Validation of the Expressions of Moral Injury Scale‐Military version‐Short Form

Military personnel may encounter morally injurious events that lead to emotional, social, and spiritual suffering that transcend and/or overlap with mental health diagnoses (e.g., post‐traumatic stress disorder [PTSD]). Advancement of scientific research and potential clinical innovation for moral injury (MI) requires a diversity of measurement approaches. Drawing on results from the bifactor model in Currier et al.'s (2017) psychometric evaluation of the Expressions of Moral Injury Scale‐Military version (EMIS‐M), this study validated a four‐item short form of the instrument with two samples of veterans with a history of war‐zone service. Namely, despite the reduced number of items, the EMIS‐M‐Short Form (SF) yielded favourable internal consistency and comparable levels of convergent validity with theoretically related constructs (e.g., PTSD and struggles with morality and ultimate meaning) as the full‐length version. Notwithstanding the possible utility of distinguishing between self‐ and other‐directed forms of MI, factor analytic results further revealed that the EMIS‐M‐SF was best conceptualized with a unidimensional factorial model that might allow for a general assessment of MI‐related outcomes. Overall, these initial results suggest that the EMIS‐M‐SF may hold promise as a short, reliable, and valid assessment of overall outcomes related to a possible MI.     

Application of Absorption Modeling in Rational Design of Drug Product Under Quality-by-Design Paradigm

Physiologically based absorption models can be an important tool in understanding product performance and hence implementation of Quality by Design (QbD) in drug product development. In this report, we show several case studies to demonstrate the potential application of absorption modeling in rational design of drug product under the QbD paradigm. The examples include application of absorption modeling—(1) prior to first-in-human studies to guide development of a formulation with minimal sensitivity to higher gastric pH and hence reduced interaction when co-administered with PPIs and/or H2RAs, (2) design of a controlled release formulation with optimal release rate to meet trough plasma concentrations and enable QD dosing, (3) understanding the impact of API particle size distribution on tablet bioavailability and guide formulation design in late-stage development, (4) assess impact of API phase change on product performance to guide specification setting, and (5) investigate the effect of dissolution rate changes on formulation bioperformance and enable appropriate specification setting. These case studies are meant to highlight the utility of physiologically based absorption modeling in gaining a thorough understanding of the product performance and the critical factors impacting performance to drive design of a robust drug product that would deliver the optimal benefit to the patients.KEY WORDS: absorption modeling, PBPK, pharmacokinetics, Quality by Design (QbD), quality target product profile (QTPP)     

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

BACKGROUNDHepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases, which may signal pathologic hepatic tissue reformation. AIMTo investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODSThis is a single-center, prospective, randomized controlled trial conducted at the 4^th Department of Surgery of the Medical School of Aristotle University of Thessaloniki, between August 2016 and December 2017. Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning (by replacement of propofol with desflurane, administered 30 min before induction of ischemia) or the control group for standard intravenous propofol. The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion. The secondary endpoints of neutrophil infiltration, coagulation profile, activity of antithrombin III (AT III), protein C (PC), protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTSThe desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2, significantly decreased levels of matrix metalloproteinases 2 and 9, decreased neutrophil infiltration, and less profound changes in the coagulation profile.  During the 5-d postoperative period, all patients showed significantly decreased activity of AT III, PC and protein S (vs baseline values, P < 0.05). The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5 (P < 0.05), showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group. Compared to the control group, the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days (P < 0.005) and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3 (P < 0.05).   Total length of stay was significantly less in the desflurane group (P = 0.009).CONCLUSIONDesflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.     

Food Effect Projections via Physiologically Based Pharmacokinetic Modeling: Predictive Case Studies

Food can alter the absorption of orally administered drugs. Biopharmaceutics physiologically based pharmacokinetic (PBPK) modeling offers the possibility to simulate a compound's pharmacokinetics under fasted or fed states. To advance the utility of PBPK modeling, with a view to regulatory impact, we have pooled our experience across 4 pharmaceutical companies to propose a general multistep PBPK workflow leveraging pre-existing clinical data for immediate-release formulations of Biopharmaceutics Classification System I and II compounds. With this strategy, we wish to promote pragmatic PBPK approaches for compounds where absorption is well understood, that is, compounds with moderate-to-high permeability that are not substrates for uptake transporters. Five case studies demonstrate how food effect can be well predicted using appropriately established and validated models. The case studies integrate solubility and dissolution data for initial model development and apply a “middle-out” validation with clinical data in one prandial state. Then, whenever possible, a validation against both fasted and fed state data is recommended before application of the models prospectively for to-be-marketed formulations. Thus, when combined with limited clinical data, PBPK models could be used to simulate outcomes for new doses, formulations, or active pharmaceutical ingredient forms, in lieu of a clinical food-effect study.     

[Cu(POP)(N^S)][PF6] and [Cu(xantphos)(N^S)][PF6] compounds with 2-(thiophen-2-yl)pyridines

A series of [Cu(POP)(N^S)][PF₆] and [Cu(xantphos)(N^S)][PF₆] compounds (POP = bis(2-(diphenylphosphino)phenyl)ether, xantphos = 4,5-bis(diphenylphosphino)-9,9-dimethylxanthene) in which the N^S ligand is a 2-(thiophen-2-yl)pyridine (1), 2-(thiophen-2-yl)-6-methylpyridine (2), 2-(5-methylthiophen-2-yl)pyridine (3) or 2-(5-methylthiophen-2-yl)-6-methylpyridine (4) have been prepared and characterized in solution and the solid state. Single crystal structures of [Cu(POP)(1)][PF₆], [Cu(xantphos)(1)][PF₆], [Cu(xantphos)(2)][PF₆], [Cu(POP)(3)][PF₆]·CH₂Cl₂, and [Cu(xantphos)(4)][PF₆] confirm chelating N^S and P^P ligands, and distorted tetrahedral copper(i) centres. There is close cation⋯anion association, particularly in [Cu(xantphos)(1)][PF₆]. Although the compounds are stable over days in CH₂Cl₂ solution, they are susceptible to the effects of competing ligands such as chloride ion and MeCN. Analysis of the NMR spectroscopic data of a solution of [Cu(POP)(3)][PF₆] with added Cl⁻, gives a K_d value of 0.14 ± 0.03 mM, indicative of ion-pairing. [Cu(POP)(N^S)][PF₆] and [Cu(xantphos)(N^S)][PF₆] exhibit quasi-reversible or irreversible Cu⁺/Cu²⁺ oxidations. They are blue emitters in solution, and the presence of the 5-methyl group in the thiophene ring in 3 and 4 leads to a red-shift in the emission. The highest photoluminescence quantum yields are for [Cu(POP)(2)][PF₆] (30.8%) and [Cu(POP)(4)][PF₆] (33.2%), both of which have a 6-methyl-substituted pyridine ring in the N^S ligand. Excited-state lifetimes are <5 ns. On going from solution to powder samples, red-shifts of 133 to 163 nm are observed leading to yellow emitters. The brightest emitter, [Cu(xantphos)(1)][PF₆], was tested in a LEC device but showed poor electroluminescence and poor charge transporting characteristics.

[Cu(P^P)(N^S)][PF₆] with N^S = 2-(thiophen-2-yl)pyridines show close cation⋯anion association in the solid-state; complex cation association with Cl⁻ occurs in solution. The compounds are blue-emitters in solution with a red-shift of the emission on going to the solid.     

Increased transduction of human intestinal epithelial cells by adenoviral vectors in inflammatory bowel disease

BACKGROUND: Delivery of genes encoding anti-inflammatory proteins has been proposed as a strategy for the treatment of inflammatory bowel disease (IBD). The goal of this study was to assess the ability of a standard adenoviral vector to transfect epithelial cells in intestinal explants from patients with IBD compared with controls. METHODS: Endoscopic colon biopsies obtained from patients with no history of IBD and endoscopically normal colon (n = 4), patients with a history of ulcerative colitis (UC; n = 5), and patients with a history of Crohn's disease (CD; n = 3) were placed in explant culture and exposed to an adenoviral vector carrying the nuclear targeted beta-galactosidase reporter gene. RESULTS: X-Gal staining showed that the total number of transduced cells per square millimeter was greater in UC explants than in controls (mean, 11.3 versus 0.9 blue nuclei/mm, respectively; P < 0.02) and that the frequency of epithelial cell transduction was greater in UC explants than in controls (86% versus 47% of explants, respectively; P = 0.01). Transduction of mature columnar surface epithelial cells occurred exclusively in UC and CD explants and was not seen in controls. Attenuated epithelial cells at sites of tissue damage or ulceration showed increased transduction compared with mature columnar epithelial cells (62% versus 19% of occurrences, respectively; P < 0.0001). CONCLUSIONS: We conclude that intestinal epithelial cells from IBD patients are more readily transfected by standard adenoviral vectors than are those from control patients. These results suggest that targeting genes to inflamed intestine through the luminal route may be possible.