Dissertations / Theses on the topic 'Verapamil'

A maioria dos agentes terapêuticos, frequentemente prescritos são formulados e comercializados sob a forma racêmica, embora para alguns deles, já tenha sido demonstrado que os efeitos farmacológicos e ou tóxicos estejam relacionados apenas a um dos enantiômeros. Além disso, é conhecido o fato de que os enantiômeros podem apresentar perfis farmacocinéticos e farmacodinâmicos diferentes. O estudo avaliou a influência da exposição inalatória ao vapor de gasolina e ao etanol combustível na farmacocinética enantiosseletiva dos fármacos verapamil, ibuprofeno e fluoxetina. Ratos machos Wistar foram divididos em 09 grupos: controle, gasolina, etanol combustível. A exposição aos solventes foi realizada em câmara de exposição do tipo apenas pelo nariz, durante 6 horas/dia, cinco dias por semana, durante 6 semanas. A análise das AUCs foram calculadas diretamente no intervalo de zero a infinito com base na Quadratura de Gauss- Laguerre. As concentrações correspondentes aos tempos foram estimadas por interpolação polinomial. A comparação dos valores de AUC e Cl/f obtidos para cada fármaco e para cada Grupo exposto e seu respectivo Controle, foi realizada através da construção de Intervalos de Confiança, ao nível de 95%. A farmacocinética do verapamil, do ibuprofeno e da fluoxetina é enantiosseletiva. Os dados mostram que a exposição inalatória de ratos ao etanol combustível na concentração de 2 LEOSTEL mostrou indução do CYP2C através da redução do AUC e do aumento do clearance aparente do enantiômero (+)-(S)-ibuprofeno, inibição do CYP2D indicada pelo aumento da AUC e redução do clearance aparente do enantiômero (-)-(R)- fluoxetina e indução do CYP3A evidenciada por redução dos valores de AUC e aumento dos valores de clearance aparente de ambos os enantiômeros do verapamil. A exposição inalatória de ratos à gasolina na concentração de 2-LEOTWA também mostrou indução do CYP2C denotada pela redução do AUC e do aumento do clearance aparente de ambos os enantiômeros do ibuprofeno, inibição do CYP2D indicada pelo aumento dos valores de AUC e redução dos valores de clearance aparente de ambos enantiômeros da fluoxetina e, em não alteração do CYP3A evidenciada pela obtenção de valores de AUC e clearance aparente do verapamil similares aos do grupo controle.
Most therapeutic agents frequently used are formulated and sold under the racemic form, although for some of them, it has been demonstrated that the pharmacological or toxic and are associated only with one of the enantiomers. The study evaluated the influence of inhalation exposure to vapor of gasoline and ethanol in the enantioselective pharmacokinetics of the drug verapamil, ibuprofen and fluoxetine. Male Wistar rats were divided into 09 groups: control, gasoline, ethanol. The exposure was carried out in solvent exposure chamber by nose only exposure system for 6 hours / day, five days per week for six weeks. The analysis of the AUC were calculated directly in the range of zero to infinity on the basis of Quadrature Gauss-Laguerre. The concentrations corresponding to the times were estimated by polynomial interpolation. The comparison of AUC and Cl/f obtained for each drug and for each exposed group and its respective control, was accomplished through the construction of confidence intervals, at 95%. In conclusion, the pharmacokinetics of verapamil, ibuprofen and fluoxetine is enantioselective. The data show that inhalation exposure of rats to ethanol at a concentration of 2-LEO STEL showed induction CYP2C by reducing of the AUC and increase the apparent clearance of the enantiomer (+)-(S)-ibuprofen, inhibition of CYP2D indicated AUC increase and the reduction in the apparent clearance of the enantiomer (-)-(R)-fluoxetine and CYP3A induction as evidenced by reduction in AUC and increase and the values of apparent clearance of both enantiomers of verapamil. Inhalation exposure of rats to gasoline in a concentration of 2-LEO-TWA also showed induction CYP2C denoted by the reduction of AUC and increase and the apparent clearance of both enantiomers of ibuprofen, inhibition of CYP2D indicated by the increase in AUC and reduction values of apparent clearance of both enantiomers of fluoxetine and does not change the CYP3A evidenced by obtaining AUC and apparent clearance of verapamil similar to the control group.

Mosquitoes affect human health worldwide as a result of their ability to vector multiple diseases. Mosquitocide resistance is a serious public health challenge that warrants the development of improved chemical control strategies for mosquitoes. Previous studies demonstrate the mosquito blood-brain barrier (BBB) to interfere with the target-site delivery and action of anticholinesterase chemistries. The ATP-binding cassette (ABC) transporters are efflux proteins that assist in maintaining the BBB interface and serve as a first line of defense to mosquitocide exposures. To date, there are three subfamilies (ABC -B, -C, -G) of ABC transporters; however, knowledge of these chemistries interacting with mosquito ABC transporter(s) is limited. Here, I report that tacrine and bis(7)-tacrine are relative non-toxic anticholinesterases at solubility limits; however, the addition of verapamil enhances toxicity of both tacrine and bis(7)-tacrine to mosquitoes. Verapamil significantly increases the mortality of mosquitoes exposed to tacrine and bis(7)-tacrine compared to the tacrine- and bis(7)- tacrine-only treatments. Tacrine and bis(7)-tacrine reduce acetylcholinesterase activity in mosquito head preparations compared to the untreated mosquitoes; however, the addition of verapamil significantly increases the anticholinesterase activity of tacrine and bis(7)-tacrine compared to the tacrine-and bis(7)-tacrine-only treatments. Tacrine and bis(7)-tacrine increase ATPase activity in Aedes aegypti at lower concentrations compared to that of verapamil (Fig. 3). The differential increase in ATPase activity suggests that tacrine and bis(7)-tacrine are more suitable substrates for ABC transporter(s) compared to verapamil and, thus, provides putative evidence that ABC transporter(s) is a pharmacological obstacle to the delivery of these anticholinesterases to their intended target site.
Master of Science in Life Sciences

O verapamil (VER) é um composto quiral comercializado como mistura racêmica dos enantiômeros (+)-(R)-VER e (-)-(S)-VER. O VER é biotransformado em norverapamil (NOR) e em outros metabólitos por vias dependentes do CYP. O tolueno e o n-hexano são solventes orgânicos que podem alterar o metabolismo de medicamentos dependente do CYP. Assim, o estudo investiga a estereosseletividade na farmacocinética do verapamil administrado a ratos na dose de 10 mg kg-1, sob forma racêmica, e do seu metabólito, norverapamil, bem como a influência do n-hexano e do tolueno na disposição cinética dos enantiômeros (+)-(R) e (-)-(S)-VER e (R)- e (S)-norverapamil em animais tratados com os solventes por inalação em câmara de exposição do tipo nose only nas concentrações de 88, 176 e 352 mg/m3 para o n-hexano e 94, 188 e 376 mg/m3 para o tolueno. Os enantiômeros do VER e do NOR foram separados na coluna de fase quiral Chiralpak® AD e analisados por LC-MS/MS (m/z = 441,3->165,5 para os enantiômeros do norverapamil e m/z 455,3->165,5 para os enantiômeros do verapamil). A análise farmacocinética foi realizada com base no modelo monocompartimental. A farmacocinética do verapamil é estereosseletiva em ratos do grupo controle não tratado com os solventes com acúmulo plasmático do eutômero (-)-(S)-VER (AUC0-? = 250,8 vs 120,4 ng mL-1 h; P<=0,05, teste de Wilcoxon). O metabólito (S)-NOR também foi acumulado no plasma dos animais do grupo controle com razão S/R relativa ao parâmetro AUC0-? de 1,5. Os parâmetros farmacocinéticos AUC0-?, Cl/F, Vd/F e t1/2 relativos aos enantiômeros (-)-S e (+)-(R)-VER e aos enantiômeros (S) e (R)-NOR não foram alterados pela exposição em câmara de exposição do tipo nose only ao n-hexano nas concentrações de 88, 176 e 352 mg/m3 e ao tolueno nas concentrações de 94, 188 e 376 mg/m3; teste de Kruskall-Wallis; P<=0,05. No entanto, a exposição ao n-hexano nas concentrações de 176 mg/m3 e 352 mg/m3 e ao tolueno nas concentrações de 94 mg/m3, 188 mg/m3 e 376 mg/m3 resultou em perda da enantiosseletividade observada para o grupo controle.
Verapamil (VER) is a chiral compound which is commercialized as a racemic mixture of the (+)-(R)-VER and (-)-(S)-VER enantiomers. VER is biotransformed into norverapamil (NOR) and other metabolites through CYP-dependent pathways. Toluene and n-hexane are organic solvents that can alter the metabolism of CYP-dependent drugs. The present study investigated the stereoselectivity in the pharmacokinetics of racemic VER administered to rats at a dose of 10 mg kg-1 and of its metabolite NOR. In addition, the influence of n-hexane and toluene on the kinetic disposition of the (+)-(R) and (-)-(S)-VER and (R)- and (S)-NOR enantiomers was analyzed in animals exposed by nose-only inhalation to n-hexane at concentrations of 88, 176 and 352 mg/m3 and to toluene at concentrations of 94, 188 and 376 mg/m3. The VER and NOR enantiomers were separated on a Chiralpak® AD chiral phase column and analyzed by LC-MS/MS (m/z = 441.3->165.5 for the NOR enantiomers and m/z 455.3->165.5 for the VER enantiomers). Pharmacokinetic analysis was performed using a monocompartmental model. The pharmacokinetics of VER was stereoselective in control rats not treated with the solvents, with plasma accumulation of the (-)-(S)-VER eutomer (AUC0-? = 250.8 vs 120.4 ng mL-1 h; P<=0.05, Wilcoxon test). The (S)-NOR metabolite was also found to accumulate in plasma of control animals, with an S/R AUC0-? ratio of 1.5. The pharmacokinetic parameters AUC0-?, Cl/F, Vd/F and t1/2 obtained for the (-)-S-VER, (+)-(R)-VER, (S)-NOR and (R)-NOR enantiomers were not altered by nose-only exposure to n-hexane at concentrations of 88, 176 and 352 mg/m3 or to toluene at concentrations of 94, 188 and 376 mg/m3 (P<=0.05), Kruskal-Wallis test). However, exposure to 176 and 352 mg/m3 n-hexane and to 94, 188 and 376 mg/m3 toluene resulted in the loss of enantioselectivity observed for the control group.

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Resumo: A epidemiologia das infecções causadas por Candida sofreu mudanças nos últimos anos. Embora Candida albicans ainda seja o principal patógeno causador de candidíase, relatos recentes reportam o aumento da incidência de infecções causadas por espécies de Candida não-albicans. A toxicidade dos fármacos antifúngicos utilizados juntamente com o desenvolvimento da resistência tem se tornado um sério problema clínico. Com isso, atualmente existe a urgência na descoberta de novos compostos com atividades antifúngicas. Objetivos: avaliar a atividade antifúngica do fármaco Cloridrato de Verapamil, determinar a Concentração Inibitória Mínima (CIM) e a Concentração Fungicida Mínima (CFM), frente à Candida albicans ATCC 18804, Candida krusei ATCC 6258, Candida parapsilosis ATCC 90018 e Candida glabrata ATCC 9030. Além de avaliar a citotoxicidade do fármaco em queratinócitos humanos (HaCaT). Metodologia: a determinação da CIM foi realizada pela técnica de microdiluição de acordo com The European Committee on Antimicrobial Susceptibility Testing (EUCAST). A CFM foi determinada por plaqueamento em ágar Sabouraud de alíquotas provenientes das diluições do ensaio de microdiluição. A avaliação da citotoxicidade foi realizada pela técnica de redução da resazurina, sendo possível avaliar a atividade mitocondrial das células HaCaT. Resultados: o fármaco Cloridrato de Verapamil demonstrou atividade antifúngica contra as quatro espécies patogênicas de Candida, com o valor de CIM de 1250 µM; valor de CFM maior que 1250 µM, sendo assim este fármaco foi considerado fungistático. Além disso, o Cloridrato de Verapamil não apresentou citotoxicidade nas concentrações avaliadas no estudo, pois, a redução de células viáveis nas concentrações mais elevadas não ultrapassa 30%. Com relação à redução de biomassa em biofilme de Candida, após tratamento com Cloridrato de Verapamil, houve redução (de 10 a 20%) para as quatro espécies de Candida em estudo, quando utilizadas concentrações de fármaco correspondentes a CIM; quando utilizadas concentrações de fármaco correspondentes a cinco vezes o valor de CIM, houve um aumento significativo na redução de biomassa (de 25% a 60%) em biofilme formado pelas quatro espécies de Candida. Conclusão: o fármaco Cloridrato de Verapamil apresentou atividade antifúngica para Candida albicans e Candida não-albicans, sendo considerado um fármaco fungistático, além de não apresentar citotoxicidade em queratinócitos humanos, e demonstrar atividade na redução de biomassa em biofilme formado pelas quatro espécies de Candida. Demais estudos são necessários para verificar a ação desse fármaco em diferentes mecanismos de virulência frente a células de Candida spp.
Abstract: The epidemiology of Candida infections has changed in recent years. Although Candida albicans is still the main pathogen causing candidiasis, recent reports have reported an increase in the incidence of infections caused by nonalbicans Candida species. The toxicity of the antifungal drugs used together with the development of resistance has become a serious clinical problem. With this, there is now an urgency in the discovery of new compounds with antifungal activities. Objectives: To evaluate the antifungal activity of the drug Verapamil Hydrochloride, to determine the Minimum Inhibitory Concentration (MIC) and the Minimum Fungicidal Concentration (CFM) against Candida albicans ATCC 18804, Candida krusei ATCC 6258, Candida parapsilosis ATCC 90018 and Candida glabrata ATCC 9030 In addition to evaluating the cytotoxicity of the drug in human keratinocytes (HaCaT). Methodology: MIC determination was performed by the microdilution technique according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST). The CFM was determined by plating on Sabouraud agar from aliquots from the dilutions of the microdilution assay. The evaluation of cytotoxicity was performed using the resazurin reduction technique, and it was possible to evaluate the mitochondrial activity of HaCaT cells. Results: The drug Verapamil Hydrochloride demonstrated antifungal activity against the four pathogenic species of Candida, with MIC value of 1250 μM; CFM value greater than 1250 μM, so this drug was considered fungistatic. In addition, Verapamil Hydrochloride did not present cytotoxicity in the units evaluated in the study, because the reduction of viable cells in the most cells is not exceeded by 30%. Regarding the biomass reduction in Candida biofilm, after treatment with Verapamil Hydrochloride, there was a reduction (from 10 to 20%) for the four Candida species in study, when the use of drug corresponding to MIC; when the use of drug corresponding to 5 times of MIC, there was a significant increase in the biomass reduction (from 25% to 60%) in the biofilm molded by the four Candida species. Conclusion: Thus, the drug Verapamil Hydrochloride led to the antifungal activity of Candida albicans and non-albicans Candida species, being considered a fungicidal drug, besides not presenting cytotoxicity in human serotonizers, and were submitted to biomass reduction in biofilm molded by four Candida species. More studies are needed to verify the action of the drug on different mechanisms of virulence against Candida spp cells.

Introdução: A hipertrofia cardíaca induzida por sobrecarga hemodinâmica crônica (HC) é caracterizada por espessamento das paredes do ventrículo esquerdo e do tecido intersticial. As atividades aumentadas de calpaína-1 e metaloproteinase de matriz(MMP)-2 são observadas em diferentes modelos de hipertensão arterial e estão relacionadas com as mudanças fisiopatológicas na HC. Por outro lado, a atividade de MMP-2 parece ser modulada positivamente por ativação de calpaína-1 em diferentes modelos. O objetivo deste trabalho é analizar se a calpaína-1 contribui para o aumento da atividade de MMP-2 no coração e se esse mecanismo resulta nas mudanças crônicas cardíacas na hipertensão renovascular. Métodos: Ratos Wistar submetidos ao modelo de 2-rins-1 clipe (2R-1C)(180-200g) e seus respectivos controles (Sham) foram tratados com verapamil (VRP), um bloqueador de canais para cálcio tipo L (BCCL, 8mg/kg/bid) ou veículo durante 8 semanas. O BCCL reduz as concentrações intracelulares de cálcio, o que leva à diminuição da ativação de calpaína-1, e então à possível modulação da atividade e expressão proteica de MMP-2. Pressão arterial sistólica (PAS) dos ratos foi monitorada durante 10 semanas de hipertensão por pletismografia de cauda. O ventrículo esquerdo (VE) foi analisado por histologia e ecocardiografia para avaliação das dimensões ventriculares. A atividade de calpaína-1 e MMP-2 foi avaliada por zimografia em gel. A expessão proteica de calpaína-1 e MMP-2 foi avaliada por western blot e imunofluorescência. Os corações foram submetidos à avaliação funcional por Langendorff. Todos os protocolos foram aprovados pelo Comitê de Ética em Pesquisa Animal da Faculdade de Medicina de Ribeirão Preto (43/2017). Resultados: Após 10 semanas, a PAS teve um aumento sustentado nos animais 2R-1C e o tratamento com VRP não foi capaz de reduzí-la em nenhum tempo de hipertensão. O peso corporal não apresentou diferença significativa entre os grupos. O grupo hipertenso teve um aumento da massa cardíaca quando comparado ao sham e o tratamento com verapamil reduziu esse parâmetro. A análise da espessura do ventrículo esquerdo demonstra que o VRP é capaz de reverter a HC induzida por sobrecarga pressórica nos animais hipertensos. Os animais 2R-1C apresentaram um aumento singificativo na expressão proteica e atividade de calpaína-1 e o VRP foi capaz de diminuir esses níveis. Foi observado aumento da atividade das isoformas de MMP-2 nos ratos 2R-1C quando comparados aos controles e o VRP foi capaz de reduzir a atividade da isoforma de 64kDa. A contratilidade cardíaca intrínseca dos animais 2R-1C sugere uma disfunção cardíaca quando comparados aos controles sham, embora a fração de ejeção desses animais esteja preservada. O VRP não foi capaz de alterar esses parâmetros. Conclusão: O VRP pode contribuir para a redução da hipertrofia cardíaca por diminuir a expressão proteica de calpaína-1 e MMP-2 na hipertensão renovascular. Apoio financeiro: Capes, CNPq, FAPESP
Introduction: The chronic hemodynamic overload-induced cardiac hypertrophy (CH) is characterized by thickening of the left ventricle walls and hypertrophy of the cardiomyocytes and interstitial tissue. Increased activity of calpain-1 and matrix metalloproteinase(MMP)-2 was observed in different models of arterial hypertension models and contributes to the pathophysiologic changes shown in CH. On the other hand, MMP-2 activity is also positively modulated by activation of calpain-1 in different animal models of cardiovascular diseases. The objectives here are to analyze whether calpain-1 contributes to increase the activity of MMP-2 in the heart and whether this mechanism results in chronic cardiac changes in the renovascular hypertension. Methods: Two kidney-one clip (2K1C) hypertensive male Wistar rats (180-200g) and their respective controls (Sham) were orally treated with verapamil (VRP), a L-type calcium channels blocker (LCCB, 8mg/kg/bid), or vehicle during 8 weeks. The LCCB reduces the intracellular concentration of calcium, thus decreasing the activation of calpain-1, and then may modulate the activity of MMP-2. Systolic blood pressure (SBP) was monitored in the rats during 10 weeks of hypertension. Left ventricle (LV) was analyzed by histology and echocardiography to evaluate ventricle thickening. Calpain- 1 and MMP-2 activities were analyzed by zymography and their expression by immunofluorescence and western blot. Hearts were submitted to functional evaluation by Langendorff. All the protocols were approved by the Ethical Committee in Animal Research of Ribeirao Preto Medical School (43/2017). Results: After 10 weeks, the systolic blood pressure had sustained increase and treatment with VRP was not able to decrease it in any time of hypertension. The body weight did not present significant changes between the groups. Hypertensive group had significant increase in the ventricle/body weight ratio (VW/BW) when compared to sham and treatment with VRP decreased it. Analysis of ventricle thickening showed that VRP is able to revert CHinduced pressure overload. The 2K-1C rats showed a significant increase in the activity and expression of calpain-1 in the heart and VRP reverted it. It was also observed increased activity of MMP-2 forms in the hypertensive rats and VRP decreased the 64kDa MMP-2 activity. The 2K-1C group had cardiac dysfunction when compared to controls groups, and VRP did not alter it. The ejection fraction was not changed in 2K- 1C rats. Conclusion: VRP decreased expression and activity of calpain-1 and MMP-2 in the hearts of 2K-1C rats and then contributed to ameliorate hypertension-induced cardiac hypertrophy

A oxcarbazepina (OXC) é indicada como terapia adjuvante ou monoterapia no tratamento de crises epilépticas parciais ou crises tônico-clônicas generalizadas em adultos e crianças. A OXC sofre rápida eliminação pré-sistêmica com formação do metabólito ativo 10-hidroxicarbazepina (MHD), o qual possui como enantiômeros o R-(-)- e o S-(+)-MHD. A OXC e o MHD são substratos da glicoproteína-P (P-gp), que pode ser inibida pelo verapamil. O presente estudo avalia a influência do verapamil na farmacocinética e perfusão cerebral da OXC e dos enantiômeros do MHD em voluntários sadios. Os voluntários sadios (n=12) receberam em uma ocasião doses de 300 mg/12h de OXC e em outra ocasião doses de 300 mg/12h de OXC associadas com 80 mg/8h de verapamil. As amostras de sangue foram coletadas no estado de equilíbrio durante 12 horas e a avaliação da perfusão cerebral realizada utilizando a tomografia computadorizada por emissão de fóton único (SPECT) antes do início do tratamento e nos tempos 4, 6 ou 12h após a administração da OXC. As concentrações plasmáticas total e livre da OXC e dos enantiômeros do MHD foram avaliadas por LC-MS/MS. A análise farmacocinética não compartimental foi realizada com o programa WinNonlin e a farmacocinética populacional foi desenvolvida utilizando a modelagem não-linear de efeitos mistos com o programa NONMEM. Os limites de quantificação obtidos foram de 12,5 ng OXC/mL de plasma e 31,25 ng de cada enantiômero MHD/mL de plasma para a análise da concentração total, enquanto foi de 4,0 ng de OXC/mL de plasma e de 20,0 ng de cada enantiômero do MHD/mL de plasma para a determinação da concentração livre. Os coeficientes de variação obtidos nos estudos de precisão e a porcentagem de inexatidão inter e intra-ensaios foram inferiores a 15%, assegurando a reprodutibilidade e repetibilidade dos resultados. A análise farmacocinética não compartimental da OXC em monoterapia resultou nos seguintes parâmetros: concentração plasmática máxima (Cmax) de 1,35 ?g/mL como valor total e 0,32 ?g/mL como concentração livre em 1,0 h, área sob a curva concentração plasmática versus tempo (AUC0-12) de 3,98 ?g.h/mL e meia-vida de eliminação de 2,45 h, volume de distribuição aparente (Vss/F) de 352,17 L e clearance aparente (CLss/F) de 75,58 L/h. A disposição cinética do MHD é enantiosseletiva, com observação de maior proporção para o enantiômero S-(+)-MHD em relação ao R-(-)-MHD (razão AUC0-12 S-(+)/R-(-) de 4,26). A fração livre avaliada no tmax da OXC foi 0,26 para a OXC, 0,42 para o R-(-)-MHD e 0,38 para o S- (+)-MHD, mostrando enantiosseletividade na ligação às proteínas plasmáticas do MHD. O tratamento com o verapamil reduziu o tempo médio de residência (MRT) (4,71 vs 3,83 h) e Cmax como concentração livre (0,32 vs 0,53 ?g/mL) da OXC e aumentou os valores para ambos os enantiômeros do MHD de Cmax como valor total (2,60 vs 3,27 ?g/mL para o R-(-)- e 11,05 vs 11,94 ?g/mL para o S-(+)-MHD), Cmax como concentração livre (3,11 vs 4,14 ?g/mL para o S-(+)-MHD), Cmédia (2,11 vs 2,42 ?g/mL para o R-(-)- e 8,10 vs 9,07 ?g/mL para o S-(+)-MHD) e AUC0-12 (25,36 vs 29,06 ?g.h/mL para o R-(-)- e 97,19 vs 111,37 ?g.h/mL para o S-(+)-MHD). A ii farmacocinética populacional da OXC foi melhor descrita por modelo de dois compartimentos com eliminação de primeira ordem e com um conjunto de três compartimentos de trânsito para descrever o perfil de absorção da OXC. A disposição de ambos os enantiômeros do MHD foi caracterizada por modelo de um compartimento. Os valores de CLss/F estimados na monoterapia foram de 84,9 L/h para a OXC e de 2,0 L/h para ambos enantiômeros do MHD, enquanto os valores de Vss/F foram de 587 L para a OXC, 23,6 L para o R-(-)-MHD e 31,7 L para o S-(+)- MHD. Concluindo, a associação do verapamil aumentou a biodisponibilidade da OXC em 12% (farmacocinética populacional) e aumentou os valores de AUC de ambos os enantiômeros do metabólito MHD (farmacocinética não compartimental), o que está provavelmente relacionado com a inibição da P-gp no trato intestinal. A associação do verapamil aumentou as concentrações cerebrais preditas de ambos os enantiômeros do MHD em maior extensão do que aquelas observadas no plasma. As mudanças no fluxo sanguíneo cerebral (SPECTs realizados 6h após a administração da OXC) associadas à coadministração de verapamil provavelmente foram causadas pelo aumento dos níveis cerebrais de ambos os enantiômeros do MHD. A confirmação dessa observação requer um braço experimental adicional com SPECTs realizados também após a administração do verapamil em monoterapia.
Oxcarbazepine (OXC) is indicated as adjunctive therapy or monotherapy for the treatment of partial or generalized tonic-clonic seizures in adults and children. OXC undergoes rapid pre-systemic reduction with formation of the active metabolite 10- hydroxycarbazepine (MHD), which has the enantiomers R-(-)- and S-(+)-MHD. OXC and MHD are substrates of P-glycoprotein (P-gp), which can be inhibited by verapamil. The present study evaluates the influence of verapamil on the pharmacokinetics and cerebral perfusion of OXC and the MHD enantiomers in healthy volunteers. The healthy volunteers (n=12) received on one occasion doses of 300 mg/12h OXC and on another occasion they received doses of 300 mg/12h OXC associated with 80 mg/8h of verapamil. Blood samples were collected at steady state for 12 hours and the assessment of cerebral perfusion was performed using a single-photon emission computed tomography (SPECT) before the beginning of treatment and at times 4, 6 or 12 hours after OXC administration. The total and free plasma concentrations of OXC and MHD enantiomers were assessed by LC-MS/MS. The non-compartmental pharmacokinetics analysis was performed using the WinNonlin program, and population pharmacokinetics was developed using nonlinear mixed effects modelling with NONMEM.The limits of quantification obtained were 12.5 ng/mL plasma for OXC and 31.25 ng of each MHD enantiomer/mL plasma for total concentration analysis, while it was 4.0 ng OXC/mL plasma and 20.0 ng of each MHD enantiomer/mL plasma for the free concentration determination. The coefficients of variation obtained in studies of accuracy and the percentage of inaccuracy inter and intra-assay were less than 15%, ensuring the result reproducibility and repeatability. The non-compartmental pharmacokinetic analysis of OXC in monotherapy treatment, resulted in the following parameters: maximum plasma concentration (Cmax) of 1.35 ?g/mL as total concentration and 0.32 mg/mL as free concentration in 1.0 h, area under the plasma concentration vs time curve (AUC0-12) was 3.98 ?g.h/mL, half-life of 2.45 h, apparent volume of distribution (Vss/F) of 352.17 L and the apparent clearance (CLSS/F) of 75.58 L/h. The MHD kinetic disposition is enantioselective, with observation of a greater proportion of the S-(+)-MHD enantiomer compared to R-(-)-MHD (ratio AUC0-12 S-(+)/R-(-) of 4.26). The free fraction measured in the tmax of OXC was 0.26 for OXC, 0.42 for R-(-)-MHD and 0.38 for S-(+)-MHD, showing enantioselectivity in the plasma protein binding of MHD. Verapamil treatment reduced the mean residence time (MRT) (4.71 vs 3.83 h) and Cmax (0.26 vs 0.31 ?g/mL) as free concentration for OXC and increased the both MHD enantiomers values of Cmax (2.60 vs 3.27 ?g/mL for R-(-)- and 11.94 vs 11.05 ?g/mL for S-(+)-MHD) as total concentration, Cmax (3.11 vs 4,14 ?g/mL for S- (+)-MHD) as free concentration, Cavg (2.11 vs 2.42 ?g/mL for R-(-)- and 8.10 vs 9.07 ?g/mL for S-(+)-MHD) and AUC0-12 (25.36 vs 29.06 ?g.h/mL for R-(-)- and 97.19 vs 111.37 ?g.h/mL for S-(+)-MHD). The population pharmacokinetics of oxcarbazepine was best described by a two-compartment model with first-order elimination and a iv set of three transit compartments to describe the absorption profile of the parent compound. The disposition of both MHD enantiomers was characterised by onecompartment model. The CLss/F estimates in monotherapy were 84.9 L/h for OXC and 2.0 L/h for both MHD enantiomers, whereas the values of Vss/F were 587 L for OXC, 23.6 L for R-(-)-MHD and 31.7 L for S-(+)-MHD. In conclusion, verapamil coadministration increased the OXC bioavailability in 12% (population pharmacokinetics) and increased the AUC of both metabolite MHD enantiomers (non-compartmental pharmacokinetics), which is probably related to the inhibition of P-gp in the intestinal tract. Verapamil co-administration increased the predicted brain concentrations of both MHD enantiomers in a greater extent than those observed in plasma. Changes in cerebral blood flow (SPECTs performed 6h after administration of OXC) associated with co-administration of verapamil were probably caused by an increase in brain levels of both MHD enantiomers. Confirmation of this observation requires additional experimental arm with SPECTs also performed after administration of verapamil in monotherapy.

Chemotherapy is used in the treatment of cancer. Unfortunately, drugs often fail due to multidrug resistance (MDR) caused by P-glycoprotein (P-gp1or ABCB1) and the multidrug resistance-associated protein (MRP1 or ABCC1). These proteins bind and transport drugs out of cancer cells, thereby conferring MDR.
The second chapter of this thesis addresses an unexplained phenomenon that accompanies P-gp1 expression, collaterally sensitive to verapamil. The collective results of this work demonstrated that treatment of cells that over-express P-gp1 with verapamil induces apoptosis. Furthermore, the findings show that the ATPase activity of P-gp1 was activated by verapamil. The degree of ATPase activation was proportional to the level of apoptosis and the increased demand for ATP resulted in the production of reactive oxygen species (ROS). Finally, the production of ROS led to cell death mediated by apoptosis in that experimental model system.
Chapters three and four are devoted to understanding the binding characteristics of MRP1 with two of its physiological substrates, glutathione (GSH) and leucotriene C4(LTC4). Photoreactive derivatives of these substrates were synthesised to address this objective, IAAGSH and IAALTC4. Photolabelling and transport studies showed that these derivatives have similar binding characteristics as the native compounds. In addition, photolabelling of MRP1 occurred with a high specificity with both compounds. IAAGSH and IAALTC 4 were also used to determine the locations of GSH and LTC4 binding sites. This was accomplished using MRP1-variants containing hemagglutinin (HA) epitopes at specific locations in the amino acid sequence. Through photoaffinity labelling, immunoprecipitation, and trypsin digestion, a map of binding sites for IAAGSH or IAALTC4 was obtained. Both LTC4 and GSH bound to transmembrane (TM) regions 10-11 and 16-17 which have been previously implicated in drug binding. Furthermore, novel binding sites for both substrates were discovered. IAALTC4 photolabelled a novel site within the first five TMs (TMD0) of MRP1, whereas IAAGSH labelled two cytoplasmic regions (L1 and L0). These may represent specific binding sites for LTC4 and GSH.
The work within this thesis explores some of the biochemical characteristics of Pgp1 and MRP1 that are not directly related to drug resistance and may lead to new strategies in cancer treatment.

Schweinfurthins are intriguing natural product chemotherapeutics due to their potent yet selective activity and their unknown mechanism of growth inhibition in cancer. Much progress has been made in characterizing the intracellular effects of the schweinfurthins since they were first isolated from Macaranga schweinfurthii in 1986. Here, the L-type calcium channel and P- glycoprotein (Pgp) inhibitor verapamil has been found to enhance schweinfurthin- induced growth inhibition. Verapamil induces an increase in the intracellular concentration of a fluorescent schweinfurthin. However, the synergistic relationship between the schweinfurthins and verapamil is complex and not obvious in that verapamil fails to increase the intracellular concentration of a schweinfurthin analogue that is a known substrate of Pgp. Schweinfurthins are also found to induce alterations to cholesterol homeostasis by increasing the expression of the cholesterol efflux pump ABCA1 in an apparent liver X receptor- independent fashion. In addition, schweinfurthin treatment blunts epidermal growth factor downstream activation and phosphorylation of Akt. Lastly, a schweinfurthin-resistant cell line has been created and characterized for resistance to schweinfurthin-induced growth inhibition. The variety of intracellular effects characteristic of schweinfurthin treatment described here provide mechanistic framework for identifying the potential target and mechanism of growth inhibition for the schweinfurthins.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A presente pesquisa teve como objetivo caracterizar e isolar uma estirpe de campo de Haemonchus contortus resistente à ivermectina, avaliar a ação reversora do verapamil, por meio de testes in vitro (migração de larvas em gel de ágar) e in vivo (redução de OPG e necropsias parasitológicas), e realizar a análise de genes relacionados à glicoproteína-P e canais de cloro ativados por glutamato (GP-P e HcGluCL). A estirpe de H. conctortus isolada apresentou elevada resistência à ivermectina, sendo observada eficácia ínfima de 6,59%. O verapamil isoladamente não apresentou efeito nematodicida, porém, em concentrações crescentes, associado à ivermectina (DL50-4,317μmol) proporcionou aumento de eficácia contra a cepa resistente de H. contortus, alcançando o percentual de 94,3% (verapamil 100 mmol). Os resultados do teste anti-helmíntico controlado, em que foram utilizados 42 ovinos experimentalmente infectados com H. contortus resistente à ivermectina, revelaram que o verapamil apresentou uma atividade de reversão parcial significativa (P<0,05) da resistência. Pela análise genotípica efetuada nas sete amostras desta população de H. contortus, submetidas aos diferentes tratamentos com ivermectina, verapamil ou associação entre estas drogas, verificou-se similaridade em relação à glicoproteína-P e pouca semalhança em relação aos canais de cloro ativados por glutamato.
The present work aimed to identify and isolate a field ivermectin-resistant Haemonchus contortus strain, evaluate the effect of verapamil as a P-GP modulator agent by in vitro (agar gel larval migration assay) and in vivo (FECRT and controlled test), and analyze the genes related to the P-glycoprotein (P-GP) and H. contortus glutamate chloride (HcCluCl) chanel expression. The H. contortus field strain isolated was highly resistant to ivermectin, showing only 6.59% of efficacy. Verapamil alone didn’t show any in vitro anthelmintic action but increasing concentrations of this drug associated to ivermectin (LD50-4.317μmol) resulted in higher efficacy, when compared to ivermectin alone, with 94.3% efficacy in the 100 mmol concentration. The results of the anthelmintic controlled test, in wich it was used 42 sheep experimentally infected with the field ivermectin-resistant H. contortus strain, showed a significant (P<0,05) parcial ivermectin resistance reversion by verapamil. The genomic analysis of the seven samples from this H. contortus resistant population submited to diferent treatment with ivermctin, verapamil and the association between theese two drugs, showed similarity in the genes related to the expression of P-GP and high polimorfism related to HcGluCL.

Resumo: A presente pesquisa teve como objetivo caracterizar e isolar uma estirpe de campo de Haemonchus contortus resistente à ivermectina, avaliar a ação reversora do verapamil, por meio de testes in vitro (migração de larvas em gel de ágar) e in vivo (redução de OPG e necropsias parasitológicas), e realizar a análise de genes relacionados à glicoproteína-P e canais de cloro ativados por glutamato (GP-P e HcGluCL). A estirpe de H. conctortus isolada apresentou elevada resistência à ivermectina, sendo observada eficácia ínfima de 6,59%. O verapamil isoladamente não apresentou efeito nematodicida, porém, em concentrações crescentes, associado à ivermectina (DL50-4,317μmol) proporcionou aumento de eficácia contra a cepa resistente de H. contortus, alcançando o percentual de 94,3% (verapamil 100 mmol). Os resultados do teste anti-helmíntico controlado, em que foram utilizados 42 ovinos experimentalmente infectados com H. contortus resistente à ivermectina, revelaram que o verapamil apresentou uma atividade de reversão parcial significativa (P<0,05) da resistência. Pela análise genotípica efetuada nas sete amostras desta população de H. contortus, submetidas aos diferentes tratamentos com ivermectina, verapamil ou associação entre estas drogas, verificou-se similaridade em relação à glicoproteína-P e pouca semalhança em relação aos canais de cloro ativados por glutamato.
Abstract: The present work aimed to identify and isolate a field ivermectin-resistant Haemonchus contortus strain, evaluate the effect of verapamil as a P-GP modulator agent by in vitro (agar gel larval migration assay) and in vivo (FECRT and controlled test), and analyze the genes related to the P-glycoprotein (P-GP) and H. contortus glutamate chloride (HcCluCl) chanel expression. The H. contortus field strain isolated was highly resistant to ivermectin, showing only 6.59% of efficacy. Verapamil alone didn't show any in vitro anthelmintic action but increasing concentrations of this drug associated to ivermectin (LD50-4.317μmol) resulted in higher efficacy, when compared to ivermectin alone, with 94.3% efficacy in the 100 mmol concentration. The results of the anthelmintic controlled test, in wich it was used 42 sheep experimentally infected with the field ivermectin-resistant H. contortus strain, showed a significant (P<0,05) parcial ivermectin resistance reversion by verapamil. The genomic analysis of the seven samples from this H. contortus resistant population submited to diferent treatment with ivermctin, verapamil and the association between theese two drugs, showed similarity in the genes related to the expression of P-GP and high polimorfism related to HcGluCL.
Orientador: Alvimar José da Costa
Coorientador: Marcelo Beltrão Molento
Banca: Giane Serafim da Silva
Banca: Alessandro Francisco Talamini do Amarante
Banca: Gilson Pereira de Oliveira
Banca: Adjair Antonio do Nascimento
Doutor

In eukaryotes, sophisticated mechanisms have been evolved to ensure that key events in the cell cycle take place at the correct time. The triggering of these events is largely controlled by transient increases in the concentration of intracellular free calcium ions [Ca2+ ]i. If these transient increases m [Ca2+ ]i are prevented by the use of drugs that either block the voltage operated calcium channels (VOCCs), inhibit the release of Ca2+ from the cells' internal reserves, or block the receptor proteins that bind intracellular Ca2+ ions, the cell cycle will stop at specific points. The cell cycle will only recommence following removal of the Ca2+ blockade. In bacteria, many genes have now been identified that are essential for specific cell cycle events. However, no regulator has been identified that actually controls the timing of these events. Many theoretical models have been developed to explain bacterial cell cycle control, but there is little solid evidence to support them. A hypothesis has been developed that states that Ca2+ ions regulate the bacterial cell cycle in a manner analogous to eukaryotes. To test this hypothesis, temperature sensitive mutants of the E. coli strain, N43, resistant to the eukaryotic VOCC inhibitors verapamil and diltiazem were isolated, although detailed characterisation was confined to a verapamil resistant mutant, N43verA1. All the mutants are affected at a specific locus on the E. coli chromosome consisting either of deletions or major genetic rearrangements of three genes, hns, galU and hnrG (renamed rrx in this work). These genes do not constitute the expected receptor, but nevertheless, detailed examination of N43verA1 demonstrated that it appears to be unable to regulate its [Ca2+]I, since it is hypersensitive both to the concentration of Ca2+ in the medium and the Ca2+-chelator, EGTA. Moreover, when N43verA1 was transferred from the permissive to non-permissive temperature, it formed filaments, minicells and "chains of sausages", demonstrating some defect in cell division. An examination of the wild-type and mutant's responses to treatment with verapamil, EGTA or Ca2+ by labelling cell proteins with [35S-] methionine, indicated an extremely complex response. N43verA1 constitutively expresses a number of heat-stable proteins, which are further induced following treatment with verapamil or EGTA. Preliminary data suggests that some of the EGTA inducible proteins possess calmodulin-like properties. The three genes, hns, galU and rrx appear to interact, either at the genetic or protein level. Measurements of hns expression indicated that it is induced by verapamil, but not by EGTA. Overexpression of galU results in hyper-resistance to verapamil and Ca2+, which is modulated by hns and rrx, respectively. It is proposed that these genes in some way regulate the [Ca2+]i, in addition to, or in relation to their role in nucleoid organisation and control of the stationary phase sigma factor, RpoS.

Orientador: Thales Rocha de Mattos Filho
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Doutorado

Includes bibliographical references
Tuberculosis (TB) is one of the major infectious diseases and epidemics in the world. It is responsible for severe morbidity and mortality rates, especially in poor and resource-deficient countries. According to the World Health Organization 2014 report, about one third of the world's population is infected with tuberculosis and about 10-15% is co-infected with HIV, which further complicates the TB epidemic. Tuberculosis claims 2-3 million lives every year and is one of the biggest social and financial burdens on many countries. The disease is treatable but has been hampered by the emergence of drug resistance in the causative bacterium, Mycobacterium tuberculosis (Mtb). Resistant strains of Mtb counter the efficacy of various anti-TB drugs via mechanisms that help it overcome the toxic and inhibitory effects of these drugs. These mechanisms include mutation, enzymatic drug degradation, target modification and drug efflux. Drug efflux by efflux pumps (EPs) is one of the major mechanisms responsible for the development of drug tolerance leading to the emergence of drug resistance. These efflux pumps are regulated by the house keeping proteins present in the cell membrane of Mtb and perform a pre-existing role of rescuing the Mtb from toxic agents. These EPs extrude structurally unrelated compounds from the cell including anti-TB drugs and reduce the drug concentration to sub-inhibitory levels and aid Mtb in developing resistance. Therefore, development of antimycobacterials that target EPs and reduce their activity can be a viable strategy to reduce the global TB burden and counter the emergence of resistance. Many strategies have been used to counter the EP-mediated resistance in Mtb. In this study, two strategies were employed: (i) the development of efflux pump inhibitors (EPIs) via structural modification of a known efflux pump inhibitor, verapamil (VER), and the development of hybrid efflux pump inhibitors (HEPIs) incorporating a VER motif; and (ii) the development of antimycobacterial agents based on covalent linking or attachment of efflux pump inhibitor moieties to an anti-TB drug. These agents are termed reversed anti-TB agents and are based on isoniazid for this study.

Resistance to the avermectin/milbemycin class of anthelmintics in nematodes has become a serious problem worldwide due to their unrestricted usage. Resistance to these compounds is attributed to the over-expression of the transport protein, P-glycoprotein (P-gp). P-gp acts by pumping drug molecules out from the cell or organism, P-gp efflux activity can be blocked using multidrug resistance (MDR) modulators associated with chemotherapy to enhance their therapeutic effect. A series of experiments was undertaken to determine if the association of the anthelmintics, ivermectin (IVM) and moxidectin (MOX), and MDR modulators would increase the anthelmintics' efficacy against resistant parasites. Using an in vitro migration assay, IVM and MOX in the presence or absence of verapamil (VRP), CL347,099 and cyclosporin A (CyA) were used against IVM- and MOX-selected strains of H. contortus. The modulators alone had no effect on reducing the number of migrating larvae, IVM and MOX had a significant increase in efficacy of 52.7 and 58,3% respectively, when used in association with VRP, above that obtained with the anthelmintics alone. CL347,099 was also able to significantly increase the IVM and MOX efficacy by 24.2 and 38.9%, respectively. The effect of IVM and MOX in combination with VRP and CL347,099 was determined in jirds infected with selected strains of H. contortus. The combinations of VRP with either IVM or MOX significantly reduced worm counts of the selected strains compared with the untreated controls, whereas IVM or MOX alone did not. CL347,099 plus MOX combination was significantly more efficacious than moxidectin alone against the selected strains. To evaluate the effect of VRP on the pharmacokinetic behaviour of the anthelmintics IVM and MOX, the drug combination was given to sheep. The IVM plus VRP treatment resulted in an increase of the pharmacokinetic parameters of IVM. The peak concentration (83%) and area under the curve (54%) were significantly differen