(3aS,7aS)-5-[(S)-3,3,3-Trifluoro-2-meth­oxy-2-phenyl­propano­yl]-2,3,4,5,6,7-hexa­hydro-1H-pyrrolo[3,4-c]pyridin-3(2H)-one monohydrate

rac-Benzyl 3-oxohexa­hydro-1H-pyrrolo[3,4-c]pyridine-5(6H)-carboxyl­ate was separated by chiral chromatography, and one of the enanti­omers ([α]22 D = +10°) was hydrogenated in the presence of Pd/C in methanol, producing octa­hydro-3H-pyrrolo[3,4-c]pyridin-3-one. The latter was reacted with (2R)-3,3,3-trifluoro-2-meth­oxy-2-phenyl­propanoyl chloride [(R)-(−)-Mosher acid chloride], giving rise to the title compound, C17H19F3N2O3·H2O. The present structure established the absolute configuration of the pyrrolopiperidine fragment based on the known configuration of the (R)-Mosher acid chloride. The piperidine ring has a somewhat distorted chair conformation and is cis-fused with the five-membered envelope-shaped ring; the plane of the exocyclic amide bond is approximately orthogonal to the plane of the phenyl ring, making a dihedral angle of 82.31 (3)°. The water mol­ecule acts as an acceptor to the proton of the amino group in an N—H⋯O inter­action, and as a double proton donor in O—H⋯O hydrogen bonds, generating infinite bands along the a axis

Mechanisms of action of the SGLT2 inhibitor canagliflozin on tubular inflammation and damage:A post-hoc mediation analysis of the CANVAS trial

AIMS: Exposure of tubular cells to albumin stimulates pro-inflammatory pathways including the release of Monocyte Chemoattractant Protein-1 (MCP-1) which may result in interstitial fibrosis and tubular damage reflected by increased urinary kidney injury molecule-1 (KIM-1). SGLT2 inhibition reduces urine albumin-creatinine ratio (UACR) and small studies suggest it also reduces MCP-1 and KIM-1. We hypothesised that the reduction in KIM-1 observed with the SGLT2 inhibitor canagliflozin is mediated through its effect on UACR and MCP-1. To test this hypothesis, we assessed the proportion of effect of canagliflozin on KIM-1 mediated through its effects on MCP-1 and UACR in patients with type 2 diabetes and albuminuric kidney disease. MATERIAL AND METHODS: KIM-1 and MCP-1 were measured in urine samples of the CANVAS trial at baseline and week 52 with the Mesoscale QuickPlex SQ 120 platform. KIM-1 and MCP-1 were standardized by urinary creatinine. The proportion of mediated effect of canagliflozin through UACR and MCP-1/Cr on KIM-1/Cr was estimated with G-computation. RESULTS: In total, 763 (17.6% of total cohort) patients with micro- or macroalbuminuria were included. Baseline characteristics were well balanced between the canagliflozin and placebo group. At year 1, canagliflozin compared to placebo reduced UACR, MCP-1/Cr, and KIM-1/Cr by 40.4% (95%CI 31.0, 48.4), 18.1% (95%CI 8.9, 26.4), and 30.9% (95%CI 23.0, 38.0), respectively. The proportion of the effect of canagliflozin on KIM-1/Cr mediated by its effect on UACR and in turn on MCP-1/Cr was 15.2% (95%CI 9.4, 24.5). CONCLUSION: Canagliflozin reduces urinary KIM-1 suggesting decreased tubular damage. This effect was partly mediated through a reduction in MCP-1, indicative of reduced tubular inflammation, which was in turn mediated by a reduction in UACR. This post-hoc analysis suggest that urinary albumin leakage may lead to tubular inflammation and induction of injury, and provide mechanistic insight for how canagliflozin may ameliorate tubular damage, but further research is required to confirm these findings. This article is protected by copyright. All rights reserved

The transition of adolescents with juvenile idiopathic arthritis or epilepsy from paediatric health-care services to adult health-care services: A scoping review of the literature and a synthesis of the evidence

Young people with long-term health conditions (LTCs) can face challenges when making the transition to adult health services. This paper sought to identify studies that assess and explore transitional care for young people with LTCs. Two conditions were used as exemplars: juvenile idiopathic arthritis (JIA) and epilepsy. A scoping review of the literature was conducted by using search terms to search for papers in English between 2001 and 2016 concerning transitional care on four databases. Qualitative papers were reviewed and synthesized using thematic analysis. Quantitative papers using health outcomes were also synthesized. Twenty-eight papers were selected for review. Despite the wealth of literature concerning aspects of transitional care that are key to a successful transition for young people with JIA or epilepsy, there is a paucity of outcomes that define ‘successful’ transition and consequently a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services

Hemimysis anomala in Lake Ontario food webs: stable isotope analysis of nearshore communities

a b s t r a c t a r t i c l e i n f o Hemimysis anomala, a littoral freshwater mysid native to the Ponto-Caspian region, is the newest invader to the Laurentian Great Lakes basin. Discovered in 2006, they have since been found in all of the Great Lakes (except Lake Superior) and have the potential to offset the dietary energy sink caused by invasive dreissenid mussels (Dreissena bugensis and D. polymorpha) in the littoral zone. We evaluated nearshore food web structure at four sites along Lake Ontario's north shore spanning a gradient of Hemimysis density to determine: 1) if dominant nearshore food web pathways change seasonally, and 2) whether fish are exhibiting a dietary shift towards consumption of Hemimysis. No Hemimysis were found in any of the 431 fish (alewife Alosa pseudoharengus, round goby Neogobius melanostomus, and yellow perch Perca flavescens) stomachs analysed. We used stable isotopes of carbon ( C of Hemimysis. Our results suggest that Hemimysis are being incorporated into diets of round gobies, alewife and small yellow perch and their reliance on Hemimysis as a dietary component increases with Hemimysis density. As Hemimysis populations continue to establish and stabilize, fish may incorporate this species into their diets at a higher rate

Sodium glucose co-transporter 2 inhibition increases epidermal growth factor expression and improves outcomes in patients with type 2 diabetes

Underlying molecular mechanisms of the kidney protective effects of sodium glucose co-transporter 2 (SGLT2) inhibitors are not fully elucidated. Therefore, we studied the association between urinary epidermal growth factor (uEGF), a mitogenic factor involved in kidney repair, and kidney outcomes in patients with type 2 diabetes (T2D). The underlying molecular mechanisms of the SGLT2 inhibitor canagliflozin on EGF using single-cell RNA sequencing from kidney tissue were examined. Urinary EGF-to-creatinine ratio (uEGF/Cr) was measured in 3521 CANagliflozin cardioVascular Assessment Study (CANVAS) participants at baseline and week 52. Associations of uEGF/Cr with kidney outcome were assessed using multivariable-adjusted Cox regression models. Single-cell RNA sequencing was performed using protocol kidney biopsy tissue from ten young patients with T2D on SGLT2i, six patients with T2D on standard care only, and six healthy controls (HCs). In CANVAS, each doubling in baseline uEGF/Cr was associated with a 12% (95% confidence interval 1-22) decreased risk of kidney outcome. uEGF/Cr decreased after 52 weeks with placebo and remained stable with canagliflozin (between-group difference +7.3% (2.0-12.8). In young persons with T2D, EGF mRNA was primarily expressed in the thick ascending loop of Henle. Expression in biopsies from T2D without SGLT2i was significantly lower compared to HCs, whereas treatment with SGLT2i increased EGF levels closer to the healthy state. In young persons with T2D without SGLT2i, endothelin-1 emerged as a key regulator of the EGF co-expression network. SGLT2i treatment was associated with a shift towards normal EGF expression. Thus, decreased uEGF represents increased risk of kidney disease progression in patients with T2D. Canagliflozin increased kidney tissue expression of EGF and was associated with a downstream signaling cascade linked to tubular repair and reversal of tubular injury.</p