both strain and strain rate were not. In our test configuration, an impact energy density of 2.93 mJ/mm³, an energy dissipation density of 1.68 mJ/mm³, a nominal stress of 4.18 MPa, and a nominal stress rate of 689 MPa/s all corresponded to a 50% probability of microcracking in the network of collagen.

CONCLUSIONS

An impact energy density of 1.0 mJ/mm³ corresponded to a ∼20% probability of microcracking. Such changes may initiate a degenerative cascade leading to post-traumatic osteoarthritis.

High-quality conforming hexahedral meshes of patient-specific abdominal aortic aneurysms including their intraluminal thrombi

In order to perform finite element (FE) analyses of patient-specific abdominal aortic aneurysms, geometries derived from medical images must be meshed with suitable elements. We propose a semi-automatic method for generating conforming hexahedral meshes directly from contours segmented from medical images. Magnetic resonance images are generated using a protocol developed to give the abdominal aorta high contrast against the surrounding soft tissue. These data allow us to distinguish between the different structures of interest. We build novel quadrilateral meshes for each surface of the sectioned geometry and generate conforming hexahedral meshes by combining the quadrilateral meshes. The three-layered morphology of both the arterial wall and thrombus is incorporated using parameters determined from experiments. We demonstrate the quality of our patient-specific meshes using the element Scaled Jacobian. The method efficiently generates high-quality elements suitable for FE analysis, even in the bifurcation region of the aorta into the iliac arteries. For example, hexahedral meshes of up to 125,000 elements are generated in less than 130 s, with 94.8 % of elements well suited for FE analysis. We provide novel input for simulations by independently meshing both the arterial wall and intraluminal thrombus of the aneurysm, and their respective layered morphologies.

Modeling sample/patient-specific structural and diffusional responses of cartilage using DT-MRI

We propose a new 3D biphasic constitutive model designed to incorporate structural data on the sample/patient-specific collagen fiber network. The finite strain model focuses on the load-bearing morphology, that is, an incompressible, poroelastic solid matrix, reinforced by an inhomogeneous, dispersed fiber fabric, saturated with an incompressible fluid at constant electrolytic conditions residing in strain-dependent pores of the collagen-proteoglycan solid matrix. In addition, the fiber network of the solid influences the fluid permeability and an intrafibrillar portion that cannot be 'squeezed out' from the tissue. We implement the model into a finite element code. To demonstrate the utility of our proposed modeling approach, we test two hypotheses by simulating an indentation experiment for a human tissue sample. The simulations use ultra-high field diffusion tensor magnetic resonance imaging that was performed on the tissue sample. We test the following hypotheses: (i) the through-thickness structural arrangement of the collagen fiber network adjusts fluid permeation to maintain fluid pressure (Biomech. Model. Mechanobiol. 7:367-378, 2008); and (ii) the inhomogeneity of mechanical properties through the cartilage thickness acts to maintain fluid pressure at the articular surface (J. Biomech. Eng. 125:569-577, 2003). For the tissue sample investigated, both through-thickness inhomogeneities of the collagen fiber distribution and of the material properties serve to influence the interstitial fluid pressure distribution and maintain fluid pressure underneath the indenter at the cartilage surface. Tissue inhomogeneity appears to have a larger effect on fluid pressure retention in this tissue sample and on the advantageous pressure distribution.

Granisetron as antiemetic therapy in children with cancer

The safety and efficacy of the new 5HT-3 antagonist granisetron as an antiemetic in children with cancer was evaluated in 40 children at a single dose of 40 micrograms/kg. No adverse affects attributable to the granisetron were noted. The overall major and complete response rate was 82.5% and this was highest in the younger children. Only 2 patients showed no response. Pharmacokinetic studies showed associations between some pharmacokinetic parameters and age which were no longer apparent after normalisation for body weight. Granisetron is an effective and very well-tolerated antiemetic and appears to be an important addition to the supportive care available for children with cancer.

Pharmacokinetics and tolerability of ascending intravenous doses of granisetron, a novel 5-HT3 antagonist, in healthy human subjects

The pharmacokinetics and tolerance of granisetron, a novel 5HT3-receptor antagonist which is under development as an anti-emetic agent have been studied after administration of single 30 min intravenous infusions to three groups of 8 healthy male subjects, in a series of placebo-controlled ascending dose studies (50, 80, 100 and 130 micrograms.kg-1 to group 1; 150, 180, 200 and 230 micrograms.kg-1 to group 2 and 270 and 300 micrograms.kg-1 to group 3). Plasma and urine samples were analysed for granisetron by HPLC with fluorimetric detection. Administration of granisetron was well tolerated by the volunteers and there were no serious adverse effects reported. Pharmacokinetic parameters and dose-normalised plasma levels appeared to be independent of dose in the range 50 to 300 micrograms.kg-1, although there was extensive inter-subject variability. Granisetron was extensively distributed, with mean volumes of distribution ranging from 186-264 l at the various doses. Total plasma clearance was, in general, rapid (mean values of 37.0 to 49.9 l.h-1) and predominantly non-renal, with most subjects excreting less than 20% of the dose unchanged in urine. Mean t1/2 values ranged from 4.1 to 6.3 h and MRT from 5.2 to 8.1 h.

The tolerance to and pharmacokinetics of penciclovir (BRL 39,123A), a novel antiherpes agent, administered by intravenous infusion to healthy subjects

The tolerance to and pharmacokinetics of intravenously administered penciclovir (BRL 39,123A), a novel anti-herpes agent, were investigated in 15 healthy male subjects. The volunteers were divided into three groups, receiving either 10, 15 or 20 mg/kg penciclovir by a 60 min constant-rate infusion. Blood samples were taken sequentially up to 48 h after the start of the infusion and urine collections made at appropriate intervals up to 72 h. After a simple solid phase extraction, concentrations of penciclovir in plasma and urine were determined using HPLC with U.V. detection. Mean values of Cmax, corresponding usually with the end of infusion, and of AUC appeared to increase proportionately with dose. Furthermore, there was no evidence that dose significantly affected any individual pharmacokinetic parameter. Penciclovir was distributed into tissues with an overall mean volume of distribution of approximately 1.5 l.kg-1, i.e. approximately double that of body water. It was rapidly eliminated, with a mean total plasma clearance of 39.3 l.h-1, and a mean terminal-phase half-life of 2.0 h. The majority of the dose, approximately 70%, was excreted unchanged in the urine. Mean renal clearance of BRL 39,123 was 28.1 l.h-1, which exceeds normal glomerular filtration rate and approaches renal plasma flow. At all dose-levels, the infusions of penciclovir were well tolerated, with no evidence of drug-related adverse events.

A review of the clinical pharmacokinetics and metabolism of the alpha 1-adrenoceptor antagonist indoramin

1. The alpha 1-adrenoceptor antagonist indoramin is rapidly and extensively absorbed after oral administration, but with only low to moderate bioavailability (8-24% median) from the tablet (Baratol). Although plasma protein binding is high (72-86%), the drug is widely distributed into tissues (with median Vz 6.3-7.7 l/kg after i.v. dosage). 2. Elimination of indoramin is rapid in most healthy volunteers, with median plasma clearances of 18-26 ml/min per kg, after i.v. dosage. Elimination occurs principally by metabolism, the major route being indole 6-hydroxylation, followed by sulphate conjugation of 6-hydroxyindoramin. The faecal route of excretion predominates (45-50% of dose), with a further 35-40% in the urine. 3. Extensive variation in single-dose oral pharmacokinetics of indoramin is due largely to the existence of a poor metabolizer phenotype which co-segregates with that of debrisoquine. 4. On repeated administration (37.5 mg twice daily) to healthy volunteers, plasma concentrations of indoramin accumulate 3-4-fold above those anticipated from single-dose kinetics. However, steady state is achieved within the first week of dosing. 5. The pharmacokinetics of indoramin are substantially altered in the elderly. The oral AUC for a 50 mg dose is increased approx. 5-fold and the t1/2 2.5-fold. 6. Cirrhotic liver disease enhances bioavailability and decreases clearance, approx. 2-fold in each case for single oral and i.v. doses of 50 mg and 0.15 mg/kg respectively. 7. After oral indoramin Cmax and AUC are both raised (58% and 25%, respectively, for a 50 mg dose) by co-ingested ethanol (0.5 g/kg). After i.v. indoramin, kinetics are unaffected by alcohol, but indoramin (0.175 mg/kg) slightly increases (26%) blood ethanol concentrations during the first hour after dosing. 8. The pharmacodynamics of indoramin appear to be related to the combined pharmacokinetics of the drug and its 6-hydroxylated metabolite, which contributes to the antihypertensive effect.

The pharmacokinetics of oral indoramin during pregnancy

1. The pharmacokinetics of indoramin (Baratol; Wyeth) and its active metabolite 6-hydroxyindoramin administered to 13 women as a single 37.5 mg dose of indoramin were compared under pregnant and post-partum conditions. 2. No significant differences were observed between values determined under pregnant and post-partum conditions, for any pharmacokinetic parameter. Cmax and AUC values in individual subjects differed, in most cases, by no more than two-fold, i.e. the same order of magnitude as intra-subject variation seen in volunteers dosed repeatedly with indoramin. 3. Median values of Cmax, AUC(0.24) and t 1/2,z were of a similar order to values seen previously in normal volunteers after a single 37.5 mg dose. 4. It is concluded that in treating hypertension associated with pregnancy, this study does not provide evidence to depart from the usual clinical practice of titrating indoramin dosage with control of blood pressure as the end-point, keeping in mind the restriction of the dose-limiting side-effect of sedation.

High-performance liquid chromatographic method for the determination of 9-(4-hydroxy-3-hydroxymethylbut-1-yl)guanine (BRL-39123) in human plasma and urine

A rapid, sensitive and reliable reversed-phase high-performance liquid chromatographic (HPLC) method with UV detection has been developed for the assay of a novel anti-herpes agent, 9-(4-hydroxy-3-hydroxymethylbut-1-yl)guanine (BRL-39123), in human plasma and urine. The drug and the internal standard, the structural analogue BRL-42377, were extracted from the biological matrix by adsorption on a cation-exchange column and were subsequently eluted under alkaline conditions prior to HPLC. The method is reproducible, with coefficients of variation of ca. 5%, and linear from 0.1 to at least 30 micrograms ml-1 in plasma and from 50 to at least 2000 micrograms ml-1 in urine. The method has been used extensively to measure BRL-39123 in plasma and urine samples generated during clinical studies and is adequate for defining pharmacokinetics at projected therapeutic doses.

Pharmacokinetic interaction between indoramin and ethanol

1. The effect of ethanol consumption (0.5 g/kg) on the pharmacokinetics of the alpha adrenoceptor antagonist indoramin, administered orally (50 mg) or intravenously (0.175 mg/kg) has been investigated in young volunteers. Sedation was also assessed using a visual analogue scale. 2. After oral indoramin administration, ethanol caused increases of 58% (P less than 0.01) in Cpmax, and 25% (P less than 0.05) in AUC. There was no effect of alcohol on elimination half-life. The combination of ethanol and indoramin was more sedative than indoramin alone. 3. Ethanol did not alter the pharmacokinetics of an intravenous dose of indoramin. However indoramin caused a small but statistically significant increase (26%) in blood ethanol concentrations during the first 1.25 h after dosing. Both indoramin and ethanol caused sedation. 4. The increased bioavailability of oral indoramin in the presence of ethanol may reflect some enhanced absorption, but it is also consistent with inhibition of first-pass metabolism of a flow-limited drug. The clinical implications are discussed.

Pharmacokinetics of indoramin and its 6-hydroxylated metabolite after repeated oral dosing

The pharmacokinetics of indoramin and its active 6-hydroxylated metabolite have been studied in healthy male volunteers after repeated oral dosing with 37.5 mg twice daily for 2 weeks. Plasma concentrations of indoramin accumulated, on average, three to four-fold above those anticipated on the basis of the kinetics after the first dose, though steady state was achieved by the end of the first week and no further increase was observed after 2 weeks. The degree of accumulation was consistent between subjects, with a highly significant (p less than 0.001) correlation between the concentration 2 h after a single dose and the average steady-state concentration. Possible explanations for the accumulation of indoramin are discussed. Plasma concentrations of 6-hydroxyindoramin, in contrast, did not accumulate on multiple dosing. At steady state, concentrations of the metabolite, as represented by the AUC0-8h, were approximately 30-40 per cent of those of the unchanged drug. Since the two compounds are approximately equipotent the metabolite may accounts for 25 per cent of the hypotensive activity of indoramin during a typical clinical regime of 37.5 mg twice daily.

Intra- and inter-subject variation in the pharmacokinetics of indoramin and its 6-hydroxylated metabolite

Intra- and inter-subject variation in the kinetics of indoramin and its active metabolite 6-hydroxyindoramin have been studied in 5 young, healthy, male volunteers administered a single oral dose of the drug on 5 separate occasions. Inter-subject variation represented the main source of variability in indoramin plasma concentrations with, for example, the between-subjects sum of squares (a measure of the contribution to the total variability) representing around 97% of the total sum of squares for Cmax and AUC (0-24). Intra-subject and inter-subject coefficients of variation (C.V.s) were circa 20% and 100% respectively for both these parameters. Variability in 6-hydroxyindoramin concentrations was much lower and was approximately equally derived from intra- and inter-subject variation, with the C.V.s being approximately 44% for both Cmax and AUC (0-24). The results imply that the kinetic behaviour of indoramin within an individual will prove relatively consistent, despite widespread inter-subject variation, once an appropriate dosage regime has been established.

Pharmacokinetics and systemic availability of the antihypertensive agent indoramin and its metabolite 6-hydroxyindoramin in healthy subjects

We have studied the pharmacokinetics and absolute systemic availability of indoramin (50 mg) given orally in solution or as a tablet with reference to intravenously administered drug (0.15 mg/kg) in 9 healthy volunteers. After intravenous administration the median apparent volume of distribution was 6.3 l X kg-1, plasma clearance was 20.0 ml X min-1 X kg-1, and terminal half-time was 4.1 h. When given by tablet indoramin was absorbed with moderate rapidity, with a median tmax of 1.5 h. The median systemic availability was 24%. After oral administration in solution the drug was more rapidly absorbed, with a median tmax of 1.0 h (p less than 0.01). The median systemic availability was 43% (15-85%). Plasma concentrations of an active metabolite, 6-hydroxyindoramin, after single oral doses in either dosage form, were of a similar order to those of unchanged drug and fell with similar rapidity. After intravenous administration, however, concentrations of the metabolite were negligible.

The pharmacokinetics of indoramin and 6-hydroxyindoramin in poor and extensive hydroxylators of debrisoquine

Five poor metabolisers (PM) and seven extensive metabolisers (EM), of debrisoquine, all healthy volunteers, received 50 mg indoramin orally following an overnight fast. Plasma concentrations of indoramin and 6-hydroxyindoramin were determined by HPLC with fluorimetric detection. In PM subjects, mean values of Cmax (158 ng/ml) and AUC(0-24) (2556 ng X h X m-1) for indoramin were substantially elevated and t 1/2 beta (18.5 h) prolonged by comparison with values in the EM subjects (21.6 ng/ml, 151 ng X h X ml-1 and 5.2 h respectively). For 6-hydroxyindoramin, on the other hand, Cmax (12.4 ng/ml) and AUC (0-8) (47.5 ng X h X ml-1) in PM subjects were significantly lower than in the EM subjects (28.2 ng/ml and 94.7 ng X h X ml-1). There was a tendency to a higher incidence of side-effects in the PM group. Although the difference did not achieve statistical significance (0.1 greater than p greater than 0.05), all the PM subjects experienced sedation compared to only two in the EM group. Differences in blood pressure and pulse rate between the two groups were small. It is concluded that the oxidative metabolism of indoramin is subject to genetic polymorphism, which is probably under the control of the same gene locus as that influencing debrisoquine oxidation. The clinical consequences are discussed.

The pharmacokinetics of fentiazac and its metabolite, p-hydroxyfentiazac, after twice-daily oral administration to male volunteers

The pharmacokinetics of the anti-inflammatory agent fentiazac and its principal plasma metabolite, p-hydroxyfentiazac, have been investigated after repeated oral administration of fentiazac to male volunteers. Each volunteer received 200 mg of fentiazac twice daily for 15 d. Absorption was quite rapid, though some inter-subject variation in rates of absorption and bioavailability was observed. tmax values after the first dose ranged from 0.75-3 h while Cpmax values were 1050-4880 ng/ml. Elimination of fentiazac from plasma occurred rapidly in curvilinear fashion, so that concentrations were only 1% of their maximum value by 12 h after dosing. Maximum concentrations of p-hydroxyfentiazac after a single dose of fentiazac were 25.6-79.4% of those of fentiazac and were achieved at similar times. The metabolite was more slowly eliminated; the mean concentration of p-hydroxyfentiazac 12 h after a single dose was still 8% of its maximal value. On repeated administration, AUC0-12 h values for fentiazac and hydroxyfentiazac increased, as indicated by accumulation factors of 1.17 +/- 0.11 and 1.30 +/- 0.11 on days 8 and 15, respectively, for fentiazac and 1.72 +/- 0.15 and 1.77 +/- 0.10 for hydroxyfentiazac. There was no significant difference between days 8 and 15 in the extent of accumulation of either compound. Trough concentrations of fentiazac and hydroxyfentiazac on days 12 and 15 were similar to those on day 8. The clinical significance of these observations is discussed.

Pharmacodynamic correlates of modified absorption: studies with lormetazepam

The bioavailability, pharmacokinetics, and effects on performance of lormetazepam (1 mg) have been compared using soft gelatin capsule and tablet formulations. Lormetazepam was more rapidly absorbed from the soft gelatin capsule (tmax = 1.0 +/- 0.2 h) than from the tablet (tmax = 2.4 +/- 0.4 h), and the plasma concentration-time curve for the capsule was shifted to the left. Bioavailability and elimination kinetics did not differ between the formulations. The number of substitutions in the digit symbol test was reduced between 0.5 and 1.5 h for both formulations (P less than 0.001), but the degree of impairment at 0.5 h was greater after the capsule than after the tablet (P less than 0.01). Visuo-motor co-ordination was impaired from 0.5 to 1.5 h after the tablet and the capsule (P less than 0.01), and extended to 5.5 h after the tablet (P less than 0.05). These observations reflect the differences in the plasma concentration-time curves.

The disposition of a novel tetrahydroquinoline, tiquinamide, in rats and patas monkeys

The absorption of tiquinamide occurred rapidly and extensively in both rats and patas monkeys. The major site of localization of radioactivity was in the stomach in both species. Tiquinamide was 50-60% bound to rat plasma and 50-75% to monkey plasma. The elimination of unchanged drug from plasma took place rapidly, with half lives of 1.6 h in rats and 0.7 h in monkeys. Elimination of total radioactivity in the rat was very slow and monoexponential, with a half-life of 90 h. However, in the monkey it took place in a biphasic manner and most radioactivity was eliminated in the first phase with a half-life of 0.75 h. Possible reasons for the species difference in elimination are discussed. The principle route of excretion in both species was via the urine. Excretion was slower in the rat than in the monkey. In the former species, only 50% of the administered dose was excreted in the first 24 h after dosing, and a further 12% was recovered from the carcasses after 7 days. In the monkey, however, excretion was virtually complete in the first 6 h.

Selection of solvents for thin-layer chromatography by means of a simple ranking system based on dielectric constants

1. A system devised for ranking t.l.c. solvent mixtures on the basis of their dielectric constants is useful in selecting mixtures for routine t.l.c. 2. For three basic compounds (tiquinamide, meptazinol and ciclazindol) and three acidic compounds (fentiazac, oxaprozin and 5, 6, 7, 8-tetrahydroquinoline-3-carboxylic acid), chromatographed on silica in the unionized state, a good correlation was found between RF and dielectric constant of the eluting solvent mixture.

Studies on the biotransformation of indoramin in the patas monkey

1. Studies on absorption, excretion and biotransformation of the antihypertensive agent indoramin (3-[2-(4-benzamidopiperidino)ethyl]indole hydrochloride) have been carried out in patas monkeys. 2. Absorption of the drug was extensive, as indicated by less than 8% of the dose appearing in faeces as the unchanged compound. 3. Approx. 35% of an orally administered dose of the 3H-labelled drug was recovered in urine while a similar amount was found in faeces. Urinary excretion of total 3H was mono-exponential with a half-life of 17 h. 4. Biotransformation was extensive, the unchanged drug constituting less than 4.5% of the urinary metabolites. The principal identified metabolites were a sulphate conjugate of 3-[2-(4-benzamidopiperidine)ethyl]indol-6-ol and an acid-labile conjugate of the parent drug. A minor metabolite resulting from N-dealkylation of the drug was identified as 4-benzamidopiperidine. Small amounts of 3-[2-(4-[4-hydroxybenzamido]piperidino)-ethyl]indole were found in a dichloromethane extract of acid-hydrolysed urine. 5. The faeces contained only negligible amounts of conjugated metabolites. The principal components were the indole-6-hydroxylated derivative of the parent drug with smaller amounts of the 5-hydroxylated compound and the unchanged compound.

Comparability of two methods of estimating real-depth acuity

The purpose of this study was to determine whether a motor adjustment (method of average error) and a verbal response (method of constant stimuli) procedure would yield comparable estimates of depth acuity using the classic Howard apparatus. The findings were that: (1) thresholds derived from the two procedures were not significantly correlated under either binocular or monocular viewing conditions; (2) essentially equivalent thresholds were derived from the two procedures under the binocular viewing condition; (3) thresholds derived from the verbal procedure were significantly higher than those derived from the motor adjustment procedure under monocular viewing conditions.

Relationship between monocular and binocular depth acuity

Estimates of monocular and binocular depth acuity were obtained on two samples of subjects with adequate visual acuity and capacity for stereopsis. Both a method of average error and a modified method of limits were employed to secure the estimates. Eight ratios of binocular to monocular depth acuity ranged from 2.4:1 to 4.2:1 at a distance of 15 ft. The results contradict the familiar generalization that binocular depth perception is about 20 times as acute as monocular depth perception.