新一代醛固酮拮抗剂依普利酮

目的：介绍新一代选择性醛固酮拮抗剂依普利酮在心血管疾病中的应用。方法：通过查阅国内外文献，进行分析、归纳和综述。结果：醛固酮增高与高血压和充血性心力衰竭等心血管疾病有关，醛固酮拮抗剂依普利酮用于治疗高血压病和充血性心力衰竭。结论：该药物具有重要的临床意义，值得临床医师关注和重视。     

醛固酮阻断剂依普利酮在心血管疾病中的作用

肾素-血管紧张素-醛固酮系统过度激活及高醛固酮血症对心血管系统均有损伤作用。血管紧张素转化酶(ACE)抑制剂和血管紧张素受体阻断剂(ARB)已被证实可有效降低血压和保护靶器官，减少心力衰竭的发病率和死亡率；但长期使用ACE抑制剂或ARB治疗后，血醛固酮浓度又会回到基线水平，即所谓“醛固酮逃逸”，因此降低了这些药物进一步的疗效。醛固酮受体拮抗剂螺内酯对心血管系统有显著的保护作用，但它的性激素相关副作用限制了其应用。新一代选择性醛固酮受体拮抗剂依普利酮为心血管疾病的治疗开辟了新的道路。     

药品信息

抗高血压药依普利酮 (eplerenone) 　 是一种新型选择性醛固酮受体拮抗剂 ,能特异性地抑制醛固酮功能。醛固酮是肾素 血管紧张肽 醛固酮系统中一种重要的成分 ,在调节人体心血管系统功能时发挥着重要作用 ,血管紧张肽转化酶抑制剂 (ACEI)和血管紧张肽Ⅱ受体拮抗剂 (ARB)可以抑制肾上腺分泌醛固酮 ,但经过一段时间治疗后 ,醛固酮的释放量有所恢复 ,其血浆浓度甚至可能超过基线水平。因此 ,有必要采用醛固酮受体拮抗剂治疗高血压。动物实验表明 ,依普利酮对高血压、心功能衰竭、心肌梗死、肾脏疾病及动脉粥样硬化有一定治疗作用。临床研…     

醛固酮受体拮抗剂——心力衰竭药物治疗的新纪元

神经内分泌失调与慢性心力衰竭(CHF)的不良预后相关,是临床CHF治疗的一个重要靶点.心力衰竭患者虽已接受血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体阻断剂(ARB)以及β受体阻断剂等治疗,但心血管事件发生率仍然很高.选择性醛固酮受体拮抗剂依普利酮与神经内分泌抑制剂联合应用,可降低轻度收缩性心力衰竭患者的死亡率和...     

基于FAERS数据库醛固酮受体拮抗剂不良反应信号挖掘与分析

目的 基于美国食品药品监督管理局不良事件报告系统（FAERS）数据库挖掘醛固酮受体拮抗剂依普利酮和螺内酯的不良反应（ADR）信号,对比和分析两者ADR的相关情况,为临床安全用药提供参考依据。方法 基于FAERS数据库,利用Open Vigil FDA分析工具提取2004年1月1日—2022年11月4日上报的目标药物依普利酮与螺内酯相关的不良事件情况数据。采用报告比值比法进行数据挖掘,按国际医学用语词典25.1版中的首选系统器官分类（SOC）和首选术语（PT）对不良事件进行统计分类并分析。结果 共检索到醛固酮受体拮抗剂依普利酮和螺内酯相关的ADR报告112 518份,其中依普利酮ADR报告8 516份,风险信号50个,信号累及12个系统/器官;螺内酯ADR报告104 002份,风险信号60个,信号累及13个系统器官分类;其中36个为重叠信号。依普利酮说明书未提及的有13个风险信号,主要涉及呼吸、胃肠等系统器官分类;螺内酯说明书未提及的有19个风险信号,主要涉及血液及淋巴系统疾病、精神病类等系统器官分类。结论 临床应用醛固酮受体拮抗剂时,除重点关注说明书提及的ADR,还需对未提及的风险信号和原有疾病进展情况引起重视。     

依普利酮在首次治疗的30天内可提高心力衰竭患者生存率

一项新的在心力衰竭患者中评估依普利酮作用的大规模临床(EPHESUS)研究分析显示,辉瑞公司的选择型醛固酮拮抗剂eplerenone(依普利酮,Inspra),在患者心脏病发作的30天治疗期内,有益于提高生存率。有6600例患者参与EPHESUS临床研究(全称:依普利酮急性心肌梗死后心衰效力和存活率研究,eplerenone post-acute myocardial infarc-     

新型醛固酮受体阻断剂——依普利酮研究进展

目的 依普利酮是在螺内酯的基础上研发的一种新型选择性盐皮质激素受体拮抗剂.该药对心力衰竭和高血压具有良好的疗效,对肾脏具重要的保护作用,且性激素相关不良反应少.本文重点介绍依普利酮的最新临床研究进展.     

依普利酮抑制细胞增殖拮抗急性环孢素A肾损伤的研究

目的探讨盐皮质激素受体阻断剂依普利酮抑制细胞增殖拮抗环孢素A肾损伤的作用。方法经口灌服环孢素A(100 mg.kg-1.d-1),诱导小鼠急性肾脏损伤,给以依普利酮100 mg.kg-1.d-1治疗,d 10采血、摘取肾脏。放免法检测血清醛固酮水平,免疫组化检测增殖细胞核抗原(PC-NA)、纤连蛋白表达;RT-PCR、Western blot检测PCNA、FN、TGF-β1表达。结果血清醛固酮水平检测显示环孢素A组(318.83±95.72)ng.L-1较空白对照组(82.05±23.04)ng.L-1升高,依普利酮可明显抑制其分泌(149.50±36.20)ng.L-1。环孢素A组肾脏PCNA阳性细胞增多,纤连蛋白表达增强;PCNA、FN、TGF-β1蛋白及mRNA表达较空白对照组明显上调,依普利酮可抑制其表达。结论依普利酮可以抑制醛固酮的分泌、抑制细胞增殖,减轻环孢素A诱导的肾脏损伤。     

依普利酮

本品由法玛西亚公司开发，2002年9月获美国FDA批准，用于高血压治疗。据《美国高血压杂志》报道，选择性醛固酮受体阻断圳依普利酮能够有效控制轻中度高血压，且耐受性良好。     

醛固酮受体阻断剂依普利酮的研究进展

依普利酮是第一个获准上市的选择性醛固酮受体阻断剂(SARA）,可望用于高血压和心力衰竭等的治疗。本文就依普利酮的临床研究开发进展以及临床实践中所获得的证据进行探讨和总结。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.