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Biomedical subjects

B B Rasmussen

Publications and source records attributed to B B Rasmussen.

At least 37 records · Page 2Linked to original sources
PubMed1997

Fluvoxamine inhibits the CYP2C19-catalyzed bioactivation of chloroguanide.

OBJECTIVE: To investigate the interaction between fluvoxamine and chloroguanide (INN, proguanil) to confirm that fluvoxamine inhibits CYP2C19. METHODS: The study was carried out with a randomized, in vivo, crossover design. Six volunteers were extensive metabolizers of the S-mephenytoin oxidation polymorphism, and six volunteers were poor metabolizers. In period A of the study, each subject took 200 mg chloroguanide orally. In period B, each subject took 100 mg/day fluvoxamine for 8 days and on day 6 ingested 200 mg chloroguanide. In both periods, blood and urine were sampled at regular intervals. Chloroguanide and its two metabolites cycloguanil and 4-chlorphenylbiguanide in plasma and in urine were assayed by means of HPLC. RESULTS: During fluvoxamine use, the median of the total clearance of chloroguanide decreased in a statistically significant way from 1282 ml/min to 782 ml/min among the extensive metabolizers, whereas there was no change among the poor metabolizers. The partial clearance of chloroguanide by means of cydoguanil and 4-chlorphenylbiguanide formation among the extensive metabolizers decreased from 222 ml/min and 97 ml/min before to 33 ml/min and 11 ml/min during fluvoxamine intake, respectively. Among poor metabolizers the corresponding values were 35 ml/min and 7.6 ml/min before and 38 ml/min and 6.9 ml/min during fluvoxamine intake. For each metabolite clearance the change was statistically significant among the extensive metabolizers but not among the poor metabolizers. Both cycloguanil and 4-chlorphenylbiguanide formation clearances were statistically significantly higher among the extensive metabolizers than the poor metabolizers in period A but not in period B (phenocopy). CONCLUSION: Fluvoxamine is an effective inhibitor of CYP2C19.

Administration, Oral↗
PubMed1997

Imipramine demethylation in vivo: impact of CYP1A2, CYP2C19, and CYP3A4.

OBJECTIVE: To further substantiate the role of CYP1A2 and CYP3A4 for the N-demethylation in vivo. At least three different P450s appear to be responsible for the N-demethylation of imipramine to desipramine in vivo: CYP1A2, CYP2C19, and CYP3A4. The role of CYP2C19 in this regard is well documented, but for the two other P450s the evidence is either indirect or based on in vitro studies. METHODS: Phenotypic tests for imipramine N-demethylation, CYP1A2 (caffeine testing), CYP2C19 (mephenytoin and chloroguanide [proguanil] testing), and CYP3A4 (hydrocortisone and quinidine testing) were carried out in 32 healthy young Danes; all were poor (n = 31) or extremely slow extensive metabolizers (n = 1) of sparteine. RESULTS: By exclusion of the insignificant log-transformed variables, multiple regression analysis for In (desipramine/imipramine) showed that only in (mephenytoin S/R) correlated (p = 0.013; r2 = 0.19). For in (2-hydroxydesipramine/2-hydroxyimipramine) we found that in (mephenytoin S/R) and in (4-chlorophenylbiguanide/chloroguanide) correlated (p = 0.001; r2 = 0.41). CONCLUSION: We did not find in vivo evidence of either CYP1A2 or CYP3A4 activity in the N-demethylation of imipramine. This could be due in part to inadequate CYP1A2 and CYP3A4 in vivo function tests.

Adult↗
PubMed1997

Griseofulvin and fluvoxamine interactions with the metabolism of theophylline.

Theophylline is predominantly metabolized by cytochrome P4501A2 (CYP1A2). A possible interaction between griseofulvin and theophylline was reported to our laboratory, which led us to form the hypothesis that griseofulvin induces the metabolism of theophylline. One purpose of this study was to investigate this hypothesis. The study was carried out as a randomized crossover study of 12 healthy volunteers. In period A of the study, each volunteer received a single dose of 300 mg theophylline ethylenediamine orally. In period B, the subjects took fluvoxamine, 50 mg for 1 day and 100 mg for 6 days, and on day 4, the subjects ingested 300 mg theophylline ethylenediamine. Fluvoxamine is a potent inhibitor of CYP1A2, and period B was included as a positive control. In period C, the subjects took 500 mg griseofulvin for 9 days; on day 8 the subjects again ingested 300 mg theophylline ethylenediamine. Theophylline and its metabolites (1-methyluric acid [IMU], 3-methylxanthine [3MX], and 1,3-dimethyluric acid [13DMU]) in plasma and urine were assayed by high-performance liquid chromatography. During fluvoxamine intake, the median of the total clearance of theophylline decreased from 80 ml/min to 24 ml/min, and the half-life increased from 6.6 to 22 h. The partial formation clearances of the metabolites decreased from 17 to 1.7 ml/min, from 8.9 to 0.9 ml/min, and from 21 to 6.8 ml/min for 1MU, 3MX, and 13DMU, respectively. The results confirm that assessment of theophylline metabolism indeed serves as a biomarker for CYP1A2. During griseofulvin ingestion, the median of the total and partial clearances of theophylline were 84 ml/min, 22 ml/min (1MU), 9.4 ml/min (3MX), and 25 ml/min (13DMU). The half-life decreased significantly from 6.6 to 5.7 h. The increase in partial formation clearances of 1MU and 13DMU, but not of 3MX, were statistically significant. The increase in the total clearance reached only borderline significance. In four subjects a marked induction was seen for all pharmacokinetic parameters, suggesting that the susceptibility to induction is more pronounced in some subjects. This susceptibility could theoretically be explained by a polymorphism in the inducibility of the gene coding for the CYP1A2 enzyme.

Adult↗
PubMed1997

Theophylline has no advantages over caffeine as a putative model drug for assessing CYPIA2 activity in humans.

AIMS: The cytochrome P4501A2 (CYP1A2) catalyses the metabolism of a number of clinically used drugs, and thus there is an interest in determining the activity of CYP1A2 in patients before treatment with CYP1A2 substrates. Caffeine is the most commonly used model drug to assess CYP1A2 function, but due to the complex metabolism of caffeine, there is a need for an alternative drug to use as an index of CYP1A2 activity. In this study the CYP1A2 substrate theophylline was tested as a possible alternative to caffeine as a model drug for CYP1A2. METHODS: Twelve healthy volunteers ingested 200 mg of caffeine, and the caffeine metabolic ratios (CMR), CMRurine = (AFMU + 1MX + 1MU)/17DMU and CMRplasma = 17DMX/137TMX were determined 6 h after drug intake. After a period of about 2 months the volunteers ingested 257 mg theophylline and blood samples were drawn and urine was collected during the following 48 h. The oral and partial clearance of theophylline were calculated via N-demethylation and 8-hydroxylation. The theophylline metabolic ratios, 1MU/13DMX and 3MX/13DMX being evaluated as indices of CYP1A2 catalysed N-demethylation and 13DMU/13DMX as an index of partly CYP1A2 catalysed 8-hydroxylation, were estimated in 0-12 h, 0-24 h and 0-48 h urine samples, and in plasma and spot urine samples 6 h after the intake of theophylline. RESULTS: The theophylline plasma ratios for the N-demethylation pathways correlated with the oral clearance of theophylline (rs = 0.881-0.934, P < 0.001) and with the respective formation clearances of the metabolites (rs = 0.712-0.925, P < 0.05). Furthermore, all of the theophylline plasma ratios correlated with the caffeine plasma ratio (rs = 0.645-0.663, P < 0.05). None of the caffeine metabolic ratios and none of the 6 h urinary theophylline ratios correlated with the oral or the partial clearances of theophylline (rs = 0.042-0.556, P < 0.05). The theophylline 0-12 h urine ratios correlated with the oral clearance of theophylline (rs = 0.677-0.757, P < 0.05) and with the respective formation clearances of the metabolites (rs = 0.705-0.750, P < 0.05). However, none of the theophylline urine ratios correlated with any of the caffeine metabolic ratios. CONCLUSIONS: In summary the theophylline 6 h plasma and 0-12 h urine ratios 1MU/13DMX and 3MX/13DMX, both reflecting N-demethylation seem to be predictors of the CYP1A2 mediated metabolism of theophylline, whereas only the plasma ratio correlated with the caffeine plasma 17DMX/13TMX ratio. Thus, it would appear that the plasma theophylline N-demethylation ratios are superior to the urine ratios as indices of CYP1A2 activity. However, because in some individuals the concentrations of theophylline metabolites in plasma were close to the limit of detection, it is concluded that theophylline does not have marked advantages over caffeine as a model drug for assessing CYP1A2 activity.

Adult↗
PubMed1997

Phosphorylation of rat muscle acetyl-CoA carboxylase by AMP-activated protein kinase and protein kinase A.

This study was designed to compare functional effects of phosphorylation of muscle acetyl-CoA carboxylase (ACC) by adenosine 3',5'-cyclic monophosphate-dependent protein kinase (PKA) and by AMP-activated protein kinase (AMPK). Muscle ACC (272 kDa) was phosphorylated and then subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by autoradiography. Functional effects of phosphorylation were determined by measuring ACC activity at different concentrations of each of the substrates and of citrate, an activator of the enzyme. The maximal velocity (Vmax) and the Michaelis constants (Km) for ATP, acetyl-CoA, and bicarbonate were unaffected by phosphorylation by PKA. Phosphorylation by AMPK increased the Km for ATP and acetyl-CoA. Sequential phosphorylation by PKA and AMPK, first without label and second with label, appeared to reduce the extent of label incorporation, regardless of the order. The activation constant (Ka) for citrate activation was increased to the same extent by AMPK phosphorylation, regardless of previous or subsequent phosphorylation by PKA. Thus muscle ACC can be phosphorylated by PKA but with no apparent functional effects on the enzyme. AMPK appears to be the more important regulator of muscle ACC.

Acetyl-CoA Carboxylase↗
PubMed1997

Effect of exercise intensity on skeletal muscle malonyl-CoA and acetyl-CoA carboxylase.

Malonyl-CoA is synthesized by acetyl-CoA carboxylase (ACC) and is an inhibitor of fatty acid oxidation. Exercise induces a decline in skeletal muscle malonyl-CoA, which is accompanied by inactivation of ACC and increased activity of AMP-activated protein kinase (AMPK). This study was designed to determine the effect of exercise intensity on the enzyme kinetics of ACC, malonyl-CoA levels, and AMPK activity in skeletal muscle. Male Sprague-Dawley rats were killed (pentobarbital sodium anesthesia) at rest or after 5 min of exercise (10, 20, 30, or 40 m/min at 5% grade). The fast-twitch red and white regions of the quadriceps muscle were excised and frozen in liquid nitrogen. A progressive decrease in red quadriceps ACC maximal velocity (from 28.6 +/- 1.5 to 14.3 +/- 0.7 nmol . g-1 . min-1, P < 0.05), an increase in activation constant for citrate, and a decrease in malonyl-CoA (from 1.9 +/- 0.2 to 0.9 +/- 0.1 nmol/g, P < 0.05) were seen with the increase in exercise intensity from rest to 40 m/min. AMPK activity increased more than twofold. White quadriceps ACC activity decreased only during intense exercise. We conclude that the extent of ACC inactivation during short-term exercise is dependent on exercise intensity.

AMP-Activated Protein Kinases↗
PubMed1997

Endurance training attenuates the decrease in skeletal muscle malonyl-CoA with exercise.

Muscle malonyl-CoA has been postulated to regulate fatty acid metabolism by inhibiting carnitine palmitoyltransferase 1. In nontrained rats, malonyl-CoA decreases in working muscle during exercise. Endurance training is known to increase a muscle's reliance on fatty acids as a substrate. This study was designed to investigate whether the decline in malonyl-CoA with exercise would be greater in trained than in nontrained muscle, thereby allowing increased fatty acid oxidation. After 6-10 wk of endurance training (2 h/day) or treadmill habituation (5-10 min/day), rats were killed at rest or after running up a 15% grade at 21 m/min for 5, 20, or 60 min. Training attenuated the exercise-induced drop in malonyl-CoA and prevented the exercise-induced increase in the constant for citrate activation of acetyl-CoA carboxylase in the red quadriceps muscle of rats run for 20 and 60 min. Hence, contrary to expectations, the decrease in malonyl-CoA was less in trained than in nontrained muscle during a single bout of prolonged submaximal exercise.

Animals↗
PubMed1996

Determination of theophylline and its metabolites in human urine and plasma by high-performance liquid chromatography.

A method for the quantitation of theophylline (13DMX) and the three metabolites, 1-methyluric acid (1MU), 3-methylxanthine (3MX) and 1,3-dimethyluric acid (13DMU) in human plasma and urine has been developed. The method is based on a simple one-step liquid-liquid extraction with ethylacetate-2-propanol followed by isocratic, reversed-phase high-performance liquid chromatography with UV detection (detection wavelength: 273 nm). The overall mean recoveries ranged from 86 to 95% for the four compounds. The detection limit was 1 microM for 1MU, 3MX and 13DMU and 2 microM for 13DMX in urine, and 0.1 microM for 1MU, 3MX and 13DMU and 0.2 microM for 13DMX in plasma. The intra-day and inter-day coefficient of variation was < 6% and < 9%, respectively, and the accuracy was within +/- 10% in both urine and plasma. The simple but sensitive method is highly suitable for the development of theophylline as a probe drug for assessing CYP1A2 activity in man.

Biotransformation↗
PubMed1996

Comparison of two monoclonal antibodies for the detection of estrogen receptors in primary breast carcinomas.

A new monoclonal antibody against estrogen receptor (ID5, Dako) has shown promising results when applied to formalin fixed, paraffin embedded tissue. In order to determine whether this antibody can compete in specificity and sensitivity with the ER-ICA antibody (Abbott Laboratories), a comparative, prospective study of the two antibodies was carried out on paraffin embedded and fresh frozen tissue in three laboratories. Two hundred and fifteen breast carcinomas were examined. Formalin fixed, paraffin embedded tissue was available from 215 tumors, and fresh frozen tissue from 189 of the tumors. Of these, 124 tumors were also investigated by the enzyme-linked immunosorbent assay. The results from each of the three laboratories correspond with those obtained for the whole material. The percentage of tumors positive for estrogen receptors within the different methods, was as follows: 71% by ID5 on paraffin sections, 50% by ER-ICA on paraffin sections, 65% ER-ICA on frozen sections and 88% by the EIA. When comparing the different immunohistochemical results and the EIA in 2 x 2 tables, agreement was reached in 69% to 91% of the cases. The best agreement (91%) was found between results obtained with the ID5 antibody used on formalin fixed, paraffin embedded tissue and the ER-ICA kit used on fresh frozen tissue. The advantages of using the ID5 antibody are associated with its applicability to formalin fixed, paraffin embedded tissue: improved morphology, reproducibility, retrospective studying and low costs. Finally, it is reproducible not only within the same laboratory but also among different laboratories.

Antibodies, Monoclonal↗
PubMed1996

Determination of urinary metabolites of caffeine for the assessment of cytochrome P4501A2, xanthine oxidase, and N-acetyltransferase activity in humans.

Caffeine metabolism via the 3-demethylation pathway is sequentially catalyzed by cytochrome P4501A2 (CYP1A2), xanthine oxidase, and N-acetyltransferase. The activities of the three enzymes can be estimated from urinary metabolic ratios of four caffeine metabolites, 5-acetylamino-6-formylamino-3-methyluracil (AFMU), 1-methyluric acid (1MU), 1-methylxanthine (1MX), and 1,7-dimethyluric acid (17DMU), after the ingestion of caffeine. A method for quantitation of the four metabolites in human urine has been developed. The method is based on a one-step extraction with ethyl acetate/2-propanol followed by high-performance liquid chromatography with UV detection. The detection limit was 1 microM for AFMU, 1MU, and 1MX and 2 microM for 17DMU. The intraday and interday coefficients of variation were < 3% and < 7%, respectively, and the accuracy was within +/- 3%. The method was employed in a population study of 277 healthy volunteers, each of whom ingested 200 mg caffeine and provided a urine sample approximately 6 h later. The metabolite concentration ranges in the urines were 2.1-327 microM, 4.0-744 microM, 4.9-598 microM, and 6.4-260 microM for AFMU, 1MU, 1MX, and 17DMU, respectively. The CYP1A2 ratio (AFMU + 1MU + 1MX/17DMU) was significantly lower in women than in men, excluding smokers and oral contraceptive users. The CYP1A2 ratio was higher in smokers than in nonsmokers, confirming the induction of CYP1A2 by smoking. In women using oral contraceptives, the CYP1A2 ratio was, as expected, significantly lower than in women not using oral contraceptives. For the N-acetyltransferase ratio (AFMU/1MX) and the xanthine oxidase ratio (1MU/1MX), no differences were seen in terms of sex, smoking habits, or the use of oral contraceptives. All results are in agreement with previous reports on CYP1A2, N-acetyltransferase, and xanthine oxidase activities in humans. Thus, the method is both analytically and biologically reliable for the assessment of CYP1A2, N-acetyltransferase, and xanthine oxidase in humans.

Acetyltransferases↗
PubMed1995

Selective serotonin reuptake inhibitors and theophylline metabolism in human liver microsomes: potent inhibition by fluvoxamine.

1. Fluvoxamine and seven other selective serotonin reuptake inhibitors (SRRI) were tested for their ability to inhibit a number of human cytochrome P450 isoforms (CYPs). 2. None of the drugs showed potent inhibition of CYP2A6 (coumarin 7-hydroxylase) or CYP2E1 (chlorzoxazone 6-hydroxylase), while norfluoxetine was the only potent inhibitor of CYP3A having IC50 values of 11 microM and 19 microM for testosterone 6 beta-hydroxylase and cortisol 6 beta-hydroxylase, respectively. 3. Norfluoxetine, sertraline and fluvoxamine inhibited CYP1A1 (7-ethoxyresorufin O-deethylase) in microsomes from human placenta (IC50 values 29 microM, 35 microM and 80 microM, respectively). Fluvoxamine was a potent inhibitor of CYP1A2-mediated 7-ethoxyresorufin O-deethylase activity (IC50 = 0.3 microM) in human liver. 4. In microsomes from three human livers fluvoxamine potently inhibited all pathways of theophylline biotransformation, the apparent inhibitor constant, Ki, was 0.07-0.13 microM, 0.05-0.10 microM and 0.16-0.29 microM for inhibition of 1-methylxanthine, 3-methylxanthine and 1,3-dimethyluric acid formation, respectively. Seven other SSRIs showed either weak or no inhibition of theophylline metabolism. 5. Ethanol inhibited the formation of 1,3-dimethyluric acid with K(i) value of 300 microM, a value which is consistent with inhibition of CYP2E1. Ethanol and fluvoxamine both inhibited 8-hydroxylation by about 45% and, in combination, the compounds decreased the formation of 1,3-dimethyluric acid by 90%, indicating that CYP1A2 and CYP2E1 are equally important isoforms for the 8-hydroxylation of theophylline. 6. It is concluded that pharmacokinetic interaction between fluvoxamine and theophylline is due to potent inhibition of CYP1A2.

Antidepressive Agents↗
PubMed1994

Flow cytometric DNA ploidy defines patients with poor prognosis in node-negative breast cancer.

Flow cytometric DNA analysis was performed on fine-needle aspirates from frozen tumour biopsies from 421 node-negative, non-adjuvantly-treated breast-cancer patients with a median observation time of 6.75 years. Among premenopausal patients (n = 175), those having at least one DNA "hypoploid" subpopulation defined as DNA index (DI) < 0.96 or 1.44 < or = 1.92 (n = 81) were characterized by early recurrences (log-rank p = 0.05), Wilcoxon p = 0.007), poor overall survival (OS) (p < 0.001) and poor survival after recurrence (p < 0.001). In the postmenopausal group (n = 246), there were no significant difference among 7 different DI classes regarding either recurrence-free survival (RFS) or OS. S-phase fraction (SPF), divided into quartiles, predicted OS in premenopausal patients only (p = 0.02). Conventional multivariate Cox analysis of OS in the premenopausal group revealed hypoploidy to be the only independent prognostic factor involving a relative risk (RR) of 22.8. Age < or = 40 years was of marginal significance, whereas SPF, histological grade (WHO), oestrogen and progesterone receptor (PgR) content, tumour size and number of lymph nodes removed were excluded from the model. Application of the conventional Cox model to the premenopausal group regarding RFS was found inappropriate due to lack of proportionality of the hazards of hypoploidy due to lack of proportionately of the hazards of hypoploidy, SPF and histological grade. However, introduction of time-dependent co-variates using 2 years as cut-off level showed hypoploidy with a RR of 3.52 and age < or = 40 years with a RR of 3.28 to be independent prognostic factors. In the postmenopausal group, the conventional Cox model identified the number of lymph nodes removed to be the only independent prognostic factor regarding RFS as well as OS, whereas SPF < 9% (lowest quartile) was of marginal significance in RFS analysis. Hypoploidy was correlated to high SPF, low PgR content and low differentiation, indicating that hypoploid tumours proliferate rapidly and hormone-independently. These patients may therefore benefit from adjuvant chemotherapy administered while tumour burden and risk of drug resistance are still low.

Adult↗
PubMed1994

Determination of theophylline metabolites in human liver microsomes by high-performance liquid chromatography.

A method for the quantitation of three metabolites of theophylline, 1-methylxanthine (1 MX), 3-methylxanthine (3MX), and 1,3-dimethyluric acid (13DMU) in human liver microsomes has been developed. The method is based on a simple one-step extraction followed by isocratic, reversed-phase high-performance liquid chromatography with uv detection (detection wavelength: 273 nm). The detection limit was 0.03 nmol.mg-1.h-1, which corresponds to 10 pmol per sample for all three metabolites. Linear standard curves were obtained for all three compounds within a concentration range of 0.6-6.0 nmol.mg-1.h-1 for 3MX and 1MX and 2.4-24.0 nmol.mg-1.h-1 for 13DMU. The absolute recoveries ranged from 61 to 80%, 68 to 74%, and 74 to 85% for 1MX, 3MX, and 13DMU, respectively, within the concentration range of the standard curve. The reproducibility and repeatability showed a coefficient of variation < 12% at five concentrations within the standard curve range. The accuracy for all three metabolites was within +/- 5% at three concentrations, except for 1MX in the lowest concentration (12%). The simple but sensitive method developed is highly suitable as a probe for cytochrome P4501A2 (CYP1A2) and probably also CYP2E1 function in human liver microsomes.

Chromatography, High Pressure Liquid↗
PubMed1994

Estrogen- and progesterone receptors in normal cycling endometrium as studied by end-point titration.

A thorough knowledge of the normal physiological fluctuations in estrogen- (ER) and progesterone receptors (PgR) is essential to characterize the changes in ER and PgR in the abnormal endometrium. We investigated the distribution of ER and PgR in frozen human cycling endometrial tissue using the commercially available ER- and PgR-ICA kits. Two-fold end-point titration (EPT) of ER and PgR antibodies was implemented to semi-quantitate more accurately ER and PgR. Semiquantitation of ER and PgR using EPT was significantly correlated to results obtained using either simple scoring or enzyme-immunoassay (EIA) methods. ER and PgR staining fluctuated in relation to the menstrual cycle. In most subphases PgR exceeded ER in both epithelial and stromal cells. Highest levels of ER and PgR were demonstrated in the glands of the functionalis in mid-to-late proliferative phases, whereas both receptors were almost undetectable by immunohistology in the glands of mid-to-late secretory phases. Endometrial stromal cells had high and nearly constant EPT values for PgR, but low values for ER throughout the menstrual cycle. EPT values for ER and PgR were generally higher in the basalis than in the functionalis but showed similar cyclic fluctuations. Our results further substantiate the view that the response to hormonal stimulation is cell-type specific, and suggest differences in steroid metabolism according to cell type and layer.

Adult↗
PubMed1994

The Nottingham Prognostic Index applied to 9,149 patients from the studies of the Danish Breast Cancer Cooperative Group (DBCG).

In primary, operable breast cancer, the Nottingham Prognostic Index (NPI) based on tumour size, lymph node stage and histological grade can identify three prognostic groups (PGs) with 10-year survival rates of 83%, 52%, and 13%. With the aim of defining a subset of patients having so good prognosis that adjuvant therapy can be withhold, the NPI was applied to a Danish population-based study group comprising 9,149 patients. As opposed to the British study, we used conventional axillary lymph-node staging. Histological grading was in both studies done by means of a similar slight modification of the Bloom and Richardson procedure, but in the Danish study only ductal carcinomas were graded. The 10-year crude survival was 68.1% for 4,791 patients with tumour size < or = 2 cm and 70.0% for 2,900 patients with grade I tumours. For 4,761 node-negative patients, the 10-year survival was also 70.0%, the expected survival being 89.3%. The relative mortality (observed:expected) was even at 10 years 2.1 demonstrating that more than 10 years observation time is necessary to estimate cumulated mortality. By application of the NPI, the Danish good PG comprising 27.3% of the patients had a 10-year survival of 79.0%. Thus, the index defined a subset with better survival than could be defined individually by each of its three components, but it did not succeed in defining a subset with survival similar to the expected; additional prognostic factors are therefore needed. The somewhat poorer survival of the Danish good PG may be ascribed to the British inclusion of non-ductal carcinomas, to interobserver variation present only in the Danish study, and to poorer expected survival of the Danish patients. The 10-year survival of the Danish moderate PG and poor PG was 56% and 25%, respectively. These improved survival rates are attributed to the administration of adjuvant therapies. There were virtually no node-positive patients in the good PG and no node-negative patients in the poor PG. Patients should therefore still be stratified initially by lymph-node status, but tumour size and histological grade are significant prognostic factors primarily within the node-negative group, and they should be included in future prognostication procedures.

Adult↗
PubMed1993

Fluvoxamine is a potent inhibitor of cytochrome P4501A2.

Fluvoxamine is a new antidepressant and selectively inhibits serotonin reuptake (SSRI). The present study demonstrates that fluvoxamine is a very potent inhibitor of the high-affinity O-deethylation of phenacetin, which is catalysed by cytochrome P4501A2 (CYP1A2), in microsomes from three human livers. Thus, the apparent inhibitor constant of fluvoxamine, Ki, ranged from 0.12 to 0.24 microM. Seven other SSRIs, citalopram, N-desmethylcitalopram, fluoxetine, norfluoxetine, paroxetine, sertraline and litoxetin either did not inhibit or were weak inhibitors of the O-deethylation of phenacetin. Our findings explain the mechanism of the pharmacokinetic interactions between fluvoxamine and drugs that are metabolized by CYP1A2, e.g. theophylline and imipramine.

Cytochrome P-450 CYP1A2↗
PubMed1993

Reproducibility of subjective immunohistochemical estrogen- and progesterone receptor determination in human endometrium.

To obtain a reliable scoring system for semi-quantitation of estrogen- (ER) and progesterone receptors (PgR) in human endometrial tissue, we investigated the reproducibility of subjective immunohistochemical ER and PgR determination. Specimens of frozen endometrial tissue were stained once (n = 129) or twice (n = 22) using the ER-ICA and PgR-ICA kits from Abbott. The semi-quantitative approach we used included subjective estimates of the overall staining intensity (I) and of the fraction of stained cells (%). Scoring was performed twice by the same observer and once by another observer (n = 87). Intra- and inter-observer agreement were evaluated using Kappa statistics. We found that more comprehensive scorings of I and % could not be agreed upon by the observers. Only simplified estimates of the fraction of cells stained and overall staining intensity were reproducible. Subjective estimates obtained by this method agreed with estimates obtained by counting (n = 38). Simplified H-scores, which were obtained by multiplication of the simplified estimates of % and I, were reproducible, too. In addition, semi-quantitation of ER and PgR by immunohistology was significantly correlated to quantitation by enzyme-immunoassay (n = 39). Thus, it was possible to reproducibly semi-quantitate ER and PgR only by employing a very simple immunohistochemical scoring of ER and PgR.

Endometrium↗