The impact of obesity on the pharmacokinetics of drugs in adolescents and adults

  Despite the increasing number of obese patients, evidence-based dosing guidelines are scarce, particularly for obese children and morbidly obese adults (BMI > 40 kg/m2). For both these populations, pharmacokinetic studies are needed to provide a basis for evidence-based dosing guidelines. In this thesis, we studied the pharmacokinetics of the CYP3A substrate midazolam, the renally excreted drug metformin and acetaminophen (metabolized by glucuronidation, sulphation and CYP2E1) in obese adolescents and/or morbidly obese adults. We address several currently unanswered questions; Can doses for obese adolescents be predicted on the basis of data obtained in morbidly obese adults? How to analyse pharmacokinetic data in obese adolescents, for whom body weight is influenced by growth, age and obesity? How to achieve safe and effective acetaminophen dosing for morbidly obese patients? The studies described in this thesis contribute to the existing gaps in knowledge regarding the pharmacokinetics and evidence-based dosing of drugs in obese adolescents and morbidly obese adults.  Department of Clinical Pharmacy, St. Antonius Hospital Department of Anaesthesiology and Intensive Care, St. Antonius HospitalPharmacolog

The role of auxin transport in the control of shoot branching

Branching is a highly plastic trait, enabling plants to adapt their growth form in response to environmental stimuli. In flowering plants, shoot branching is regulated through the activity of axillary buds, which grow into branches. Several classes of plant hormones have been shown to play pivotal roles in regulating bud outgrowth. Auxin derived from the primary shoot apex and active branches inhibits bud outgrowth, whereas cytokinin promotes it. Strigolactones also inhibit bud outgrowth, by changing properties of the auxin transport network, increasing the competition between buds. This occurs by modulating access to the polar auxin transport stream (PATS) in the main stem. The PATS provides directional, long distance transport of auxin down the stem, involving basal localisation of the auxin transporter PIN-FORMED1 (PIN1). Buds need to export their auxin across the stem towards the PATS in order to activate, but since PIN1 is mainly expressed in narrow files of cells associated with the stem vasculature, PIN1 itself it is unlikely to facilitate this connectivity. This thesis re-examines the role of auxin transport in the stem, showing that, besides the PIN1-mediated PATS, other auxin transport proteins constitute a more widespread and less polar auxin transport stream, allowing auxin exchange between the PATS and surrounding tissues. Disruption of this transport stream is shown to reduce bud-bud communication and to partially rescue the increased branching observed in strigolactone mutants. Furthermore, it is shown that distinct classes of auxin transport proteins within this stream can differentially affect bud outgrowth mediated by BRANCHED1 (BRC1). BRC1 is a transcription factor proposed to determine bud activation potential. Taken together, the data presented here provide a more comprehensive understanding of the shoot auxin transport network and its role in shoot branching regulation

Patient Self-Management and Tracking A European Experience

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Connective auxin transport contributes to strigolactone-mediated shoot branching control independent of the transcription factor BRC1

The shoot systems of plants are built by the action of the primary shoot apical meristem, established during embryogenesis. In the axil of each leaf produced by the primary meristem, secondary axillary shoot apical meristems are established. The dynamic regulation of the activity of these axillary meristems gives shoot systems their extraordinary plasticity of form. The ability of plants to activate or repress these axillary meristems appropriately requires communication between meristems that is environmentally sensitive. The transport network of the plant hormone auxin has long been implicated as a central player in this tuneable communication system, with other systemically mobile hormones, such as strigolactone and cytokinin, acting in part by modulating auxin transport. Until recently, the polar auxin transport stream, which provides a high conductance auxin transport route down stems dominated by the auxin export protein PIN-FORMED1 (PIN1), has been the focus for understanding long range auxin transport in the shoot. However, recently additional auxin exporters with important roles in the shoot have been identified, including PIN3, PIN4 and PIN7. These proteins contribute to a wider less polar stem auxin transport regime, which we have termed connective auxin transport (CAT), because of its role in communication across the shoot system. Here we present a genetic analysis of the role of CAT in shoot branching. We demonstrate that in Arabidopsis, CAT plays an important role in strigolactone-mediated shoot branching control, with the triple pin3pin4pin7 mutant able to suppress partially the highly branched phenotype of strigolactone deficient mutants. In contrast, the branchy phenotype of mutants lacking the axillary meristem-expressed transcription factor, BRANCHED1 (BRC1) is unaffected by pin3pin4pin7. We further demonstrate that mutation in the ABCB19 auxin export protein, which like PIN3 PIN4 and PIN7 is widely expressed in stems, has very different effects, implicating ABCB19 in auxin loading at axillary bud apices.Gatsby Charitable Foundatio

Heterogeneous hydride pyrolysis in a chemical beam epitaxy cracker cell and growth of high quality InP

The decomposition of phosphine and arsine in a chemical beam epitaxy cracker cell was investigated with a quadrupole mass spectrometer. We have determined the kinetical parameters for a unimolecular reaction of the first order, i.e. the activation energy and frequency factor, from the decomposition efficiency as a function of temperature. These results are compared with data from literature. We find the lowest activation energies ever reported for the hydride pyrolysis, namely 72 and 48 kJ/mol for phosphine and arsine, respectively. This is due to the heterogeneous decomposition on catalytic molybdenum baffles inside the cracker cell. Additionally, we have studied the impurity incorporation in epitaxially grown bulk InP layers in relation to the efficiency of this particular molybdenum containing cracker cell. Impurity levels were determined by fitting calculated Hall values to experimental data. The best quality is achieved for the cracker temperature at which the efficiency starts to saturate. At this cracker temperature, optimized mass flow rates resulted in InP layers with a maximum mobility of 186¿000 cm2/V¿s and impurity concentrations in the low 1014 cm-3 range

Cardiac left atrium CT image segmentation for ablation guidance

Catheter ablation is an increasingly important curative procedure for atrial fibrillation. Knowledge of the local wall thickness is essential to determine the proper ablation energy. This paper presents the first semi-automatic atrial wall thickness measurement method for ablation guidance. It includes both endocardial and epicardial atrial wall segmentation on CT image data. Segmentation is based on active contours, Otsu's multiple threshold method and hysteresis thresholding. Segmentation results were compared to contours manually drawn by two experts, using repeated measures analysis of variance. The root mean square differences between the semi-automatic and the manually drawn contours were comparable to intra-observer variation (endocardium: p = 0.23, epicardium: p = 0.18). Mean wall thickness difference is significant between one of the experts on one side, and the presented method and the other expert on the other side (

Individualized dosing of evinacumab is predicted to yield reductions in drug expenses

Background: Evinacumab is a first-in-class inhibitor of angiopoietin‐like protein 3 (ANGPTL3) for treatment of the rare disease homozygous familial hypercholesterolemia (HoFH). With projected drug costs of $450,000 per person per year, the question rises if cost-efficacy of evinacumab can be further improved. Objectives: To develop an individualized dosing regimen te reduce drug expenses. Methods: Using the clinical and pharmacological data as provided by the license holder, we developed an alternative dosing regimen in silico based on the principles of reduction of wastage by dosing based on weight bands rather than a linear milligram per kilogram body weight (mg/kg) dosing regimen, as well as dose individualization guided by low density lipoprotein cholesterol (LDL-C) response. Results: We found that the average quantity of drug used for a dose could be reduced by 34% without predicted loss in efficacy (LDL-C reduction 24 weeks after treatment initiation). Conclusion: Dose reductions without compromising efficacy seem feasible. We call for implementation and prospective evaluation of this strategy to reduce treatment costs of HoFH.</p