THE DRUG TREATMENT OF ALCOHOL WITHDRAWAL SYMPTOMS: A SYSTEMATIC REVIEW

A computer-assisted and cross-reference literature search identifiedtrials of therapy for alcohol withdrawal symptoms. Those witha randomized, double-blind placebo-controlled design were systematicallyassessed for quality of methodology. Fourteen studies were identifiedinvestigating 12 different drugs. The quality of methodologicaldesign, even among this highly selected group of published studies,was often poor. Study populations were generally under-defined,most studies excluded severely ill patients, control groupswere poorly matched, and the use of additional medication mayhave confounded results in some studies. Twelve different ratingscales were used to assess severity of symptoms. All 12 compoundsinvestigated were reported to be superior to placebo, but thishas only been replicated for benzodiazepines and chlormethiazole.Further research using better methods is required to allow comparisonof different drugs in the treatment of alcohol withdrawal symptoms.On the evidence available, a long-acting benzodiazepine shouldbe the drug of first choice.     

New antagonists of LHRH II. Inhibition and potentiation of LHRH by closely related analogues

Modifications of the previously described LHRH antagonists, [Ac-d -Nal(2)¹, d -Phe(4Cl)², d -Trp³, d -Cit⁶, d -Ala¹⁰]LHRH and the corresponding d -Hci⁶ analogue, have been made to alter the hydrophobicity of the N-terminal acetyl-tripeptide portion. Substitution of d -Trp³ with the less hydrophobic d -Pal(3) had only marginal effects on the antagonistic activities and receptor binding potencies of the d -Cit/d -Hci⁶ analogues, but it appeared to further improve the toxicity lowering effect of d -Cit/d -Hci⁶ substitution. Antagonists containing d -Pal(3)³ and d -Cit/d -Hci⁶ residues, i.e. [Ac-d -Nal(2)¹, d -Phe(4Cl)², d -Pal(3)³d -Cit⁶, d -Ala¹⁰]LHRH (SB-75) and [Ac-d -Nal(2)¹, d -Phe(4Cl)², d -Pal(3)³, d -Hci⁶, d -Ala¹⁰]LHRH (SB-88), were completely free of the toxic effects, such as cyanosis and respiratory depression leading to death, which have been observed in rats with the d -Trp³, d -Arg⁶ antagonist and related antagonists. Replacement of the N-acetyl group with the hydrophilic carbamoyl group caused a slight decrease in antagonistic activities, particularly in vitro. Introduction of urethane type acyl group such as methoxycarbonyl (Moc) or t-butoxycarbonyl (Boc) led to analogues that showed LHRH-potentiating effect. The increase in potency induced by these analogues, e.g. [Moc-d -Nal(2)¹, d -Phe(4Cl)², d -Trp³, d -Cit⁶, d -Ala¹⁰]LHRH and [Boc-d -Phe¹, d -Phe(4Cl)², d -Pal(3)³, d -Cit⁶, d -Ala¹⁰]LHRH, was 170-260% and persisted for more than 2 h when studied in a superfused rat pituitary system.     

Chemical Approaches to Improve the Oral Bioavailability of Peptidergic Molecules

This review discusses both tools and strategies that may be employed as approaches towards the pursuit of orally active compounds from peptidergic molecules. Besides providing a review of these subjects, this paper provides an example of how these were utilized in a research programme at SmithKline Beecham involving the development of orally active GPIIb/IIIa antagonists. The tools for studying oral drug absorption in-vitro include variants of the Ussing chamber which utilize either intestinal tissues or cultured epithelial cells that permit the measurement of intestinal permeability. Example absorption studies that are described are mannitol, cephalexin, the growth hormone-releasing peptide SK&F 110679 and two GPIIb/ IIIa antagonist peptides SK&F 106760 and SK&F 107260. With the exception of cephalexin, these compounds cross the intestine by passive paracellular diffusion. Cephalexin, on the other hand, crosses the intestine via the oligopeptide transporter. Structure-transport studies are reviewed for this transporter. The tools for studying oral drug absorption in-vivo involve animals bearing in-dwelling intestinal or portal vein catheters. A study of the segmental absorption of SK&F 106760 is provided. The review concludes with two chemical strategies that may be taken towards the enhancement of oral bioavailability of peptidergic molecules. The first strategy involves the chemical modification of peptides which enhance intestinal permeability, specifically the modification of amide bonds. The second strategy involves the design of compounds bearing nonpeptide templates, which are more amenable to the discovery of compounds with oral activity, from peptide pharmacophore models. An example is given regarding the discovery of SB 208651, a potent orally active GPIIb/IIIa antagonist, designed from the peptides SK&F 106760 and SK&F 107260.     

Profound suppression of cellular proliferation mediated by the secretions of nematodes

Loss of T lymphocyte proliferation and the emergence of a host response that is dominated by a Th2-type profile are well-established features of human filarial infection. Downregulation and modulation of host T cell responses during lymphatic filariasis has been investigated by implantation of parasite stages into inbred mice. Adherent peritoneal exudate cells (PEC) from mice transplanted with adult or larval Brugia malayi parasites are profoundly anti-proliferative but do not prevent antigen-specific cytokine production by T cells. We demonstrate here that the excretory/secretory (E/S) products of the adult parasite are sufficient to induce PEC that block proliferation if injected daily into mice. We have previously shown that in vivo production of host IL-4 is required for the generation of suppressive cells. Because the induction of host IL-4 is characteristic of infection with nematodes, we asked whether E/S from two other nematode parasites, Nippostrongylus braziliensis and Toxocara canis were also capable of generating a suppressor cell population. Injection of E/S from these two parasites also led to a reduction in T cell proliferation suggesting that this mechanism of down-regulating host responses is a feature common to nematode parasites .     

The serum amyloid P response in the mouse air pouch

Abstract— Levels of the acute phase reactant serum amyloid P (SAP) have been measured in the mouse pouch model of rheumatoid arthritis. Implantation of cartilage resulted in a significant and rapid elevation in the SAP concentration, which remained high for the duration of the experiment (14 days). Initial studies with several clinically employed antirheumatic drugs indicated that dexamethasone and cyclosporin A had a marked inhibitory effect.