Analgesia and Opioids: A pharmacogenetics shortlist for implementation in clinical practice

BACKGROUND: The use of opioids to alleviate pain is complicated by the risk of severe adverse events and the large variability in dose requirements. Pharmacogenetics (PGx) could possibly be used to tailor pain medication based on an individual's genetic background. Many potential genetic markers have been described, and the importance of genetic predisposition in opioid efficacy and toxicity has been demonstrated in knockout mouse models and human twin studies. Such predictors are especially of value for neonates and young children, in whom the assessment of efficacy or side effects is complicated by the inability of the patient to communicate this properly. The current problem is determining which of the many potential candidates to focus on for clinical implementation. CONTENT: We systematically searched publications on PGx for opioids in 5 databases, aiming to identify PGx markers with sufficient robust data and high enough occurrence for potential clinical application. The initial search yielded 4257 unique citations, eventually resulting in 852 relevant articles covering 24 genes. From these genes, we evaluated the evidence and selected the most promising 10 markers: cytochrome P450 family 2 subfamilyDmember 6 (CYP2D6), cytochrome P450 family 3 subfamily A member 4 (CYP3A4), cytochrome P450 family 3 subfamily A member 5 (CYP3A5), UDP glucuronosyltransferase family 2 member B7 (UGT2B7), ATP binding cassette subfamily B member 1 (ABCB1), ATP binding cassette subfamily C member 3 (ABCC3), solute carrier family 22 member 1 (SLC22A1), opioid receptor kappa 1 (OPRM1), catechol-O-methyltransferase (COMT), and potassium voltage-gated channel subfamily J member 6 (KCNJ6). Treatment guidelines based on genotype are already available only for CYP2D6. SUMMARY: The application of PGx in the management of pain with opioids has the potential to improve therapy. We provide a shortlist of 10 genes that are the most promising markers for clinical use in this context

A Prospective Population Pharmacokinetic Study on Morphine Metabolism in Cancer Patients

Background: Oral and subcutaneous morphine is widely used for the treatment of cancer-related pain; however, solid pharmacokinetic data on this practice are lacking. Furthermore, it is largely unknown which factors contribute to the variability in clearances of morphine and its metabolites and whether morphine clearance is related to treatment outcome. Methods: Blood samples from 49 cancer patients treated with oral and/or subcutaneous morphine were prospectively collected and were used to develop a population pharmacokinetic model for morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). The influence of age, gender, renal function and several polymorphisms possibly related to the pharmacokinetics of the three compounds was investigated. In addition, the relation between treatment failure and morphine and metabolite clearances was explored. Results: A one-compartment model including an extensive first-pass effect adequately described the data of morphine and its metabolites. Estimated mean area under the plasma concentration–time curve (AUC) ratios following oral versus subcutaneous administration were: M3G/morphine 29.7:1 vs. 11.1:1; M6G/morphine 5.26:1 vs. 1.95:1; and M3G/M6G 5.65:1 vs. 5.70:1. Renal function was significantly correlated with clearance of the metabolites, which increased 0.602 L/h per every 10 mL/min/1.73 m2 increase of estimated glomerular filtr

Anomalous magnetic properties of CaRuO3 probed by AC and DC magnetic measurements and by low Ti impurity doping

Calcium ruthenate (CaRuO3) is widely believed to be located close to a quantum critical point due to the strong non-Fermi-liquid behavior expressed in the temperature dependence of electronic transport, specific heat, optical conductivity, etc. However, the corresponding anomalous behavior, marking crossover temperature regimes in the magnetic response of CaRuO3, is still lacking. Here we report detailed AC and DC magnetic susceptibility measurements of CaRuO3 and CaR u0.97 Ti 0.03 O3. The AC magnetic susceptibility measurements of CaRuO3 show a slight dependence on the frequency of AC magnetic field below ∼40K, and an additional subtle change of curvature around 12 K. We interpret these results as a critical slowing down of spin fluctuations towards T = 0 K. We confirm these observations by magnetic measurements of CaRu0.97 Ti 0.03 O3, which show a pronounced magnetic response corresponding to the above temperatures

Identification of Phenolic Compounds from Seed Coats of Differently Colored European Varieties of Pea (Pisum sativum L.) and Characterization of Their Antioxidant and In Vitro Anticancer Activities

To date little has been done on identification of major phenolic compounds responsible for anticancer and antioxidant properties of pea (Pisum sativum L.) seed coat extracts. In the present study, phenolic profile of the seed coat extracts from 10 differently colored European varieties has been determined using ultrahigh-performance liquid chromatography-linear trap quadrupole orbitrap mass spectrometer technique. Extracts of dark colored varieties with high total phenolic content (up to 46.56mg GAE/g) exhibited strong antioxidant activities (measured by 2,2-diphenyl-1-picrylhydrazyl or DPPH assay, and ferric ion reducing and ferrous ion chelating capacity assays) which could be attributed to presence of gallic acid, epigallocatechin, naringenin, and apigenin. The aqueous extracts of dark colored varieties exert concentration-dependent cytotoxic effects on all tested malignant cell lines (human colon adenocarcinoma LS174, human breast carcinoma MDA-MB-453, human lung carcinoma A594, and myelogenous leukemia K562). Correlation analysis revealed that intensities of cytotoxic activity of the extracts strongly correlated with contents of epigallocatechin and luteolin. Cell cycle analysis on LS174 cells in the presence of caspase-3 inhibitor points out that extracts may activate other cell death modalities besides caspase-3-dependent apoptosis. The study provides evidence that seed coat extracts of dark colored pea varieties might be used as potential cancer-chemopreventive and complementary agents in cancer therapy

Biological activity of electrochemically synthesized silver doped polyvinyl alcohol/graphene composite hydrogel discs for biomedical applications

Silver/poly(vinyl alcohol), Ag/PVA, and silver/poly(vinyl alcohol)/graphene, Ag/PVA/Gr, composite hydrogel discs were produced by freezing/thawing, followed by electrochemical reduction of Ag+ ions inside respective matrices, at constant voltage in specially designed electrochemical cell. Raman, FT-IR and FE-SEM characterized interactions between PVA, graphene and silver nanoparticles. Ag/PVA and Ag/PVA/Gr discs classified as non-cytotoxic towards peripheral blood mononuclear cells (PBMC) according to MTT cytotoxicity test, while exhibiting antibacterial activity against Staphylococcus aureus and Escherichia coli. The slow silver release and high remaining silver content of similar to 67-68 wt % after 28 day immersion in simulated body fluid confirmed that both composites can preserve their sterility overtime

Ruthenium(II) Complexes of Isothiazole Ligands: Crystal Structure, HSA/DNA Interactions, Cytotoxic Activity and Molecular Docking Simulations

Two new neutral ruthenium(II) complexes [Ru(eta(6)-p-cymene)Cl-2(1)] (3) and [Ru(eta(6)-p-cymene)Cl-2(2)] (4) (1=5-(phenylamino)-3-pyrrolidin-1-ylisothiazole-4-carbonitrile;2=3-morpholin-4-yl-5-(phenylamino)isothiazole-4-carbonitrile) have been synthesized and characterized using elemental analysis, IR, UV-Vis and NMR spectroscopy. The crystal structure was confirmed for complex3and both ligands. Examination of the interactions of ligands and complexes with CT-DNA (Calf Thymus DNA), as well as with HSA (Human Serum Albumin) revealed that ligands and complexes could interact with CT-DNA through intercalation and could bind strongly with HSA. Docking experiments toward DNA dodecamer indicate excellent accordance with experimental Delta G values. The cytotoxic activity of ligands and complexes was evaluated by MTT assay against HCT116 and HeLa tumoral cells. The complexes3and4showed good activity and selectivity on HCT116 cells. Neither of the tested compounds shows cytotoxic activity against a healthy MRC-5 cell line. Flow cytometry analysis showed the apoptotic death of the HCT116 cells with a cell cycle arrest in the S-phase