Investigation of drug–drug interactions between clopidogrel and fluoxetine

Drug–drug interactions may contribute to the variability of the response of clopidogrel. Several hypotheses have been proposed concerning the potential modification of clopidogrel pharmacokinetics and pharmacodynamics by fluoxetine. This open‐label crossover study assessed the effect of fluoxetine on the pharmacological activity of clopidogrel in healthy volunteers. Eight healthy male volunteers received a single 600‐mg loading dose of clopidogrel followed by 20 mg of fluoxetine on 4 days and then 20 mg of fluoxetine plus 600 mg of clopidogrel on the fifth day. Eleven blood samples were withdrawn after clopidogrel administration to determine plasma concentrations of clopidogrel active metabolite (CAM) and platelet function. Platelet aggregation was measured by light transmittance aggregometry (LTA) and platelet reactivity index by flow cytometric vasodilator‐stimulated phosphoprotein (VASP) analysis. The areas under the curve and maximum plasma concentrations of CAM were, respectively, 20.6 and 25.3% lower after co‐administration of fluoxetine compared with administration of clopidogrel alone. The percentage maximum platelet aggregation values in the presence of 5 μm and 10 μm adenosine diphosphate, measured by LTA, were, respectively, 13.9 and 22.4% lower after fluoxetine co‐administration. The platelet reactivity index measured by the flow cytometric VASP method was 36.8% lower when clopidogrel was administered in conjunction with fluoxetine.     

Performance comparison of two nucleic acid amplification systems for SARS‐CoV‐2 detection: A multi‐center study

BackgroundMany rapid nucleic acid testing systems have emerged to halt the development and spread of COVID‐19. However, so far relatively few studies have compared the diagnostic performance between these testing systems and conventional detection systems. Here, we performed a retrospective analysis to evaluate the clinical detection performance between SARS‐CoV‐2 rapid and conventional nucleic acid detection system.MethodsClinical detection results of 63,352 oropharyngeal swabs by both systems were finally enrolled in this analysis. Sensitivity (SE), specificity (SP), and positive and negative predictive value (PPV, NPV) of both systems were calculated to evaluate their diagnostic accuracy. Concordance between these two systems were assessed by overall, positive, negative percent agreement (OPA, PPA, NPA) and κ value. Sensitivity of SARS‐CoV‐2 rapid nucleic acid detection system (Daan Gene) was further analyzed with respect to the viral load of clinical specimens.ResultsSensitivity of Daan Gene was slightly lower than that of conventional detection system (0.86 vs. 0.979), but their specificity was equivalent. Daan Gene had ≥98.0% PPV and NPV for SARS‐CoV‐2. Moreover, Daan Gene demonstrated an excellent test agreement with conventional detection system (κ = 0.893, p = 0.000). Daan Gene was 99.31% sensitivity for specimens with high viral load (C _t < 35) and 50% for low viral load (C _t ≥ 35).ConclusionsWhile showing an analytical sensitivity slightly below than that of conventional detection system, rapid nucleic acid detection system may be a diagnostic alternative to rapidly identify SARS‐CoV‐2‐infected individuals with high viral loads and a powerful complement to current detection methods.     

Sunitinib–ibuprofen drug interaction affects the pharmacokinetics and tissue distribution of sunitinib to brain,liver, and kidney in male and female mice differently

Tyrosine kinase inhibitor sunitinib (used in GIST, advanced RCC, and pancreatic neuroendocrine tumors) undergoes CYP3A4 metabolism and is an ABCB1B and ABCG2 efflux transporters substrate. We assessed the pharmacokinetic interaction with ibuprofen (an NSAID used by patients with cancer) in Balb/c male and female mice. Mice (study group) were coadministered (30 min apart) 30 mg/kg of ibuprofen and 60 mg/kg of sunitinib PO and compared with the control groups, which received sunitinib alone (60 mg/kg, PO). Sunitinib concentration in plasma, brain, kidney, and liver was measured by HPLC as scheduled and noncompartmental pharmacokinetic parameters estimated. In female control mice, sunitinib AUC_0→∞ decreased in plasma (P < 0.05), was higher in liver and brain (P < 0.001), and lower in kidney (P < 0.001) vs. male control mice. After ibuprofen coadministration, female mice showed lower AUC_0→∞ in plasma (P < 0.01), brain, liver, and kidney (all P < 0.001). However, in male mice, AUC_0→∞ remained unchanged in plasma, increased in liver and kidney, and decreased in brain (all P < 0.001). The tissue‐to‐plasma AUC_0→∞ ratio was similar between male and female control mice, but changed after ibuprofen coadministration: Male mice showed 1.6‐fold higher liver‐to‐plasma ratio (P < 0.001) while remained unchanged in female mice and in kidney (male and female mice) but decreased 55% in brain (P < 0.05). The tissue‐to‐plasma partial AUC ratio, the drug tissue targeting index, and the tissue‐plasma hysteresis‐like plots also showed sex‐based ibuprofen–sunitinib drug interaction differences. The results illustrate the relevance of this DDI on sunitinib pharmacokinetics and tissue uptake. These may be due to gender‐based P450 and efflux/transporters differences.     

Biodistribution and evaluation of 131I‐labeled neuropilin‐binding peptide for targeted tumor imaging

Neuropilin‐1 (NRP‐1) is overexpressed in several kinds of cancer cell and contributes to tumor aggressiveness. Recently, the arginine/lysine‐rich peptide with C‐terminal motifs (R/K)XX(R/K) indicated promising penetrating and transporting capability into NRP‐1 positive cancer cells. In the present study, we describe a ¹³¹I‐labeled C‐end rule motif peptide conjugate, Tyr–tLyp‐1, for NRP‐1 positive tumor targeting and imaging properties. Briefly, a truncated Lyp‐1 peptide was designed to expose its C‐end motif and conjugated to tyrosine for radiolabeling after structural modification. The peptide indicated specific binding to A549 cancer cells at 2 μM concentration, and its binding was dependent on NRP‐1 expression and could be inhibited by other NRP‐1‐binding peptides. In vivo imaging of ¹³¹I‐labeled Tyr–tLyp‐1peptide showed that a subcutaneous A549 xenograft tumor could be visualized using a SPECT/CT scanner. The tumor uptake of ¹³¹I‐Tyr–tLyp‐1 was 4.77 times higher than the uptake in muscles by SPECT/CT software quantification at 6 h post injection. Together, this study indicated that truncated Lyp‐1 peptide could specifically localize in NRP‐1 positive tumors and successfully mediate the ¹³¹I radionuclide diagnosis, indicating promising targeted imaging capability for NRP‐1 positive tumors. Copyright © 2016 John Wiley & Sons, Ltd.