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Knudsen S, Hansen A, Foegh M, Petersen S, Mekonnen H, Jia L, Shah P, Martin V, Frykman G, Pili R. A novel drug specific mRNA biomarker predictor for selection of patients responding to dovitinib treatment of advanced renal cell carcinoma and other solid tumors. PLoS One 2023; 18:e0290681. [PMID: 37647320 PMCID: PMC10468037 DOI: 10.1371/journal.pone.0290681] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE Dovitinib is a receptor tyrosine kinase inhibitor of VEGFR1-3, PDGFR, FGFR1/3, c-KIT, FLT3 and topoisomerase 1 and 2. The drug response predictor (DRP) biomarker algorithm or DRP-Dovitinib is being developed as a companion diagnostic to dovitinib and was applied retrospectively. PATIENTS AND METHODS Archival tumor samples were obtained from consenting patients in a phase 3 trial comparing dovitinib to sorafenib in renal cell carcinoma patients and the DRP-Dovitinib was applied. The biomarker algorithm combines the expression of 58 messenger RNAs relevant to the in vitro sensitivity or resistance to dovitinib, including genes associated with FGFR, PDGF, VEGF, PI3K/Akt/mTOR and topoisomerase pathways as well as ABC drug transport, and provides a likelihood score between 0-100%. RESULTS The DRP-Dovitinib divided the dovitinib treated RCC patients into two groups, sensitive (n = 49, DRP score >50%) or resistant (n = 86, DRP score ≤ 50%) to dovitinib. The DRP sensitive population was compared to the unselected sorafenib arm (n = 286). Median progression-free survival (PFS) was 3.8 months in the DRP sensitive dovitinib arm and 3.6 months in the sorafenib arm (hazard ratio 0.71, 95% CI 0.51-1.01). Median overall survival (OS) was 15.0 months in the DRP sensitive dovitinib arm and 11.2 months in the sorafenib arm (hazard ratio 0.69, 95% CI 0.48-0.99). The observed clinical benefit increased with increasing DRP score. At a cutoff of 67% the median OS was 20.6 months and the median PFS was 5.7 months in the dovitinib arm. The results were confirmed in five smaller phase II trials of dovitinib which showed a similar trend. CONCLUSION The DRP-Dovitinib shows promise as a potential biomarker for identifying advanced RCC patients most likely to experience clinical benefit from dovitinib treatment, subject to confirmation in an independent prospective trial of dovitinib in RCC patients.
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Affiliation(s)
| | | | - Marie Foegh
- Allarity Therapeutics, Boston, MA, United States of America
| | | | - Hana Mekonnen
- Amarex Clinical Research, Germantown, MD, United States of America
| | - Lin Jia
- Amarex Clinical Research, Germantown, MD, United States of America
| | - Preeti Shah
- Amarex Clinical Research, Germantown, MD, United States of America
| | - Victoria Martin
- Amarex Clinical Research, Germantown, MD, United States of America
| | | | - Roberto Pili
- Jacobs School of Medicine, Buffalo, NY, United States of America
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Pili R, Knudsen S, Kazempour K, Mekkonen H, Foegh M. 87P Clinical development of a predictive biomarker with 58 tumor genes for dovitinib treatment of solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.367] [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: 10/20/2022] Open
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Plummer R, Dua D, Cresti N, Drew Y, Stephens P, Foegh M, Knudsen S, Sachdev P, Mistry BM, Dixit V, McGonigle S, Hall N, Matijevic M, McGrath S, Sarker D. First-in-human study of the PARP/tankyrase inhibitor E7449 in patients with advanced solid tumours and evaluation of a novel drug-response predictor. Br J Cancer 2020; 123:525-533. [PMID: 32523090 PMCID: PMC7434893 DOI: 10.1038/s41416-020-0916-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/14/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background This phase 1 study examined the safety, maximum-tolerated dose (MTD) and antitumour activity of E7449, a novel PARP 1/2 and tankyrase 1/2 inhibitor. Methods E7449 was orally administered once daily in 28-day cycles to patients with advanced solid tumours (50–800-mg doses). Archival tumour samples from consenting patients were evaluated for the expression of 414 genes in a biomarker panel (2X-121 drug-response predictor [DRP]) found to be predictive of the response to E7449 in cell lines. Results Forty-one patients were enrolled (13 pancreatic, 5 ovarian, 4 each with breast, lung or colorectal cancer and 11 with other tumour types). The most common grade ≥3 treatment-related adverse event was fatigue (n = 7, 17.1%). Five patients experienced a dose-limiting toxicity (fatigue, n = 4, 800 mg; anaphylaxis, n = 1, 600 mg) for an MTD of 600 mg. E7449 exhibited antitumour activity in solid tumours, including 2 partial responses (PRs), and stable disease (SD) in 13 patients, which was durable (>23 weeks) for 8 patients. In 13 patients, the 2X-121 DRP identified those achieving PR and durable SD. E7449 showed good tolerability, promising antitumour activity and significant concentration-dependent PARP inhibition following 50–800-mg oral dosing. Conclusion The results support further clinical investigation of E7449 and its associated biomarker 2X-121 DRP. Clinical trial registration www.ClinicalTrials.gov code: NCT01618136.
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Affiliation(s)
- Ruth Plummer
- Northern Institute for Cancer Care, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK.
| | | | - Nicola Cresti
- Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yvette Drew
- Northern Institute for Cancer Care, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK
| | - Peter Stephens
- Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | | | | | | | | | | | | | | | | | | | - Debashis Sarker
- King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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Plummer ER, Dua D, Cresti N, Suder A, Drew Y, Stephens P, Foegh M, Knudsen S, McGonigle S, Ink B, Sarker D. First-in-human phase 1 study of the PARP/tankyrase inhibitor 2X-121 (E7449) as monotherapy in patients with advanced solid tumors and validation of a novel drug response predictor (DRP) mRNA biomarker. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Nicola Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Aneta Suder
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Yvette Drew
- Newcastle University, Northern Institute for Cancer Research, Newcastle-upon-Tyne, United Kingdom
| | - Peter Stephens
- Northern Centre for Cancer Care, Newcastle Upon Tyne, United Kingdom
| | | | | | | | - Barbara Ink
- Eisai, Hatfield, Hertfordshire, United Kingdom
| | - Debashis Sarker
- King's College Hospital, Institute of Liver Studies, London, United Kingdom
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Kaunitz AM, Archer DF, Mishell DR, Foegh M. Safety and tolerability of a new low-dose contraceptive patch in obese and nonobese women. Am J Obstet Gynecol 2015; 212:318.e1-8. [PMID: 25220709 DOI: 10.1016/j.ajog.2014.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The safety and tolerability of a new low-dose levonorgestrel/ethinyl estradiol (LNG/EE) contraceptive patch was compared with 2 combination oral contraceptives in 2 clinical studies in which approximately 30% of enrolled participants were obese. STUDY DESIGN Two phase 3, open-label, randomized, parallel-group, multicenter trials compared the LNG/EE contraceptive patch (n = 1579) with combination oral contraceptives (n = 581) in healthy women 17-40 years of age. Combination oral contraceptives were LNG 100 μg per EE 20 μg (combination oral contraceptive 20; n = 375) or LNG 150 μg per EE 30 μg (combination oral contraceptive 30; n = 206). Safety and tolerability data from the 2 trials were evaluated in integrated safety analyses. RESULTS Treatment-emergent adverse events of 2% or greater in the LNG/EE contraceptive patch were nasopharyngitis (5.2%), nausea (4.1%), upper respiratory infection (3.5%), headache (3.4%), sinusitis (2.9%), cervical dysplasia (2.3%), and urinary tract infection (2.1%). Including skin reaction-related treatment-emergent adverse events, the proportion of women who experienced any treatment-emergent adverse event was similar among women randomized to the contraceptive patch (47.5%), the combination oral contraceptive 20 (47.4%), or the combination oral contraceptive 30 (46.8%). The incidence of treatment-emergent adverse events was similar in obese vs nonobese participants in all groups. Serious adverse events occurred in less than 1% of participants in any of the treatment groups. CONCLUSION The LNG/EE contraceptive patch and combination oral contraceptives were well tolerated and associated with similar treatment-emergent adverse event incidences in obese and nonobese women.
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Kaunitz AM, Portman D, Westhoff CL, Mishell DR, Archer DF, Foegh M. New contraceptive patch wearability assessed by investigators and participants in a randomized phase 3 study. Contraception 2015; 91:211-6. [DOI: 10.1016/j.contraception.2014.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022]
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Kaunitz AM, Portman D, Westhoff CL, Archer DF, Mishell DR, Foegh M. Self-reported and verified compliance in a phase 3 clinical trial of a novel low-dose contraceptive patch and pill. Contraception 2014; 91:204-10. [PMID: 25582984 DOI: 10.1016/j.contraception.2014.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 07/14/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pregnancy rates in US contraceptive clinical trials are increasing due to decreased treatment compliance. This study compared compliance with a new low-dose levonorgestrel (LNG) and ethinyl estradiol (EE) contraceptive patch (CP, Twirla™) with that of a low-dose combination oral contraceptive (COC) in a demographically diverse population. STUDY DESIGN This analysis was part of an open-label, parallel-group, multicenter phase 3 study that randomized healthy sexually active women (17-40years) to 13cycles of LNG/EE CP or 6cycles of COC, then 7cycles of LNG/EE CP. We defined self-reported compliance as cycles that, according to diaries, show 21days of patch wear without missed days or any patch worn >7days or 21days of pill-taking without missed pill days. We verified compliance by detectable plasma presence of LNG and EE at cycles 2, 6, and 13. RESULTS Of the intention-to-treat population with diary information (N=1328, mean age 26.4years, 46% minorities, 33% obese), 10.0% of the CP (n=998) versus 21.2% of the COC group (n=330) self-reported noncompliance after 6cycles (p<.001). Laboratory assessments verified 10-14% of participants in both groups as noncompliant. Self-reported perfect use did not vary between obese [body mass index (BMI) ≥30kg/m(2)] versus nonobese (BMI <30kg/m(2)) participants in both groups or when stratified by age, education, or race/ethnicity in the CP group. CONCLUSIONS Self-reported compliance was significantly greater in the CP than COC group and did not vary by obesity status. Discrepancies between self-reported and verified compliance question reliability of patient diaries. IMPLICATIONS STATEMENT This paper, based on an analysis of a phase 3 trial, shows that compliance was significantly greater with a new weekly transdermal CP than with a once-daily COC in obese as well as nonobese participants. Discrepancies between self-reported compliance and laboratory-verified compliance raise questions regarding the reliability of patient diaries.
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Affiliation(s)
- Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
| | - David Portman
- Columbus Center for Women's Health Research, 99 Brice Road North, Columbus, OH 43213, USA
| | - Carolyn L Westhoff
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - David F Archer
- Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, VA 23507, USA
| | - Daniel R Mishell
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, Room 220, Los Angeles, CA 90033, USA
| | - Marie Foegh
- Department of Pharmacology, New York Medical College, Basic Science Building, 15 Dana Road, Valhalla, NY 10595, USA
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Kaunitz AM, Portman D, Westhoff CL, Archer DF, Mishell DR, Foegh M. In reply. Obstet Gynecol 2014; 123:1107-1108. [PMID: 24785870 DOI: 10.1097/aog.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida Columbus Center for Women's Health Research, Columbus, Ohio Mailman School of Public Health, Columbia University, New York, New York Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, Virginia Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California Department of Pharmacology, New York Medical College, Valhalla, New York, Previously Agile Therapeutics, Princeton, New Jersey
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Stanczyk FZ, Archer DF, Rubin A, Foegh M. Therapeutically equivalent pharmacokinetic profile across three application sites for AG200-15, a novel low-estrogen dose contraceptive patch. Contraception 2013; 87:744-9. [DOI: 10.1016/j.contraception.2012.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/25/2012] [Accepted: 10/31/2012] [Indexed: 11/15/2022]
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Archer DF, Stanczyk FZ, Rubin A, Foegh M. Pharmacokinetics and adhesion of the Agile transdermal contraceptive patch (AG200-15) during daily exposure to external conditions of heat, humidity and exercise. Contraception 2013; 87:212-9. [DOI: 10.1016/j.contraception.2012.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
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Foegh M, Archer DF, Stanczyk FZ, Rubin A, Mishell DR. Ovarian activity in obese and nonobese women treated with three transdermal contraceptive patches delivering three different doses of ethinyl estradiol and levonorgestrel. Contraception 2012; 87:201-11. [PMID: 23036478 DOI: 10.1016/j.contraception.2012.08.042] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/31/2012] [Accepted: 08/30/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of obesity on ovarian follicular suppression in women using low-estrogen dose contraceptive patches has not been determined. STUDY DESIGN A Phase II, parallel-group, multicenter, three-cycle study evaluated three patches containing different ethinyl estradiol (EE) and levonorgestrel (LNG) doses. Serum levels of EE, LNG, sex hormone-binding globulin and progesterone were compared in 41 obese [body mass index (BMI) ≥30] and 75 nonobese (BMI <30) women. RESULTS Suppression of ovulation during the luteal phase was dose dependent, with the highest dose (AG200-15) preventing progesterone increases in all women (cycles 2-3). In the follicular phase, the lowest-dose patch had the highest rate of increased progesterone in nonobese subjects. Progesterone levels ≥3.0 ng/mL in the follicular phase were more common in obese than nonobese women. CONCLUSIONS AG200-15 suppresses ovulation in obese and nonobese women. All three patches found increased progesterone in the follicular phase, albeit more in obese versus nonobese women.
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Affiliation(s)
- Marie Foegh
- Agile Therapeutics, Princeton, NJ 08540, USA.
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Archer DF, Stanczyk FZ, Rubin A, Foegh M. Ethinyl estradiol and levonorgestrel pharmacokinetics with a low-dose transdermal contraceptive delivery system, AG200-15: a randomized controlled trial. Contraception 2012; 85:595-601. [DOI: 10.1016/j.contraception.2011.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/04/2011] [Accepted: 10/14/2011] [Indexed: 10/14/2022]
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Archer D, Stancyk F, Rubin A, Flood L, Mishell D, Foegh M. Serum ethinyl estradiol levels with a low-dose combination transdermal contraceptive (AG200-15) compared with a low-dose combination oral contraceptive. Contraception 2012. [DOI: 10.1016/j.contraception.2011.11.026] [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: 11/30/2022]
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Stanczyk FZ, Rubin A, Flood L, Foegh M. Pharmacokinetics, tolerability and cycle control of three transdermal contraceptive delivery systems containing different doses of ethinylestradiol and levonorgestrel. Horm Mol Biol Clin Investig 2011; 6:231-40. [PMID: 25961260 DOI: 10.1515/hmbci.2011.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/12/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The only available contraceptive patch, Ortho Evra®, delivers a relatively high dose of estrogen. MATERIALS AND METHODS Three transdermal contraceptive delivery systems (TCDS) containing low doses of ethinylestradiol (EE) and levonorgestrel (LNG) were evaluated in two open-label randomized trials. In a phase 1, two-period, cross-over trial, AG200-12.5 and AG200LE were compared with a 150 μg LNG/30 μg EE oral contraceptive (OC) (Levlen®) in 39 women. In a phase 2, parallel-group, multicenter, three-cycle study, AG200LE, AG200-12.5 and a higher-dose formulation, AG200-15, were evaluated in 123 women. RESULTS In Study 1, mean steady-state plasma concentrations (Css, pg/mL) for the TCDS were 17 pg/mL to 26 pg/mL for EE and 1117 pg/mL to 1505 pg/mL for LNG (for AG200LE and AG200-12.5 respectively). Maximum concentration (Cmax) and Css for both analytes were significantly lower than for Levlen. In both studies, the Css levels for EE and LNG in all groups were within the ranges reported for low-dose OCs. Cycle control for AG200-15, assessed by breakthrough bleeding and spotting episodes as well as number of days of unscheduled bleeding and/or spotting, was similar to that reported for low-dose OCs. Most adverse events were considered mild to moderate in intensity. The incidence of patches falling off was <2%. CONCLUSIONS All three patches exhibited excellent safety and wearability profiles while maintaining plasma drug levels required for ovulation suppression and adequate cycle control. A slight increase in the EE dose in AG200-15 still places this TCDS within the range of low-dose OCs, with EE exposure much lower than reported for Ortho Evra. AG200-15 was selected for further testing in phase 3 studies.
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Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005; 106:492-501. [PMID: 16135578 DOI: 10.1097/01.aog.0000175834.77215.2e] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [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: 02/06/2023]
Abstract
OBJECTIVE To compare the efficacy of a new low-dose oral contraceptive pill (OCP) formulation with placebo in reducing symptoms of premenstrual dysphoric disorder. METHODS This multicenter, double-blind, randomized clinical trial consisted of 2 run-in and 3 treatment cycles with daily symptom charting; 450 women with symptoms of premenstrual dysphoric disorder were randomized to either placebo or an OCP formulation containing drospirenone 3 mg and ethinyl estradiol 20 microg. Hormones were administered for 24 days, followed by 4 days of inactive pills (24/4). RESULTS Scores on the total Daily Record of Severity of Problems decreased by -37.49 in the drospirenone/ethinyl estradiol group and by -29.99 in the placebo group (adjusted mean difference -7.5, 95% confidence interval [CI] -11.2 to -3.8; P < .001 by rank analysis of covariance). Mood symptom scores were reduced by -19.2 and -15.3 in active-treatment and placebo groups, respectively (adjusted mean difference -3.9, 95% CI -5.84 to -2.01; P = .003); physical symptom scores were reduced by -10.7 and -8.6 in active-treatment and placebo groups, respectively (adjusted mean difference -2.1, 95% CI -3.3 to -0.95; P < .001); and behavioral symptom scores were reduced by -7.7 and -6.2 in active-treatment and placebo groups, respectively (adjusted mean difference -1.5, 95% CI -2.251 to -0.727; P < .001). Response, defined as a 50% decrease in daily symptom scores, occurred in 48% of the active-treatment group and 36% of the placebo group (relative risk 1.7, 95% CI 1.1 to 2.6; P = .015) and corresponds to a number-needed-to-treat of 8 patients. CONCLUSION A 24/4 regimen of drospirenone 3 mg and ethinyl estradiol 20 mug improves symptoms associated with premenstrual dysphoric disorder. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale University, New Haven, Connecticut 06510, USA.
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Archer DF, Thorneycroft IH, Foegh M, Hanes V, Glant MD, Bitterman P, Kempson RL. Long-term safety of drospirenone-estradiol for hormone therapy: a randomized, double-blind, multicenter trial. Menopause 2005; 12:716-27. [PMID: 16278615 DOI: 10.1097/01.gme.0000177318.24005.b1] [Citation(s) in RCA: 71] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this multicenter, double-blind, randomized, parallel-group study was to determine the effect of thirteen 28-day cycles of drospirenone combined with estradiol, compared with estradiol alone, on the endometrium of postmenopausal women. DESIGN Postmenopausal women not on hormone therapy but with an intact uterus were enrolled (N = 1,147); 1,142 were evaluated. Participants were randomly assigned to treatment with 1.0 mg of estradiol alone (E(2) monotherapy) or 1.0 mg of estradiol plus 0.5, 1.0, 2.0, or 3.0 mg of drospirenone (DRSP/E(2)). Endometrial biopsies were performed at baseline, at 7 months if indicated, and at study end in the 13th month. Safety was evaluated with peripheral blood samples for hematology, liver and renal function, and lipids, along with vital signs and interval medical evaluations. RESULTS When compared with estradiol alone, combinations of drospirenone and estradiol were effective in protecting against endometrial hyperplasia. The probability of hyperplasia was 0.060 (95% CI, 0.043-0.078) for the E(2) monotherapy group, 0.007 for the 2-mg DRSP/E(2) group, and nonsignificant for the remaining drospirenone/estradiol groups. Endometrial bleeding decreased in all treatment groups over time. The combination of drospirenone and E(2) relieved menopausal symptoms and resulted in improvements in health-related quality-of-life measures. There were no significant adverse events, and effects on triglycerides, total cholesterol, and high-density lipoprotein cholesterol were positive. CONCLUSIONS The use of drospirenone combined with estradiol provides protection against endometrial hyperplasia, reduces endometrial bleeding with time, and relieves menopausal symptoms. There were no safety issues and blood pressure was reduced in women with hypertension.
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Affiliation(s)
- David F Archer
- CONRAD Clinical Research Center, 601 Colley Avenue, Norfolk, VA 23507, USA.
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Meiser BM, Mueller M, Foegh M, Von Scheidt W, Reichart B. Short-term angiopeptin therapy and the incidence of graft vessel disease after heart transplantation. J Heart Lung Transplant 2002; 21:1264-73. [PMID: 12490271 DOI: 10.1016/s1053-2498(02)00460-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/27/2022] Open
Abstract
BACKGROUND Graft vessel disease, the major limitation for long-term success after heart transplantation, is triggered by injury to the graft vessel endothelium, resulting in the expression of adhesion molecules, the migration of leukocytes into the graft, and the release of growth factors. Angiopeptin, a stable analog of somatostatin, is a growth-hormone inhibitor with additional anti-proliferative effects. We evaluated angiopeptin for prevention of graft vasculopathy after cardiac transplantation in the first prospective, randomized, double-blind, clinical trial. METHODS Thirty-one patients received treatment with either angiopeptin (n = 13) or placebo (n = 18). Patients were randomized according to the presence of hypercholesterolemia, recipient cytomegalovirus-antibody status, and donor age. All patients received standard triple-drug immunosuppression. Angiopeptin 1.5 mg or placebo was given subcutaneously immediately before surgery and twice a day after transplantation from Day 1 to Day 14. Furthermore, 1.5 mg was added to each liter of cardioplegic solution, 1.5 mg was given intravenously during surgery, and another 3 mg was given during the first 6 post-operative hours. During the first post-operative year, angiopeptin 1.5 mg or placebo was added to each treatment for acute rejection (twice a day subcutaneously). Baseline angiography was performed within the first 4 post-operative weeks and annually thereafter. Twenty-three patients each underwent an additional intracoronary ultrasound. RESULTS One- and 4-year survival rates were comparable: 85% and 85% for the group receiving angiopeptin, and 89% and 78% for the placebo group, respectively. One patient in the control group died of myocardial infarction caused by graft vessel disease. Although the mean number of rejection and infection episodes was similar, the overall incidence of newly occurring graft vessel disease after 2 and 4 years was greater in the control cohort: 9% vs 38% after 2 years and 27% vs 44% after 4 years (p = 0.183, 0.448). Comparison of the results of intracoronary ultrasound performed in a sub-group of patients confirmed that trend: the modified Stanford score, the mean intimal thickness, and the mean intimal index were lower in the angiopeptin group. Again, because of the relatively small number of patients available for evaluation, the difference did not reach statistical significance. CONCLUSIONS Short-term peri-operative angiopeptin treatment along with additional injections during rejection episodes within the first year resulted in a marked decrease in graft vessel disease 2 and 4 years after heart transplantation. Based on our results, continuous, long-term application of slow-release angiopeptin could significantly decrease or even prevent graft vessel disease.
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Affiliation(s)
- Bruno M Meiser
- Department of Cardiac Surgery, University of Munich/Grosshadern Medical Center, 81366 Munich, Germany
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Freeman EW, Kroll R, Rapkin A, Pearlstein T, Brown C, Parsey K, Zhang P, Patel H, Foegh M. Evaluation of a unique oral contraceptive in the treatment of premenstrual dysphoric disorder. J Womens Health Gend Based Med 2001; 10:561-9. [PMID: 11559453 DOI: 10.1089/15246090152543148] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). This is the first trial of a unique oral contraceptive containing a combination of drospirenone (DRSP, 3 mg) and ethinyl estradiol (EE, 30 microg) for the treatment of PMDD. DRSP is a spironolactone-like progestin with antiandrogenic and antimineralocorticoid activity. Spironolactone has been shown to be beneficial in PMS, whereas oral contraceptives have shown conflicting results. In this double-blind, placebo-controlled trial, 82 women with PMDD (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. [DSM IV]) were randomized to receive DRSP/EE or placebo for three treatment cycles. The primary end point was change from baseline in luteal phase symptom scores as assessed on the Calendar of Premenstrual Experiences (COPE) scale. Patients treated with DRSP/EE showed a numerically greater change from baseline compared with those treated with placebo on each of the 22 COPE items and each of the 4 symptom factors. Between-group differences in symptom improvement reached statistical significance in factor 3 only (appetite, acne, and food cravings, p = 0.027). The secondary end points, Beck Depression Inventory (BDI) and Profile of Mood States (PMS), were consistent with the primary end point in that patients treated with the oral contraceptive showed a numerically greater improvement from baseline compared with those treated with placebo. The results of this study show a consistent trend in the reduction of symptoms that suggested a beneficial effect of DRSP/EE for the treatment of PMDD, despite limitations of the study design.
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Affiliation(s)
- E W Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, PA, USA
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19
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Grant MB, Wargovich TJ, Bush DM, Player DW, Caballero S, Foegh M, Spoerri PE. Expression of IGF-1, IGF-1 receptor and TGF-beta following balloon angioplasty in atherosclerotic and normal rabbit iliac arteries: an immunocytochemical study. Regul Pept 1999; 79:47-53. [PMID: 9930582 DOI: 10.1016/s0167-0115(98)00027-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Growth factors have been implicated in the pathogenesis of restenosis (myointimal hyperplasia after coronary interventions). In this study, we examined the expression of insulin-like growth factor-I (IGF-1), IGF-1 receptor, and transforming growth factor-beta (TGF-beta) in atherosclerotic and normal rabbit iliac arteries following overstretch balloon angioplasty of the iliac arteries to create a vascular lesion. Animals were sacrificed at 0, 3, 7, 15 and 42 days post angioplasty. The iliac arteries were processed for immunocytochemical localization of IGF-1, IGF-1 receptor and TGF-beta using colloidal gold and the data were quantitatively analyzed. IGF-1, IGF-1 receptor and TGF-beta immunoreactivity were all significantly increased in atherosclerotic arteries compared to control at all of the time points examined. Following balloon angioplasty, the levels of IGF-1 and IGF-1 receptor increased significantly in both control and even further in hypercholesterolemic vessels. In control vessels, the IGF-1 levels returned to preintervention levels, while in atherosclerotic vessels, the levels of IGF-1 and IGF-1 receptor remained elevated. In addition, TGF-beta levels in control vessels showed an initial rise in the first week following injury but then returned to baseline levels. In contrast, atherosclerotic vessels demonstrated a sustained expression of TGF-beta. Thus, IGF-1 and TGF-beta expression is different in normal vs. atherosclerotic vessels following vascular injury. The intensity of expression of IGF-1 and its receptor, which is not reduced at 42 days compared to 15 days following injury, support a role for IGF-1 in smooth muscle cell proliferation and migration. The sustained increase in TGF-beta could facilitate extracellular matrix (ECM) accumulation. Local vascular therapy that is directed towards modulating the effects of IGF-1 and TGF-beta could reduce restenosis.
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Affiliation(s)
- M B Grant
- Department of Medicine, College of Medicine, University of Florida, Gainesville 32610, USA.
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20
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Paul LC, Häyry P, Foegh M, Fellström B. Chronic rejection and graft arteriosclerosis: 4 years after the Alexis Carrel proposal on diagnostic criteria. Transplant Proc 1997; 29:2628-9. [PMID: 9290769 DOI: 10.1016/s0041-1345(97)00535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L C Paul
- Division of Nephrology, University of Toronto, St Michael's Hospital, ON, Canada
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21
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Hong MK, Kent KM, Tio FO, Foegh M, Kornowski R, Bramwell O, Cathapermal SS, Leon MB. Single-dose intramuscular administration of sustained-release Angiopeptin reduces neointimal hyperplasia in a porcine coronary in-stent restenosis model. Coron Artery Dis 1997; 8:101-4. [PMID: 9211050 DOI: 10.1097/00019501-199702000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In-stent restenosis results primarily from neointimal hyperplasia. In a previous study we showed that continuous subcutaneous Angiopeptin infusion for 1 week significantly reduces neointimal hyperplasia in a porcine coronary overstretch in-stent restenosis model. The present study evaluated the relative efficacy of immediate-release and sustained-release Angiopeptin in the same model. METHODS Thirty pigs (n = 10 in each group) were randomly assigned to three groups: controls receiving no Angiopeptin (Group 1); a sustained-release treatment group receiving one time intramuscular administration of 20 mg of Angiopeptin (Group 2); and a systemic treatment group receiving continuous Angiopeptin over a 1-week period via a subcutaneous osmotic pump (200 micrograms/kg total dose) (Group 3). One oversized Palmaz-Schatz stent (mean stent/artery = 1.25) was subsequently implanted in the left anterior descending coronary artery. The degree of neointimal reaction was evaluated 4 weeks later by angiography (maximal per cent diameter stenosis) and histology (maximal neointimal area corrected for injury score). RESULTS A trend towards a reduction in diameter stenosis was observed by angiography, despite a similar degree of injury (25 +/- 17% in Group 1, 13 +/- 8% in Group 2, and 14 +/- 9% in Group 3; P = 0.072 by ANOVA). Histology demonstrated that both Angiopeptin treatment strategies significantly reduced in-stent neointimal area compared with the control group (1.65 +/- 0.97 mm2 in Group 1 versus 0.93 +/- 0.41 mm2 in Group 2 versus 0.85 +/- 0.28 mm2 in Group 3; P = 0.016 by ANOVA). Measurement of plasma Angiopeptin levels revealed comparable levels in both treatment groups, which persisted for up to 2 weeks. CONCLUSIONS This study shows that single-dose intramuscular administration of sustained-release Angiopeptin reduces in-stent restenosis as effectively as the prolonged systemic treatment requiring a subcutaneous pump. Thus, a practical, effective, pharmacologic therapy for preventing in-stent restenosis may be available and should be evaluated in patients.
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Affiliation(s)
- M K Hong
- Department of Internal Medicine (Cardiology Division), Washington Hospital Center, Washington, District of Columbia, USA
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22
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Hong MK, Kent KM, Mehran R, Mintz GS, Tio FO, Foegh M, Wong SC, Cathapermal SS, Leon MB. Continuous subcutaneous angiopeptin treatment significantly reduces neointimal hyperplasia in a porcine coronary in-stent restenosis model. Circulation 1997; 95:449-54. [PMID: 9008463 DOI: 10.1161/01.cir.95.2.449] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In-stent restenosis results primarily from neointimal hyperplasia. This study evaluated the efficacy and the optimal mode of administration of angiopeptin, a somatostatin analogue with antiproliferative activity, in a porcine coronary in-stent restenosis model. METHODS AND RESULTS Forty pigs were randomly assigned to one of four groups (n = 10 per group): (1) controls receiving saline infusion at the site of stent implantation via a local delivery catheter, (2) local treatment group receiving one-time treatment (200 (micrograms angiopeptin) at the site of stent placement, (3) systemic treatment group receiving continuous angiopeptin over a 1-week period via a subcutaneous osmotic pump (200 micrograms/kg total dose) and (4) combined local and systemic treatment group. Then, one oversized Palmaz-Schatz stent (mean ratio of stent to artery diameters, 1.3:1) was implanted in the left anterior descending coronary artery. The degree of neointimal reaction was evaluated 4 weeks later by angiography (maximal percent diameter stenosis), intravascular ultrasound (total in-stent neointimal volume), and histology (maximal area stenosis). Systemic treatment produced the least neointimal hyperplasia and significantly reduced in-stent restenosis compared with the control group by all end points, despite similar degrees of injury. Angiography showed 25 +/- 17% versus 50 +/- 17% diameter stenosis in the systemic angiopeptin group versus the control group (P < .0001), intravascular ultrasound revealed 23 +/- 10 versus 58 +/- 27 mm3 neointimal volume in the systemic angiopeptin versus control group (P = .0002), and histology showed 41 +/- 16% versus 69 +/- 18% area stenosis (P = .0016) in the systemic angiopeptin versus control group. Plasma angiopeptin levels revealed rapid clearance (within 6 hours) after local therapy, whereas the levels persisted for up to 2 weeks in the systemic group. CONCLUSIONS This study shows that continuous subcutaneous treatment with angiopeptin after stent implantation significantly reduces in-stent restenosis by inhibiting neointimal hyperplasia.
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Affiliation(s)
- M K Hong
- Department of Internal Medicine (Cardiology Division) of the Washington (DC) Hospital Center, Washington, DC, USA
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Frystyk J, Skjaerbaek C, Alexander N, Emanuelsson H, Suryapranata H, Beyer H, Foegh M, Orskov H. Lanreotide reduces serum free and total insulin-like growth factor-I after angioplasty. Circulation 1996; 94:2465-71. [PMID: 8921789 DOI: 10.1161/01.cir.94.10.2465] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Several experiments point to a participating role of insulin-like growth factor-I (IGF-I) in the vascular events leading to restenosis after percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS We measured fasting serum total (extractable) IGF-I in 553 patients in a controlled clinical trial. Half of the patients received continuous subcutaneous infusion of the somatostatin analogue lanreotide from the day before (baseline) and for 4 days after PTCA. We also measured ultrafiltrated serum free IGF-I and IGF-II, total IGF-II, IGF-binding protein-1 (IGFBP-1), IGFBP-3, and insulin in a subgroup of 18 placebo-treated and 20 lanreotide-treated patients. Total IGF-I had decreased by 7% (P < .0001) 1 day after initiation of lanreotide infusion and stayed reduced, whereas no early changes occurred in placebo-treated patients. The same pattern was observed in the subgroup. Free IGF-I decreased significantly from baseline by 22% to 27% (P < .05) in lanreotide-treated patients and increased insignificantly by 10% to 30% (P = .054) in placebo-treated patients. IGFBP-1 increased (P < .05) in both groups postoperatively, but levels in lanreotide-treated patients exceeded (P < .05) those of placebo-treated patients. Lanreotide treatment resulted in minor reductions (P < .05) in free and total IGF-II and IGFBP-3, whereas insulin was unaltered. CONCLUSIONS Lanreotide administration acutely decreases circulating total and free IGF-I, the latter relatively more, and increases IGFBP-1. These alterations in the IGF system may participate in the improvement of the long-term outcome after PTCA noted with lanreotide treatment.
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Affiliation(s)
- J Frystyk
- Institute of Experimental Clinical Research, Aarhus (Denmark) University Hospital, Denmark
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Eriksen UH, Amtorp O, Bagger JP, Emanuelsson H, Foegh M, Saunamäki KI, Schaeffer M, Thayssen P, Orskov H, Kuntz RE, Popma JJ. [Angiopeptin versus placebo for reductin of restenosis after PTCA treatment. A randomized, double-blind study]. Ugeskr Laeger 1996; 158:6605-6608. [PMID: 8966826] [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: 05/22/2023]
Abstract
Angiopeptin, a somatostatin analogue, inhibits intimal hyperplasia after (percutaneous transluminal coronary angioplasty) (PTCA) in several animal models. This pilot study sought to determine the effect of subcutaneous infusion of angiopeptin on clinical events and restenosis in patients undergoing successful PTCA. One hundred and twelve patients were randomized to receive continuous subcutaneous angiopeptin (750 micrograms/day) or placebo infusion from the day before PTCA and for the following four days in a double-blind study. Eighty patients had a successful PTCA, and 75 of these patients with 94 lesions underwent angiography 6 +/- 2 months after PTCA. All 112 patients underwent clinical follow-up at 12 months. The 12-month event rate (death, myocardial infarction, coronary artery bypass grafting and re-PTCA) was reduced from 34% to 25% (p = 0.30) by angiopeptin by intention to treat analysis. Restenosis (> or = 50% diameter stenosis) was significantly reduced in lesions treated with angiopeptin (12% vs 40%; p = 0.003). Late lumen loss was also significantly reduced after angiopeptin treatment (0.12 +/- 0.46 mm vs 0.52 +/- 0.64 mm; p = 0.003). In conclusion, continuous subcutaneous angiopeptin infusion for five days tended to decrease clinical events and restenosis after PTCA.
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Affiliation(s)
- U H Eriksen
- Kardiologisk afdeling B., Arhus Universitetshospital, Skejby Sygehus
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Eriksen UH, Amtorp O, Bagger JP, Emanuelsson H, Foegh M, Henningsen P, Saunamäki K, Schaeffer M, Thayssen P, Orskov H. Randomized double-blind Scandinavian trial of angiopeptin versus placebo for the prevention of clinical events and restenosis after coronary balloon angioplasty. Am Heart J 1995; 130:1-8. [PMID: 7611096 DOI: 10.1016/0002-8703(95)90227-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Angiopeptin, a somatostatin analogue, inhibits intimal hyperplasia after percutaneous transluminal coronary artery balloon angioplasty (PTCA) in several animal models. This pilot study sought to determine the effect of subcutaneous infusion of angiopeptin on clinical events and restenosis in patients undergoing successful PTCA. One hundred twelve patients were randomized to receive continuous subcutaneous angiopeptin (750 micrograms/day) or placebo infusion from the day before PTCA and for the following 4 days in a double-blind study. An additional subcutaneous injection of 375 micrograms of angiopeptin or saline was given immediately before PTCA. Eighty patients had a successful PTCA, and 75 of these patients with 94 lesions underwent angiography 6 +/- 2 months after PTCA. All 112 patients underwent a 12-month clinical follow-up examination. Age, sex, smoking, diabetes, hypertension, hyperlipidemia, and morphologic features of stenosis were similar in both groups. The hierarchical 12-month event rate (death, myocardial infarction, coronary artery bypass grafting, and repeated PTCA) was reduced from 34% to 25% (p = 0.30) by angiopeptin by intention-to-treat analysis. Restenosis (> or = 50% diameter stenosis) was significantly reduced in lesions treated with angiopeptin (12% vs 40%; p = 0.003). Late lumen loss also was significantly reduced after angiopeptin treatment (0.12 +/- 0.46 mm vs 0.52 +/- 0.64 mm; p = 0.003). In conclusion, continuous subcutaneous angiopeptin infusion for 5 days tended to decrease clinical events and restenosis after PTCA.
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Affiliation(s)
- U H Eriksen
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
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26
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Foegh M, Rego A, Lou H, Katz N, Ramwell P. Gender effects on graft myointimal hyperplasia. Transplant Proc 1995; 27:2070-2. [PMID: 7792889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Foegh
- Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA
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Emanuelsson H, Beatt KJ, Bagger JP, Balcon R, Heikkilä J, Piessens J, Schaeffer M, Suryapranata H, Foegh M. Long-term effects of angiopeptin treatment in coronary angioplasty. Reduction of clinical events but not angiographic restenosis. European Angiopeptin Study Group. Circulation 1995; 91:1689-96. [PMID: 7882475 DOI: 10.1161/01.cir.91.6.1689] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Angiopeptin is a cyclic octapeptide analogue of somatostatin that has been shown to limit myointimal thickening of arteries in balloon injury models and to restore the vasodilating response to acetylcholine. A randomized, double-blind placebo controlled trial was conducted to assess the effect of angiopeptin in restenosis prevention after percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS Patients received a continuous infusion of either placebo or angiopeptin subcutaneously 6 to 24 hours before PTCA and for 4 days after PTCA (3 mg per 24 hours before PTCA followed by 6 mg per 24 hours after PTCA and for the remaining period). A 1.5-mg bolus dose of placebo or angiopeptin was given at PTCA. Aspirin (acetylsalicylic acid, 150 mg/d) was administered throughout the study period. Coronary angiograms obtained before and after PTCA and at 6-month follow-up were subjected to computerized quantification. Clinical follow-up was performed after 12 months. Primary clinical end points were death, myocardial infarction, coronary artery bypass surgery, or repeat PTCA. In total, 553 patients with 742 lesions were randomized. Clinical follow-up was available for all 553 patients. Angiopeptin decreased the clinical events during 12 months of follow-up from 36.4% in the placebo-treated group to 28.4% in the angiopeptin-treated patients (P = .046). Quantitative angiography after PTCA and at follow-up was available in 423 of 455 patients who underwent successful PTCA. The minimal lumen diameter at follow-up was 1.52 +/- 0.64 mm in the angiopeptin-treated group compared with 1.52 +/- 0.64 mm in the placebo-treated patients (P = .96). The late losses were 0.31 +/- 0.59 and 0.30 +/- 0.62 mm (P = .81) and the restenosis rates (> 50% diameter stenosis at follow-up) were 36% and 37% (P = .85) in the angiopeptin- and placebo-treated groups, respectively. CONCLUSIONS In this study, angiopeptin significantly decreased the incidence of clinical events, principally the rate of revascularization procedures. In contrast, no significant effect was seen on angiographic variables.
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De Scheerder IK, Wilczek KL, Van Dorpe J, Desmet W, Verbeken E, Cathapermal S, Schacht E, Piessens JH, Foegh M. 772–6 Anglopeptin Loaded Stents Inhibit the Neointimal Reaction Induced by Polymer Coated Stents Implanted In Porcine Coronary Arteries. J Am Coll Cardiol 1995. [DOI: 10.1016/0735-1097(95)92648-o] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lou H, Kodama T, Katz N, Foegh M. 936-83 Chronic Estradiol Treatment of Rabbits with Cardiac Allografts Attenuates Graft Vascular Proliferation Induced by Insulin-like Growth Factor-I (IGF-I) and Interleukin-6 (IL-6). J Am Coll Cardiol 1995. [DOI: 10.1016/0735-1097(95)92104-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wahlers T, Mügge A, Oppelt P, Heublein B, Fieguth HG, Jurmann MJ, Uthoff K, Haverich A, Albes JM, Foegh M. Preventive treatment of coronary vasculopathy in heart transplantation by inhibition of smooth muscle cell proliferation with angiopeptin. J Heart Lung Transplant 1995; 14:143-50. [PMID: 7727463] [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: 01/26/2023] Open
Abstract
BACKGROUND The underlying mechanism of accelerated coronary vasculopathy in cardiac allografts still remains unclear. Our hypothesis was that inhibition of smooth muscle cell proliferation with the somatostatine analogue Angiopeptin may reduce vasculopathy. METHODS Fifty-four patients received Angiopeptin injections (1500 micrograms x three times daily subcutaneously) for 21 days after the operation and three additional injections with every rejection treatment. Angiography was performed yearly, and data were compared with a matched historic control group. RESULTS Actuarial survival was 85% at 1 year and 80% at 2 years, comparable with our results in general (80%/77%). Forty-six long-term survivors could be followed by coronary angiography. At 1 year, vasculopathy was assessed in nine patients (17%). Of the 18 patients investigated at 2 years thus far, an additional three patients were found to have vasculopathy. In the control group vasculopathy was comparable, being 13% after 1 year and 20% after 2 years. A significantly lower incidence of rejections and lower creatinine values were found in the study group within the entire observation period (p < 0.05). CONCLUSIONS We conclude that Angiopeptin treatment appears to be safe without significant side effects; it may reduce the number of acute rejections, at least during the first year after heart transplantation. However, the results of the 2-year follow-up in the remaining patients would have to be included in assessing the effect of Angiopeptin. Long-term follow-up will be necessary to decide whether Angiopeptin will be helpful in reducing the incidence of transplant vasculopathy.
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Affiliation(s)
- T Wahlers
- Department of Cardiothoracic Surgery, Hannover Medical School, Germany
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Wolthers T, Grøfte T, Orskov H, Hamberg O, Foegh M, Vilstrup H. Effect of lanreotide, a somatostatin analogue, on urea synthesis in normal man. Clin Nutr 1994; 13:105-10. [PMID: 16843368 DOI: 10.1016/0261-5614(94)90068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/1993] [Accepted: 10/11/1993] [Indexed: 10/26/2022]
Abstract
The aim was to investigate the effect of lanreotide (Angiopeptin) on urea synthesis. Lanreotide is a somatostatin analogue used in therapy trials of certain cancers. Cancer patients are often protein catabolic, thus the effect of lanreotide on whole body protein metabolism is of importance. We investigated the effect of lanreotide by measuring urea nitrogen synthesis rate (UNSR) and blood alpha-amino nitrogen levels before, during and after a 30 min iv infusion of 25 g of an electrolyte-free amino acid solution. 6 healthy male subjects were studied following, i) placebo (saline), ii) lanreotide 5 mug/kg, and iii) lanreotide 80 mug/kg. Lanreotide decreased urea nitrogen synthesis rate (mmol/h) during amino acid infusion significantly compared to saline, independent of dose of lanreotide (max +/- SE of urea nitrogen synthesis rate measurements in each study: 117 +/- 8 mmol/h (saline), 85 +/- 10 mmol/h (high dose) and 85 +/- 12 mmol/h (low dose)). This occurred in spite of significantly higher plasma alpha-amino nitrogen following lanreotide (peak +/- SE of alpha-amino nitrogen level in each study: 3.7 +/- 0.1 mmol/l placebo versus 4.8 +/- 0.2 mmol/l low dose and 4.7 +/- 0.4 mmol/l high dose (p < 0.01). We conclude that a single dose of lanreotide decreases whole body urea nitrogen synthesis rate thereby conserving body protein. The results indicate that long term lanreotide therapy may not lead to further protein catabolism in cancer patients.
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Affiliation(s)
- T Wolthers
- Department of medicine M, Aarhus University Hospital, Denmark
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Howell M, Orskov H, Frystyk J, Flyvbjerg A, Grønbaek H, Foegh M. Lanreotide, a somatostatin analogue, reduces insulin-like growth factor I accumulation in proliferating aortic tissue in rabbits in vivo. A preliminary study. Eur J Endocrinol 1994; 130:422-5. [PMID: 8162175 DOI: 10.1530/eje.0.1300422] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Coronary artery restenosis following percutaneous transluminal angioplasty occurs with a very high incidence. Major efforts have been aimed at revealing the mechanisms and at developing therapies that might prevent or delay the myointimal proliferation. Most clinical trials have been unsuccessful. Endothelial denudation was induced in 30 rabbits using balloon catheterization of iliac arteries and aorta. Immunoreactive insulin-like growth factor I (IGF-I) was measured in arterial tissue samples obtained 1, 2 and 4 days postoperatively using a double extraction procedure to remove IGF-I binding proteins. Half of the animals were treated with subcutaneous injections of lanreotide, 10 micrograms/kg twice daily, and the other half served as controls. In the latter group, arterial IGF-I was unaltered from baseline at day 1 and increased by 300 and 400% at days 2 and 4. No increase was observed in the rabbits treated with lanreotide. The results indicate that initial local accumulation of IGF-I may be one of the mechanisms involved in myointimal proliferation after experimental arterial injury. The reduction of local IGF-I accumulation by lanreotide may be involved in the previously observed reduction in myointimal proliferation.
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Affiliation(s)
- M Howell
- Department of Surgery, Georgetown University, Washington
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Wolthers T, Grøfte T, Flyvbjerg A, Frystyk J, Vilstrup H, Orskov H, Foegh M. Dose-dependent stimulation of insulin-like growth factor-binding protein-1 by lanreotide, a somatostatin analog. J Clin Endocrinol Metab 1994; 78:141-4. [PMID: 7507120 DOI: 10.1210/jcem.78.1.7507120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
It was recently reported that octreotide, besides its many, almost obligatory, inhibitory actions, stimulates the release of insulin-like growth factor-binding protein-1. The present study sought to exclude the possibility that the inescapable preceding somatostatin analog-induced reduction in serum insulin participated in the observed effect. We, therefore, administered sc two clinically relevant doses (5 and 80 micrograms/kg) of lanreotide, another somatostatin octapeptide analog, which induced identical 60% initial suppressions of serum insulin. In spite of this, clear dose-dependent increases in insulin-like growth factor-binding protein-1 were observed, starting between 1-2 h after administration of lanreotide, and levels were still elevated several-fold 5 h after administration of 80 micrograms/kg lanreotide. In addition, we found that infusion of amino acids had no discernible effect on binding protein-1 release. The changes found in immunoreactive binding protein-1 were confirmed employing Western ligand blotting. The data indicate that the lanreotide-induced increase in binding protein-1 levels in serum is not due to the changes in circulating insulin. The magnitude and duration of the increase raise the possibility that the stimulation may have clinically relevant implications in somatostatin analog treatment.
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Affiliation(s)
- T Wolthers
- Institute of Experimental Clinical Research, University Hospital, Kommunehospitalet, Aarhus C, Denmark
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Djurup R, Chiabrando C, Jörres A, Fanelli R, Foegh M, Soerensen HU, Joergensen PN. Rapid, direct enzyme immunoassay of 11-keto-thromboxane B2 in urine, validated by immunoaffinity/gas chromatography-mass spectrometry. Clin Chem 1993. [DOI: 10.1093/clinchem/39.12.2470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
We have developed a direct enzyme immunoassay (EIA) for quantifying immunoreactive 11-keto-thromboxane B2 (iKTXB) in unprocessed human urine. Cross-reactivity with other thromboxane metabolites and prostanoids was negligible. Analytical recovery of 11-keto-TXB2 in urine specimens was 97.4% to 99.8%. Total imprecision for two clinical specimens was 8.5% and 12.2%. Intake of acetylsalicylic acid decreased the measured concentration of iKTXB. Cardiopulmonary bypass, a procedure known to activate platelets, increased the mean excretion rate of iKTXB 10-fold. Simultaneous gas chromatography-mass spectrometry analysis of 11-keto-TXB2 and 11-keto-2,3-dinor TXB2 in urine specimens (n = 17) from healthy subjects indicated that urinary iKTXB concentrations measured by EIA represented a sum of the two 11-keto metabolites. We conclude that the direct EIA is sufficiently sensitive, rapid, simple, and specific to allow screening for alterations in thromboxane biosynthesis in patients.
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Affiliation(s)
- R Djurup
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - C Chiabrando
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - A Jörres
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - R Fanelli
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - M Foegh
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - H U Soerensen
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
| | - P N Joergensen
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
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Djurup R, Chiabrando C, Jörres A, Fanelli R, Foegh M, Soerensen HU, Joergensen PN. Rapid, direct enzyme immunoassay of 11-keto-thromboxane B2 in urine, validated by immunoaffinity/gas chromatography-mass spectrometry. Clin Chem 1993; 39:2470-7. [PMID: 8252718] [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: 01/29/2023]
Abstract
We have developed a direct enzyme immunoassay (EIA) for quantifying immunoreactive 11-keto-thromboxane B2 (iKTXB) in unprocessed human urine. Cross-reactivity with other thromboxane metabolites and prostanoids was negligible. Analytical recovery of 11-keto-TXB2 in urine specimens was 97.4% to 99.8%. Total imprecision for two clinical specimens was 8.5% and 12.2%. Intake of acetylsalicylic acid decreased the measured concentration of iKTXB. Cardiopulmonary bypass, a procedure known to activate platelets, increased the mean excretion rate of iKTXB 10-fold. Simultaneous gas chromatography-mass spectrometry analysis of 11-keto-TXB2 and 11-keto-2,3-dinor TXB2 in urine specimens (n = 17) from healthy subjects indicated that urinary iKTXB concentrations measured by EIA represented a sum of the two 11-keto metabolites. We conclude that the direct EIA is sufficiently sensitive, rapid, simple, and specific to allow screening for alterations in thromboxane biosynthesis in patients.
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Affiliation(s)
- R Djurup
- Novo Nordisk, Immunochemical Department, Bagsvaerd, Denmark
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Santoian ED, Schneider JE, Gravanis MB, Foegh M, Tarazona N, Cipolla GD, King SB. Angiopeptin inhibits intimal hyperplasia after angioplasty in porcine coronary arteries. Circulation 1993; 88:11-4. [PMID: 8100489 DOI: 10.1161/01.cir.88.1.11] [Citation(s) in RCA: 78] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Restenosis is mediated by uncontrolled neointimal growth at the site of coronary angioplasty. Angiopeptin is an octapeptide analogue of somatostatin that has been shown to decrease the experimental intimal hyperplasia associated with vascular injury in rats and rabbits. The study purpose was to determine if angiopeptin inhibits the development of intimal hyperplasia in normolipemic swine coronary arteries after overstretch-balloon injury. METHODS AND RESULTS Overstretch-balloon injury was performed in normolipemic swine coronary arteries using a 3.5-mm angioplasty balloon. Treated animals received angiopeptin (50 micrograms/kg) 1 hour before and at the time of balloon injury. Angiopeptin was administered at 100 (micrograms/kg)/day SQ in two divided doses for 14 days. Animals were killed at 14 and 28 days (2 weeks after cessation of angiopeptin) after balloon injury. Treatment animals were compared with control animals receiving balloon injury alone. Angiopeptin significantly limited the experimental intimal hyperplasia estimated by the maximal intimal thickness and residual lumen (lumen area/lumen area+intimal area) compared with controls. CONCLUSIONS Angiopeptin inhibits the development of intimal hyperplasia in swine coronary arteries after balloon injury. The beneficial effect was detectable 2 weeks after cessation of angiopeptin therapy.
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Affiliation(s)
- E D Santoian
- Andreas Gruentzig Cardiovascular Center Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, Ga
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Orskov H, Flyvbjerg A, Frystyk J, Grønbaek H, Foegh M, Harris AG. IGF-1 and acute renal hypertrophy: inhibition by somatostatin analogues. Transplant Proc 1993; 25:2061-2. [PMID: 8097067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- H Orskov
- Institute of Experimental Clinical Research, University of Aarhus, Denmark
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Paul LC, Hayry P, Foegh M, Dennis MJ, Mihatsch MJ, Larsson E, Fellström B. Diagnostic criteria for chronic rejection/accelerated graft atherosclerosis in heart and kidney transplants: joint proposal from the Fourth Alexis Carrel Conference on Chronic Rejection and Accelerated Arteriosclerosis in Transplanted Organs. Transplant Proc 1993; 25:2022-3. [PMID: 8470261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- L C Paul
- Division of Nephrology, Foothills Hospital, Calgary, Alberta, Canada
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Asotra S, Foegh M, Conte JV, Cai BR, Ramwell PW. Inhibition of 3H-thymidine incorporation by angiopeptin in the aorta of rabbits after balloon angioplasty. Transplant Proc 1989; 21:3695-6. [PMID: 2569778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S Asotra
- Department of Physiology, Georgetown University Medical Center, Washington, DC 20007
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Foegh M. Prostaglandins, leukotrienes, and the immune response. Trends Pharmacol Sci 1989. [DOI: 10.1016/0165-6147(89)90070-9] [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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Zhao Y, Conte J, Cai B, Kagan E, Katz N, Foegh M. Feasibility of serial fine needle aspiration biopsies to monitor dog single lung allografts. Transplant Proc 1989; 21:3653-4. [PMID: 2669274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Y Zhao
- Department of Surgery, Georgetown University Medical Center, Washington DC 20007
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Ramwell PW, Myers A, Foegh M. Effects of 17 beta-estradiol in cardiovascular models. Postgrad Med 1989; Spec No:74-7; discussion 89-90. [PMID: 2657700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P W Ramwell
- Department of Physiology, Georgetown University Medical Center, Washington, DC
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Barter J, Marlow D, Kamath R, Harbert J, Torrisi J, Foegh M, Barnes W, Newsome J, Delgado G. Lack of protective effect of thromboxane A2 synthetase inhibitor (CGS-13080) on radiated canine intestine. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)90937-2] [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: 11/28/2022]
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Abstract
The routine availability of nucleated human cells for experimental use in limited in the absence of venipuncture. In this paper we have demonstrated that macrophages may be harvested routinely from the waste dialysis bags of patients undergoing continuous ambulatory peritoneal dialysis. These cells were identified as macrophages by morphology, adherence, phagocytosis, chemotaxis, non-specific esterase staining and peroxidase staining. Macrophages from patients with end-stage renal disease produced arachidonate cyclo-oxygenase products in a pattern similar to that of ascites macrophages obtained from patients with normal kidney function. Arachidonate metabolism was shown to be manipulatable. Thus, indomethacin blocked synthesis of cyclooxygenase products, and OKY-1581, a specific thromboxane synthase inhibitor, increased the release of prostaglandin E2 and prostacyclin, measured as its stable breakdown product 6-keto-prostaglandin F1, whereas the thromboxane B2 synthesis was effectively inhibited.
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Abstract
In a series of 18 experiments on long-term myocardial preservation we evaluated whether vasoactive substances like thromboxane and prostacyclin are associated with the secondary increase in coronary resistance during preservation perfusion of the canine heart. In a control group (n = 12) and in a group treated with a specific thromboxane synthetase inhibitor (OKY 1581) coronary resistance was measured at 10 and 30 min, and at 1, 4, and 24 hr. At the same time intervals thromboxane A2 and prostacyclin (PGI2) production were determined as TXB2 and 6-keto PGF1 alpha, respectively. After OKY 1581 treatment no increase in TXB2 occurred and no secondary increase in coronary resistance was observed, while in the control group both TXB2 levels and resistance increased (P less than 0.01); 6-keto PGF1 alpha levels showed the same increase in control and in treated hearts. From this study it is concluded that during 24-hr myocardial preservation the characteristic secondary increase in coronary resistance is related to thromboxane production in the heart and is prevented by inhibition of thromboxane synthetase.
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Abstract
Macrophages were isolated from the dialysis fluid of patients undergoing continuous ambulatory peritoneal dialysis and separated by gradient centrifugation and purification on 50% Percoll. The cells were prelabeled with [14C]arachidonic acid for 1.5 h. The labeled cells were then incubated with calcium ionophore A23187 (1 microM), serum-treated zymosan (200 micrograms/ml), and a lipoxygenase inhibitor, nordihydroguairetic acid (1 X 10(-5) M). The arachidonate metabolites in the medium were separated on Sep-Pak columns, and finally purified by reverse-phase high-pressure liquid chromatography (HPLC). The labeled products co-chromatographed with authentic leukotriene B4 and leukotriene C4 standards. Serum-treated zymosan and A23187 significantly stimulated and nordihydroguairetic acid significantly inhibited leukotriene synthesis. Leukotriene D4 was not detected, which suggests that these cells contain low gamma-glutamyltranspeptidase or high dipeptidase activity. These results establish, for the first time, that human peritoneal macrophages synthesize the lipoxygenase products, leukotriene B4 and leukotriene C4.
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Pedersen H, Foegh M. Male contraception: the effect of d-norgestrel and testosterone enanthate on spermatogenesis--ultrastructural characteristics. Contracept Deliv Syst 1983; 4:67-70. [PMID: 12264719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Electron microscopy was performed on testicular biopsies from men during a contraceptive regimen with d-norgestrel and testosterone enanthate. There was a considerable reduction of spermatogenesis, the seminiferous tubules being lined with a low epithelium of early spermatogenetic cells and only few late stages and spermatozoa. At the ultrastructural level, no qualitative changes could be observed in any of the tubular cells, a fact that seems to be of significance in contraception where any possible change should be entirely reversible.
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Abstract
The present study examined the effect of leukotrienes C4 and D4, the products of the 5'lipoxygenase pathway on prostaglandins and thromboxane release from rat peritoneal macrophages. Incubation of rat peritoneal macrophages with leukotrienes C4 and D4 enhanced the release of prostaglandin E2 (PGE2), 6-keto PGF1 alpha and thromboxane B2 (TxB2) in a dose-dependent manner. The increase of PGE2 was more pronounced than that of 6-keto-PGF1 alpha and TxB2. Lipopolysaccharide, a known stimulator of these cells elicited a similar pattern of increase of the arachidonate metabolites assayed. These results suggest that leukotrienes C4 and D4 are potential activators of macrophages. Since leukotrienes C4 and D4 are produced by these cells, it is suggested that endogenous leukotrienes may be involved in activation of macrophages.
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